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Breast Cancer Awareness Month PNJ • 2015
Sponsored by Quint and Rishy Studer In memory of Rishy’s mother, Mary Perdue, who lost her courageous battle with breast cancer when she was far too young.
Local mammogram resources • Costs of treatment • Facts & Myths
Breast cancer is the most common cancer diagnosed in women in the United States, other than skin cancer. It is the second leading cause of cancer death in women, after lung cancer. The chance of a woman having invasive breast cancer sometime during her life is about 1 in 8. The chance of dying from breast cancer is about 1 in 37. Breast cancer death rates have been going down. This is probably the result of finding the cancer earlier and better treatment. Right now there are more than 3.1 million breast cancer survivors in the United States. For more information about breast cancer, how to find it early, and how to help finish the fight against the disease, visit our breast cancer information and resources or contact the American Cancer Society at 1-800-227-2345 anytime, day or night.
Are you a breast cancer survivor and want to share your experience with someone who is currently facing a diagnosis? Help someone facing breast cancer in our community by calling 850-266-2280.
Signs & Symptoms W
idespread use of screening mammograms has increased the number of breast cancers found before they cause any symptoms. Still, some breast cancers are not found by mammogram, either because the test was not done or because, even under ideal conditions, mammograms do not find every breast cancer.
doesn’t run in your family? True False
cancer runs 2 Ifinbreast your family, you’re
Other possible symptoms of breast cancer include: • Swelling of all or part of a breast (even if no distinct lump is felt)
still need 3 You mammograms
• Skin irritation or dimpling • Breast or nipple pain
• Redness, scaliness, or thickening of the nipple or breast skin
When breast cancer is found early, it can be easier to treat. If you are 40 or older, get a mammogram and breast exam every year and report any breast changes to your doctor right away. Sign up for our breast cancer screening reminder and we’ll remind you to receive your screening; recommended screenings are based on our latest early detection guidelines.
• Sometimes a breast cancer can spread to lymph nodes under the arm or around the collar bone and cause a lump or swelling there, even before the original tumor in the breast tissue is large enough to be felt. Swollen lymph nodes should also be reported to your doctor.
• Nipple discharge (other than breast milk)
Although any of these symptoms can be caused by things other than breast cancer, if you have them, they should be reported to your doctor so that he or she can find the cause.
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sure to get it. True False
after menopause. True False
can get 4 Men breast cancer.
How the American Cancer Society helps you stay well and reduce your risk of breast cancer
— American Cancer Society
can get breast 1 You cancer even if it
The most common symptom of breast cancer is a new lump or mass. A painless, hard mass that has irregular edges is more likely to be cancerous, but breast cancers can be tender, soft, or rounded. They can even be painful. For this reason, it is important to have any new breast mass or lump or breast change checked by a health care professional experienced in diagnosing breast diseases.
• Nipple retraction (turning inward)
You can help reduce your breast cancer risk by maintaining a healthy weight throughout life, being physically active on a regular basis (the ACS recommends at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week), and limiting alcohol intake to less than 1 drink each day for women (2 drinks for men).
Test your breast cancer knowledge
— American Cancer Society
“Every day I put my feet on the ground is a good day.” — Kathy Harris, Breast & Lung Cancer Survivor
True False
and needle 5 Surgery biopsies can cause breast cancer to spread. True False
nothing you 6 There’s can do to lower your breast cancer risk. True False
Answers 1. True 2. False 3. True 4. True 5. False 6. False
Did you know?
Source: American Cancer Society
7
Facts & research
Things to know about getting a
mammogram
Exercise can improve survivors’ quality of life Exercise is not only safe and possible during and after breast cancer treatment, but it also can reduce symptoms and improve quality of life. Despite these benefits, a lot of women don’t get any regular physical activity beyond their usual daily activities. Studies of breast cancer survivors have shown that regular exercise significantly improves physical functioning and reduces fatigue. Certain kinds of exercise appear to help breast cancer survivors at high risk for arm, breast and chest swell-
ing (lymphedema) avoid the condition. And some types of exercise can improve symptoms for those who already have it. Physical activity has also been linked to a 24% decrease in breast cancer coming back, and a 34% decrease in breast cancer deaths. Always check with your doctor, however, before starting any exercise routine, to make sure it’s safe for you. While exercise is an important part of fitness, you need time to heal after surgery and should follow the advice of your health care team.
