Breast Cancer Awareness • 5B
www.crossville-chronicle.com • Friday, October 2, 2015
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Billie Mitchell, right, and her husband, Jim, made the move to Fairfield Glade earlier this year after Billie completed treatment for stage 1 breast cancer. Thanks to an annual mammogram, her small yet aggressive tumor was found early. She’s urging all women to take advantage of early detection tools to protect their health.
Survivor encourages women to take advantage of early detection tools
By Heather Mullinix Chronicle assistant editor
Billie Mitchell firmly believes making time for her helped her to find a small, yet aggressive, tumor in her breast last year. That early detection, she said, made her treatment and recovery from breast cancer a much easier road. “Get your mammograms,” Mitchell said. “It can’t be said enough. “That’s the one thing you can do for yourself. If they have a diagnostic test and your insurance can take care of it, or you can get it for free, you must do it.” Billie and her husband, Jim, were living in central Illinois, preparing to move to Fairfield Glade, when she went to her annual mammogram screening in July 2014. She was called the next day and told additional imaging was needed. “The folks that do the tests can’t really tell you very much, but I knew if they were calling me back in, there was something they wanted to look at,” she said. Before she left the hospital that second day, she had an appointment with a surgeon. “I still didn’t know what was going on. I just knew there was something fairly small and the surgeon wanted to have a look at it,” she said.
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The surgeon told her there was a one in nine chance the small area identified in her mammograms was malignant and scheduled a needle biopsy. “I had to wait so many days and then came the diagnosis,” she said. “I don’t care what kind of cancer it is; I don’t care how small it is; it’s everyone’s fear to have cancer and it’s very devastating news to hear.” Her first mammogram was performed July 10. The next few weeks were a flurry of testing, doctor’s visits and consultations. Mitchell was scheduled for a partial mastectomy on Aug. 4. Their September move was put on hold so that she could go through treatment with the medical team she knew and the family and friends who would provide much-needed support over the next several months. “In your mind, you jump from one catastrophe to the next, but the medical professionals know how to lead you through each and every step so you feel like they’re doing something proactive for you,” Mitchell said. “I love that the folks did not let any time linger. I didn’t have to wait and wonder very much about what was going on because the fear in the night is hard.” Mitchell had no family history of the disease and was exhibiting no symptoms or noticeable changes in her breast when the
Every two minutes, a woman in the United States is diagnosed with breast cancer. In fact, breast cancer is the leading cancer among Caucasian and African American women. Mammography screenings are a woman’s best chance for detecting breast cancer early, so get yours today.
tumor was found. A selfbreast exam following the imaging tests revealed nothing out of the ordinary to her. The tumor was removed during surgery. It was very small, only 1.4 centimeters, and was a stage 1 cancer. The surgeon removed additional tissue to have clear margins, tissue that has no trace of cancer cells, and her sentinel lymph node was clear of cancer, meaning the cancer cells had not spread. Additional testing revealed the tumor was small but aggressive and invasive. “It was small but it wasn’t messing around,” Mitchell said. Mitchell has known a number of individuals diagnosed with various forms of cancer who did not receive as good of news as she did. “I had some guilt,” she said. “I have young friends who had double mastectomies within weeks of my diagnosis. A friend, a seven-year survivor of ovarian
cancer, told me, ’Take the good news, Billie, because See early page 6B
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CMC Regional Breast Center on front line of diagnosis By Heather Mullinix Chronicle assistant editor
Part of fighting breast cancer is finding and diagnosing cancer in the earliest stages, when it is most easily treated and before it has spread to other areas of the body. Of the screening and diagnostic tools available, mammography is the “gold standard” of medical imaging for early stage breast cancer, said Amanda King, director of medical imaging at Cumberland Medical Center. “You have the ability to see extremely small areas,” King said. CMC’s Regional Breast Center utilizes digital mammography, with two units available at the CMC location and one unit available at the CMC Medical Arts facility in Fairfield Glade. This technology offers advantages over previous mammography technology, including faster imaging, less radiation exposure and faster results. Also, because the files are digital, the radiologist
EARLY
