Having breast cancer means you have us.
Breast Cancer Awareness 2024
Publisher
Donna K. Anderson
editorial
Vice President & Managing Editor
Christianne Rupp
editor
Megan Joyce
Contributing Writers
Gabriele Amersbach
Lynda Hudzick
Barry Sparks
art dePartment
Production Coordinator
Lauren Phillips
business develoPment
Senior Marketing Consultant
Josh Binkley
Events Manager
Kimberly Shaffer
Business Manager
Elizabeth Duvall
Dear
All women fear that someday they’ll hear four alarming words: “You have breast cancer.” And with statistics that 1 in 8 women will be diagnosed with breast cancer, chances are that you or someone you know will hear or has already heard those words.
I want to thank three women who have already heard that diagnosis but took the time to share their experiences with us. I’m sure it’s hard to relive what they’ve gone through and, in some cases, are still undergoing. But these courageous ladies want to make sure we realize how important it is to take control of our well-being and have yearly mammograms.
WellSpan Health is a leader in our region for high-quality healthcare. Learn how artificial intelligence is helping their radiologists detect areas of concerns in women’s breasts. This AI technology is integrated into the care pathway for breast cancer patients. It doesn’t replace the radiologist; it’s another “set of eyes.”
You may have heard the words “oncoplastic surgery” but weren’t sure what it was. During this type of surgery, an oncological surgeon and a plastic surgeon work together — performing the lumpectomy or mastectomy and reconstructive surgery concurrently — to help women feel more comfortable in how they look afterward.
The waiting period between receiving a breast cancer diagnosis and the actual start of treatment, when the best outcome is within sight, is often fraught with anxiety and uncertainty for the patient. Read how WellSpan Health has dramatically shortened the time from screening/ suspicion to diagnosis and treatment.
Another thank you goes to WellSpan Health for working with us to provide the valuable information included in this Breast Cancer Awareness magazine.
Ladies, if you’re over 40 or you have any concerns about your breast health, take time to set up your mammogram screening today! It could be a lifesaver.
Christianne Rupp Vice President and Managing Editor
Breast and Cervical Cancer Prevention and Treatment Breast and Cervical Cancer Prevention and Treatment
The Breast and Cervical Cancer Prevention and Treatment (BCCPT) program is administered by the Department of Human Services and provides full healthcare benefits to individuals needing treatment for breast or cervical cancer or precancerous conditions of the breast or cervix.
The individual must:
• Be uninsured or have no credible health insurance
• Be under age 65
• Be a U.S. citizen or qualified non-citizen
• Be a Pennsylvania resident
• Provide or apply for a Social Security number
Individuals who qualify for this coverage can receive free healthcare, including healthcare for medical needs unrelated to a breast or cervical cancer diagnosis, throughout the course of treatment for cancer or a precancerous condition of the breast or cervix.
Individuals can apply for BCCPT one of two ways:
1. Be screened and/or diagnosed with cancer through a Pennsylvania Breast & Cervical Cancer Early Detection Program (PA-BCCEDP) provider. Individuals can call 800.215.7494 to see if they qualify for PA-BCCEDP and find a provider in their area.
The PA-BCCEDP provider completes the BCCPT application with the individual and either forwards the application to their
local county assistance office for the initial opening in the program or emails the application to the PA-BCCEDP Case Management Team at Adagio Health at bccpt@adagiohealth.org (preferred method of application delivery).
2. Any medical provider can complete the BCCPT application and email the application or fax the completed form to the PABCCEDP Case Management Team at Adagio Health at bccpt@ adagiohealth.org or 412.201.4702. Adagio Health will process the form and send it to their local county assistance office for the initial opening in the program.
The PA-BCCEDP program provides free:
• Mammograms
• Clinical breast and pelvic exams
• Pap tests
• Follow-up diagnostic tests for an abnormal screening result
PA-BCCEDP is available to women ages 40-64 for breast services and 21-64 for cervical services. PA-BCCEDP imposes a 250% income limit based upon the federal poverty income guidelines, which are updated annually. Nonparticipating providers can refer individuals to the PA-BCCEDP website or call 800.214.7494.
Source: Commonwealth of Pennsylvania – pa.gov/en/agencies/dhs/ resources/medicaid/bccpt.html
Cancer – A Life-Changing Experience
By Lynda HudziCk
July 15, 2023, was the day that would change Jennifer Hamilton’s life. That was the day she first felt the lump in her left breast that would begin her journey through breast cancer diagnosis, treatment, and continued recovery. At the time, she had just turned 35 years old — a full five years before the start of screening mammograms.
Once she felt the lump, Hamilton said she called and made an appointment with her OB/GYN, who referred her to WellSpan Imaging – Rhonda Brake Shreiner Women’s Center in Chambersburg.
“They scheduled a mammogram/ ultrasound for me … then a biopsy … and then — cancer,” Hamilton said.
She was diagnosed with invasive triple-negative breast cancer, a rare and aggressive type of breast cancer that accounts for between 10% and 20% of all breast cancer cases. Hamilton recalled that once the diagnosis was made, things moved very quickly.
