The key to successfully treating breast cancer is education and prevention.
The Women’s Imaging Center at Oroville Hospital now offers 3D mammography imaging with our digital breast tomosynthesis technology. 3D images offer a more comprehensive view of breast tissue as images are displayed as individual slices which allow physicians to examine breast tissue more closely.
In this important segment, Elizabeth Johnson, MD and Beverly Davis, RN discuss when you should get a mammogram, and the services provided if you have an abnormal mammogram through the nurse navigator program at Oroville Hospital.
When Should I Get a Mammogram?
Featuring:
Elizabeth Johnston, MD & Beverly Davis, RN
Dr. Elizabeth Johnston joined Oroville Hospital’s general surgery practice in 2013 as the Director of the Breast Care Program. She received her medical training from Loma Linda University and completed a residency in general surgery with a special interest in breast surgery at University of Nebraska’s College of Medicine. Dr. Johnston works closely with each patient to tailor breast health treatment plans based on diagnoses and medical history. She, along with the hospital’s breast care nurse navigators and medical staff, guides patients through each step of care with support, education and compassion.Beverly Davis is a nurse navigator for Oroville Hospital’s Breast Care Program and has been a registered nurse for more than 35 years. After earning an associate’s degree in nursing from Bakersfield College, she helped patients in a variety of roles and specialties including oncology, case management, home infusion and health administration. Beverly is an accredited oncology nurse (OCN) and enjoys helping patients focus on care, while giving them confidence to remove fear of treatment. As a nurse navigator, she works directly with patients to guide them through all aspects of cancer treatment including diagnostic testing, radiation and infusion.
Transcription:
Melanie Cole (Host): One of the best things a woman can do for herself is take good care of her breasts and know what’s involved in breast health, whether that’s screening or self exams. Here to tell us about that today are my guests, Dr. Elizabeth Johnston. She’s a breast and general surgeon with Oroville Hospital and Beverly Davis. She’s the nurse navigator at the Center for Breast Health at Oroville Hospital. Welcome to the show ladies. Explain a little bit about breast cancer. Dr. Johnston, what are you seeing as far as incidents and awareness and are more women getting screened?
Dr. Elizabeth Johnston (Guest): It’s been kind of interesting over the years that I’ve been here. There’s been some national guidelines that have changed a little bit, so I think that some women might be a little bit confused about when to get their mammograms and how often to get their mammograms. I think the incidents of cancer in this country is going up. We know that over time, and so there are a lot of different things that go into why women get breast cancer. I always tell people bad genes and bad luck. For people that have a family history of breast cancer, there’s a lot more understanding of that and ability to get genetic testing and know what your risk factors are. So those women are getting screened better and earlier and earlier ages if they get into a good program that can assess their risks. The other women that have no real strong family history of breast cancer I think have different options and their risk of breast cancer is still about 1 in 13 is what it is in this country now, and they should also still be getting screened. The biggest risk factor for breast cancer is increasing age. So as we grow older, our risk for breast cancer is higher and we need to make sure that we continue to get the recommended mammograms.
Melanie: Dr. Johnston, I’d like to stick with you just for a minute because there’s a lot of disparities in the guidelines and as you’ve mentioned. So please tell us why there’s this confusion and clear it up for us. Tell us about the screening, who should get screened, at what age, and how often?
Dr. Johnston: So I think that some of the confusion with the guidelines – there’s women that get mammograms that find an abnormality, then they get a biopsy of the abnormality and it’s nothing to worry about, and that’s great except for it’s really stressful to get an abnormal mammogram and have a biopsy and be worried that there might be something there. So the risk of getting cancer and having a screen for cancer is balanced by the risk of having something abnormal that shows up that isn’t anything to worry about. So we really need to kind of assess people’s risks before we get screening tests on them, and people that are at higher risks, well we want to make sure that we catch something early, even if that means we find more things that are nothing to worry about. So we screen people that are at higher risk with tests like MRIs and those are very, very sensitive, but that also means they find things that aren’t anything to worry about. So I think that’s where the guidelines are coming from. For people that are at really low risk, they probably don’t need to get mammograms quite so often; however, I find that there are a lot of people that are actually at higher risks than they might think they are for getting breast cancer. Many of us have a family member who’s had breast cancer and that puts us at a little bit higher risk and many of us have other risk factors for breast cancer. Some of those are drinking more alcohol, having a child at a later age in life or having no children at all and of course as we get older, our risk is a little more elevated as well. So for somebody with absolutely zero risk factors for breast cancer, my personal feeling is that it would be best to get a mammogram at age 40 just as a baseline and then it would be okay to get mammograms every two years afterwards, but like I said, the vast majority of our population actually does have some risk factors for breast cancer. The biggest risk factor in our society is obesity and that’s very prevalent and I think those people that are at a little higher risk ought to get a baseline mammogram at age 40 and then every year thereafter.