• Continued from 5B you’d have to take the bad.’” Mitchell said finding breast cancer early was imperative in her diagnosis. Because the cancer was aggressive and invasive, a delay in finding it could have allowed it to spread to a larger area in the breast or throughout her body. “I don’t know how fast my tumor was growing, and you never know,” she said. “It could have been fine a month later, or it could have been at stage 4,” she said. “If it starts to metastasize, they have to do so much more to you. They have to give you a harder chemo. The road is just harder when you’re at late-stage cancer.” While her cancer was found early, she was still afraid of the treatment regimen awaiting her. She needed chemotherapy, 12 weekly treatments, followed by 25 daily radiation treatments. She lost her hair but was fortunate to not experience much stomach distress. But the treatments took their toll. “You don’t feel spiffy,” she said. Radiation treatments, at first, were easier for her than the chemotherapy treatments, but she said she struggled with those emotionally towards the end. However, she knows her experience could have been harder. “I would never run to treatment again, but I’m not running away from it, either,” she said. “It wasn’t so hard that I couldn’t do it.” During her treatments, she leaned on her husband and family, who circled the wagons to care for her. “My hero husband,” Mitchell said of Jim. “He never missed a beat. he sat through the doctors appointments and worried through the surgeries. He never backed up once.” She was also blessed to receive cards, letters, notes, emails and messages through social media and calls from friends scattered near and far. “They said, ‘I’m a fiveyear survivor.’ ‘I’m a sevenyear survivor.’ ‘I’m a nineyear survivor.’ One little
can enlarge areas for closer scrutiny and can file them away with the patient’s medical records to use for comparison in future years. “It offers the radiologist the ability to manipulate the image, level the image, darken it, contrast it, without having to call the patient back for extra imaging,” Kind explained. “We can magnify those images, too.” Women can get a baseline mammogram as early as 35. Women should consult with their physician on when to begin regular mammograms based on risk factors and family medical history. “You don’t have to have a physician referral to have your screening mammogram at either facility,” King said. While the Fairfield Glade imaging center offers screening mammogram services, the CMC Regional Breast Center is able to offer a variety of tools and procedures to aid in the diagnosis of breast cancer and other diseases. This includes diagnostic
mammograms and ultrasound. “Having that capability within the breast center makes it more convenient for the patient,” King said. “The ultrasound technicians at the hospital are trained in breast ultrasound, as is one of our mammographers is credentialed, as well.” All of the mammographers at CMC are credentialed in mammography imaging through the American Registry of Rediologic Technologists. It shows mammographers have met a recognized national standard which includes completion of clinical experience, ethics standards and successful completion of the mammography examination. Ultrasound imaging can differentiate solid lesions, identifying the borders of lesions. It isn’t effective with calcifications, however, so it isn’t the first choice for screening images. “We want to start with effective screening so that we don’t do unnecessary tests, but yet we don’t
want to leave any stone unturned,” King said of the methodology in employing various diagnostic tools. CMC Regional Breast Center also works with surgeons to help in biopsy and treatment through stereotactic breast biopsy and placement of wires to guide surgeons. Stereotactic biopsy uses two images to provide almost three-dimensional images to guide surgeons during biopsy procedures. “It’s a GPS. We know exactly where we need to go to biopsy,” King said. “We can use it with wires, as well. If you need an excisional biopsy or have a definitive diagnosis, we’ll put a wire in to serve as a guide for the surgeon. It lets him know exactly where that area of concern is so that he goes right to it.” As a member of Covenant Health, patients at Cumberland Medical Center benefit from the collaborative efforts of the health system’s many facilities. See front page 7B
“I cannot live my life fearfully. Everything is different after cancer, but life is still good and more precious.”
But I cannot live my life fearfully,” she said. “Everything is different after cancer, but life is still good and more precious.”
Billie Mitchell
Breast Cancer Survivor gals in the nursing home told me she was a 25-year survivor. That gave me such hope,” she said. “There has to be a blessing in there somewhere. If you can catch it early and the doctors can work on you, you have a really good chance.” She had a network of what she called Cancer Angels, survivors who were well educated on cancer diagnosis and treatment, who could offer information and emotional support when needed. Mitchell has tried to pay that forward with those she knows who have been diagnosed. “My experience is not yours, but let me know what you need,” is what she tells those she shares with. She also found her faith sustaining to her during treatment. Mitchell encourages women to make time for screening tests, including yearly mammograms beginning at age 40 and annual breast exams for younger women. Women are also encouraged to “know their normal” and see a doctor if they notice any changes in their breasts.
“Early detection is the main thing,” she said. Breast cancer, unlike many other cancers, has readily available screening tests and Mitchell encourages everyone to take advantage of those. She’s become a champion for early detection. “My first Facebook post after I finished treatment was ‘Get your mammograms,’” she said. “There are so many cancers they don’t have good screenings for. You have to wait for symptoms. I had no symptoms.” Billie and Jim settled in to their new home in Fairfield Glade in March, just days after her doctors released her from treatment. She has found a new medical team to assist her in her post-treatment care and is making the new house and new community her home. She’s also had her first post-treatment scan which came back clear of cancer. She knows there is a chance the cancer could recur, but she’s looking forward. “Does that mean I’m never afraid? I don’t know anyone who would say that.