“I had my port surgery and then an MRI,” Hamilton said. Except for an aunt on her father’s side, there was no history of breast cancer in Hamilton’s family.
“I had three previous biopsies on my right side, all negative,” she said. “I really waited too long to take that first step to call the doctor this time, as I thought, ‘Here we go again, another lump.’”
But unfortunately, this time around, the results weren’t negative. A fear of the unknown loomed, and Hamilton recalled that “lots of tears were shed” as a treatment plan was put in place.
She worked on that plan at WellSpan Medical Oncology and Hematology in Chambersburg, and from the beginning, felt heard and encouraged.
“They told me from the start, ‘You can do this,’ and I did just that. The hardest part was trying to stay out of my own head. I kept busy, cried on hard days, and flourished on good days. Truly lived in the moment.”
Beginning on Oct. 3, Hamilton had 12 rounds of Taxol every week. On Dec. 26, she received her last dose of that particular drug.
“Jan. 9 was my first round of ‘red devil’ (Adriamycin), four treatments every two weeks. Feb. 20 was my last one,” she said. “I had a double mastectomy on March 20 because not all the lumps reacted to the chemo.”
She also had three lymph nodes removed, but thankfully those tested negative for cancer.
“My reconstruction surgery was April 3, and my radiation treatment started on May 15, every day for five weeks,” recalled Hamilton.
That particular round of treatment wrapped up on June 19,
although Hamilton will continue with some chemo for six months as a precaution and will also have immunotherapy every three weeks.
Hamilton will have a follow-up visit every three months from now on. Her doctor is optimistic, though, and has been very encouraging.
“With everything I went through, I will have a better prognosis and will hopefully be fine,” she said.
It was a lot to take in, from the initial diagnosis through all the testing and treatment, but Hamilton said that she felt “very seen and heard” through the whole
“So many questions were asked that got answered thoroughly,” she said. “I had education classes, which were awesome. I often say this is like another language — so much to take in and process.”
Handling the whole process emotionally is perhaps an even bigger challenge than handling it physically, because it affected not
“Breaking the news to my parents was so hard,” she said. “Being 35 years old, telling your parents you have cancer, was not an easy
Since her family lives in North Carolina, it was a bit more challenging because they weren’t physically present to help.
“As anyone can probably relate, you always lean on your mom when you are sick,” Hamilton said. “Being that far away was a big worry on me, but she was always a phone call away, no matter the time of day. She was my biggest cheerleader and still is.”
Hamilton and her husband have four sons, ranging from 2 to 10 years old. She remembers that the oldest took it the hardest.
“He cried and was scared for Mom, especially when I lost all my hair,” she said. “That was the biggest stab — Mom’s looks were changing — but he was there for me. Held me when I cried and even cried with me.”
She talked to him about it only when he asked, she recalls.
“I didn’t want him knowing too much.”
Their two middle sons were a big support as well.
“They would bring me home artwork from school of the pink ribbon and just recently made me pink bracelets,” Hamilton said.
And standing strong next to her through it all was, and continues to be, her husband, whom Hamilton referred to as her “backbone through all this. He was there for every appointment, every treatment, and every tear shed,” she said.
Knowing what she knows now, Hamilton has advice for others who may find themselves putting off that all-important phone call to the doctor: don’t
“Never think that this cannot happen to you,” she said. “Get your yearly mammogram, and listen to your body.”
AI Revolutionizes Breast Cancer Detection, Saves Lives
By B a RRy SPa R k S
WellSpan Health is committed to providing the highest-quality care to its breast cancer patients. That’s why it’s incorporating artificial intelligence (AI) solutions to help analyze mammograms and detect breast cancer.
“AI is absolutely revolutionary, and it’s here to stay,” says Heidi Beilis, M.D., FACR, vice president and chief medical officer of the diagnostic service line at WellSpan Health. “It’s a fantastic tool to help radiologists detect areas of concern on imaging, and it helps save lives.”
Breast cancer is the No. 2 killer of women who die from cancer, behind only lung cancer. In the United States, 1 in 8 women, about 13%, will develop breast cancer. Breast cancer also can occur in men.
WellSpan Health diagnosed more than 800 cases of breast cancer this past year. More women, however, are surviving than in the past, mainly because of effective screening. When breast cancer is caught early, a woman’s chance of survival increases significantly.
Although many patients may not be aware, at WellSpan Health AI is used in breast cancer diagnoses. Beilis says, “Artificial intelligence in breast care is an emerging and rapidly developing technology. At WellSpan Health, we are on the forefront. Here, it is newly integrated into our workflow care pathway for every breast patient’s care.”
WellSpan Health also uses AI solutions in other areas, such as stroke evaluation, trauma care, detecting blood clots in the lungs, and prostate cancer.
AI developers train computers to analyze vast amounts of medical data swiftly and precisely. The critical information is then escalated to the physician.
For breast cancer detection, developers input validated information from hundreds of thousands to millions of mammograms. Using an algorithm, AI software learns what a normal mammogram looks like and what a mammogram with possible cancer looks like.
