BREAST CANCER

GUIDE

INSIDEWarning signs & risk factors

Self-exam guide

Local mammogram resources

This special section generously provided by

Quint and Rishy Studer

2 October 23, 2013

GET ACTIVE

EAT WELL

LIMIT ALCOHOL

Source: American Cancer Society

Source: Centers for Disease Control and Prevention

Tell your doctor if you experience any of these warning signsof breast cancer.• New lump in the breast or underarm (armpit).• Thickening or swelling of part of the breast.• Irritation or dimpling of breast skin.• Redness or fl aky 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.

WARNING SIGNS

Women with breast cancer may experience these warning signs, but some will not. The best way to fi nd 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.

This special section generously provided by

Quint and Rishy Studer

3October 23, 2013

RISK FACTORS & EARLY DETECTION

Research has found several risk factors that may increase your chances of getting breast cancer.

Reproductive risk factorsBeing 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.Not breastfeeding.Long-term use of hormone-replacement therapy.

Other risk factorsGetting 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.

What are the risk factors for breast cancer?

1 in 8 women will be diagnosed with breast cancer in her lifetime.

THE AMERICAN CANCER SOCIETY’S

ABCs of Breast Cancer Early Detection

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.

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.

MammogramPart A

Clinical breast examPart B

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.

Breast awarenessPart C

Sources: Centers for Disease Control and Prevention, American Cancer Society

ABCs of Early Detection and other information generously provided by

INSIDE THIS SPECIAL EDITIONPossible breast cancer warning signsBreast cancer risk factors & early detectionBreast self-exam instructionsLocal mammography resources

4 October 23, 2013

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.

BREAST SELF-EXAM

With arms by your sideWith arms over your head With hands on hips,

chest muscles tightened

Use light, medium and fi rm pressure to feel all the breast tissue.

Use an up-and-down pattern to check all of your breast.

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

Light

Medium

Firm

1.

3.

Use the pads of your middle fi ngers to feel for lumps in the right breast, using overlapping dime-sized circular motions.

Use a mirror to look for changes in:

Sit or stand, and feel each underarm area.

Size, shape, contour, dimpling, rash, redness, scaliness of nipple or breast skin

Repeat the exam on your left breast.

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.

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

5October 23, 2013

MaMMograM resources

By Sloane Stephens Cox

A mammogram is an X-ray exam-ination of the breasts, used to de-tect 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. Mam-mography 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

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 mam-mography equipment. The breast will then be compressed, and the X-ray will be taken.

• When you have a digital mam-mogram, 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, sched-ule 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

What is a mammogram?

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 micro-calcifications, which often surround a tumor. Ultrasounds are not recommended in the place of mammograms, according to the American Cancer Society.

Mammograms versus ultrasounds

“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

“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

Mammograms are critical in the fight against breast cancer

6 October 23, 2013

By Sloane Stephens Cox One in eight American women

will develop breast cancer some-time 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 de-tection is having an annual mam-mogram 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 ear-lier. For example, women who have received thoracic radiation between ages 10 and 30 have a signifi cantly increased risk of breast cancer.

But getting a mammogram isn’t always easy. Many women have to overcome obstacles that can in-clude cost, accessibility, fi nding 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.

BAPTIST HEALTH CAREFREE SCREENINGS: Baptist

Hospital provides “Free Screening Mammos” for uninsured wom-en within the community during October, which is Breast Cancer Awareness Month. This program is funded by community donations and fundraisers. To qualify for a free mammogram, patients must:

• Have a primary care physician.

• Be over age 35.• Not have had a mammogram

within the past 12 months.• Have had at least fi ve years of

cancer-free screenings. (No diag-nostic screening will be

done in this program.)• Not currently be experienc-

ing any breast problems.

• Be unin-sured — self-pay.• Patients

must com-

plete a Financial Assistance Appli-cation, 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 documenta-tion to prove fi nancial hardship.

Upon meeting this criteria and as long as Baptist has spaces avail-able (due to available funding), the patient would qualify for a Free Screening Mammo. Details: 850-434-4080.REFERRALS: The hospital requires

patients to have seen their physi-cian 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, Bap-tist was the fi rst 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 MileDIGITAL 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 HospitalDIGITAL MAMMOGRAPHY

E-REMINDERS: For women over age 40, Baptist Health Care offers Mammography e-Reminders to help them remember their appointments.

MAMMOGRAM RESOURCESOptions abound in local mammographyExtended hours, assistance programs help meet patient needs

FREE MAMMOGRAMSMammograms are usually cov-

ered at 100 percent by most insur-ance 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 RESOURCESAmerican Breast Cancer Foundation’s Key to Life Breast Cancer Assistance ProgramWHEN: 9 a.m. to 5 p.m. Monday

through ThursdayELIGIBILITY: Need doctor’s re-

ferral and will be mailed an appli-cation. 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. Pa-tient must bring a driver’s license.DETAILS: Chris Vanderheiden,

983-5200, ext. 139. Mobile Mammography VanELIGIBILITY: 35 and up. Travels

through Pensacola.DETAILS: Lisa Pitts, 494-3462.