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Breast Cancer Awareness • 7B
www.crossville-chronicle.com • Friday, October 2, 2015
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We Support Breast Cancer Awareness... Just One Step Towards Survival
Nurse navigator guides patients through recovery By Heather Mullinix Chronicle assistant editor
A patient’s journey from diagnosis of breast cancer to treatment and survivorship is filled with many paths. Trish Vaughn, nurse navigator at Cumberland Medical Center, helps to keep them on course, encouraging patients, answering questions, identifying barriers and offering a supportive shoulder and an attentive ear to hear their concerns and questions. “We look at the whole picture,” Vaughn said of her role as a resource for patients facing a diagnosis of breast cancer, who has a passion for her role in the cancer treatment team. She’s worked at CMC for six years, though she makes her home in Livingston. “I love what I do. I love the patients. I love it here,” Vaughn said. Vaughn meets her patients through the CMC Regional Breast Center following an abnormal screening mammogram, before they have diagnostic testing. “My role as a nurse navigator is to provide support and education to our patients,” Vaughn said. “The initial visit is for introduction and to provide education, if needed, and support.”
Trish Vaughn “It can be very nervewracking for any woman when they get a call back after a mammogram,” said Amanda King, director of medical imaging at Cumberland Medical Center. The goal of all departments of the hospital is to provide a collaborative working environment with the breast center, the nurse navigator, the referring physician and the sur-
geons and oncologists. “That’s the cornerstone for breast imaging and the continuum of care at this facility,” King said. “It improves communication throughout the process. It alleviates patient delays, and we can avert problems before they occur. We improve the quality of our services by expediting the timeliness of providing patients and phy-
sicians test results. Our nurse navigator helps with that greatly. We call the physician’s office and the patient as soon as test results come back.” Should diagnostic imaging show a need for further imaging or testing, Vaughn notifies the patient’s primary care physician and helps to coordinate follow-up care of further imaging or a biopsy to be performed by a surgeon. Vaughn ensures patients have transportation for their biopsy procedures and follows them while at the hospital and continues to keep open communication after the patient goes home. Should a biopsy show the presence of cancerous cells, a patient then has numerous decisions to make regarding treatment. Vaughn gives every patient the “Breast Cancer Treatment Handbook,” provided by Susan G. Komen, which has a wealth of information for patients, from the emotions they may experiencing to communicating with children about the disease. It also reviews the many different treatment options that may be available, though not every option applies to every patient and treat-
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Mammography Questions What is mammography? Specific imaging using low-dose X-ray to examine breasts. A mammogram is used to aid in the early detection and diagnosis of breast disease in women. Why should I have one? A mammogram can find breast cancer even when it is too small to be felt. Who should have a screening mammogram? Women age 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health. Screening mammograms are for women without breast symptoms. Women who have had breast cancer and those with a genetic history of breast cancer should seek expert medical advice about when to begin screening. Who should have a diagnostic mammogram? Diagnostic mammograms are used to evaluate a patient with abnormal clinical findings such as a breast lump or
FRONT
• Continued from 6B “We work closely with our sister facilities,” King said. “We use their resources and they use ours to ensure that all patients throughout Covenant get the best care possible.” CMC works with Thompson Cancer Survival Center’s Comprehensive Breast Center and Thompson’s Cancer Outreach Services. Partnerships with Susan G. Komen and the Tennessee Department of Health also help ensure care for those who are uninsured or underinsured. While offering good diagnostic and screening tools to patients was a top priority, patient comfort was not far behind. Both the CMC Regional Breast Center and the Medical Arts at Fairfield Glade facility kept patient privacy and comfort in mind, with private dressing areas, private waiting areas and segregated facility areas for women only. Even plush robes were brought in to add to patient comfort.
“We want to make it as positive an experience as we can,” King said. For more information
lumps found by the woman or her doctor. Diagnostic mammography may also be done after an abnormal screening mammography in order to evaluate the area of concern. What screenings should I have before age 40? Women in their 20s and 30s should have a clinical breast exam as part of a regular health exam by a health professional. A woman should also conduct breast self-exams and familiarize herself with what is normal for her body. Any breast changes should be reported to a health professional right away. A breast self-exam should not take the place of routine clinical breast exams and mammograms. What if I have breast implants? Women with breast implants should also have mammograms, though implants pose special challenges. You will need additional imaging during a screening mammogram. It is important to tell the mammographer you have implants before your mammogram. Screening guidelines are the same as for women without breast implants. -American Cancer Society or to schedule a mammogram, call 459-7040.
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From the left are Dr. Jason Hardin, M.D., Board Certified radiologist; Elizabeth Dycus, R.T.(R)(M)(B.D.), staff mammographer; Stephanie Jennings, R.T.(R)(M)(B.D.), chief mammographer; Ann Downs, R.T.(R)(M)(B.D.), lead mammographer; and Amanda Brannon, manager of the Outpatient Imaging Center.