The AI solution evaluates each image against the reference standards and highlights areas of concern for further evaluation and investigation by the radiologist.
“AI works with radiologists; it does not replace radiologists,” stresses Beilis. “It serves as another ‘set of eyes,’ and it may ‘tap us on the shoulder’ and direct our attention and say, ‘Take a closer
Heidi Beilis, M.D., FACR, vice president and chief medical officer of the Diagnostic Service Line at WellSpan Health.
look at this area of concern identified on the mammogram, MRI, or CT scan.’ The radiologist then decides if this is of clinical significance.”
AI offers several advantages in the detection of breast cancer. Combining AI with highly trained radiologists may help identify cancer earlier. According to the National Cancer Institute, screening mammograms miss about 29% of breast cancers. AI systems can detect early signs of breast cancer that radiologists may overlook.
Radiologists and the AI solution working together was 2.6% better at detecting breast cancer than a radiologist alone, according to a study in Germany and the United States, which was published
in The Lancet digital Health in July 2022.
“The goal is to expedite appropriate patient care,” says Beilis. “The earlier we can detect breast cancer, the more treatment options we have available. If there are concerns, we can start to have conversations within 24-48 hours.”
AI solutions can help radiologists reduce the number of false positives, which occur when a mammogram is flagged as having a concerning radiographic finding, but there is ultimately no cancer found in the breast.
While this is good news for the patient, it can create anxiety, uncertainty, and inconveniences. Multiple follow-up tests, such as another mammogram, ultrasound, or biopsy, may be required in order to rule out breast cancer.
A study in the United States and the U.K. found the use of an AI system lowered the rate of false positives by 6% in the United States and 1.2% in the U.K.
AI solutions for the breast may ultimately reduce the number of negative biopsies, which are performed to determine whether an area flagged during a screening mammogram is cancer or not.
About 80% of biopsies turn out to be benign (non-cancerous), according to the National Breast Cancer Foundation.
Beilis says AI can assist in the evaluation of screening mammograms in a more efficient manner.
“AI expedites workflow, especially for complex patients and those with dense breast tissue.”
Beilis has been incredibly impressed by WellSpan Health’s dedication to patient care.
“The AI solution was validated to ensure efficacy in the local population. We are working with people’s lives, so we performed trials to ensure value was present for our patients,” she points out.
The AI tool is currently in use at all WellSpan Health imaging sites that offer mammograms.
“This is not just a new, shiny object,” stresses Beilis. “It’s a revolutionary tool that is being thoughtfully integrated into our system. It will be extremely useful, particularly for patients with dense breasts. It’s a robust system that streamlines cases, increases accuracy, decreases turnaround times, and allows us to bring back patients appropriately.”
Beilis adds that AI promotes health equity and inclusivity, evaluating every patient in the same manner.
Once a patient is diagnosed with breast cancer, the goal is to get them into the WellSpan Health system as quickly as possible. Beilis says WellSpan Health has a talented and dedicated team and the resources to work with the patient on their care pathway.
Looking ahead, Beilis sees an exciting future for the use of AI solutions in the detection of breast cancer and other critical patient care areas.
“We’ll see great advancements and tremendous use of the artificial intelligence solution, where appropriate,” she says. “If it helps one patient, it has been a success.”
Radiologist Beatrix Olofsson, M.D., Ph.D., reads breast images as part of the multidisciplinary breast care team at WellSpan Health.
Oncoplastic Surgery Offers Women another Treatment Option
By Ba RRy SPa R k S
Receiving a breast cancer diagnosis can be emotionally overwhelming. It can trigger fear, anger, sadness, hopelessness, anxiety, and depression.
Survival rates, however, tend to be incredibly high. According to the American Cancer Society, there is a 90% five-year survival rate when averaging all stages of breast cancer.
Women have more options than ever when it comes to breast cancer treatment. Surgery — either a lumpectomy, partial removal of the breast, or a mastectomy (complete removal of the breast) — is the gold standard.
When they think of breast surgery, women typically are concerned about the changes to their bodies and their body image.
Today, however, many women can benefit from oncoplastic surgery, a combination of cancer surgery and plastic surgery. The technique improves cosmetic outcomes by reconstructing the breast tissue to create a more naturallooking breast.
“The goal is to make women comfortable with how they look and feel after the surgery,” says Jaime Slotkin, D.O., FACS, FACOS, a surgical oncology specialist at WellSpan Health Good Samaritan Hospital in Lebanon. “Women don’t want to walk around looking like they’ve had breast cancer, nor do they want a constant reminder of the surgery.”
Oncoplastic surgery, which has grown in popularity over the past decade, involves the surgical oncologist removing the tumor and a margin of healthy tissue to make sure all the cancer has been excised.
Then a plastic surgeon uses healthy tissue to fill in and reshape the breast into a more natural shape. Surgery may be required on the noncancerous breast in order to make the breasts symmetrical. Oncoplastic surgery is most commonly performed in association with a lumpectomy.