Can breast cancer be prevented? There is no sure way to prevent breast cancer. But there are things you can do that might lower your risk, such as changing risk factors that are under your control. For example, body weight, physical activity, and diet have all been linked to breast cancer, so these might be areas where you can take action.
Sitting too much increases cancer risk in women Researchers from the American Cancer Society have found that women who spend 6 hours or more of free time sitting per day have a 10% greater risk of getting cancer than women who spend less than 3 hours of free time sitting per day. They were also more likely to develop certain types of cancer: multiple myeloma, ovarian cancer, and invasive breast cancer. Sitting time did not increase cancer risk for most men in the study. Source: American Cancer Society
If you have a strong family history of breast cancer, you can talk to your doctor about genetic testing for mutations in genes that increase the risk of breast cancer, such as the BRCA genes. If you have such as mutation or come from a family with a mutation but haven’t been tested, you could consider surgery to lower your risk of cancer.
Find out more Find out much more information about breast cancer at the American Cancer Society’s website (www.cancer.org). • Lowering breast cancer risk • Detecting breast cancer early • Treating Breast Cancer • Latest news about breast cancer • Breast cancer survivor stories • Breast cancer videos • Breast cancer research highlights
BREAST SELF-EXAM The BSE can help you become familiar with what’s normal for you and alert you to changes. There are different ways of doing a breast self-exam. Your nurse or doctor may teach you a different method from what is shown here, and that is OK.
1.
Use a mirror to look for changes in: Size, shape, contour, dimpling, rash, redness, scaliness of nipple or breast skin With arms by your side
With arms over your head
With hands on hips, chest muscles tightened
2. Lie down and feel for changes in each breast with the opposite hand. Start by placing a pillow under your right shoulder, and your right arm behind your head.
Light
Medium Use the pads of your middle fingers to feel for lumps in the right breast, using overlapping dime-sized circular motions.
or stand, and feel 3. Sit each underarm area. With your arm only slightly raised, feel the area under each arm.
Firm
Use light, medium and firm pressure to feel all the breast tissue. Use an up-and-down pattern to check all of your breast.
Repeat the exam on your left breast.
See your doctor or nurse if you notice any of the following: • Lump, hard knot or thickening • Change in size or shape of the breast • Dimpling or puckering of the skin • Rash, redness or scaliness of the nipple or breast skin • Nipple discharge that starts suddenly • New pain that does not go away
Examine your breasts at the same time every month, usually about a week after the start of your period.
Source: American Cancer Society; Graphics: American Cancer Society, Andy Marlette
Survivor story Making Strides Against Breast Cancer events When you participate in a Making Strides Against Breast Cancer walk, you are sharing your passion and raising funds to help save more lives from breast cancer. There’s still time to sign up for a Making Strides walk near you, and make a difference with every step you take. Get more information at www.cancer.org.
Making Strides of Pensacola
When: Saturday, Oct. 31 Time: 8 a.m. Where: Cordova Mall, 5100 N. Ninth Ave., Pensacola
Making Strides of South Alabama
When: Saturday, Oct. 31 Time: 8 a.m. Where: Bienville Square, 150 Dauphin St., Mobile, AL
Making Strides of Panama City
When: Saturday, Oct. 31 Time: 8 a.m. Where: Aaron Bessant Park, 500 W. Park Drive, Panama City Beach
Empowering herself, others By Amanda Dobbs American Cancer Society
A
t age 35, Makeda McLune had just made a big change in her life. After years in the workforce, she decided to go back to school to complete her degree, and she enrolled full-time in college. As a new student, she wanted to take advantage of her school’s health care facilities, so she went in for a routine check-up that included a breast exam. She fully expected a clean bill of health. “That’s when the nurse practitioner did an exam and asked me if I’d noticed a lump that was on my right breast,” says McLune. In that moment, McLune realized that she might be in for another big life change — facing cancer.
