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Deborah Howell: Now more than ever, women and men need to stay on top of their breast health. And today, we'll learn a bit more about the High Risk Breast Program at Deaconess The Women's Hospital.

My guest is Claire Sutherby, a clinical nurse specialist at the High Risk Breast Program at the Women's Hospital. Claire, welcome to you

Claire Sutherby: Thank you so much.

Deborah Howell: I've been looking forward to this one. How long have you been with The Women's Hospital?

Claire Sutherby: I actually started with The Women's Hospital in April of 2021. Before that, I actually worked as a nurse at Deaconess, beginning in 2009 and worked through that point and advanced to an advanced practice provider and then had an opportunity to come to The Women's Hospital.

Deborah Howell: Wonderful. Congratulations. And what drew you to this particular program?

Claire Sutherby: I think the opportunity to help women germane to this opportunity, as well as the opportunity to work with The Women's Cancer Center and be a part of this great team.

Deborah Howell: Awesome. And what is the High Risk Breast Program and who are your patients?

Claire Sutherby: The High Risk Breast Program is really a program that can benefit women who have either a family history of breast cancer, prior breast biopsies that maybe haven't had a cancer diagnosis, but have been diagnosed with a high risk breast lesion, such as atypical ductal hyperplasia or something like that as well as maybe they've been treated with cancer as a child or young adult and received radiation therapy to the chest before age 30, that would also qualify them. Maybe they've had a personal or family history of ovarian cancer as well. So those are some things that we see.

Deborah Howell: I hadn't realized the ovarian cancer piece of this. Okay. So if you're at high risk, how often should you be screened?

Claire Sutherby: That can vary for each patient. And when I sit down with everybody, we develop their genetic pedigree or their family tree. We sit down and we look at that, talk about the different cancers that are in their family as well as develop and perform risk assessments. So everybody has a different five-year risk of developing a breast cancer and a lifetime risk of developing a breast cancer. And so depending on where they fall, when we screen them and perform risk assessments, everybody's plan and screening mechanisms are going to be just a little bit different and individualized. So usually if they're at increased risk, we will recommend that they get annual screening mammograms, and then alternate that based on NCCN guidelines or National Comprehensive Cancer Network guidelines with recommendation of a breast MRI.

Deborah Howell: And that's annual as well?

Claire Sutherby: Yes, that would be annual. So they would have two sets of imaging a year. So that would be a screening mammogram and then six months later, breast MRI. And then in six months, they would be ready for their screening mammogram again.

Deborah Howell: Okay. I can guarantee you, there are people listening right now that are saying, "Ooh, isn't that a lot of, you know, stuff going into my body?" What do you say to that?

Claire Sutherby: So the benefits probably outweigh the risks, especially since that's every six months. And if you are worried about that or if, say, your insurance doesn't like that, but, say, they would pay for it more of a breast ultrasound, that's also an option, just not as sensitive of a test.

Deborah Howell: Got it. I bet it's kind of sobering for people to sit down with you and go over their family tree. And you know, if you put a red circle around everyone in their family who's ever been affected by cancer, it can be pretty daunting.

Claire Sutherby: It is, yes. Some women realize that they are probably at high risk. However, when they figure out that they are in that greater than 20% lifetime risk category that really places them at increased risk, then I think the realization hits and a lot of times, they're like, "Okay, what can I do or what do I need to do at this point?"

Deborah Howell: Exactly. What kinds of screenings are offered?

Claire Sutherby: So we offer screening mammograms as well as we have a conversation about breast ultrasound, depending on where they fall in the risk category and depending on what they want to do. Breast MRI is also something that we talk about if they qualify. And then another thing I think that people sometimes forget about are clinical breast exams in the office with your provider, whether that be a physician or advanced practice provider. Those are important if the patient is at high risk every six to 12 months to be performed.

Deborah Howell: Okay. And what about self-diagnosis?

Claire Sutherby: Yep. So self-diagnosis or self-breast exams, the terminology is kind of gearing more towards self-breast awareness so that the patient is more aware of what their breast tissue feels like, looks like, because everybody is different. And so just the more you know your body, the better. That way, you can identify if anything has changed or if anything is different for you.