The oncological surgeon and plastic surgeon work together in one surgical session. That has several benefits:
• Accommodates a greater amount of tissue to be removed, which can be helpful for larger tumors
• Makes it easier to produce symmetrical breasts
• Decreases recovery time
• Is performed before radiation therapy, which helps patients avoid potential complications of exposing surgical wounds to radiation
Slotkin says oncoplastic surgery requires multidisciplinary coordination among radiologists, oncologists, radiation oncologists, pathologists, and plastic surgeons. This team and a multidisciplinary team of navigators, financial counselors, and social workers provide support to breast cancer patients.
“When a woman has a breast removed, it’s not only removing a part of her body, it’s also removing part of her identity, a part of how she feels as a woman, part of her sensuality,” says Slotkin. “With oncoplastic surgery, women look and feel like themselves.”
Although the best candidates for oncoplastic surgery are women with smaller, single tumors and larger breasts, Slotkin says every woman may potentially be a candidate.
“It depends on the size of the tumor, its location, and what the patient’s desired outcome is,” says Slotkin.
Women who smoke or have diabetes may not be good candidates for this surgical procedure.
“Most women do well following oncoplastic surgery,” offers Slotkin. “Long term, our happiest patients are those who had this type of surgery.”
Recovery is typically four to six weeks. During this time, patients need to take care of their incisions and limit their activities to some degree. Bruising and swelling of the reconstructed breast(s) may occur during this time. Some patients may feel good enough to return to work in two to four weeks.
Slotkin points out that clinical outcomes for oncoplastic surgery are as safe as traditional lumpectomy and total mastectomy. Clinical treatment is not sacrificed for cosmetic treatment.
A 2016 study of nearly 10,000 women at the University of Texas MD Anderson Cancer Center found that overall survival and recurrence-free survival were similar among these three
Jaime Slotkin, D.O., FACS, FACOS, surgical oncology specialist at WellSpan Health Good Samaritan.
groups (oncoplastic surgery, traditional lumpectomy, and total mastectomy). At three years, overall survival rate was about 96% to 98% for those who had oncoplastic surgery, traditional lumpectomy, or mastectomy with reconstruction. Recurrence-free survival was also similar.
More studies comparing oncoplastic surgery with traditional lumpectomy have found that women in the former group were less likely to have positive margins requiring another surgery. They also had a lower rate of complications and local recurrences, and they were more satisfied with the appearance of their breasts, according to UpToDate.com.
Slotkin recommends finding an experienced surgical team that you have good rapport with and whom you trust.
“You want them to know who you are,” she stresses. “You don’t want to rush and make a decision out of fear.”
Slotkin relates to her patients and is empathetic to what they go through. She carefully guides them through the process, helping them feel more in charge of what’s happening to them. Breast cancer patients are typically under her care for four or five years.
Will your oncoplastic surgery be covered by insurance? Yes. The Women’s Health and Cancer Rights Act of 1998 requires insurance companies that cover mastectomy to also cover reconstruction, including any procedures that are needed on the remaining healthy breast. It is important to make sure your procedure is described as reconstructive. And, if you’re having a procedure on the healthy breast, make sure it is described as being necessary for symmetry and not for cosmetic purposes.
While oncoplastic surgery is appropriate for 60% to 80% of women with breast cancer, according to the National Institutes of Health, not all women opt for the procedure. It is not available at all hospitals.
“As oncoplastic surgery becomes more available and patients become more aware and knowledgeable, more patients will opt for the procedure,” says Slotkin. “It will become the standard of care.”
Questions to Ask about Breast Reconstruction
The American Cancer Society says if you’ve been diagnosed with breast cancer and are considering breast reconstruction, it’s important to find out as much as you can about what to expect.
Your breast cancer surgeon works closely with a plastic surgeon. Together, they should be able to explain all your choices and answer all of your questions.
Here are some questions to help get you started. The American Cancer Society recommends you bring a partner or friend with you to the doctor’s appointment to take notes about what was said and to help ask other questions.
• Can I have breast reconstruction?
• When can the reconstruction be done?
• What are the reasons for and against doing it at the same time as my cancer surgery (immediate reconstruction) versus waiting (delayed reconstruction)?
• What are the risks and benefits of each option?
• How long will it take me to recover from each type?
• Will reconstruction interfere with chemotherapy or radiation therapy?
• What results can I expect?
• Will the reconstructed breast look like my other breast?
• Should I consider surgery on the other breast to help them look alike?
Breast reconstruction surgery is major surgery, and it’s important to ask questions about anything you don’t understand.
Source: american Cancer Society
Seeing Life through a Different Lens
By Ga BR ieLe a meRSB aCH
Two years after a milestone diagnosis of breast cancer in 2022, Kim Brister is now cancer-free and thriving. Her journey from diagnosis to renewed health is a lesson in optimism, commitment to one’s health, and the value of community.
As WellSpan Health’s vice president and chief of diversity, equity, and inclusion, Brister has always been passionate about her work.