Melanie: Beverly, tell us a little bit about the nurse navigator program at Oroville Hospital and your process for helping patients obtain immediate follow up care after an abnormal mammogram. As Dr. Johnston mentioned, sometimes some of these tests find things, and we all know as women, we freak out when we get that notice from our doctor saying you got to come back. So tell us how you work with the patients and calm them down a little bit during this process.
Beverly Davis (Guest): Well the nurse navigator program is intentioned to be kind of like the tour guide through this whole process. You would be assigned an RN and you are met before the biopsy is actually given and meet this navigator and know that you have an advocate and if you have any questions or concerns that you are giving as much information as the patient wants or willing to absorb and at that point then we sit and wait while they go through the biopsy, and often times we see them during the biopsy too; we’re down there cheering them on. Then we follow up on the other side once they’re given the results of the biopsy, and then no matter what path that goes down, they know we’re there and we’re cheering them on and directing them in the direction – sometimes we play the role of secretary, we say don’t forget you have an appointment this day, how are you doing after the biopsy? We’re making phone calls to these people and opening the door to them to come to us if they have any questions or concerns and just know that they have an advocate and that they’re not out there doing it on their own.
Melanie: Dr. Johnston, when women hear about mammography, they think of the standard type of mammogram, but now there’s tomosynthesis, digital mammography, tell us a little bit about how this has changed the landscape of finding breast cancer.
Dr. Johnston: You know I’m really excited about the 3D mammograms that we have here. These are mammograms with tomosynthesis as you said. This enables the radiologist to kind of have a 3D map of the breast, and it gives them a much better idea of whether something is more likely to be a cancer, which is something solid and not see through or a cyst that is kind of more fluid filled. This means that not only is it, with digital mammography, a better picture overall, we can see things much more clearly, especially little things, we can have a computer that actually goes through and looks for things that maybe even the human eye couldn’t see very well, but we also can have the ability to determine if something’s actually something we need to go after or whether it’s like a cyst that we don’t need to go after. So our ability to determine higher risk lesions is a lot better and we don’t do quite as much worrying about things that aren’t anything to worry about. So that makes it a lot better for patients. They don’t have to get called back for extra imaging and the 3D mammograms, a lot of my patients tell me that they are easier on them as far as there’s less squishing than the old mammograms used to have. So that’s always a lot better for patients. People always worry about getting so squished with the mammograms but these 3D mammograms I think are a little bit easier on women’s breasts.
Melanie: Beverly, what about self exams? Do you as a nurse navigator and you’re a breast health expert, what do you think of self exams and do you think women should be doing this every month and how do we know what to do?
Beverly: Yes, the recommendation is patients should be doing their own breast self exams on a monthly basis. I teach and encourage them to do that with every visit. I have demonstrated and we highly recommend the best place for this is in the shower when you’re soapy and your skin is warm and you can gently do the process. We have wonderful handouts that we give to our patients to show them how to do this, and we often say how are you doing and encourage them to stay with it on a monthly basis.
Melanie: Dr. Johnston, first last word to you. I’d like you to wrap this up and summarize breast health and mammograms and clearing up some of the confusion of what you want women to know about the importance of self advocacy and making sure that they are proactive in good breast health.
Dr. Johnston: You know in this country, we have a lot of breast cancer in this country and it’s pretty great that we have the ability to detect it early and small and I think that we as women need to be aware that there is a risk, but if we can catch something early and small with mammograms and ultrasounds if need me, that it’s much easier to treat something that is small and early than it is something that’s bigger and later in it’s process. I think we need to be aware of our breasts and find anything abnormal and take care of it right away, but the screening opportunities that we have, like mammograms are really helpful and I think if you as a woman know that your risk is elevated; if you have a strong family history, getting into see somebody that can do the higher risk screening or the genetic testing that would be helpful, is great or determine that your risk is a little bit higher, and then we can catch something earlier or determine better ways of preventing breast cancer even.
Melanie: Beverly, last word to you here, wrap it up for us with your best advice for women as you teach these classes and you work with women every day on self advocacy, what do you want them to know and take home from this segment?
Beverly: I think that they need to know that they are important and there’s something they can do for themselves and they need to advocate for themselves and they need to take control of what’s going on and they need to get to their exams, to their mammograms and they need to be seeing their doctors, they need to say wait something’s not right, not wait. So many times we see patients come in and say oh yeah that’s been there for two years and now we’ve got something that’s not as easy to manage or control. They can take care of this. Let’s get it early. If you have any questions, my goodness you can call us anytime because we are champions for the women that have concerns about their breasts and we just need you to speak up for yourself.
