Amanda Wilde (Host): We're exploring how we understand breast cancer and the services available to help navigate through the process of screenings and beyond. Welcome to Doc Talk, presented by Montefiore St. Luke's Cornwall. I'm Amanda Wilde. My guests are Vera Sanchez, Clinical Navigation Coordinator, and Tina Unsworth, Clinical Oncology Navigator and Coordinator at Montefiore St. Luke's Cornwall. Welcome to you both. Thank you for being here for this important conversation.

Tina Unsworth, MSN, RN, CMSRN: Thanks for having us.

Carla Vera Sanchez, BSN, RN: Thank you.

Host: Tina, I'm going to start with you. You are also a certified breast care nurse. So you are absolutely a specialist in this field, and I know the field's always evolving. So can you first talk about what are the latest breast cancer statistics? Because we're always doing things to heighten awareness. Has that changed anything over the years?

Tina Unsworth, MSN, RN, CMSRN: Sure. Breast cancer is the most common cancer in women worldwide. The average risk of a woman in the United States developing breast cancer sometime in her lifetime is about 13%. This means you have a one in eight chance she will develop breast cancer and white women have a higher risk of getting breast cancer. However, black women are more likely to die from breast cancer than any other race or ethnic group. Overall, five year survival rate for breast cancer is 91%, and the five year survival rate for early stage localized breast cancer is over 99%. So breast cancer is the second leading cause of death in women worldwide. The American Cancer Society and the Susan G. Komen websites are great websites for education and resources for breast cancer. It has the latest statistics.

Host: Have those statistics changed much over the year, even though you say it's still a killer? You seem to have a very high treatment success rate as well.

Tina Unsworth, MSN, RN, CMSRN: Right. So breast cancer has definitely affected either yourself or someone you know, because it's one in eight chance. So it is early detected now. So we have a lot of screening recommendations that we can go into that can detect it early, and it is very treatable.

Host: So what are the latest breast cancer screening guidelines?

Tina Unsworth, MSN, RN, CMSRN: So according to the US Preventative Services Task Force, women of average risk of getting breast cancer should begin screening mammograms at age 40. And a mammogram is an x-ray imaging used to detect breast cancer. It involves taking detailed images of the breast tissue to identify any abnormalities or suspicious areas.

And for most women, it is the best test for screening. Mammography is highly effective in detecting breast cancer, even when it's small and can help identify dense breast tissue. So if your mammogram is abnormal, additional imaging such as an ultrasound, MRI or breast biopsy may be recommended.

Host: And Tina, you just mentioned something about breast density. How does that impact mammogram results and cancer detection? I know there's been some recent recommendations on that.

Tina Unsworth, MSN, RN, CMSRN: Breast density describes how your breasts look on a mammogram. So high breast density means you have more breast and connective tissue than fat. Women with high breast density have an increased risk of breast cancer. So if you have dense breasts, talk to your doctor about whether other types of imaging in addition to your mammograms might be right for you.

Host: Tina, in terms of screening, can you explain how a self-breast exam is performed and why is that important?

Tina Unsworth, MSN, RN, CMSRN: So self-breast exam, the main thing you want to know is what is your normal? Learn how your breasts normally look and feel. Report any changes to your breasts, including a lump, hard knot, swelling, redness, darkening, change in size, change in shape, or dimpling of the skin, itchy, scaly, sore, or rash on the nipple, pulling in of your nipple, nipple discharge or new pain that does not go away and talk to your doctor about those things. You can also do a clinical breast exam and that's done in the office with a doctor or a nurse and they look and feel your breasts for any changes or signs of breast cancer.

Host: Back to the screening guidelines. How often should individuals be screened and how often should individuals do self-exam?

Tina Unsworth, MSN, RN, CMSRN: Self-exam should be done as much as you can. You want to know your normal. That's the main goal. You want to know any changes and you want to report those. And screening recommendations after 40 for mammograms is every two years. Most women do do it every year though.

Host: Now Tina and Carla, I want to bring you in on this if you would like, what are the primary risk factors associated with breast cancer?

Tina Unsworth, MSN, RN, CMSRN: So breast cancer is complex and involves the risk factors. Some of the risk factors are outta your control, such as age. And there are risk factors that you can control. So some risk factors of breast cancer are being a woman, getting older, having a family history of breast cancer, genetic mutation of certain genes, dense breasts, Ashkenazi Jewish heritage, birth control pill use, drinking alcohol, weight gain, smoking and radiation treatment to the chest.

However you can make healthy lifestyle choices to lower your risk, things that you can control, such as maintaining a healthy weight, exercising routinely, limiting alcohol intake, and breastfeeding if you can.

Host: Thanks Tina. So Carla, can you discuss the prevalence and treatment of male breast cancer? Where does that fall into this field?

Carla Vera Sanchez, BSN, RN: So with male breast cancer, we just wanted to make sure that they also understand the, statistics. So as Tina mentioned before with women, with male is a little bit different. So in USA, 1% of male can be diagnosed with breast cancer, that means one in a thousand. Yes, there is some conditions that put you at higher risk, but usually for male is anybody who is an elderman more than 69 years old.

And especially with heritage, if you're Hispanic, Black, it puts you at higher risk. One of the main reasons why males are often diagnosed at a later stage of breast cancer is because they're usually the less likely to report anything abnormal or, go to the doctor. So this puts you a little bit as a risk because if we're thinking about cancer, survival is the highest when breast cancer is found early and treated early.

