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Arizona Daily Sun
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Sunday, September 30, 2018 - 1
OCTOBER IS BREAST CANCER AWARENESS MONTH
Flagstaff
Breast Cancer Clinic Neighbors taking care of neighbors
By Janel States James
Oncologists in Flagstaff are taking a united approach in breast cancer care. (Adobe Stock)
I
t’s almost universal. A serious medical diagnosis changes
everything in a moment and puts people into uncharted and often overwhelming territory. It’s universal, too, that when faced with a life-changing diagnosis, we want to know that someone has our back, that people will work together to help us when we need it most, and that our care matters. Flagstaff’s Breast Cancer Clinic operates with a comprehensive care approach to meet the needs of those facing a breast cancer diagnosis. The clinic is fairly new, opening its doors just two years ago after Kate Preston, a surgical oncologist with Flagstaff Surgical Associates, suggested that a multidisciplinary approach to breast cancer care might be beneficial to patients. She put together a team of doctors from each of the three major cancer treatment disciplines: surgical oncology, medical oncology and radiation oncology. Under the multidisciplinary approach, all three physicians meet at the same time with a newly diagnosed cancer patient to determine the best course of treatment. “Just having a surgeon take the lead made it easier to get the clinic started,” says breast cancer nurse Nancy Foreman. “[Preston] just said, ‘Let’s make this happen.’” Dr. Peter Mathern of Arizona Oncology and Dr. Andrew David, director of radiation oncology for
Northern Arizona Healthcare in Flagstaff, joined Preston on the team, and together they see about 60 patients a year, a number which is expected to grow as the clinic becomes better known. “We’ve seen the great benefit of having all three doctors see the patient at one time. It’s just a really good system,” says Foreman. “To be honest, as a nurse who has worked with physicians for a lot of years, I really didn’t know how three of them in one room working together would be, but these are the best, most coordinated physicians.” In addition to the three primary specialists, the clinic also works closely with Northern Arizona Healthcare Surgery, Plastic Surgeons of Northern Arizona, Cancer Centers of Northern Arizona, Northern Arizona Radiology, and Pathology of Northern Arizona to ensure complete cancer care. “This is a very united breast cancer clinic,” says Foreman. Before the Breast Cancer Clinic opened,
cancer care could look quite different, with the patient seeing three separate doctors for three separate appointments. “You may have been scheduled to see the surgeon first,” says Foreman, “but the surgeon may have decided you really needed to see the medical oncologist or the radiation oncologist first.” This could be an unwelcome surprise to a patient expecting to begin treatment right away, with the additional delay only adding to the stress of the situation. “We are not working in individual silos,” says Foreman. “We work together to give the patient the best plan and the speediest entry into the system.” Everyone gives their input, she says, and together they create a customized treatment plan. In fact, the beginning of treatment through the Breast Cancer Clinic averages 14 days after diagnosis, a full week earlier than treatment in a more traditional system. On top of that, says Foreman, they are also “getting the sequence of treatment right more quickly.” Once a patient is admitted to the clinic, Foreman is the first one they see. She answers questions and explains what are often new terms for patients. “It’s like learning another language,” she says, but having to learn it under intense stress. “When patients come in, sometimes their brains just shut down. I always tell people you need to hear things over and over for it really to sink in. “One of our nurses was diagnosed with breast cancer several years ago and I went with her to see the surgeon. He did a really good job of sitting down with her and going over everything, but when he left the room, she
looked at me and said, ‘What did he just say?’ The emotional stress is just incredible.” In fact, Foreman says, patients retain only 5 to 10 percent of what you tell them, so “giving them a good baseline education before they meet the team is really important.” Foreman’s job goes beyond the preliminary education, however. She is also the point person for coordinating future appointments, for sorting out the small details that don’t seem so small when facing cancer treatment – like transportation and health insurance – and for emotional support. “I make sure they’ve got a support system and that they know when to stop asking their neighbors for opinions. I help them figure out how to tell their kids, or their 90-year-old mother, that they’ve been diagnosed with breast cancer. I spend a lot of time with them after the doctors see them in the clinic. They get to be friends, and that’s just awesome.” Foreman hopes that more people will become aware of the top-notch care the Breast Cancer Clinic offers right here in Flagstaff. Too often, she says, people still think they need to go to Phoenix for care. “They do have excellent care there,” she says, “but we are also excellent here.” As Charlotte Thweatt, one of Foreman’s colleagues says, “We are neighbors taking care of neighbors.” Foreman agrees. “It really is like that. A lot of good neighbors. Everybody really cares.” The Flagstaff Breast Cancer Clinic is accessed by primary care physician referral. For additional information, call (928) 213-6213.
Big or Small, Save Them All! Fight for your mother, sister, aunt, niece, grandmother, or daughter!
