Facing breast cancer fears with education, support

Wednesday, October 10, 2018

What to expect when beginning mammogram screenings?

Breast cancer is big — education is bigger.

Knowing the process of clinical breast exams, mammograms and possible diagnosis can help patients make informed decisions about next steps. Also, being aware of signs and symptoms can push women to make that appointment for a yearly mammogram. Early detection of breast cancer is key to positive outcomes.

According to the Susan G. Komen Missouri 2015 community profile report, data from 2006-2010 female breast cancer incidence rates shows that in Missouri, 4,264 women are diagnosed with breast cancer annually. In Barry County, the annual average is 27 women, and in Lawrence County, the average is 25.

According to the report, there are 890 deaths in Missouri annually due to breast cancer in women, and six annual deaths in Barry County. In Lawrence County has about three deaths per year.

The report states that of women 50-74 years old in Missouri, only 2,055 self-report a screening mammography in the last two years, and 14 women that age in Barry County self-report getting the mammogram in the last two years. In Lawrence County, 8 self-reported.

The report offers a model that shows how a woman typically moves through the Cancer Continuum of Care (COC), to receive the best outcomes. The COC model is a circular rotation of events, that is designed for women who are diagnosed with breast cancer, but the model has detour arrows for normal screenings and a cancer-free diagnosis.

Education is the outer rim of the model, showing it plays an important role in the COC process. Women may enter the COC at any stage, however, with education of breast cancer, ideally, a woman enters the COC by being screened for breast cancer.

The screening process for breast cancer begins with a clinical breast exam, or a mammogram screening. If the screening process is normal, the woman would then be detoured to the follow-up stage, which leads directly into the screening stage for a continuous loop of awareness.

However, if the screening stage results return as abnormal, tests would need to be performed to determine if the abnormal result is, in fact, breast cancer.

If breast cancer is the case, the woman is moved to the diagnosis stage. When the diagnostic results come back, and the result is no cancer, the woman is again moved to the follow-up stage to continue the process. However, if the diagnosis is breast cancer, the woman is moved to treatment stage of the COC.

Once treated, the woman is then moved to the follow-up and/or survivorship stage, which leads directly into the screening stage again.

The Susan G. Komen Missouri 2015 community profile reports data is a few years old, and according to the report, numbers can change rapidly for a number of reasons.

The report offered a link, https://statecancerprofiles.cancer.gov, which gives data from 2011-2015. This data shows that in that time frame in Missouri, the average annual count of breast cancer incidence report is 4,775. In Barry County, the average annual count is 20 women, and in Lawrence county, the average is 30.

Julitta Shirley, family nurse practitioner at the CoxHealth Center in Cassville, defined a mammogram as a special imaging of the breast.

“Usually at age 40 is when a woman will begin getting a mammogram,” Shirley said. “However, that depends on if there is a heavy family history [of breast cancer].”

Shirley said the American Cancer Society is still recommending that a woman, at age 40, get a mammogram done yearly.

“It is still recommended that women still do monthly breast exams on themselves,” Shirley said. “We teach women how to feel for different lumps and what areas to feel in. If a woman is doing the self-exams monthly, they are more familiar with how their breast should feel, and are more likely to pick up on something.”

Shirley said if, during a self breast exam, the woman were to feel anything that may be abnormal — that wasn’t there the month before — then they should have a clinical breast exam done.

“I usually recommend that patients come in for a clinical breast exam six months after getting the mammogram,” Shirley said. “A clinical breast exam is different from a breast self-exam because, we are trained to pick up on things that someone doing a self-exam may not pick up on.”

According to Shirley, most mammograms are digital now, but there are also breast ultra-sounds and breast MRIs. A breast MRI, which is generally recommended for women at a higher risk of developing breast cancer or women who have dense breasts, is usually more costly and limited as far as accessibility.

“If a lump is found in a regular mammogram, then the patient will get a diagnostic mammogram,” Shirley said. “It offers different views of the breast to help hone in on the problem area. Usually, at that point, they will also do a breast ultra-sound on the patient, which can see the difference between a solid lump and a fluid filled lump.”

Shirley said that generally, there isn’t a lot of pain associated with breast cancer unless it has gotten very big.

If the Cassville CoxHealth Center determines an abnormality during a clinical breast exam, the patient is then referred to Monett Cox Hospital.

