Breast Cancer Screening & Prevention
BREAST CANCER BY THE NUMBERS... IN THE UNITED STATES ALONE...
These basic statistics highlight the importance of screening and early detection for all women between the ages of 25 and 90+. Breast cancer is common, serious and silent in the early stages though is highly curable when found in time.
THE IMPORTANCE OF EARLY DETECTION IN BREAST CANCER
Indeed, this is the slogan of the American Cancer Society. Early detection is truly the key to success and cure. Stage 0, I and II node-negative breast cancers are by far the easiest to treat with generally excellent (90%+) long-term survival rates.
Many think that family history, personal history, environment, identifiable gene mutations (BRCA 1,2), age at first pregnancy, or lack of breast feeding are the major risk factors contributing to breast cancer. These factors do play a role, yet the 3 main risk factors applicable to most women for acquiring breast cancer are:
1. FEMALE GENDER (Males rarely acquire breast cancer)
3. BREAST DENSITY
How to Early Detect?
Screening for all women of appropriate age is the key. Our best research supports the following methodologies:
1. SBE (Self Breast Exam) done properly and consistently
2. PBE (Professional Breast Exam)
4. Breast Ultrasound (Sonogram) of both breasts
It is estimated that 15% of women find their own breast cancers with SBE, 50% are detected by Mammography and 30 to 40% by Sonography (Ultrasound). MRI is useful in special circumstances but is not practical for screening due to excessive cost (also not covered by insurance) and the requirement for radioactive IV contrast material (long-term safety not established). Note that by combining SBE, PBE, Mammography and Ultrasound the likelihood of finding a given breast cancer in the early stages (node-negative) is 90+%.
Evidence Based Care…
‘EARLY DETECTION IS OUR BEST PROTECTION’
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!
To provide Comprehensive Women’s Healthcare that is evidence-based, simple, safe, comfortable, accurate, accessible, useful and affordable.
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.
BREAST ULTRASOUND FOR EARLY DETECTION OF BREAST CANCER
While there is no question that mammograms are effective in saving lives from breast cancer, they are by no means perfect in finding all early stage abnormalities. Mammography is quite accurate in smooth and translucent breasts yet are only
50% capable of finding small cancers in women with dense breasts (85% of the population). Therefore it is critical that we access additional screening methodologies to improve the pick-up rate for early, localized cancers. Currently available and simple strategies to accomplish this goal are tried and proven. Note the following:
· 15% of breast cancers are found by the woman herself if she is performing self breast exams (SBE) monthly with proper technique.
· A large number of breast cancers are found by ultrasound, not seen on mammography.
Many women are reluctant to have a mammogram for several reasons:
· Fear of the small amount of radiation exposure.
· For some…the unpleasant (painful) compression of the breast required to obtain the image.
· The concern for releasing abnormal cells into the circulation (unlikely).
· The occasional request to return for more images.
So, if you are reluctant to have a mammogram at the recommended scheduled interval, are unsure or inconsistent with performing a SBE consistently, have ‘dense breasts’ as do 85% of the population or would simply like the additional assurance of healthy breast status, come to our office for the simplest and best breast surveillance available…BREAST ULTRASOUND. It is safe, effective, painless and radiation free. We specialize in and have years of experience with this technology.
BECAUSE KNOWLEDGE IS A POWERFUL TOOL Women and their families often worry over the ‘what ifs’, misconceptions and perceived unknowns of breast and pelvic cancers. Knowing your individual and families risk status and being armed with accurate and useful information plus screening…you will have a tailored prevention and surveillance strategy that replaces any worry with full confidence.