NHG-Standaard
M07
4.1
december 2016
december 2021
W/X/Y. Zwangerschap / anticonceptie / geslachtsorganen man en vrouw

Diagnostiek en verwijsbeleid bij klachten van de borst(en)

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Rol huisarts bij verwijzing naar mammapoli

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Follow-up na behandeling

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Lymfoedeem en schouderklachten

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Bijwerkingen antihormonale therapie

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Gewichtstoename

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Hormoontherapie & anticonceptie

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Terugkeer naar werk

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Screening en verwijzing vanwege familiaire belasting

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Bevolkingsonderzoek borstkanker

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Rol van de huisarts bij bevolkingsonderzoek borstkanker

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Belangrijkste wijzigingen

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Kernboodschappen

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Achtergronden

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Epidemiologie

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Kans op borstkanker bij klachten

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Risicofactoren

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Indicaties voor screening buiten het bevolkingsonderzoek

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Pathologie en pathofysiologie

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Carcinoma in situ en invasieve borstkanker

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Ziekte van Paget

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Inflammatoir borstkanker

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Behandelingsmogelijkheden 2e lijn

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Adjuvante therapie

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Radiotherapie
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Chemotherapie
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Immunotherapie
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Antihormonale therapie
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Richtlijnen diagnostiek bij klachten van de borst(en)

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Lichamelijk onderzoek

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Alarmsymptomen

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Aanvullend onderzoek

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Indicaties voor aanvullend onderzoek

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Geen indicatie voor aanvullend onderzoek of verwijzing

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Aanvullend onderzoek

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Richtlijnen beleid bij klachten van de borst(en)

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Voorlichting

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Consultatie en verwijzing

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Verwijzing naar mammapoli

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Advies radioloog

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Blijvende ongerustheid

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Rol huisarts bij verwijzing naar mammapoli

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Aandachtspunten bij verwijzing

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Informatieve websites

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Follow-up na behandeling

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Terugverwijzing naar bevolkingsonderzoek of huisarts

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Borstzelfonderzoek

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Lymfoedeem en schouderklachten

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Beleid bij lymfoedeem en schouderklachten
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Bijwerkingen antihormonale therapie

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Aandachtspunten bij tamoxifen
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Vermoeidheid

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Gewichtstoename

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Hormoontherapie en anticonceptie

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Seksualiteit

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Terugkeer naar werk

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Bedrijfsartsconsulenten
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Screening en verwijzing vanwege familiaire belasting

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Risicoschatting op basis van familieanamnese

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Screening buiten het bevolkingsonderzoek

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Praktische uitvoering
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Verwijzing naar een klinisch geneticus

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Implicaties van erfelijkheidsonderzoek

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Genetisch onderzoek/DNA-diagnostiek

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Aangetoonde genmutatie of 50% kans op dragerschap

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Kans op borst-, eierstok- of eileiderkanker
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Screening en preventieve chirurgie
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Genmutatie bij mannen
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Ondersteuning door klinisch geneticus
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Genmutatie niet aangetoond

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Heroverweging verwijzing naar een klinisch geneticus

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Bevolkingsonderzoek borstkanker

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Effectiviteit borstkankerscreening
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Leeftijdsgrenzen
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Rol van de huisarts bij bevolkingsonderzoek borstkanker

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Verantwoordelijkheden huisarts bij een uitslag BI-RADS 4 of 5, of BI-RADS 0
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Bijzondere situaties

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NHG-werkgroep:
De Bock GH, Bronsgeest MHE, Corsten MC, Hinloopen RJ, Korver JC, De Meij MA, Verstappen V, van der Weele GM, Wittenberg J
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