Finding the right resources
McLune immediately began talking to her nurse practitioner about the practical aspects of seeking out additional tests and care. “She gave me some recommendations, but before any of that I said, ‘I have no insurance. What is this going to cost?’” says McLune. When her contract job ended a few months earlier, so did her salary and her health insurance coverage, and she was also taking on school-related debt so she could get her degree. The nurse practitioner offered some suggestions, and McLune reached out to the American Cancer Society and other breast cancer organizations to see what services
were available. Eventually, McLune was diagnosed with stage II invasive carcinoma and underwent a mastectomy of her right breast. As she “Opening went through my life up treatment, she to others was pleased to allowed me find programs that helped to face it address not head on.” only her physical health, Makeda McLune, but also her Breast & Lung quality of life. Cancer Survivor When the American Cancer Society connected her with Look Good Feel Better, a free program that helps cancer patients manage the appearancerelated side effects of treatment, she really loved the environment. “I told people, ‘This is so awesome. You have to go,’” she says. “It made you feel so positive and feminine.”
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She found something else that helped her, too: being open with her family and friends about what she was going through as she faced the disease.
Connecting with others reaps rewards
“For a lot of people of color, talking about being sick can be a real taboo,” says McLune, but she felt strongly that she wanted to communicate with people around her about what
was going on with her health. She began posting on social media with updates about her cancer journey. “Opening my life up to others allowed me to face it head on,” she says of her efforts. “I didn’t stop pursuing my education, my desire to volunteer, and my political activism — I continued to push forward.” As she shared her story, she was amazed by the feedback she got. “The response was overwhelmingly positive,” she says, and the effects of sharing what she was going through — and the positive responses she received — have stayed with her. “Doing ‘something’ redirected how I got through my business and personal life. I go into things being as open and as transparent as possible,” she says. “Now, I ask myself, ‘Did you positively impact other people? Did you do something positive for someone else?’” Today, McLune takes one tamoxifen pill a day to help reduce her chances for recurrence, and she actively seeks out opportunities to tell her story. She has been a guest speaker at multiple American Cancer Society Relay For Life events — which raise money to invest in cancer research and to provide information and services to cancer patients and caregivers. She firmly believes that talking about what she went through is a powerful way to make a difference, not just in her own life, but in the lives of others. “Maybe if I share my story one more time,” says McLune, “I’m helping somebody who needs it.”
Mammogram REsources
Options abound in local mammography Extended hours, assistance programs help meet patient needs • Have had at least five years of cancer-free screenings. (No diagnostic screening will be done in this program.) One in eight American women will develop breast • Not currently experiencing any breast problems. cancer sometime in her lifetime, and the most • Be uninsured — self-pay. important thing women can do is be vigilant by per• Meet or be at least 200 percent above Federal forming regular self-exams and undergoing regular Poverty Guidelines. (Patients must have comclinical exams and mammograms, doctors say. pleted Financial Assistance Application, along with Finding cancer early does not always reduce a providing proof of income, proof of Food Stamps woman’s chance of dying from breast cancer. But eligibility, prior year tax returns and two most early detection and early treatment leads to the recent bank statements, plus any other required greatest possibility of success. documentation to prove financial hardship.) A key component in early detection is having an Upon meeting this criteria and as long as Baptist annual mammograms beginning at age 40. A mammogram is a low-dose X-ray of the breast that’s used has spaces available (due to available funding), patient would qualify for a Free Screening Mammo. to detect and evaluate breast changes. It can detect For information, 850-434-4080. breast masses years before they can be felt, and it REFERRALS: The hospital requires patients to may reveal other critical changes in the breast tissue. have seen their physician within the last two years. Women with certain breast cancer risk factors For a screening mammogram, patients don’t need should begin clinical screenings and mammoa referral. But patients having any kind of breast grams earlier. For example, women who have reproblem need an order from their physician. ceived thoracic radiation between ages 10 and 30 DIGITAL MAMMOGRAPHY — 3D BREAST have a significantly increased risk of breast cancer. IMAGING: In 2011, Baptist was the first But getting a mammogram isn’t always easy. Many women have to overcome obstacles that can hospital in Florida to gain FDA approval to perform digital breast tomosynthesis, or include cost, accessibility, finding the time, getting 3D digital mammography, which is available at a doctor’s referral and the fear of the exam itself. these Baptist Health Care locations: Here, we provide information on some of the • Baptist Hospital local breast services that are offered, from free to • Gulf Breeze Hospital reduced-price exams to mobile units that come to • Baptist Medical Park — Nine Mile your area. Digital Mammography: Baptist offers the most advanced equipment available for digital BAPTIST HEALTH CARE mammography, Hologic Selenia Dimensions, FREE SCREENINGS: Baptist Hospital provides at these locations: “Free Screening Mammos” for uninsured women • Baptist Hospital within the community during October, which is • Gulf Breeze Hospital Breast Cancer Awareness Month. This program is • Baptist Medical Park — Nine Mile funded by community donations • Baptist Medical Park — Navarre and fundraisers. To qualify for a Digital mammography free mammogram, patients What is a mobile e-Reminders: For women over must: mammography unit? age 40, Baptist Health Care offers • Have a primary care It’s is a customized vehicle Mammography e-Reminders to help physician. that goes to various locations them remember their appointments. • Be over age 35. to offer mammograms. To schedule a mammogram, • Not have had a The purpose is to make 850-469-7500. mammogram within the screenings convenient and to Details: www.ebaptist past 12 months. increase community access to healthcare.org. From Pensacola News Journal Staff Reports
Q:
A:
mammograms.