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2- Sunday, September 30, 2018
Arizona Daily Sun
Special advertising supplement
The BRCA
A
Gene
ctress Angelina Jolie made headlines in 2013 when
she announced she had a double mastectomy despite not having breast cancer. Instead, she found out she had a genetic mutation in the BRCA gene, which significantly increased her risk of breast cancer. Her decision jump-started a conversation about whether women should undergo elective surgery to lessen their risk of breast cancer before any diagnosis or the different factors to take into consideration when determining treatments.
WHAT IS IT?
According to the Mayo Clinic, the BRCA gene mutation is responsible for 5 to 10 percent of breast cancer cases and about 15 percent of ovarian cancer cases. A blood test can find the mutation in the BRCA1 or BRCA2 genes. You may consider this form of testing if you have a personal history of breast cancer diagnosed at a young age or affecting both breasts; a personal history of ovarian cancer; a family history of breast, ovarian or pancreatic cancer; or a relative with a known BRCA gene mutation. People who have a close male relative with breast cancer are at greater risk as well. Talk to your doctor about your family history with all types of cancer to get a better understanding of your risk.
WHAT TO DO?
If you get a positive result, this does not mean you will develop breast cancer. If you know you’re at greater risk, consider more frequent clinical screenings; taking oral contraceptives, which have been shown to reduce the risk of ovarian cancer; chemoprevention, which is hormonal medication that reduces the risk of breast cancer; or Jolie’s choice to have preventive surgery. This reduces the chance of breast cancer by about 90 percent, according to research. It’s not clear how much it reduces the risk of ovarian cancer.
WHO BENEFITS
Women who have been diagnosed with breast cancer may also benefit from getting the test. The National Cancer Institute discussed a study related to the BRCA mutation, in which women 40 years old and younger who had been diagnosed with breast cancer were tested for the mutation. Of the hundreds of women tested, about a third told researchers it influenced their cancer treatment — 86 percent of those with the mutation had both breasts removed even though both were not affected by the cancer, while 53 percent also had their ovaries and fallopian tubes removed.
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Arizona Daily Sun
T
Sunday, September 30, 2018 - 3
Signs & screenings Special advertising supplement
here are a number of ways doctors can test for breast
abnormalities, including simple physical exams and family history assessments to X-rays and other radiation screenings to find a tumor, pinpoint a problem area or determine how far cancer has spread. The testing will start with basic exams and mammograms. If your doctor finds anything abnormal in the regular screenings, she may order additional tests such as ultrasounds, MRIs, blood tests or a biopsy.
SIGNS OF BREAST CANCER
Although cancer presents differently in different people, the National Cancer Institute listed a number of warning signs for which women should be on the alert and contact their doctor if these appear. They include: a lump or thickening in or near the breast or underarm; changes in a breast’s size or shape; skin puckering or dimpling; a nipple turned inward; fluid coming from the nipple; or scaly, red or swollen skin.
SELF-EXAMS
Checking yourself can be part of a healthy breast regimen. According to the NCI, selfexams have not been found to help reduce the number of deaths from breast cancer, but it can offer some benefit; many women find lumps on their own, though these frequently are not indicative of cancer. The breast tissue can have cysts and other lumps. It’s important to remember breast tissue changes during menstruation and menopause; pregnancy, aging and taking birth control all can cause the breasts to feel different.
CLINICAL BREAST EXAMS
During an annual physical, your doctor will examine your breasts
for lumps or other changes. She will also feel around the breast and test the lymph nodes, which are one of the first places cancer spreads. As with self-exams, the breast tissue can change from year to year; your doctor will determine if further testing is needed. During this time, you can also talk about your family history with your doctor, which could be indicative of cancer risk.
MAMMOGRAMS
A mammogram is an X-ray of the breast, which can find tumors that can’t be felt with physical exams. Mammograms can also find small deposits of calcium that may indicate breast cancer. Doctors also may use it after breast cancer has been found to determine how far it’s spread. The medical community recommends regular mammograms for women age 40 and older.
LOCAL WOMAN PENS BOOK TO HELP OTHERS HEAL A Flagstaff-based mother, wife and 17-year breast cancer survivor addresses her new book on spirituality and healing to her “breast cancer sisters.” In “Thriving in God’s Love: Seven Powerful Steps to Heal Body, Soul, and Spirit After Breast Cancer,” author Suzanne Bonner says breast cancer is more than a physical disease; it’s also an emotional and spiritual disease affecting body, soul and spirit. She provides seven steps to healing addressing family, forgiveness, food, fitness
Specializing in all types of Breast Reconstruction. Now accepting appointments for Breast Reconstruction consultations in Flagstaff & locations throughout Northern Arizona.
