Early detection saves lives

October 30, 2012

Northern Inyo Hospital radiologic technologists Mary Mairs, Krissy Acala, Sherry Nostrant, Panda Kilminster and Vicki Waggoner (l-r) specialize in breast imaging and they use this mammography unit every day to screen women for breast cancer. Photo by Marilyn Blake Philip

An effort is under way to remove fear about and break down barriers surrounding annual mammogram breast cancer screenings. As part of that effort, local women are being given financial and informational support to educate and encourage them to be proactive on behalf of their own health care and even to save their own lives.
An annual mammogram can cost as little as $10 out-of-pocket. A properly-conducted monthly breast self-exam to look for lumps or changes can take as little as a few minutes time. Together, these practices can save lives, according to Toiyabe Indian Health Project Medical Director Taema Weiss, M.D.
Weiss was the featured speaker at Altrusa’s monthly educational luncheon program held at Whiskey Creek on Oct. 25. The topic was mammogram screening for early breast cancer detection.
Weiss said that in her daily practice, she found herself having the same discussion with women, trying to convince them of the importance of getting annual mammograms.
“Every day, I hear women’s fears and barriers to getting mammograms … I’d like to give facts about mammograms and quiet women’s fears.” The medical director said she hopes to convince women to get mammograms annually “because many women don’t,” regardless of income or education. “Even well-informed women don’t see it as important.”
Northern Inyo Hospital Nurse Educator Kathryn Erickson said many women have told her, “‘I don’t have time for this’ … They tell themselves, ‘I don’t have (cancer), I don’t need to get a mammogram.’” Women who find the time to take care of everyone and everything else in their lives, said Erickson, will tell themselves that they don’t have the time to get one.
That is why Weiss founded the Eastside Be Well Coalition – “to get information out to more women more efficiently.” The mission of the fledgling coalition, which became an official non-profit in April, “is to reduce barriers to health and wellness activities.”
Fortunately, money needn’t be an obstacle to getting a mammogram, said Weiss. Through the We Care: Early Breast Cancer Detection Program, women can get a mammogram for $10. NIH Radiology Clerk Leslie Perez said the program is available to women who have no insurance or who have insurance with a high deductible. The contact number for We Care at the NIH Radiology Department is (760) 873-2155 and at Mammoth Hospital, it is (760) 934-3311.
At the luncheon, Weiss screened the coalition’s four-minute video, “Get a Mammogram: Save a Life,” which features Weiss and Stuart Souders, M.D.
Souders, a radiologist who specializes in breast imaging, travels up from Huntington Beach to NIH every other week to view images on-site. Weiss said the 30-year veteran radiologist is extremely good and has diagnosed many cases successfully.
“Mammography has saved a lot of lives,” said Souders. “Early detection is the key to successful outcome.” Most authorities recommend that women start getting annual mammograms at age 40 – unless they are at higher than normal risk or have relevant genetic abnormalities. In that case, they may need to start sooner.
Souders believes that it is very important for women to do breast self-exams to look for changes or lumps. “Mammograms are complementary to monthly self-examination because there are many cancers we don’t see on mammography but (which) a woman can feel. The key is for the woman to do a regular and correctly performed breast exam.”
With the video, Weiss and Souders hope to dispel any mystery around mammography. “A mammogram is an x-ray of the breast designed to detect cancer,” Souders said. It is a “basically painless” procedure which usually takes 10-15 minutes for four views. At the appointment, the patient changes, from the waist up, into a hospital gown. Then, a female radiologic technologist takes two views of each breast using NIH’s full-field digital mammography unit. Souders studies the views sent to his computer electronically, manipulating and scrutinizing each image.
If Souders sees something suspicious, the patient is called in for a second mammogram. Souders said he wants to reassure women that only about 10 percent of patients are called back, usually because sections of compressed breast tissue can look like a mass, or a calcification might be visible. Ninety percent of the time, “findings are deemed benign or negative at the time of call-back.”
If the second mammogram reveals something suspicious, however, Souders will have the patient come in the next day for a “diagnostic work-up which could include an ultrasound or additional views” – or an MRI for high-risk or sensitive patients.
“Occasionally, the finding is most likely benign but there is slight concern,” said Souders. That means the radiologist is 98 percent certain it is benign “or classified as probably benign.’” In that case, rather than doing an invasive biopsy, the woman will be scheduled for a short-term follow-up appointment, usually six months later. This practice prevents the performance of needless biopsies. However, if a patient insists, Souders will schedule her for one.
If the short-term follow-up reveals the need for a biopsy, one is done. If cancer is diagnosed, NIH can help women find out-of-area oncologists (cancer specialists). Lumpectomies and simple mastectomies can be done at NIH. Cancer and its treatment “is a very individualized. There are a lot of options,” said Erickson.
The majority of cancers are found with mammograms, said Weiss. However, Souders stressed the importance of women doing properly-executed, monthly breast self-exams on the same day of the month each month. “Women find a large number of cancers themselves this way.”
A 34-year-old woman, whose mother had taught her to religiously self-exam when she was 14 years old, came to Souders and pointed out the exact location of a breast cancer. He said he was very surprised to discover that she had accurately pinpointed a 3-millimeter tumor. “She saved her life. And you can save your life,” Souders said.
On the video, Jillene Fries, a 12-year breast cancer survivor, said she was diagnosed with breast cancer on her third screening. She had detected no lumps or outside indicators, so the mammogram was the beginning of a life-saving journey. “I’m so lucky to be here today.” Some of the luncheon guests were also survivors; many had relatives who had survived or succumbed to breast cancer. For instance, Vi Tripp was diagnosed and successfully treated for breast cancer in 2009. In fact, Tripp said she was optimistic about seeing her oncologist the next day for her three-year check up.
One popular misconception, said Souders, is that the danger of breast cancer decreases for older women. “The single most significant risk factor is age. One in eight in woman are at risk but one in two or three are at risk after 70.”
There are other risk factors. Weiss said that two heredity genes, BCR1 and BCR2, have been identified as high-risk markers. Also, women who started their periods early, have not had children, started menopause late and/or take hormone replacement therapy can be at higher risk, too, because of higher and/or more prolonged estrogen levels. Environmental causes and unhealthy lifestyle choices can be risk factors. However, there is no connection between breast cancer and taking birth control pills, said Weiss.
“Currently, NIH offers state-of-the-art breast imaging. The equipment is superb. The staff are among the best and most enthusiastic with whom I have worked,” said Souders. New breast cancer detection technology has recently been approved. It is called Automated Breast Ultrasound Screening or ABUS, said Souders. It can even see through fibrous dense breast tissue to find minute growths. “It’s the world’s largest ultrasound transducer scanner apparatus, that goes directly on the breast” and scans it top to bottom. The images are transmitted to the radiologist who can view the reconstructed images from any angle. Souders “is currently actively working to try to get such a machine at (NIH).” However, he stressed that “it is a complement, not a replacement for mammography. The majority of cancers can be seen” with both devices.
Breast cancer screening and routine self-examinations save lives and local women have access to readily-available, no-cost information, plus state-of-the-art technology and a program that offers an annual mammogram for $10. “There’s no excuse” for not being proactive in early breast cancer detection, said Weiss.
“Get a Mammogram: Save a Life,” by Skandar Productions, can be viewed on www.youtube.com, simply by typing “Eastside Be Well Coalition” into the YouTube.com search box. For more information about Eastside Be Well Coalition, wellness, mammograms or donating to the coalition, e-mail Weiss at taemaweiss@hotmail.com.