Evidence Based Care…


We advocate for and utilize common sense, evidence-based guidelines  seasoned with clinical judgment and individualized care.  Nothing is cookbook or cast in stone.

The landmark work of Johns Hopkins University,  the endorsement of the American College of Radiology and the Society for Breast Imaging attest to the proper use of ultrasound for breast screening in appropriate candidates according  to risk status.

Breast Density  Law…

California law SB 1538 as of April 2013 and many other  states now require women who have heterogeneously dense and/or extremely dense breasts (the majority of the population) to be informed of this condition and in turn  be offered additional screening tests if desired.  The additional most practical  test is bilateral (both breast) ultrasound due to its safety, effectiveness and low cost.

Schools of Thought…

To screen or not to screen?  There really is no true debate on this issue.  Of course screening saves lives when done properly. Just as prenatal care, dental care, adult check ups, blood  pressure, diabetes  and cholesterol screening save lives and improve our quality  of life when performed appropriately. The screening simply must be evidence-based,  of high quality, accessible and affordable.

How and When to Screen:

Regarding age and the decades of life we advocate for the following: Teens:  SBE

  • 20-30 years:  SBE
  • 30-40 years:  SBE, Breast Ultrasound
  • 40-80 years:  SBE, Breast Ultrasound, Mammography
  • 80 years plus:  same as 40-80 if one has 5 or more years of life expectancy

The time interval (frequency)  is generally  once per year unless high risk…then consider  every 6 months for Ultrasound.

Accuracy of Screening…

When SBE, PBE, Mammogram and Bilateral  Ultrasound are combined in the proper interval,  most (90%) of breast cancers are found  in stage 0, I or II and are lymph node negative (excellent prognosis).

What about false positives and so-called  ‘unnecessary biopsies’?

This is not an issue when careful risk assessment, appropriate high-quality screening and follow-up are conducted in an evidence based, individualized manner.

Who Conducts the Clinical  Testing?

Full time gynecologist and women’s health specialist, John Armstrong MD MS Inc. personally conducts  the PBE, the ultrasound examination and interprets the study for you in real time at the visit.  There is no waiting  for your result or interpretation. He has extensive training and experience in the examination and clinical correlation of the findings (what to do with the results and how to use the information).  Dr. Armstrong has 34 years of post-training experience in breast health having conducted approximately 8000 ultrasound examinations with  accurate interpretations to date. We have state of the art, high-definition Toshiba Ultrasound equipment and each study is hand-held rather than automated by a robot or obtained by a technician.  This technique of real-time image acquisition, interpretation and clinical correlation all in one is far more accurate and efficient and leaves no room  for fragmentation of care or ‘separation’  errors in the conclusions  and recommendations. And, there is no waiting!

Our Vision

To provide Comprehensive Women’s Healthcare that is evidence-based,  simple, safe, comfortable, accurate, accessible, useful and affordable.

Our Mission

To reduce the mortality and morbidity of women’s cancers through education, prevention and early detection.

Candidates for Evaluation

Any woman  25 to 90 years of age with a life expectancy of 5 or more years.  Prior mammograms, mammogram issues or abnormalities are NOT required for evaluation or screening.