Frankie Smith, a mammogram technician at Cox Monett Hospital, said indications that a woman would need a mammogram before the age of 40 would include a strong family history of breast cancer.

“For instance, if a 30-year-old woman’s mother was diagnosed at the age of 40, she would need a mammogram,” Smith said. “A daughter 10 years younger than a mother’s diagnosis age, would want to start having yearly mammograms. However, a woman under the age of 30 would probably be started with an ultra-sound because there is so much breast tissue, that really depends on the physician though. Generally, insurance won’t pay when the patient is under 30 unless the mother had been diagnosed 10 years above the age that the patient is.”

According to Smith, symptoms of breast cancer can include: a new lump, breast skin dimpling/thickening, constant pain, nipple discharge/bleeding or inverted nipples.

Smith said if any of these symptoms are noticed by the patient or the primary care provider, the patient would be referred for a mammogram.

“If the mammogram results came back, and the technician wanted additional imaging, because of an area of interest that is different from the year prior, the patient would go to the Springfield Breast Care Clinic through Cox,” Smith said. “There, the patient would receive the additional imaging, and if there was still concern for a specific area at that point, the patient would not leave the Breast Care Clinic until the patient knew what the next step would be, or that they are clear of cancer.”

Smith said if the patient isn’t cleared, they would then get a breast ultra-sound, which gives the radiologist a different point of view. The radiologists will determine what to do next based on what they find. If it is determined that the patient would need a biopsy, they would schedule that. A biopsy is a minimally invasive surgery that the radiologist would perform, obtaining a tissue sample using either an ultra-sound machine, MRI guidance or stereotactically. The tissue sample would then be sent to pathology for diagnosis.

According to Smith, at that point, the patient is given a breast navigator to help them through the process. A breast navigator is certified through the National Consortium of Breast Centers, and there are three different types of breast navigators: nurse, imaging and lay advocate/survivor. Springfield Breast Care Clinic has all three, but generally they use the nurse, who will go to all of the appointments with the patient and will also give the biopsy results to the patient. The breast navigator develops a personal relationship with the patient. The navigator wants the best for every patient and helps to educate the patient to make the best decisions for them.

“The navigator at the Springfield Breast Care Clinic is a beast cancer survivor herself and is invested in women’s health,” Smith said. “Everyone just loves her.”

Smith said if the biopsy results are positive for cancer, the radiologist will contact the patient’s physician and request a surgical referral.

“That referral generally sends that patient back to the Breast Care Clinic in Springfield,” Smith said. “The Breast Care Clinic has a list of surgeons the patients can choose from.”

According to Smith, every patient’s experience is different, and there are many different routes to choose in a journey.

Smith said there is a support group that meets at the Breast Care Clinic in Springfield on the second Thursday of every month at 7 p.m. There is also, through CoxHealth, wig and prosthetic fitting, and a breast care fund accessible through the CoxHealth website by typing “breast care” into the search bar.

“The most important thing in early detection is knowing your body, knowing when your body changes, looking at your breasts, and if there is a change, go to the doctor,” Smith said.

Also, Smith said women at age 40 need to make the appointment to get a yearly mammogram.

“We can see a less than a two centimeter cancer lump on a mammogram,” Smith said. “That is something you can’t feel. By the time a woman can feel a lump, the diagnosis could be much worse, and the treatment can be more difficult.

“If I could say anything to women, it would be get your mammogram.”

Smith said mammograms aren’t as uncomfortable as they once were, compression is key to get a good view, but the machines are more digital now.

“As scared as you may be to have a mammogram, think about the alternative,” Smith said. “If you wait too long, you may be so far along with breast cancer that you would have to take more steps to get well.

“We are only reaching 45 percent of the population in this area, of women who are 40 or older and need to be coming in for a mammogram. We need to see more women to help more women.”

Christine Winter, communications director with American Cancer Society for Missouri, said there are a lot of virtual support systems like Reach to Recovery, where people can be paired with others in different stages of breast cancer, also, the survivor’s network at cancer.org.

For support in any stage of breast cancer people may call the American Cancer Society at 1-800-227-2345. Winter said the cancer information specialists that will answer the phone can help people on a local level, for any stage and any time of the day.

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