Angel Williamson Imaging CenterOffers 30 percent discount on all

medical services to the uninsured.DETAILS: 476-1161.

Baptist Hospital’s HealthSourceELIGIBILITY: Call for an appoint-

ment. Must be 35 and complete a short phone interview.DETAILS: 434-4080.

October, which is Breast Cancer Awareness Month. This program is funded by community donations

nostic screening will be done in this program.)

• Not currently be experienc-

ing any breast problems.

Q: What is a mobile mammography unit?

A: It’s is a customized vehicle that goes to

various locations to offer mammograms. The purpose

is to make screenings convenient and to increase

community access to mammograms.

7October 23, 2013

MAMMOGRAM RESOURCESSACRED HEART HEALTH SYSTEMFREE AND REDUCED-PRICE

MAMMOGRAMS: Routine screen-ing mammograms are covered by most major insurance plans. Sa-cred Heart’s Ann L. Baroco Center for Breast Health also provides a limited number of free and reduced-price mammo-grams to the uninsured throughout the year through the Ann Ba-roco Cares program.LOCATIONS:

Sacred Heart Health System has two locations: Sacred Heart Hospital in Pensacola and Sacred Heart Medical Park in Pace.REFERRALS: No referral is

needed for a routine annual screen-ing mammogram. However, you do need to have a primary care physi-cian to whom the hospital can send your results.

WEST FLORIDA HOSPITALBREAST HEALTH SERVICES OF-

FERED: West Florida Hospital was the area’s fi rst hospital to be desig-nated 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-fe-male staff of registered and certifi ed mammography technologists. In addition, two board-certifi ed radiol-ogists read all mammograms.

West Florida is certifi ed as a Medi-care Mammography screening fa-cility. Breast health services include digital mammography, comput-er-aided detection (CAD), mobile mammography, breast ultrasound, breast MRIs, bone densitometry, stereotactic guided biopsy, ultra-sound guided biopsy and MRI-guid-ed biopsy.

To schedule a mammogram, patients can call West Florida Mammography Services at 494-3497 or toll-free 888-894-2113. MOBILE MAMMOGRAMS: West

Florida Hospital provides mobile mammography services.

The mobile unit is a customized 37-foot

coach containing dedicated dig-ital mammog-raphy equip-ment that is FDA-certifi ed and accred-ited by the

American College of Ra-

diology. The unit travels throughout

Northwest Florida and Southwest Alabama.

REFERRALS: Patients do not need an order from their physician to have a screen-ing mammogram, but they must designate a physician to receive the mammogram results.

WOODLANDS MEDICAL SPECIALISTSFACILITY: Woodlands Medical

Specialists’ breast health facilities were designed to provide a warm and inviting atmosphere for breast care to ease the potential stress caused by mammograms and breast biopsies. 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 fi lms. This equipment allows for a large fi eld 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 bi-opsy and stereotactic breast biopsy.REDUCED-PRICE MAMMO-

GRAMS: 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. Tuesdays to accommo-date 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-certifi ed oncologists will help patients understand their diagnosis, develop an individualized treatment plan and coordinate all aspects of treatment and surveillance. The oncology team works collabora-tively with other specialists to help expedite the healing process.

NAVAL HOSPITAL PENSACOLABREAST 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 fi rst hospital in the Pensacola area to provide this service and the fi rst to have a breast patient navigator certifi ed by the National Consortium of Breast Cen-ters on staff. The breast cancer coor-dinator guides patients through the diagnosis and treatment of breast cancer or symptoms associated

with breast cancer. The coordinator also works with the patient and fam-ily to deal with emotional stress associated with breast cancer. PATIENT QUALIFICATIONS:

All TRICARE Prime benefi ciaries enrolled at Pensacola Naval Hos-pital are eligible to receive a mam-mogram there. If you are enrolled, you can call your Medical Home Port Team or Central Appointments at 505-7171 to schedule a mam-mogram. Mammograms can be scheduled to coincide with other appointments in order to eliminate additional visits.

SANTA ROSA MEDICAL CENTERBREAST HEALTH SERVICES: The

Women’s Place at Santa Rosa Med-ical Center offers all-digital mam-mography, ultrasound, stereotactic breast biopsy and bone densitom-etry in a spa-like environment. The Women’s Place has a certifi ed 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 mammo-grams, 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 mammo-gram 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.

for Breast Health also provides a limited number of free and reduced-price mammo-grams to the uninsured

Pensacola and Sacred

No referral is

mammography services. The mobile unit is a

customized 37-foot coach containing

dedicated dig-ital mammog-

American College of Ra-

diology. The unit travels throughout

Northwest Florida and

While mammograms can miss some cancers,

they are still a very good way to fi nd breast cancer. Eighty percent of the women treated

in Woodlands’ oncology division do not have a

family history of breast cancer.

8 October 23, 2013

Source: American Cancer Society

This special section generously provided by

Quint and Rishy Studer