FREE MAMMOGRAMS: Mammograms are usually covered at 100 percent by most insurance carriers. If a patient does not have insurance, there are several programs, such as those through the Escambia County Health Department to help with free or reduced-fee services to qualifying patients. Uninsured patients ages 50 to 64 are eligible. Details: 850-490-5910 or 850-595-6650. OTHER MAMMOGRAM RESOURCES: American Breast Cancer Foundation’s Key to Life Breast Cancer Assistance Program Eligibility: Need doctor’s referral and will be mailed an application. No age limit. Need proof of residency and must not make more than 300 percent above the poverty level. Details: 844-219-2223. Santa Rosa County Health Department’s Breast and Cervical Cancer Program Eligibility: Ages 50 to 64, must make no more than $20,800 in a one-person family, $28,000 in a two-person family or $35,000 in a three-person family. Must make an appointment, have a Pap test and exam completed and then will be referred for a mammogram. Patient must bring a driver’s license. Details: 983-5200, ext. 139. Mobile Mammography Van, West Florida Hospital affiliate Eligibility: 35 and up. Travels through Pensacola. Most insurance accepted. Details: 888-894-2113, ext. 1. Angel Williamson Imaging Center Offers 30 percent discounts on all medical services to the uninsured. Details: 476-1161 or www.awimaging.com. Baptist Hospital’s HealthSource Eligibility: Call for an appointment. Must be 35 and complete a short phone interview. Details: 434-4080.
Mammogram REsources SACRED HEART HEALTH SYSTEM FREE AND REDUCED-PRICE MAMMOGRAMS: Routine screening mammograms are covered by most major insurance plans. The Ann L. Baroco Center for Breast Health also provides a limited number of free and reduced-price mammograms to the uninsured throughout the year through the Ann Baroco Cares program. LOCATIONS: Sacred Heart Health System has two locations: Sacred Heart Hospital in Pensacola and Sacred Heart Medical Park in Pace. REFERRAL: No referral is needed for a routine annual screening mammogram. However, you do need to have a primary care physician for the hospital to send your results to. To schedule a mammogram, 850-416-8078. Details: www.sacred-heart.org. WEST FLORIDA HOSPITAL BREAST HEALTH SERVICES OFFERED: West Florida Hospital was the area’s first hospital to be designated as a Breast Imaging Center of Excellence and is fully accredited by the American College of Radiology. It offers a full range of breast health services. West Florida has an all-female staff of registered and certified mammography technologists. In addition, two board-certified radiologists read all mammograms. West Florida is certified as a Medicare Mammography screening facility. Breast health services include digital mammography, computeraided detection (CAD), mobile mammography, breast ultrasound, breast MRIs, bone densitometry, stereotactic guided biopsy, ultrasound guided biopsy and MRI-guided biopsy. MOBILE MAMMOGRAMS: West Florida Hospital provides mobile mammography services. The mobile unit is a customized 37-foot coach containing dedicated digital mammography equipment that is FDA-certified and accredited by the American College of Radiology. The unit travels throughout Northwest Florida and Southwest Alabama. REFERRALS: Patients do not need an order from their physician to have a screening mammogram, but they must designate a physician to receive the mammogram results. West Florida Hospital offers a discounted rate for mammograms for self-pay patients (uninsured). To schedule a mammogram, call West Florida Mammography Services at 494-3497 or toll-free 888-894-2113. Details: http://westfloridahospital.com. WOODLANDS MEDICAL SPECIALISTS FACILITY: Woodlands Medical Specialists’ breast health facilities were designed to provide an