CRMC recognized as a Pink Ribbon Facility for breast health The Women’s Center at Cookeville Regional Medical Center has been recognized as a Pink Ribbon Facility by Hologic, Inc. for providing excellent breast health and showing exceptional commitment and support to the women in their community. Pink Ribbon facilities offer 3D breast tomosynthesis imaging at their facility. This is the latest in breast screening technology. “Being a Pink Ribbon facility is a great way to show patients that we continue to provide them with highest quality of care, and by offering the 3D tomosynthesis, we give them that.
GUIDE
• Continued from 7B ment options will depend on the stage of the cancer and the type of breast cancer the patient has. “It goes through the whole thing, what everything means,” Vaughn said. In the back are worksheets for patients that help to manage fears, questions to ask medical providers. One question patients may struggle with is whether to have a lumpectomy, where the tumor is removed but the breast is preserved, or a mastectomy, where the entire breast is surgically removed. Reconstruction is also part of the conversation, as well, with patients needing to decide if they want to have breast reconstruction following treatment, or immediately. A questionnaire helps patients explore their feelings about all their options. In addition to helping patients find their way in the often confusing medical side of treatment, helping to juggle appointments and keep track of treatment options, patients also have practical concerns. Many patients have obstacles to treatment. Vaughn helps them find resources to remove those barriers. A distress thermometer asks patients to show how much distress they have been experiencing each week, and a questionnaire helps to identify areas of stress, from accessing insurance and finding childcare while undergoing treatment to dealing with partners or children, or other family
The Women’s Center offers the latest 3D tomosynthesis model and technology so women know that they are receiving excellent breast care when they come to us,” said Stephanie Jennings, chief mammographer at The Women’s Center. To schedule a mammogram or for any questions about 3D mammography, please contact The Women’s Center at 783-2222. The Women’s Center is now among the elite group of institutions nationwide providing breast care after receiving a three-year/full accreditation designated by the National
health issues, and emotional problems patients may find themselves struggling with. “Transportation is probably the biggest problem we have. They don’t have the money to drive back and forth for treatment,” Vaughn said. “They are truly very sick and some are about to lose their homes or are struggling to pay their utility bills. We try to meet the needs of our patients. And each patient’s barriers are different. And this community is very supportive in helping to meet the needs of patients.” Vaughn keeps a list of community resources handy to help patients access services they need. One of those resources is the Tennessee Breast and Cervical Program, which offers eligible women diagnostic follow up for suspicious screening results. Women diagnosed with breast or cervical cancer or pre-cancerous conditions are enrolled for treatment coverage through the state’s TennCare Program. The emotional aspects of care are important to Vaughn as well. Patients may feel depressed and crying, or partners may not know how they can help their loved one during this time. “Open communication is the best thing you can do,” Vaughn said. “The biggest thing regarding the feelings of depression is that it is OK to feel that way. It’s OK to cry. Those are normal feelings you are going to have when you’ve been overwhelmed with a diagnosis of cancer.”
Accreditation Program for Breast Centers (NAPBC), a program administered by the American College of Surgeons. This achievement makes Cookeville Regional’s breast program the only accredited breast center in the Upper Cumberland. The Women’s Center is the only breast imaging center in the Upper Cumberland to earn the American College of Radiology’s Breast Imaging Center of Excellence status. The Women’s Center is conveniently located one block from CRMC at 251 West Third Street in Cookeville.
Through these questions, it helps Vaughn to ensure patients have a support system available, and through it all, she’s on call. She gives patients her cell phone number to call day or night and is ready to answer with compassion and a caring attitude. “All you have to do is talk. You just have to be a support person for them,” Vaughn said. Vaugh completed certification to become a patient navigator for breast cancer patients. As part of that, she completes annual continuing education credit, including a recent conference presented by the Academy of Oncology Nurse and Patient Navigators. There, she attended numerous seminars and talks that helped grow her knowledge on patient navigation and survivorship, including a powerful presentation by someone who helped participants visualize what it’s like to be a patient. “It was an awakening,” Vaughn said. “She helped show how long we make patients wait and how scared they are. In the back of our minds, we know this, but to see it presented in this way was powerful.” One of the messages of the conference was to know what services are offered at each facility and what services the community can offer to assist patients. “We work to keep that information updated,” Vaughn said. “This community has been so good to me when I have needed something.” A new standard of care being implemented
through the Commission on Cancer is survivor care plans, Vaughn explained. “Even though I do follow patients afterwards, this is a definite care plan,” Vaughn said. “It doesn’t leave patients with the feelings of being abandoned. They’ve been in touch with someone all through this process and suddenly, they may feel all alone. This way, that doesn’t happen. There are support groups and their providers are available to them. It encourages them that they have someone to fall back on.” n Heather Mullinix may be reached at hmullinix@crossville-chronicle. com.
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