Dr. Johnston: One of the other things I want people, especially in our community to know, is that they can come to the Valley Women’s Center and schedule their own mammograms. They can say, oh it’s time for my yearly mammogram, I’m going to go in and get it scheduled. We don’t always have to have you see a doctor beforehand in order to get an order for a mammogram.
Melanie: Thank you ladies so much. It’s really great information and so important for women to hear so that they can be their own best self advocate. Thank you again for joining us. You’re listening to Growing Healthy Together, a podcast by Oroville Hospital. For more information, please visit orovillehospital.com, that’s orovillehospital.com. This is Melanie Cole, thanks so much for listening.
Melanie Cole (Host): One of the best things a woman can do for herself is take good care of her breasts and know what’s involved in breast health, whether that’s screening or self exams. Here to tell us about that today are my guests, Dr. Elizabeth Johnston. She’s a breast and general surgeon with Oroville Hospital and Beverly Davis. She’s the nurse navigator at the Center for Breast Health at Oroville Hospital. Welcome to the show ladies. Explain a little bit about breast cancer. Dr. Johnston, what are you seeing as far as incidents and awareness and are more women getting screened?
Dr. Elizabeth Johnston (Guest): It’s been kind of interesting over the years that I’ve been here. There’s been some national guidelines that have changed a little bit, so I think that some women might be a little bit confused about when to get their mammograms and how often to get their mammograms. I think the incidents of cancer in this country is going up. We know that over time, and so there are a lot of different things that go into why women get breast cancer. I always tell people bad genes and bad luck. For people that have a family history of breast cancer, there’s a lot more understanding of that and ability to get genetic testing and know what your risk factors are. So those women are getting screened better and earlier and earlier ages if they get into a good program that can assess their risks. The other women that have no real strong family history of breast cancer I think have different options and their risk of breast cancer is still about 1 in 13 is what it is in this country now, and they should also still be getting screened. The biggest risk factor for breast cancer is increasing age. So as we grow older, our risk for breast cancer is higher and we need to make sure that we continue to get the recommended mammograms.
Melanie: Dr. Johnston, I’d like to stick with you just for a minute because there’s a lot of disparities in the guidelines and as you’ve mentioned. So please tell us why there’s this confusion and clear it up for us. Tell us about the screening, who should get screened, at what age, and how often?
Dr. Johnston: So I think that some of the confusion with the guidelines – there’s women that get mammograms that find an abnormality, then they get a biopsy of the abnormality and it’s nothing to worry about, and that’s great except for it’s really stressful to get an abnormal mammogram and have a biopsy and be worried that there might be something there. So the risk of getting cancer and having a screen for cancer is balanced by the risk of having something abnormal that shows up that isn’t anything to worry about. So we really need to kind of assess people’s risks before we get screening tests on them, and people that are at higher risks, well we want to make sure that we catch something early, even if that means we find more things that are nothing to worry about. So we screen people that are at higher risk with tests like MRIs and those are very, very sensitive, but that also means they find things that aren’t anything to worry about. So I think that’s where the guidelines are coming from. For people that are at really low risk, they probably don’t need to get mammograms quite so often; however, I find that there are a lot of people that are actually at higher risks than they might think they are for getting breast cancer. Many of us have a family member who’s had breast cancer and that puts us at a little bit higher risk and many of us have other risk factors for breast cancer. Some of those are drinking more alcohol, having a child at a later age in life or having no children at all and of course as we get older, our risk is a little more elevated as well. So for somebody with absolutely zero risk factors for breast cancer, my personal feeling is that it would be best to get a mammogram at age 40 just as a baseline and then it would be okay to get mammograms every two years afterwards, but like I said, the vast majority of our population actually does have some risk factors for breast cancer. The biggest risk factor in our society is obesity and that’s very prevalent and I think those people that are at a little higher risk ought to get a baseline mammogram at age 40 and then every year thereafter.
Melanie: Beverly, tell us a little bit about the nurse navigator program at Oroville Hospital and your process for helping patients obtain immediate follow up care after an abnormal mammogram. As Dr. Johnston mentioned, sometimes some of these tests find things, and we all know as women, we freak out when we get that notice from our doctor saying you got to come back. So tell us how you work with the patients and calm them down a little bit during this process.