alternative to the standard experience for breast care. Mammograms and breast biopsies can be stressful, and this facility was designed to create a warm and inviting atmosphere. Its breast health team focuses exclusively on the detection and diagnosis of breast cancer. BREAST-IMAGING SERVICES: Woodlands Breast Health’s GE Digital Mammography system provides physicians with a clear and precise all-digital image rather than just X-ray films. This equipment allows for a large field of view to accommodate the breast size of most women. Woodlands’ imaging services for breast health include digital mammography, breast ultrasound, breast MRI, MRI-guided breast biopsy, ultrasound guided biopsy and stereotactic breast biopsy. REDUCED-PRICE MAMMOGRAMS: Insurance will cover a screening mammogram for women 40 and older. But if insurance does not, Woodlands provides screening mammograms for $99. REFERRALS: Referrals are not needed for a mammogram at Woodlands. However, any physician in the area can refer a patient to Woodlands. Woodlands handles all of the necessary referral paperwork and can transfer records upon the patient’s request. It can accept walk-in appointments and is now open on until 7 p.m. on Tuesdays to accommodate women who cannot schedule daytime appointments. DIAGNOSIS: If a mammogram patient is diagnosed with breast cancer, the Woodlands oncology team is located on-site and can be scheduled to see the patient during the follow-up visit. Its team of board-certified oncologists will help patients understand their diagnosis, develop an individualized treatment plan and coordinate all aspects of treatment and surveillance. The oncology team works collaboratively with other specialists to help expedite the healing process. To schedule a mammogram, 850-696-4000. Details: www.woodlandsmed.com.
NAVAL HOSPITAL PENSACOLA BREAST HEALTH SERVICES: The Naval Hospital has a breast cancer coordinator available to its patients. The Naval Hospital was the first hospital in the Pensacola area to provide this service and the first to have a breast patient navigator certified by the National Consortium of Breast Centers on staff. The breast cancer coordinator guides patients through the diagnosis and treatment of breast cancer or symptoms associated with breast cancer. The coordinator also works with the patient and family to deal with emotional stress associated with breast cancer. PATIENT QUALIFICATIONS: All TRICARE Prime beneficiaries enrolled at Pensacola Naval Hospital are eligible to receive a mammogram there. If you are enrolled, you can call your Medical Home Port Team or Central Appointments at 505-6719 to schedule a mammogram. Mammograms can be scheduled to coincide with other appointments in order to eliminate additional visits. SANTA ROSA MEDICAL CENTER BREAST HEALTH SERVICES: The Women’s Place at Santa Rosa Medical Center offers all-digital mammography, ultrasound, stereotactic breast biopsy and bone densitometry in a spa-like environment. It is the only center in Santa Rosa County with a certified breast health navigator who can provide education and guidance to women facing tough medical care decisions. Hours are 8 a.m. to 4:30 p.m. Monday through Friday. QUALIFIED PATIENTS: The medical center does see uninsured patients, and some of those are self-pay. REDUCED-PRICE CARE: For those who cannot afford mammograms, the medical center works to see if they are eligible for the Florida Breast Cancer Program. Inquire with the office for pricing and eligibility for discounts. The payment is typically due at the time of care, but if someone is unable to pay the full amount, the clinic is able to work with the patient to establish a payment plan. This applies not only to self-pay patients, but also to those who have not met deductibles or have high co-pays. To schedule a mammogram, 850-626-5129.
