Treating the whole person

Breast cancer centers look at the big picture

By Rebecca Berfanger

A Google search for “breast cancer” in the news for the past year turned up 1.7 million results when it comes to screenings, treatments and profiles of patients and survivors.

It’s no wonder. The American Cancer Society predicts that one in eight women, 12 percent, will be diagnosed with breast cancer at some point in her lifetime. When compared with other cancers, lung cancer in women is the only cancer with a higher death rate. There are about 3.1 million breast cancer survivors in the United States, including those who are still being treated and those who have completed treatment.

Don’t forget: Men can be diagnosed with breast cancer, too. Although the chances of a man getting breast cancer is 1 in 833, the American Cancer Society estimates that about 2,550 men will be diagnosed with a new case of invasive breast cancer. An estimated 480 men in the United States will die of the disease in 2018.

Center yourself

Technology and understanding of cancer continue to improve and include recent advances in genetic testing and diagnostic tools. Three options for breast health on the southside, that is, Community Breast Care at Community Hospital South, Franciscan Health Breast Center Indianapolis and Johnson Memorial Health Breast Care Center, continue to keep up with the latest news about the disease, how to screen it and how to treat it.

All three hospitals offer 3-D mammography, breast ultrasounds and other advanced diagnostic tools; all three can also refer patients to providers who offer tools they don’t have on site. However, their numbers vary: Community Breast Care staff performs about 1,000 mammograms a month; Franciscan tallies about 1,280 mammograms per month. Both centers offer walk-ins. Staff at the JMH Breast Care Center performs 325 mammograms per month.

Unlike Community and Franciscan centers, JMH requires a physician to order mammograms. The reason, says Randy Collins, JMH’s director of radiology, is to ensure there is someone who can follow up with the patient and guarantee that the general care provider will be aware of the results. If a patient needs additional testing or treatment, she may be referred to the JMH Cancer Center to work with a cancer patient navigator.

Comfort is key

If you had a list of fun things to do, a mammogram likely would not top it. JMH, Community and Franciscan strive to offer a calming experience to patients. At JMH, all patients are offered a foam-cushioned pad to make the procedure more comfortable, says Collins. Sometimes, he adds, patients will request a specific technician based on past experiences.

“I think being small town and personal to patients sets us apart,” Collins says. “We’re not as busy as other imaging centers. We have a little time to take with the patient. We have very short wait times, assuming all of the patients are arriving on time that day.”

JMH mammographer Stacy Winget notes that when she first meets a patient for a mammogram, she wants to know her background and if she has concerns.

“We always take the time to answer questions,” says Winget. “I can also give them brochures. Anybody that comes is usually nervous and scared and presents themselves differently. I can understand that. If a first-timer is nervous, I will tell them that as soon as it’s over, every first-timer I’ve seen will say, ‘Is that it?’”

The hospital is undergoing renovations. By fall 2019, there will be a new women’s care center with a different look and feel, says Rick Kester, chief clinical services officer.

Meanwhile, Franciscan offers a holistic approach to breast cancer patients. “We consider the mind, body and spirit,” says Lisa Davey, who serves as a nurse navigator. “You can’t separate the person from the disease. Each patient still has a life going on.”

For instance, it offers a supportive care clinic where all cancer patients can be referred for pain management, to see the counselor from cancer care for emotional support, to get advice from a dietitian and to visit with a social worker. The dietitian and social worker are resources added in the past few years.

With a slightly different approach, Community considers the entire person for each diagnosis, says nurse navigator Beth Staker. “We look more at the biology of the tumor. The cancer treatment is very specific to each type of breast cancer according to the biology.” Doctors look beyond the disease and into factors including patients’ lifestyles, support system and other health concerns to get them the best treatment, Staker says.

“We have some patients who are elderly with other serious medical problems like heart issues who might not be a good candidate for surgery,” she says. “Or if cancer is sensitive to hormones, there might be options for hormonal manipulation to help treat the cancer, to help shrink the tumor and help prevent it from spreading while not having an impact on the life they already have.”

Navigating the waters

When a patient knows someone who has been diagnosed with breast cancer, she might have a better understanding of the often-confusing subject. For example, she likely knows that not all cancers are alike and, therefore, not all treatments are alike. Davey says that sometimes people have done research before speaking with her, so they come in with preconceived notions.

“We all have life experiences, and we bring that to the situation. Patients have friends or family members telling them all kinds of different stories. They don’t understand there are [different stages] and other factors at play,” Davey says. “Treatment is not cookie cutter; it’s not apples to apples.” Sometimes, Davey says, it’s not even an experience with breast cancer that worries patients but a bad experience with chemotherapy or radiation with a different kind of cancer. However, that is part of the nurse navigator’s role: to answer questions, explain what happens next and get patients to the next steps of their journeys.

As for the one message they want everyone to know, representatives of all three health care systems emphasized that early detection is crucial.

“We still recommend doing breast self-exam. So if you notice a change, get it addressed, don’t ignore it,” Staker says. “If we can get things early, it is much more curable and treatable. When someone has advanced cancer, we will still treat and care for them as best we can.”

“If there is anything unusual, see us early, early, early, come in, come in, come in,” says Davey. “Do the screening and investigating. Don’t wait. Whether you have insurance or if you don’t, there are many ways to get it covered. The earlier we find it, the less treatment will be needed, and there will be a better chance of getting cured.”