BREAST CANCER
GUIDE
INSIDE Warning signs & risk factors Self-exam guide Local mammogram resources This special section generously provided by
Quint and Rishy Studer
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October 23, 2013
WARNING SIGNS
GET ACTIVE
EAT WELL
Tell your doctor if you experience any of these warning signs of breast cancer. • New lump in the breast or underarm (armpit). • Thickening or swelling of part of the breast.
LIMIT ALCOHOL
• Irritation or dimpling of breast skin. • Redness or flaky skin in the nipple area or the breast. • Pulling in of the nipple or pain in the nipple area. • Nipple discharge other than breast milk, including blood. • Any change in the size or the shape of the breast. • Pain in any area of the breast. Women with breast cancer may experience these warning signs, but some will not. The best way to find breast cancer early is with a mammogram. Keep in mind that some of these warning signs can happen with other conditions that are not cancer, but it’s important to report them to your doctor so he or she can determine the cause. Source: Centers for Disease Control and Prevention
This special section generously provided by Source: American Cancer Society
Quint and Rishy Studer
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October 23, 2013
RISK FACTORS & EARLY DETECTION What are the risk factors for breast cancer? Research has found several risk factors that may increase your chances of getting breast cancer.
Reproductive risk factors Being younger when you first had your menstrual period (before age 12). Starting menopause at a later age (after age 55). Being older at the birth of your first child (after age 30). Never giving birth.
1 in 8 women will be diagnosed with breast cancer in her lifetime.
Not breastfeeding.
INSIDE THIS SPECIAL EDITION
Long-term use of hormone-replacement therapy.
Possible breast cancer warning signs Breast cancer risk factors & early detection Breast self-exam instructions Local mammography resources
Other risk factors Getting older. Personal history of breast cancer or some noncancerous breast diseases. Family history of breast cancer (mother, father, sister, brother, daughter or son). Treatment with radiation therapy to the breast/chest. Dense breast tissue as seen on a mammogram. Being overweight (increases risk for breast cancer after menopause). Having mutations of the breast cancer-related genes BRCA1 or BRCA2. Drinking alcohol (more than one drink a day). Not getting regular exercise. Having a risk factor does not mean you will get the disease. Most women have some risk factors, and most women do not get breast cancer. If you have breast cancer risk factors, talk with your doctor about ways you can lower your risk and about screening for breast cancer.
THE AMERICAN CANCER SOCIETY’S
ABCs of Breast Cancer Early Detection Part A
Mammogram
The most important part of the plan is having regular mammograms. These simple breast X-rays are quick, easy and safe. The American Cancer Society advises you to have yearly mammograms beginning at age 40.
Part B
Clinical breast exam
All women in their 20s and 30s should have a clinical breast exam, which is performed by a doctor or nurse, as part of their regular health checkups at least every three years. After age 40, have a breast exam every year.
Part C
Breast awareness
You should become familiar with how your breasts normally look and feel so that you can report any changes to your doctor right away. The breast self-exam on the next page is an option for finding changes.
Sources: Centers for Disease Control and Prevention, American Cancer Society
ABCs of Early Detection and other information generously provided by
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October 23, 2013
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.
a mirror to look 1. Use 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.
Use light, medium and firm pressure to feel all the breast tissue.
Light
Medium Use the pads of your middle fingers to feel for lumps in the right breast, using overlapping dime-sized circular motions.
Firm
Use an up-and-down pattern to check all of your breast.
Repeat the exam on your left breast.
or stand, and feel 3. Sit each underarm area. With your arm only slightly raised, feel the area under each arm.
