phy screening for women beginning at age 40 is based on three factors: the incidence of breast cancer, the sojourn time for breast cancer growth, and the potential to reduce the number of deaths from it.
The time period between when a
breast cancer may be detected by a mammogram, while it is very small and before it grows big enough to become symptomatic, is known as the sojourn time. Although the sojourn time of in- dividual cancers can vary, the greatest predictor is age. Women aged 40 to 49 have the shortest average sojourn time (2 to 2.4 years), while women aged 70 to 74 have the longest average sojourn time (4 to 4.1 years). The five-year survival rate is 98 per- cent for women whose breast cancer tumors are discovered at their earliest stage, before they are palpable, and when they are small and confined to the breast.
The College continues to recommend
annual clinical breast examinations (CBEs) for women aged 40 and older and every one to three years for women aged 20 to 39. Additionally, The College encourages breast self-awareness for women aged 20 and older. Breast self- awareness involves women understand- ing the normal appearance and feel of their breasts, without a specific interval or systematic examination technique. The College endorses educating women aged 20 and older regarding breast self- awareness.
Additionally, enhanced breast cancer
screening, such as more frequent CBEs, annual MRI, or mammograms before age 40, may be recommended for wom- en at high risk of breast cancer. Breast MRI is not recommended for women at average risk for developing breast cancer. Breast cancer is the second lead- ing cause of all cancer-related deaths among American women. The incidence of breast cancer in the United States de-
clined 2 percent each year between 1999 and 2006, and deaths from breast cancer have also declined steadily over the past two decades.
Evidence suggests that the drop in
breast cancer rates is most likely due to fewer women getting mammograms and therefore not being diagnosed, as well as a significant drop in women using hor- mone therapy for menopausal symptoms. “The good news is that fewer women who are dying from breast cancer be- cause of earlier detection and improved treatments,” said Gerald F. Joseph Jr., MD, vice president for practice activities of The College. Practice Bulletin #122 “Breast Cancer
Screening” is published in the August 2011 issue of Obstetrics & Gynecology. n
Crystal Conde is associate editor of Texas Medicine. You can reach her by telephone at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by email at
crystal.conde@
texmed.org.
30 TEXAS MEDICINE October 2011
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