Breast cancer
Treatment costs hard to nail down By Peggy J. Noonan USA Today
ASBURY PARK, N.J. — The cost to treat breast cancer is anyone’s guess, but patients who are covered by insurance have lower bills than those who aren’t, researchers found. Uninsured cancer patients pay up to twice as much for doctors’ visits and 43 times as much for chemotherapy drugs compared with what Medicare and private insurance pays, a study from the University of North Carolina at Chapel Hill showed. “This is unreasonable,” said Stacie Dusetzina, an assistant professor in the Eshelman School of Pharmacy and the Gillings School of Global Public Health. “There needs to be more transparency and less variability in health care pricing.” October is Breast Cancer Awareness month, raising money for a disease that affects about one in 12 women. And researchers have made progress; the five-year survival rate has climbed from 75% in 1975 to close to 90%, government data shows. But how much does it cost to treat breast cancer? No one seems to know. The uncertainty is getting more attention since the Affordable Care Act, also called “Obamacare,” was passed in 2010. It ensured that mammograms would be covered by health insurance plans for free. But it also has led to insurance policies that have higher out-of-pocket costs — co-payments and deductibles — for consumers. How do you know what treatment costs? “You don’t,” said Jessica Morton, director of mission for Susan G. Komen Central and South Jersey, an advocacy group. “We try to pin down numbers like average cost, but it’s super hard.” Kimberly Callis, 42, of Lacey was diagnosed with breast cancer in January 2013. She has an insurance policy through Horizon Blue Cross Blue Shield that has picked up most of the bill for her treatment. But each time she walks into her oncologist’s office, she has a $50 co-payment. After a few office visits a month, it adds up. The financial strain is more acute. She and her husband own Stage Drop, which provides portable stages for events. But she hasn’t been able to work as much since her diagnosis. “It’s a lot of co-pays,” Callis said. “It’s definitely had a financial impact.” Pinning down the cost is a difficult endeavor. The
Tips to lower medicine costs
average cost of care for breast cancer in women age 65 and • Ask your doctor about older is $23,078 for generic medicines. initial treatment and $2,207 for continuing • Ask your doctor for treatment, making samples of medicines it one of the lessyou’re prescribed. expensive cancers • Ask for medications in to treat, according the form of pills, which to data from tend to cost less. the National Cancer Institute. • Shop around to Breast cancer is pharmacies. Larger stores diagnosed with many may have lower prices. cell types and stages, • Don’t order medicine said Dr. Denise from online pharmacies. Johnson Miller, Prices may be lower, but medical director of the pharmacies may not the Breast Surgery be licensed. program at Meridian • Call drugmakers to see Health, a New Jerseyif you qualify for financial based company that assistance programs. operates six hospitals in Monmouth and Source: Breastcancer.org Ocean counties. There are women diagnosed with early stage disease and some who are diagnosed late. Most women respond well to treatment, but there are still women who don’t. “Cost of treatment varies,” Miller said. “You may have breast-conserving surgery, six, seven weeks of radiation and hormonal therapy. However, if you have a complete mastectomy, breast reconstruction, chemotherapy, a year-plus of (cancer drug) Herceptin (combined with) Perjeta, the treatment costs will be greater. All women definitely need insurance.” The Affordable Care Act requires virtually all Americans to have health insurance or pay a penalty. Even so, 10.9% of New Jerseyans under age 65 weren’t covered in 2014, according to U.S. Census data. Without the negotiating power that private insurance or Medicare has, they face much higher costs if they are diagnosed with cancer, North Carolina researchers found. For example, they paid $6,711 for an infusion of the colorectal cancer drug oxaliplatin. Medicare paid $3,090 and private health plans paid $3,616 for the same drug, according to the study.
Facts & myths about breast cancer • One in eight women will be diagnosed with breast cancer in her lifetime, and every 13 minutes, a woman in the United States dies from the disease. • Except for skin cancers, breast cancer is the most common among American women — one of the leading causes of death, according to the American Cancer Society. • The risk increases with age, and having a first-degree relative also increases a woman’s chance of being diagnosed. • But less than 15 percent of women with breast cancer have a family history. African-American women have a higher rate of death from breast cancer than any other race. • The earlier breast cancer is detected, the more likely it can effectively be treated. At stages 0 and 1, cancer cells are confined to a limited area. Stage 2 is still fairly early, but at that point, the cancer has begun to grow or spread. Cancer at stage 3 is considered advanced, when there is evidence of further spreading to surrounding tissues. By the time cancer reaches stage 4, it has spread beyond the breast to other areas of the body. • By age 20, women should perform monthly self-exams to check for abnormalities in their breasts. Clinical breast exams should occur every three years until age 40. At that point, women should be participating in annual mammograms. Depending on family history and genetic tendency, some should be screened with MRI in addition to mammograms. ~ USA Today