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
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MaMMograM resources
What is a mammogram? By Sloane Stephens Cox A mammogram is an X-ray examination of the breasts, used to detect and diagnose breast diseases. Screening mammography is used as a preventive measure for women who have no symptoms of breast disease. A screening mammogram usually involves two views of each breast. Diagnostic mammography involves additional views and is used when an abnormality is found during screening, or in women who have breast complaints, such as a breast mass, nipple discharge, breast pain or skin irritation. Mammography is a very safe procedure that uses low doses of radiation to produce high-quality X-rays. How should I prepare for a mammogram? • If you have had mammograms in different facilities, call those facilities in advance and arrange to have your previous mammograms, reports and any other treatment reports forwarded. • Do not wear deodorant, powder or cream under your arms, as it may interfere with the quality of your mammogram. How is mammography performed? • You will need to undress above the waist and will be given a wrap
Mammograms are critical in the fight against breast cancer “Mammography can detect breast cancer at its earliest state. ... The earlier cancer is detected, the less invasive and more successful treatment can be. I encourage all women to take charge of their health care and receive these lifesaving exams.” — Michelle Wilkes, breast health coordinator, Naval Hospital Pensacola
to wear during the mammogram. • You and a breast imaging technologist will be the only ones present during the mammogram. The technologist will position each breast, one at a time, on the mammography equipment. The breast will then be compressed, and the X-ray will be taken. • When you have a digital mammogram, each X-ray will appear on the technologist’s computer screen, and she will be able to make sure each image shows the right view before positioning you for the next X-ray. • The entire procedure should take about 20 minutes. Is a mammogram painful? Breast compression may cause
some brief discomfort during each X-ray, but it should not be painful. Breast compression helps obtain better images in the following ways: • By spreading out the breast so the maximum amount of tissue can be examined. • By allowing a lower X-ray dose to be used, since the X-ray beams pass through a thinner amount of tissue. • By holding the breast in place to prevent blurring caused by motion. If you have sensitive breasts, schedule your mammogram at a time of the month when your breasts will be less tender. In general, the week after a period is when breasts are less tender. Source: Baptist Health Care
Mammograms versus ultrasounds Mammograms can image the entire breast at once, while ultrasounds target a specific area of concern after a breast abnormality is detected during a mammogram or a physical examination. Ultrasounds are not effective at imaging areas
deep inside the breast or picking up microcalcifications, which often surround a tumor. Ultrasounds are not recommended in the place of mammograms, according to the American Cancer Society.
“Fear is the No. 1 reason that women do not get their annual mammogram. Some women are afraid that a mammogram will hurt, and some are afraid that we will find cancer, so they’d rather put off that diagnosis. After their first exam, most women find that their fears were unfounded and are surprised at how easy it actually was compared to what they had previously thought.” — Lavonda Harrison, patient care manager, Ann L. Baroco Center at Sacred Heart “Mammograms can detect any subtle changes in your breasts from year to year. Mammograms can find cancers very small, often several years before a lump can be felt. The chances for successful treatment depend on early detection. Take 15 minutes and get your mammogram today.” — Cindi Kuhn, R.N., mammography nurse, West Florida Hospital
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MAMMOGRAM RESOURCES
Options abound in local mammography Extended hours, assistance programs help meet patient needs By Sloane Stephens Cox One in eight American women will develop breast cancer sometime in her lifetime, and the most important thing women can do is be vigilant by performing regular self-exams and undergoing regular clinical exams and mammograms, doctors say. Finding cancer early does not always reduce a woman’s chance of dying of breast cancer. But early detection and early treatment leads to the greatest possibility of success. A key component in early detection is having an annual mammogram beginning at age 40. A mammogram is a low-dose X-ray of the breast that is used to detect and evaluate breast changes. It can detect breast masses years before they can be felt, and it may reveal other critical changes in the breast tissue. Women with certain breast cancer risk factors should begin clinical screenings and mammograms earlier. For example, women who have received thoracic radiation between ages 10 and 30 have a significantly increased risk of breast cancer. But getting a mammogram isn’t always easy. Many women have to overcome obstacles that can include cost, accessibility, finding the time, getting a doctor’s referral and facing the fear of the exam itself. Here, we provide information on some of the local breast services that are offered, including free and reduced-price exams, and mobile units that come to the Greater Pensacola area.
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 the Escambia County Health Department’s, that offer free or reduced-fee services to qualifying patients. Uninsured patients ages 50 to 64 are eligible. DETAILS: 595-6650. OTHER MAMMOGRAM RESOURCES American Breast Cancer Foundation’s Key to Life Breast Cancer Assistance Program WHEN: 9 a.m. to 5 p.m. Monday through Thursday 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: 877-539-2543.
Santa Rosa County Health Department’s Breast and Cervical Cancer Program ELIGIBILITY: Ages 50 to 63, 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: Chris Vanderheiden, 983-5200, ext. 139. Mobile Mammography Van ELIGIBILITY: 35 and up. Travels through Pensacola. DETAILS: Lisa Pitts, 494-3462. Angel Williamson Imaging Center Offers 30 percent discount on all medical services to the uninsured. DETAILS: 476-1161. Baptist Hospital’s HealthSource ELIGIBILITY: Call for an appointment. Must be 35 and complete a short phone interview. DETAILS: 434-4080.
