How important is a woman's breast health and what should she be doing to to protect the health of her breasts?
Clinical Program Manager and a certified breast nurse patient navigator for the Summit Medical Group Breast Nurse Navigation Program, Carol Boyer, RN, MSN, APN, CBPN-IC, AOCNS, gives details on the three-fold approach recommended by the American Cancer Society. Supported by Summit Medical Group's Breast Care Center, this approach is designed to maintain optimal breast health and detect abnormalities early.
Selected Podcast
Breast Care Center at Summit
Featured Speaker:
Carol Boyer, RN, MSN
Founder of the Summit Medical Group Breast Nurse Navigation Program, Carol G. Boyer, RN, MSN, APN, CBPN-IC, AOCNS, is also Clinical Program Manager and a certified breast nurse patient navigator for the Summit Medical Group Breast Nurse Navigation Program. An oncology and board-certified gerontology clinical nurse specialist, Ms. Boyer has more than 25 years' experience in clinical nursing practice. Transcription:
Breast Care Center at Summit
Melanie Cole (Host): Paying attention to your breast health can be one of the most important things women do for themselves. My guest is Carol Boyer. She is Clinical Program Manager and Certified Breast Nurse Patient Navigator for the SMG Breast Care Center. Welcome to the show, Carol. Tell us about breast health for women. How important is it that we take care of them, and what should we be doing to do that?
Carol Boyer (Guest): Well, early detection with breast health is still the key. At Summit Medical Group Breast Care Center, we closely follow the American Cancer Society Guidelines, and we really take a three-fold approach to breast health. The first thing that we do and encourage is regular imaging, and that would include the breast mammogram. Mammograms are still considered the gold standard of breast imaging, and we do encourage them for women over 40 to have them annually.
Melanie: Okay, a mammogram. For women that have never had one, they're not that scary and they don’t really hurt, do they?
Boyer: Well, they really don’t hurt. It’s momentarily that they may be uncomfortable. Some women are, of course, very nervous about them. Mainly, they're nervous about the results, but it is a fairly quick, about a 10-minute procedure, and it’s really a very valuable procedure.
Melanie: We should have our mammograms every year after the age of 40. What else should we be doing?
Boyer: The next thing that’s very important besides imaging is really having your healthcare professional do a clinical breast exam annually after the age of 40 and every two to three years under the age of 40. This is where the health professional will really examine the breast thoroughly and identify any abnormalities that need to be further worked up. The breast health specialist will also help with teaching the patient how to do a self breast exam if patients don’t really know how to do it and they're nervous that they're not doing it right.
Melanie: Why don’t you walk us through how to do a self-exam properly? What should we do?
Boyer: The first thing about self-exam that’s really important is really examining your breasts in the mirror, looking for any changes, any lumps, any swelling, any skin irritation. Or there may be a dimple in the breast, and that can be of some concern. If there's any pain, if there's turning upward of the nipple, redness, scaling, and certainly, any kind of discharge from the nipple is something of concern. And just knowing what’s normal for you. So if you get to the habit of examining your breasts once a month, if there is a change from month to month, you’ll know what’s normal for you, and you should seek help when there is some type of a change.
Melanie: Now, should we be giving ourselves that self-exam? We’re looking in the mirror, should we be feeling for lumps? Would we even feel one, Carol? That’s something I've always been confused about. Would I feel anything?
Boyer: Well, if you examine your breasts regularly, when we teach breast exam, we teach someone to recognize what their own breast feels like. So dense breasts, for instance, they can feel lumpy and bumpy and they feel like it may be something. But that is normal for you and that’s always been there. It’s usually not a problem. However, if you're still examining your breast once a month and suddenly, you feel a new bump or you see a new change, that’s when we ask you to seek advice of a healthcare professional.
Melanie: So what happens after the mammogram? Suppose you have dense breasts or you’re prone to cysts, then there's that diagnostic that goes on.
Boyer: Right.
Melanie: Women really don’t want to hear that they have to come back. But what happens next?
Boyer: Okay. So what we do is the screening mammogram, and that’s where the physician literally reads many different mammograms, one after another. You go in, you might be there for 10 minutes, and you leave. The physician, after the fact reads your mammogram. If you come back for a diagnostic or you’re called back for a diagnostic mammogram—we call them call-backs—we really tell patients, “It’s really no time to panic.” It varies with different centers, but up to 20 percent of screening mammograms lead to a call-back for one reason or another. It’s not necessarily a bad thing, but it is a time it does create a lot of anxiety. So, why are you called back? What reasons are you called back for? Sometimes the radiologist wants to really take a closer look at an area, and they want the patient to be there. They actually may do the scanning themselves to take a look. Sometimes, if we have very dense breast tissue, it’s hard in a screening film to look at things more thoroughly. We like to magnify the area and take a closer look at that dense breast tissue to see if we see anything. Sometimes there's overlapping tissue, and coming back for a second exam may smooth out an overlapping tissue and it’s fine and you're sent on your way. Another area that patients are often called back for is for calcifications, and these are tiny little -- they look almost like grains of sand on the breasts, but they can be a sign of very early breast cancer. Another reason would be asymmetry. So the right breast doesn’t match the left breasts. What we’re seeing if there's an asymmetry, it means that there could be a problem with one of the breasts and, certainly, we want to look at that further.