Deborah Howell: Yeah. And if you know that you have dense breasts, does that automatically put you at high risk?

Claire Sutherby: It doesn't necessarily place you at increased risk in terms of a greater than 20% lifetime risk. However, we know that that can potentially increase your risk factors of making it harder to identify something in your breast tissue just based on that dense tissue that they're seeing on that mammogram.

Deborah Howell: But the technology has come a long way. They can see a lot more now right?

Claire Sutherby: Yes, it has. And with the addition of 3D mammography, that really helps our radiologists be able to identify even the most subtle change on that mammogram.

Deborah Howell: And besides the technology being better, I think it's more comfortable than it used to be.

Claire Sutherby: Yes. I'm sure that that has also come a long way.

Deborah Howell: Hey, Claire, can you tell us a little bit about the staff at the High Risk Breast Program?

Claire Sutherby: Yes, I can. So the staff at the High Risk Breast Program includes our front desk staff, which you will meet when you come in for your appointment. They will greet you, get you checked in. And then our nurses and CMAs will get you back in a room. Talk about your family history a little bit with you, make any updates into the computer. And then I would come in as the advanced practice provider during your appointment to talk to you and develop a specific plan for you based on what we need to do.

Deborah Howell: Sure. Now, I'm sure there are some people that don't know or don't remember or just never knew about their family history in order to, you know, put it down on the chart. So in that case, what do you do?

Claire Sutherby: So in that case, that can be a little bit of a special situation, especially trying to figure out what the best thing to do is for those patients. So some of them have some sort of idea, maybe not specific ages, but maybe they have heard that their grandma had breast cancer, or they know that an aunt had breast cancer, but they didn't talk to that side of the family. So in that case, we just factor that in and maybe we don't know a specific age. So that does play a little bit of a role in trying to identify risk, but we work with what we have and kind of go from there to develop their risk.

Deborah Howell: It seems like you really, really love your new position. What's the best part about your job?

Claire Sutherby: I really do love my new position. I love a couple of things about this job. And one of those is being able to inform women of their risk, because I feel like being able to talk to them and explain things to them, really lay it out on the table. That then puts the ball back in their court. They now know that they have an increased risk and we talk about what we can do to possibly monitor that or screen early and possibly catch something early if we're going to.

Deborah Howell: Information is power, right?

Claire Sutherby: It is, it is. Probably the other thing that I really enjoy about this job is I previously worked as the advanced practice provider in the infusion center. So I saw so many young women in that chemotherapy chair who had a diagnosis of breast cancer. And I feel like if I can prevent at least one woman from being in that chair, then that is my goal, because that is ultimately what I hope to do is to prevent that. I mean, I loved that role of being in the infusion center, but it was so sad and heartbreaking to see young women your age in that chair getting chemotherapy.

Deborah Howell: Right on. I hear that loud and clear. And we want to thank you for being on the front lines, especially during the pandemic. Has the protocol changed much between before and now?

Claire Sutherby: So probably the biggest thing that has changed has been the amount of family members that are able to be with the patient during a visit. So currently, we are at one family member in an office visit and one family member could go with them to treatment or an imaging if they needed to.

Deborah Howell: Oh, that's not so bad, right?

Claire Sutherby: Yes, not so bad. Before, it was nobody. They had to come alone and that's a scary situation when you're going in for an imaging procedure or even surgery. That can be frightening.

Deborah Howell: And hopefully, we're on our good path to even more normalization in terms of being able to bring with you whom you want for your procedure.

Claire Sutherby: I certainly hope so.

Deborah Howell: Well, this is such excellent information, Claire. Thank you so much for being with us today to talk about the High Risk Breast Program at Deaconess.

Claire Sutherby: Yes. Thank you so much for having me.

Deborah Howell: Great information. This is Deaconess The Women's Hospital, a place for all your life. For more information, visit deaconess.com/highriskbreast or call (812) 842-2210. Please remember to subscribe, rate and review this podcast and all the other Deaconess Women's Hospital podcasts. And for more health tips and updates, follow us on your social channels. This is Deborah Howell. Thanks for listening and have yourself a great day.