Stephen F. Lex, M.D. Jack Quigley, M.D. Adam K. Boettcher, M.D. Patrick Cole, M.D. Board Certified Plastic Surgeons
PLASTIC SURGEONS
of Northern Arizona
1020 North San Francisco Street, Flagstaff, AZ (928) 774-2300 (800) 962-1390 • www.psna.net
Fear. Pain. Stress. Anxiety. There are easy to learn techniques to help you regain control over the way you feel. Like so many, my life has been impacted by breast cancer. A physical therapist since 1986 and a hypnotherapist since 2007, my professional life has been dedicated to helping people overcome pain an regain control of their lives. Let’s talk. Consultations are always free.
and more, and provides examples of why these aspects are important and how they helped her on her healing journey. Bonner was raising two sons when she received news that doctors found 13 cancerous tumors in her left breast. Unsure of what to do, she turned to her Christian faith and searched the Bible for hope and support. After being placed in recovery, she began teaching numerous Bible studies to women battling the same illness to help them find their inner strength during the treatment and recovery process.
“It has been my experience that these women are surviving, but very few describe themselves as thriving,” says Bonner, a certified Christian wellness coach and health educator. “Fears of a reoccurrence, along with feelings of not quite being fully well, leave them with a desire to find something to do to improve their sense of well-being.” In honor of National Breast Cancer Awareness month, Bright Side Bookshop in Flagstaff is hosting Bonner at a book signing Tuesday, Oct. 2, from 5-7 p.m.
Put yourself
FIRST. October is Breast Cancer Awareness Month
Take charge of your health. The first step to staying well is being proactive. That’s why the American Cancer Society recommends for women 45 and older to have regular mammograms and continue to do so at the advice of their physician. Don’t delay scheduling your mammogram any longer.
Don Berlyn, PT, Certified Clinical Hypnotherapist
Flagstaff Hypnotherapy 519 N. Leroux, Flagstaff, AZ | 928-699-8263 facebook.com/flaghypno | flaghypno@gmail.com
www.flagstaffhypnotherapy.com
Take a free breast cancer risk assessment online at NAHealth.com/breast-cancer-risk.
4- Sunday, September 30, 2018
Arizona Daily Sun
Special advertising supplement
Recurrent
Breast Cancer
W
hile most breast
cancers are treatable, it may come back. According to the Mayo Clinic, recurrent breast cancer, which happens when not all cancer cells go undetected during treatment and remain in the body, may occur months or even years after you have initially been treated. RISK FACTORS
It may come back in the same place or may appear in other parts of the body; where it recurs also affects the symptoms a patient experiences.
LOCAL RECURRENCE
When the cancer reappears in the same place as your original cancer, this is known as a local recurrence. Women who had a lumpectomy could have a recurrence in the remaining breast tissue; women who had a mastectomy could experience a local recurrence in the tissue lining the wall of the chest or in the skin surrounding the breast. Symptoms of local recurrence of cancer could include a new lump or irregularly firm area, changes to the skin on or around the breast, skin
inflammation, or redness or nipple discharge. Symptoms of cancer on the chest wall include painless nodules on or under the skin and unusual thickening near the mastectomy scar.
REGIONAL OR DISTANT RECURRENCE When cancer returns to the lymph nodes near the chest, this is regional breast cancer occurrence. Possible
symptoms include lumps or swelling in the nodes in the underarm or collarbone area, in the groove above the collarbone or in the neck. Distant or metastatic recurrence means the cancer has moved to other parts of the body. Symptoms of this type of recurrence include persistent or worsening chest or bone pain, a persistent cough, lack of appetite, weight loss, headaches, seizures or difficulty breathing.
There is no way to say with certainty whether cancer will come back. However, there are features of the initial cancer diagnosis that are seen in greater frequency when cancer recurs. They include: • Cancer cells in lymph nodes at the time of the original diagnosis. • Larger tumor size. • Lack of radiation treatment after a lumpectomy. • Younger age. • Inflammatory breast cancer. • Initial cancer that didn’t respond to hormone therapy or treatments directed to the triple negative breast cancer. • Positive tumor margins.
FREE
Cancer Screening * Based On Eligibility
Well Woman HealthCheck Program at North Country HealthCare
The Well Woman HealthCheck Program is a program that provides breast and cervical cancer screenings to women 21 and over. We serve over 1,000 uninsured and underinsured women annually. Along with screenings, the Well Woman HealthCheck Program also covers the cost of diagnostic follow-up needed after abnormal screenings and link to free or affordable treatment if diagnosed with breast or cervical cancer through North Country HealthCare’s Treatment Link program.
To learn more or to see if you qualify visit northcountryhealthcare.org North Country HealthCare serves the primary care needs of 14 communities with 20 access points throughout northern Arizona. North Country HealthCare accepts Medicare, AHCCCS, commercial insurance and offers a sliding-fee scale based on income and family size.