BAPTIST HEALTH CARE • Be over age 35. FREE SCREENINGS: Baptist • Not have had a mammogram Hospital provides “Free Screening within the past 12 months. Mammos” for uninsured wom• Have had at least five years of en within the community during cancer-free screenings. (No diagOctober, which is Breast Cancer nostic screening will be Awareness Month. This done in this program.) program is funded by • Not currently community donations be experiencWhat is a mobile ing any breast and fundraisers. To mammography unit? problems. qualify for a free It’s is a customized mammogram, • Be uninvehicle that goes to patients must: sured — various locations to offer • Have a self-pay. primary care • Patients mammograms. The purpose physician. must comis to make screenings
Q:
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convenient and to increase community access to mammograms.
plete a Financial Assistance Application, along with providing proof of income, proof of Food Stamps eligibility, prior year tax returns and two most recent bank statements, plus any other required documentation to prove financial hardship. Upon meeting this criteria and as long as Baptist has spaces available (due to available funding), the patient would qualify for a Free Screening Mammo. Details: 850434-4080. REFERRALS: The hospital requires patients to have seen their physician within the past two years. For a screening mammogram, patients don’t need a referral. But patients having any kind of breast problem need an order from their physician. DIGITAL MAMMOGRAPHY – 3D BREAST IMAGING: In 2011, Baptist was the first hospital in Florida to gain FDA approval to perform digital breast tomosynthesis, or 3D digital mammography, available at these Baptist Health Care locations: • Baptist Hospital • Gulf Breeze Hospital • Baptist Medical Park - Nine Mile DIGITAL MAMMOGRAPHY: Baptist offers Hologic Selenia Dimensions digital mammography at these locations: • Baptist Hospital • Gulf Breeze Hospital • Baptist Medical Park - Nine Mile • Baptist Medical Park - Navarre • Atmore (Ala.) Community Hospital DIGITAL MAMMOGRAPHY E-REMINDERS: For women over age 40, Baptist Health Care offers Mammography e-Reminders to help them remember their appointments.
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MAMMOGRAM RESOURCES SACRED HEART HEALTH SYSTEM To schedule a mammogram, FREE AND REDUCED-PRICE patients can call West Florida MAMMOGRAMS: Routine screenMammography Services at 494ing mammograms are covered by 3497 or toll-free 888-894-2113. most major insurance plans. SaMOBILE MAMMOGRAMS: West cred Heart’s Ann L. Baroco Center Florida Hospital provides mobile for Breast Health also provides a mammography services. limited number of free and The mobile unit is a reduced-price mammocustomized 37-foot grams to the uninsured coach containing While mammograms dedicated digthroughout the year can miss some cancers, ital mammogthrough the Ann Bathey are still a very roco Cares program. raphy equipgood way to find breast LOCATIONS: ment that is cancer. Eighty percent Sacred Heart Health FDA-certified of the women treated System has two and accredin Woodlands’ oncology locations: Sacred ited by the division do not have a American Heart Hospital in family history of College of RaPensacola and Sacred diology. The unit Heart Medical Park in breast cancer. travels throughout Pace. Northwest Florida and REFERRALS: No referral is needed for a routine annual screenSouthwest Alabama. ing mammogram. However, you do REFERRALS: need to have a primary care physiPatients do not need an order from cian to whom the hospital can send their physician to have a screenyour results. ing mammogram, but they must designate a physician to receive the WEST FLORIDA HOSPITAL mammogram results. BREAST HEALTH SERVICES OFFERED: West Florida Hospital was WOODLANDS the area’s first hospital to be desigMEDICAL SPECIALISTS nated as a Breast Imaging Center of FACILITY: Woodlands Medical Excellence and is fully accredited by Specialists’ breast health facilities the American College of Radiology. were designed to provide a warm It offers a full range of breast health and inviting atmosphere for breast services. West Florida has an all-fecare to ease the potential stress male staff of registered and certified caused by mammograms and breast mammography technologists. In biopsies. Its breast health team addition, two board-certified radiol- focuses exclusively on the detection ogists read all mammograms. and diagnosis of breast cancer. West Florida is certified as a MediBREAST-IMAGING SERVICES: care Mammography screening faWoodlands Breast Health’s GE cility. Breast health services include Digital Mammography system digital mammography, computprovides physicians with a clear and er-aided detection (CAD), mobile precise all-digital image rather than mammography, breast ultrasound, just X-ray films. This equipment breast MRIs, bone densitometry, allows for a large field of view to stereotactic guided biopsy, ultraaccommodate the breast size of sound guided biopsy and MRI-guid- most women. Woodlands’ imaging ed biopsy. 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 walkin appointments and is now open on until 7 p.m. 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. NAVAL HOSPITAL PENSACOLA BREAST HEALTH SERVICES: For the past 15 years, the Naval Hospital has had 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 505-7171 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. The Women’s Place has a certified breast health navigator who can provide education and guidance to women facing tough medical care decisions. Hours are 8 a.m. to 5 p.m. Monday through Friday. Details: 626-5272. 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, Santa Rosa Medical Center works to see whether they are eligible for the Florida Breast Cancer Program. If the patients are self-pay, the cost for a screening mammogram is $200 (a 65 percent discount from the insurance-billed rate). 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.
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Source: American Cancer Society
This special section generously provided by
Quint and Rishy Studer