Health Column
August 4, 2011
MEDIA CONTACT: Stephanie Poyant
Public Information Officer
Southcoast Health System
Phone: 508-961-5280
Fax: 508-961-5876
poyants@southcoast.org
www.southcoast.org/news/releases/
Christian S. Pope, DO, FACOG
Diplomate, American Board of Obstetrics and Gynecology
HealthCare for Women, Inc., Mattapoisett, New Bedford and Dartmouth
Dr. Pope practices at St. Luke’s Hospital, the New Bedford site of Southcoast Hospitals Group.
He can be reached at 508-999-6245.
Breast Cancer Screening recommendations revised
Yes, once again there are revised guidelines for breast cancer screening. The American College of
Obstetricians and Gynecologists will release these revised guidelines in August print. Following here is a
brief review of the screening recommendations.
Incidence
Breast cancer accounts for one quarter of all new cases of cancers diagnosed in women. A women's
lifetime risk of developing breast cancer is 12 percent, or 1 in 8. Good news is breast cancer incidence is
decreasing, as well as its related mortality. This reflects both earlier detection of breast cancer and
improved treatment.
Screening Mammography Rationale
Breast cancers detected at an early stage that are small and confined to the breast are more likely to be
successfully treated, with a 98 percent five-year survival rate. Mammography screening can identify a
non-palpable mass measuring approximately 1mm to 1cm during its pre clinical phase, three years before
it becomes palpable.
This concept is commonly referred to as "sojourn time" — the time interval when a cancer may be
detected by screening before it becomes symptomatic.
The more biologically aggressive tumors typically have shortened sojourn times. It is obviously desirable
to detect tumors during this sojourn period. Screening strategies, such as mammography, should be
designed to maximize the likelihood of detecting the cancer during this pre-clinical window, when
treatment options may be greater and outcomes may be improved.
Other imaging techniques
Ultrasound is also an established technique in addition to mammography, used in the evaluation of breast
cancers and benign breast lumps. Ultrasound is useful in evaluating inconclusive mammographic
findings, evaluating younger patients and other women with dense breast tissue, and in differentiating a
breast cyst from a solid mass. It is not recommended as a screening test.
Magnetic Resonance Imaging (MRI) can be useful as well in some select patients. However, cost,
duration of the examination, and injection of contrast material prohibit its use as routine, population-based
screening technique.
The American Cancer Society does recommend MRI for screening for women with a 20 percent of
greater lifetime risk of developing breast cancer, including women with the following:

Have a known BRCA1 or BRCA2 gene mutation

Have a first-degree relative with BRCA1 or BRCA2 gene mutation

A lifetime risk of breast cancer of 20 percent or greater according to risk assessment tools that are
based mainly on family history

A history of radiation therapy to the chest between the ages of 10 years to 30 years

Other genetic syndromes which increase the breast cancer risk
Recommendations
Based on the incidence of breast cancer, the sojourn time for breast cancer growth, and the potential
reduction in breast cancer mortality, the American College of Obstetricians and Gynecologists
recommends that women aged 40 years and older be offered screening mammography yearly.

Clinical breast exams should be performed annually for women aged 40 years and older

For women 20-39 years, clinical breast exams are recommended every 1-3 years
Breast self-awareness should be encouraged, and can include breast self-examination. Women should be
encouraged to report any changes in their breasts to their physician

Women with increased breast cancer risk should be offered enhanced breast cancer screening
with ultrasound and/or MRI

Breast MRI is not recommended for screening women at average risk of developing breast cancer
Breast cancer mortality can be effectively reduced through recommended screening. Remember,
preventative health care lasts a lifetime.
Dr. Christian S. Pope specializes in obstetrics and gynecology. He has offices in New Bedford and
Mattapoisett and practices at St. Luke’s Hospital, the New Bedford site of Southcoast Hospitals Group. He
can be reached at 508-999-6245.
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