Beverly Davis (Guest): Well the nurse navigator program is intentioned to be kind of like the tour guide through this whole process. You would be assigned an RN and you are met before the biopsy is actually given and meet this navigator and know that you have an advocate and if you have any questions or concerns that you are giving as much information as the patient wants or willing to absorb and at that point then we sit and wait while they go through the biopsy, and often times we see them during the biopsy too; we’re down there cheering them on. Then we follow up on the other side once they’re given the results of the biopsy, and then no matter what path that goes down, they know we’re there and we’re cheering them on and directing them in the direction – sometimes we play the role of secretary, we say don’t forget you have an appointment this day, how are you doing after the biopsy? We’re making phone calls to these people and opening the door to them to come to us if they have any questions or concerns and just know that they have an advocate and that they’re not out there doing it on their own.
Melanie: Dr. Johnston, when women hear about mammography, they think of the standard type of mammogram, but now there’s tomosynthesis, digital mammography, tell us a little bit about how this has changed the landscape of finding breast cancer.
Dr. Johnston: You know I’m really excited about the 3D mammograms that we have here. These are mammograms with tomosynthesis as you said. This enables the radiologist to kind of have a 3D map of the breast, and it gives them a much better idea of whether something is more likely to be a cancer, which is something solid and not see through or a cyst that is kind of more fluid filled. This means that not only is it, with digital mammography, a better picture overall, we can see things much more clearly, especially little things, we can have a computer that actually goes through and looks for things that maybe even the human eye couldn’t see very well, but we also can have the ability to determine if something’s actually something we need to go after or whether it’s like a cyst that we don’t need to go after. So our ability to determine higher risk lesions is a lot better and we don’t do quite as much worrying about things that aren’t anything to worry about. So that makes it a lot better for patients. They don’t have to get called back for extra imaging and the 3D mammograms, a lot of my patients tell me that they are easier on them as far as there’s less squishing than the old mammograms used to have. So that’s always a lot better for patients. People always worry about getting so squished with the mammograms but these 3D mammograms I think are a little bit easier on women’s breasts.
Melanie: Beverly, what about self exams? Do you as a nurse navigator and you’re a breast health expert, what do you think of self exams and do you think women should be doing this every month and how do we know what to do?
Beverly: Yes, the recommendation is patients should be doing their own breast self exams on a monthly basis. I teach and encourage them to do that with every visit. I have demonstrated and we highly recommend the best place for this is in the shower when you’re soapy and your skin is warm and you can gently do the process. We have wonderful handouts that we give to our patients to show them how to do this, and we often say how are you doing and encourage them to stay with it on a monthly basis.
Melanie: Dr. Johnston, first last word to you. I’d like you to wrap this up and summarize breast health and mammograms and clearing up some of the confusion of what you want women to know about the importance of self advocacy and making sure that they are proactive in good breast health.
Dr. Johnston: You know in this country, we have a lot of breast cancer in this country and it’s pretty great that we have the ability to detect it early and small and I think that we as women need to be aware that there is a risk, but if we can catch something early and small with mammograms and ultrasounds if need me, that it’s much easier to treat something that is small and early than it is something that’s bigger and later in it’s process. I think we need to be aware of our breasts and find anything abnormal and take care of it right away, but the screening opportunities that we have, like mammograms are really helpful and I think if you as a woman know that your risk is elevated; if you have a strong family history, getting into see somebody that can do the higher risk screening or the genetic testing that would be helpful, is great or determine that your risk is a little bit higher, and then we can catch something earlier or determine better ways of preventing breast cancer even.
Melanie: Beverly, last word to you here, wrap it up for us with your best advice for women as you teach these classes and you work with women every day on self advocacy, what do you want them to know and take home from this segment?
Beverly: I think that they need to know that they are important and there’s something they can do for themselves and they need to advocate for themselves and they need to take control of what’s going on and they need to get to their exams, to their mammograms and they need to be seeing their doctors, they need to say wait something’s not right, not wait. So many times we see patients come in and say oh yeah that’s been there for two years and now we’ve got something that’s not as easy to manage or control. They can take care of this. Let’s get it early. If you have any questions, my goodness you can call us anytime because we are champions for the women that have concerns about their breasts and we just need you to speak up for yourself.
Dr. Johnston: One of the other things I want people, especially in our community to know, is that they can come to the Valley Women’s Center and schedule their own mammograms. They can say, oh it’s time for my yearly mammogram, I’m going to go in and get it scheduled. We don’t always have to have you see a doctor beforehand in order to get an order for a mammogram.
Melanie: Thank you ladies so much. It’s really great information and so important for women to hear so that they can be their own best self advocate. Thank you again for joining us. You’re listening to Growing Healthy Together, a podcast by Oroville Hospital. For more information, please visit orovillehospital.com, that’s orovillehospital.com. This is Melanie Cole, thanks so much for listening.