“I’m a workaholic. My job is a labor of love, and it’s my way of giving back to the community,” she explains. “Our region is growing increasingly more diverse, and it’s my job to ensure WellSpan Health team members are well positioned to deliver on our promise of exceptional and equitable healthcare for all.
“That looks like advancing a workplace culture that respects and celebrates all the ways we are similar and unique, and building a workforce that is representative of the population we serve so that our patients feel seen, heard, and valued.”
At 54, she had a life that kept her busy and fulfilled. An emptynester mother of three with a full-time-plus job, she stayed in close touch with her children, who live in Philadelphia and Allentown, exercised regularly, and maintained close ties with a wide community of friends and volunteerism in York, her hometown.
“I’m always extremely busy. I could have very easily missed my yearly mammogram appointment,” says Brister.
Yet, realizing that Black women have a 40% higher death rate from cancer and her own commitment to her health encouraged her to stay on top of annual exams.
After a regular mammogram appointment early in 2021, her busy life came to a pause. The procedure uncovered a suspicious spot in the right breast. While the finding did not require an immediate response, her WellSpan Health gynecologist stayed vigilant.
Later that year, Brister explains, “My doctor told me, ‘Let’s not fool around with this’ and recommended a breast ultrasound on both breasts.”
Although ultrasound is not typically used as a routine screening test for breast cancer, it is helpful to determine if a growth has changed. Ultrasounds also can help determine if the mass is a fluidfilled cyst or more solid, which could indicate cancer.
While Brister had been very worried about the spot on the right breast, the later ultrasound found a suspicious spot on the left breast. After a biopsy early in January, she got the difficult news. Brister had early hormone receptor-positive breast cancer in the left breast.
Focused and Compassionate Care
After her diagnosis, “Everything happened promptly and succinctly,” Brister explains.
With the advice of her WellSpan Health surgical oncologist, Heather Thieme, M.D., she chose to have a lumpectomy and 23 sessions of radiation over an eight-week period.
“I didn’t receive special care because I work for WellSpan Health,” says Brister, “but I actually got to experience the focused, integrated, and compassionate care we design for each person who comes through our doors.”
Throughout her treatment, Brister notes that her out-of-pocket expenses were minimal.
“I even had acupuncture to relieve soreness and pain — a free part of cancer treatment,” she says. “And because of the removal of some lymph nodes, I continue to have physical therapy in my left arm to improve my mobility. Two years later, this service is still covered.”
She was also grateful to understand the genetic component of her cancer through WellSpan Health’s no-cost Gene Health Project. Brister found out she did not have the BRCA1 or BRCA2 gene, the most common cause of hereditary breast cancer. Women who have the abnormal BRCA2 gene have a 40% to 60% risk of developing breast cancer by age 70.
The program is a community health research program sponsored by WellSpan Health and looks at genetic factors that may influence a person’s health. Its aim is to help improve access to personalized healthcare and support new research discoveries for the community.
With a daughter who already faced a suspicious (but ultimately benign) breast lump, this information was very helpful.
Kim Brister, VP and Chief of Diversity, Equity, and Inclusion at WellSpan Health.
‘I Was Never Alone’
Throughout the treatment and healing process, Brister was grateful for the support of family and friends.
“My children, mother, and siblings walked alongside with me the whole way,” she says. “I had friends who were there the entire time and also stood by my side. I was never alone.”
Brister is pleased to note that her workplace was also supportive: “I had the full support of the organization during my treatment. Bob Batory, my boss and chief human resource officer at the time, and our CEO, Dr. Roxanna Gapstur, were very clear that they were there to support me through my journey.”
Although she had support from her workplace, as well as from family and close friends, Brister was able to retain her privacy and maintain as much normalcy as possible while she completed treatment.
“It was important to me that I continue to serve my colleagues as best I could with a smile on my face,” she explains. “I would receive radiation first thing in the morning around 7 o’clock, then was at work by 8; and when I grew tired by 2 or 3, I felt comfortable ending my day because I knew my team had my back. At that point, work was still mostly virtual, and after it was all said and done, people were surprised to learn I had navigated cancer.”
Finding Her Own Way through Treatment
To maintain her positive outlook, Brister relied on her spiritual beliefs.
“I am a person of faith,” she says. “I believe in God; he directs my path and knows the outcome before it even starts. I believed that the man above still had things for me to do on this earth. I have been blessed — faith saw me through it with grace.”
She continues, “It’s important for everyone to find their own way through treatment. I leaned into my religion — find something that anchors you.”
For Brister, her faith and the support of her family, close friends, community, and work provided that anchor — and helped her stay positive even after the initial treatment was over and some medication side effects began. With receptor-positive breast cancer, she was initially prescribed tamoxifen, an antiestrogen drug. Tamoxifen blocks estrogen activity in the breast and reduces the risk of a cancer recurrence.
The drug led to early menopause.
“My transition to hot flashes was immediate,” she explains.
Eventually Brister was switched from tamoxifen to anastrozole, which reduces the risk for some side effects, although this drug can cause joint pain and reduced bone density.