So this is why, when Tina mentioned, you know, know your normal; men should also be able to, you know, and familiar on how their breast tissue typically looks. How does it feel and if they are familiar with this, it can help them to detect any changes in the tissue early and it can help them to go to the doctor.

Same thing as women, the same warning signs, can mean that something, it's not normal and they should be reaching out to the doctor if they have the lump in the breast or the chest or underarm and the axilla area. Either if it's painless or it's producing some tenderness or pain. They wanted to make sure that they know what an inverted nipple is and if they have it, or there is a rash, redness around the nipple area, they want to make sure that they search for a doctor visit. And then also there is a mutation that can be inherited. So there is a BRCA1 and a BRCA2, that can be inherited from parents and male can also pass this mutation into the children, either girls or boys.

And BRCA1 and BRCA2 is something that increases the risk of breast cancer.

Host: So the genetic risk of say, BRCA1 or 2, is that true for men also or are they mostly carriers or both?

Carla Vera Sanchez, BSN, RN: So it's true for both. And that is why the genetic testing comes in place. And it's important because if someone knows, that they already have breast cancer in the family, or there's a family history due to having inherited the gene mutation; that is why it's important to, go to the doctor and get this genetic testing because it helps you to learn how the inherited disease process works and what conditions might affect them and your family.

If you as a male patient know that can pass it to your children, you know, you want to make sure that they have all of the information necessary. So this is why at Montefiore St. Luke's, we offer the most advanced testing procedures. They do either saliva or blood test, and then we also have the genetic counseling, done by specialist providers and anybody can have genetic counseling, but it's more accurate if you had had cancer diagnosis, less than 45 years old, or if you have a close family member who was diagnosed with cancer at an early age too, or if you have two or more close family members, let's say dad, uncle, a grandparent who were diagnosed with the same cancer.

This is something, definitely important that will help you to know what conditions might affect your family and your loved ones later on. So if you want to get genetic testing or you just want more information about it, you can always call us at 845-458-4444.

And this is our patient navigation program from St. Luke's Cornwall.

Host: Well, that's a perfect segue into my next question, which is, Carla, what services St. Luke's Cornwall provides or offers breast cancer patients?

Carla Vera Sanchez, BSN, RN: So we have a couple services that we offer and we are lucky enough to have a couple accreditations. We have the breast accreditation from the National Accreditation Program for breast cancer. This is something that it's granted only to those centers who show how the commitment to providing the best possible care for patients with breast diseases.

Here in Montefiore St. Luke's, we are ensuring that our patients receive the highest quality, you know, comprehensive care for any breast condition. We also are accredited for the COC Commission on Cancer, and this is a program of the American College of Surgeons that establishes the standards to ensure that patients are getting comprehensive, high quality, patient-centered cancer care.

And having this accreditation signifies that our cancer program is meeting the standards and it's committed to providing quality care. Here at Cornwall, we offer radiation services. We also offer support services with our oncology and social worker navigators. We also have our patient navigation program, which was basically created because we know how sometimes navigating the healthcare system can be overwhelming to our patient, especially if they are, having a brand new diagnose or they're having a hard time understanding their diagnosis.

We always provide that extra hand, to help them guide through their healthcare journey. We want the patients to have the best possible outcomes, so we will do that with new education. We help them to schedule things around, going to the doctors and, scheduling tests. We help them with information that they might not understanding regards of an insurance or regards of any new diagnosis, transportations. Is there any social issues, stopping patients from following their healthcare journey and things like that? We work with a couple services. We have nurses, we have patient navigators, and we have, uh, staff that is here to, always give all the resources to patients that they need, support them, with any help that they need, any insurance coverages, benefits, information that they have to get. And all of this is because we want to make sure that the patient understands that once they're like either discharged from a hospital and they're not part of the hospital, we still want them to be very successful.

And patient navigation treats every patient as a unique person, because that's how it should be done. Everybody has their own needs, as specific needs and we try to always create care plans with them, in the unique matter. And we always try to make sure that every patient is confident.

We not only bring education, but we also bring support to our patients. And, we make sure that the best outcome that they can have is you know, improve their health.

Host: The patient navigation services are just a tremendous benefit. How do patients hook up with navigation services?

Carla Vera Sanchez, BSN, RN: So it can be either a referral from a provider or from one of our staff nurses, or they can also reach us by phone at (845) 458-4444. Or they can also reach us, via email. We are open to anybody. It doesn't have to be that you are our patient or anybody who recently went to the emergency room or who has been discharged or just referred by the community.

Host: Thank you Carla, and thank you Tina. Is there anything you'd like to add as we close to this conversation?

Tina Unsworth, MSN, RN, CMSRN: Patient navigation does go into the community and we do offer screenings. We do connect, patients to screenings, treatment, support groups, even if they're not our patient, they're invited to our support group, our oncology support group.

So from start to finish, if they are diagnosed with breast cancer, we do follow them for years. So, they're always connected to our services, so they always have someone to reach out no matter where they are in their journey.

Host: Well Tina, Carla, thank you both for providing as Carla so well said,the highest quality comprehensive care for any breast condition.

Tina Unsworth, MSN, RN, CMSRN: Thank you so much.

Carla Vera Sanchez, BSN, RN: Thank you so much for having us.

Host: Really appreciate the conversation. Tina Unsworth is a clinical oncology navigator and coordinator. Carla Vera Sanchez is Clinical navigation coordinator at St. Luke's Cornwall. Thanks for listening to Doc Talk presented by Montefiore St. Luke's Cornwall. For more information, please visit Montefiore Slc.org. That's montefioreslc.org.

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