None of the medication side effects have slowed her down. Brister’s optimistic approach to her cancer journey shines through as she explains, “I stretch, weight lift, kayak, and cycle along the Heritage Rail Trail, challenging myself to go a little further each time. The more you stick with exercise, the more the soreness goes away.”
While exercise has always been part of her life and is an integral part of her healing process, she has also made some changes in her diet.
“I limit my red meat since it increases cancer risk and eat mostly ground chicken and turkey and absolutely love seafood. Steak I eat just a couple of times a year,” she explains, adding with a smile,
“I wasn’t a big vegetable eater. Now I can juice anything — it’s relaxing as I cut up vegetables every other day for my two daily servings.”
Care for Yourself So You Can Care for Others
Her advice to women who hesitate to get regular mammograms?
“Don’t ignore any symptoms or appointments. Care for yourself, so you can care for others,” Brister advises. “Take the time you need for tests.”
She especially encourages Black women to take care of themselves.
“Some feel they can’t miss work. For others, transportation is a barrier. Black matriarchs are often busy taking care of everyone else — and they don’t take care of themselves.
“Also, many in the Black community don’t trust the medical system and still struggle under the shadow of the Tuskegee Study,” where the Black male participants were denied treatment for syphilis, with more than 100 of these men slowly dying despite available treatment.
Brister continues, “Even in my own family, some women skip appointments because they put themselves last.”
She hopes her example of seeking prompt care will make a difference.
While Kim Brister still holds her breath during regular mammograms, MRIs, and follow-up appointments, she points out a positive that has developed from her difficult journey:
“I see life through a different lens. Before I used to wait for others to do things, like travel. Last year, I traveled outside of the country multiple times — to Mexico, Turks and Caicos, and Portugal. Now I don’t want to wait anymore. I just do it.”
WellSpan Health Improves Timely Care for Breast Cancer Patients
By Ba RRy SPa R k S
WellSpan Health is dedicated to overall patient care, from providing accurate and reliable mammogram screenings to efficient and dependable diagnosis and treatment. That’s why it participated in The Patient-Reported Observations on Medical Care Procedure Timeliness (PROMPT) for breast patients, a two-year quality collaborative of the ACS National Accreditation Program for Breast Centers (NAPBC).
More than 320 NAPBC sites contributed data from 2019 to 2021 on four metrics:
• Time from screening mammogram to diagnostic mammogram
• Time from diagnostic mammogram to biopsy
• Time from biopsy to neoadjuvant therapy (treatment given as a first step to shrink a tumor before the main treatment, which is usually surgery)
• Time from biopsy to surgery
Additionally, interviews were conducted to gather patient perceptions on timely care, from screening to treatment.
“Unfortunately, there are no national benchmarks for timely care,” says WellSpan Health Oncology Program Director Michelle Shriner. “Women experience a tremendous amount of stress and anxiety in between each step of the treatment process for breast cancer. We know there is a powerful connection between mental and physical health, and we want to decrease the stress and anxiety as much as possible.
“Different patients, however, prefer different speeds. Some want
Shriner, WellSpan Health Oncology Program Director.
to go slower so they can process the emotions, while others want to move as quickly as possible. Our goal is to see women receive the
Michelle
care they need in the time frame they want.”
Shriner says WellSpan Health realized there were discrepancies across its system in regard to what services were offered, access to care, and timeliness of care.
WellSpan Health pulled together a team of 180 staff members, representing all parts of the health system, to study the process. Every hospital, service line, and surgical department was involved. The team held smaller face-to-face meetings and larger Zoom meetings.
“Each person brought a different perspective to the meetings,” says Shriner. “Everyone was committed to the process.”
It was, however, a monumental undertaking, one Shriner likened to climbing Mount Everest. It involved complex coordination, hours of meetings, and gathering of incredible amounts of data.
The team mapped out the breast cancer care process. Team members identified differences among the breast cancer centers, inefficiencies, and bottlenecks. It was clear that perceptions about the treatment path, the care, and the timeliness of the care differed from location to location.
In conjunction with this process, WellSpan Health interviewed a number of breast cancer patients to gain their perceptions.
“The patient perception is very important to us,” says Shriner. “We wanted to know about their experiences, the problems they may have encountered, and their recommendations.”
The group discussed everything from patient gowns to access to transportation.
“Talking to patients provided a personal and elevated level of understanding,” comments Shriner. “It helped us to identify additional challenges and see things from another perspective.”
Patients reported many barriers to achieving timely care. Factors such as difficulty scheduling appointments, second opinions, and additional testing and consultations delayed care. Issues with insurance coverage, financial restraints, and transportation barriers also were obstacles.
WellSpan Health worked diligently to improve and standardize its breast cancer care process. They focused on decreasing all four timely metrics cited by the PROMPT study. The time from a screening mammogram to a diagnostic mammogram was decreased from 11 days to five days.
The time from a diagnostic mammogram to biopsy used to be seven days. Now, the two can be performed in the same day, if the patient wants. Most women take advantage of the same-day availability, according to Shriner.
The time from a biopsy to neoadjuvant therapy was cut from 54 days to 28 days. Time from a biopsy to surgery used to be 40 days. Now, it’s 28 days, and the goal is to cut it to 21 days.
The PROMPT study revealed that patients preferred shorter time intervals from screening mammogram to treatment compared to time intervals reported. Patients preferred a time interval of five days from screening mammogram to diagnostic mammogram (compared to 11 days in PROMPT) and 21 days from biopsy to surgery (compared to 42 days in PROMPT).
“We’re very satisfied with our process improvement results,” offers Shriner. “But we have more we want to achieve. We believe we can further decrease the times between stages of care. We want our benchmarks to be aligned with the national benchmarks. Plus, we want all of our breast cancer care centers to be accredited by the National Accreditation Program for Breast Centers and have access to a nurse navigator.”
These are just some of the goals, says Shriner. Process improvement is a continuous endeavor, one WellSpan Health constantly monitors.
“Our goal is to deliver seamless breast cancer care in a timely manner,” she stresses. “If we don’t, we want to know about it so we can fix it. We want to prevent it from happening again. We are committed to creating an atmosphere of hope and healing through an environment that is safe, caring, and welcoming.”
The Importance of Annual Mammogram Screenings
By Lynda HudziCk
Tracey Covert, a professional hairstylist, was newly married to her husband, Jay, for only a month when she got the news that no woman wants to hear.
“I got married June 8, 2019, and went for my yearly mammogram on July 9,” she said. “They asked if I wanted the 3D mammogram, which I hadn’t had before. They said it may cost extra because many insurances won’t pay the difference — which is not the case today. I told them I didn’t mind paying extra because my new husband lost his first wife to triple-negative breast cancer.”
Today, WellSpan offers 3D mammograms at all of their locations, including their Mobile Mammo unit.
With no family history of breast cancer, and an issue with her right breast when she was 40 that turned out to be negative, Covert was surprised to learn that an abnormality had been found. A needle biopsy was scheduled — and her journey began.
“When we went in for the results of the biopsy, I knew it was not going to be great news.”
Unfortunately, her diagnosis was triple-negative as well.
Because several of the lymph nodes under Covert’s left arm tested positive, a PET scan was ordered.
“The scan lit up in my left breast, lymph nodes under my left arm, chest, spleen, and ovary,” she said.
She was diagnosed with stage 4 triple-negative invasive ductal carcinoma and met with Dr. Chan Huynh at WellSpan Health to decide what the next steps should be.
“Surgery is not an option with stage 4 metastatic cancer,” Covert said. “I started chemo and immunotherapy, with infusions on Friday. And I continued to work in the salon two days a week.”
After about four months of treatment, the areas in her chest did not seem to be changing, so a bronchoscopy was ordered, but the results were inconclusive.
“So we continued the chemo and immunotherapy,” Covert said. “We also had our ‘delayed honeymoon’ that December, and I celebrated my birthday with family and friends not knowing if I would celebrate another.”
Another bronchoscopy was ordered, and this time, there were some answers.
“Sarcoidosis, which is an autoimmune disease, can in rare cases mimic cancer on a PET scan,” Covert said. “They needed to biopsy my spleen to see if that was sarcoidosis as well. Let me tell you, that was really unpleasant. Ten out of 10; I do not recommend.
“My spleen biopsy would determine if I really was stage 4,” she said. “After the procedure, I was changed to stage 3. We stopped the immunotherapy but continued chemo.”
Plans were started for a double mastectomy with immediate
DIEP flap reconstruction. Then COVID hit. “I was really looking forward to having my surgeries and moving forward,” Covert said. “But any ‘unnecessary’ surgeries were canceled, so I needed to change my game
In April 2020, she went in for left breast and lymph node removal. She then began the “red devil” chemo treatment and, due to the location of her breast cancer and the sarcoidosis diagnosis, chose to have proton radiation with treatments five days a week. Surgery to remove her right breast and ovaries was scheduled for December 2020 but, once again, COVID got in the way.
“I was able to have the mastectomy and oophorectomy, but reconstruction was put on the backburner,” she said.
Her DIEP flap reconstruction was finally scheduled for Aug. 2. There were some complications with scar tissue along the way and several surgeries to correct those issues, but in March 2023 she had her ninth surgery, for mastectomy and reconstruction, and in January 2024, she had her 10th and last surgery.
Today she continues to have bloodwork and chest scans to keep an eye on her sarcoidosis and blood levels. She also takes hormonebased chemotherapy, which she will do for five years.
Covert can’t say enough about the caring and compassionate treatment she received throughout her more than five-year journey, especially Chanh Huynh, M.D., her hematology oncology physician.
“I am so thankful for Huynh. He saved my life. He continued to look for answers and found the sarcoidosis that changed my treatment plan. Smith was wonderful throughout early diagnosis and surgeries. They both had fantastic bedside manners.”
Because of significant scarring, Covert is no longer able to work as a hairstylist. But she is able to help others who are struggling with a cancer diagnosis that leads to hair loss by assisting with wigs.
“We can all say it’s just hair, but it is linked to our identity so closely. It is a very visible sign that something has changed, and it can be very traumatic to lose that part of yourself.”
Covert strongly encourages everyone to get annual mammograms.
“I did not feel the tumor until I had the mammogram, and they pointed it out to me,” she said.
She also wants to emphasize that it’s OK to feel whatever you need to feel when struggling with a cancer diagnosis — sad, mad, and scared. All of that is normal and it does not make you weak.
“People say things like, ‘You are so strong, and I don’t know how you do it.’ I tell them I didn’t really have any other choice. And so I did everything I could to still be here on this side of the dirt.”
Resource Books
Dr. Susan Love’s Breast Book
By Susan M. Love, M.D.
Ebook; print; audio
While the amount of information regarding a breast cancer diagnosis is vaster than ever, online and off, what continues to be missing is the explanation behind the options. Most of the data online on medical sites is generic and often comes from the same source.
Then there are the patient sites as well as many social media outlets that provide peer-to-peer support and information. This is important for emotional support but still leaves out the full range of options and the reasons for them.
The Breast Book is where people go for a deeper understanding of how to make the best possible choices for their particular situations. Now in its seventh edition, the Breast Book has been fully revised to incorporate the most recent developments in prevention, treatments, and research. This new edition covers:
• New treatments: including new drugs, vaccines, hormonal treatment, and drugs with longer duration (10 years) for estrogen-positive tumors
• The increasing focus on where cells live, both locally (immune system, hormones, etc.) and systemically (stress, etc.)
• Prevention: several new drugs have been added to the list of chemoprevention drugs; in addition, preventative surgery has received increased attention
• Increased data on “alternative” approaches, such as stress reduction and exercise in reducing recurrence
• Increased understanding of the immune system and how it either controls or promotes the cancer
• Risks for survivors
• Genetics
• Special groups: Men with breast cancer are demanding a louder voice in the conversation and research
The Best Friend’s Guide to Breast Cancer: What to Do if Your Bosom Buddy or Loved One is Diagnosed
By Sona L. Faulkner, Ph.D.
Ebook; print
Do you know someone with breast cancer? With 1 in 8 women diagnosed in a lifetime, it’s a disease likely to touch everyone.
When a woman learns she has breast cancer, her friends and family members often feel lost. Unsure what to say or how to help, they frequently disengage just when they are needed most.
Until now. The Best Friend’s Guide to Breast Cancer: What to do if your Bosom Buddy or Loved One is diagnosed is an inspiring and informative one-stop resource to coach friends and loved ones through this difficult time.
Sonja Faulkner and other breast cancer survivors offer insight about the diagnosis, treatment, and recovery phases of an illness, including: what a woman is thinking; what you should say (and not say) to her; suggestions for meaningful acts of kindness; and gift ideas.
Also, medical terminology is explained in layperson’s language so that friends and loved ones gain a rudimentary understanding of diagnostic tests, treatment options, and medical maintenance.
In addition, a chapter on the healing properties of 13 super cancer-fighting foods, as well as recipes to make during all stages of a loved one’s battle is included.
The guide also provides lists of organizations and websites to learn more about breast cancer, receive support, and find information on events or walks and opportunities to volunteer, make a donation, or become an advocate.
The Best Friend’s Guide to Breast Cancer and the healing power of social support will make an extraordinary difference in your loved one’s journey.
Thrive After Breast Cancer: A 3-Part Guide to Recovery and Wellness with Actionable Strategies, Practical Coping Techniques, and Renewed Strength to Find
Confidence and Hope
By Terri Sterk Ebook; print; audio
Navigate the journey to recovery and wellness with empowering strategies, practical coping techniques, and inspiring survivor stories.
Are you tired of living in the shadow of uncertainty, with every moment plagued by the fear of breast cancer’s grasp?
Have you ever felt isolated and alone in your struggle with breast cancer, craving a guiding light that will empower you to conquer the daunting challenges of breast cancer?
Are you searching for answers and practical strategies to reclaim your life, without sacrificing your emotional and spiritual well-being? In Thrive after Breast Cancer, you’ll learn how to:
• Navigate the overwhelming emotions that accompany a breast cancer diagnosis
• Recognize the profound impacts breast cancer has on your body, mind, and spirit, supported by insights and guidance from inspiring survivors
• Discover the path toward a healthier, happier, and more resilient version of yourself
You’ll experience a more comprehensive and balanced healing journey by integrating all aspects of your recovery, offering a fresh perspective and innovative approaches to breast cancer recovery.
Drawing from the latest research and real-life experiences, you’ll find unique insights and strategies that have the potential to transform your recovery journey. Take advantage of the opportunity to discover the missing pieces that can make all the difference.
Having breast cancer means you have us.
Breast cancer isn't a solo endeavor. It's a tight-knit community of remarkable surgeons, dedicated nurse navigators and a world-class collaboration with Johns Hopkins Medicine Kimmel Cancer Center in Baltimore that gives our patients access to clinical trials, second opinions and advanced genomics.
can focus on healing. Because here, you have more than breast cancer, you have WellSpan. You can learn more at