Melanie: Okay. Now, nobody ever wants that call-back, and women do, as you say, panic. What words of advice? You just gave so many other reasons that are not breast cancer that women would be called back. So what words of advice would you give women that are really panicky? If you're somebody with dense breasts, you get used to that call-back, because maybe the picture isn’t clear or they didn’t squish you enough or something. But for women out there that panic, whenever they go to get a mammogram, what words of advice would you offer them?
Boyer: Right. Well, the best advice I have is to call and actually find out the reason for the call-back. Some women are afraid to do that. They think they're going to hear bad news. But often, they’ll call back to their gyn or they’ll call back to their primary care doctor, and it’s a very simple explanation. It takes a healthcare professional several minutes to just review the report and give them the rationale for the call-back, and sometimes that gives women peace of mind. As a matter of fact, our navigators here often get those calls from other departments, and we’re asked to help explain somebody’s initial mammogram and help them to understand why they're being called back. Secondly, you will be meeting with the physician, the radiologist, at that time. So, that should give you peace of mind that you're going to leave the call-back or the diagnostic imaging with results in hand, and then you can take it from there. Now, here at Summit Medical Group, you will meet with the breast nurse navigator, who will guide you every step of the way from that point on. So you walk out of our office with a plan. You know what you're doing next. You know what this all means. You understand what they saw and what needs to happen to resolve the issue.
Melanie: Well, then I think it does make women feel better to know they're meeting with the radiologist, nurse navigators, and breast specialists are there and you leave with results in hand. It’s the waiting, Carol, that really makes people so anxious sometimes. Now, why don’t you speak about general breast health for women? What would you like us to know about keeping healthy breasts? Is there anything we can do to sort of prevent problems from beginning?
Boyer: Well, again, it goes back to a three-fold approach, making sure that you do your imaging every year. If you have a family history or if your mom has breast cancer, you should start your imaging 5 to 10 years before the age of her diagnosis. So really, understanding what you need to do on the imaging and do you need an ultrasound. Your doctor will tell you. If you have dense breasts, sometimes we’ll do an ultrasound. Do you need an MRI? Not all patients qualify for MRIs, but if that will provide more information, that might be a modality that will be useful for you. The second part of that is making sure you do get your clinical breast exams on a regular basis, that you go to your gyn, that you go annually over 40 and every two to three years under 40, and that you understand what your clinician is doing. Last but not least is really knowing your own breasts. Self-exam, observation, knowing what changes are occurring, and making sure that you report those and you keep a log of what you see and that you’d take action when there are any changes. That three-fold approach is probably my best advice to most women. As far as women ask us all the time, what can we do to prevent breast cancer? Certainly, we know that keeping your weight down, exercising, all the things that are important for general health are also important for breast health in addition to detection, the imaging. And also, another thing, it’s important to know your family history. If you have a family history and you’re in a higher risk pool, you go more frequently for your exams, you do careful surveillance and understand clearly what the plan for surveillance is and follow that plan. That’s also very important.
Melanie: So general breast health are the same kinds of things we would do for, really, any of our health concerns we do for our breast health. And make sure to have our mammograms yearly, do the self-exams, don’t panic if you get that call-back. These are all great pieces of advice from Carol Boyer, Clinical Program Manager and Certified Breast Nurse Patient Navigator for the SMG Breast Care Center. You’re listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. Download these podcasts. This is important information. Share it with your friends, share it with other ladies that you know, because at Summit Medical Group, they have great information for breast health and a breast care center. So thank you so much for listening. This is Melanie Melanie for SMG Radio, Summit Medical Group. Have a great day.
Breast Care Center at Summit
Melanie Cole (Host): Paying attention to your breast health can be one of the most important things women do for themselves. My guest is Carol Boyer. She is Clinical Program Manager and Certified Breast Nurse Patient Navigator for the SMG Breast Care Center. Welcome to the show, Carol. Tell us about breast health for women. How important is it that we take care of them, and what should we be doing to do that?
Carol Boyer (Guest): Well, early detection with breast health is still the key. At Summit Medical Group Breast Care Center, we closely follow the American Cancer Society Guidelines, and we really take a three-fold approach to breast health. The first thing that we do and encourage is regular imaging, and that would include the breast mammogram. Mammograms are still considered the gold standard of breast imaging, and we do encourage them for women over 40 to have them annually.
Melanie: Okay, a mammogram. For women that have never had one, they're not that scary and they don’t really hurt, do they?
Boyer: Well, they really don’t hurt. It’s momentarily that they may be uncomfortable. Some women are, of course, very nervous about them. Mainly, they're nervous about the results, but it is a fairly quick, about a 10-minute procedure, and it’s really a very valuable procedure.
Melanie: We should have our mammograms every year after the age of 40. What else should we be doing?
Boyer: The next thing that’s very important besides imaging is really having your healthcare professional do a clinical breast exam annually after the age of 40 and every two to three years under the age of 40. This is where the health professional will really examine the breast thoroughly and identify any abnormalities that need to be further worked up. The breast health specialist will also help with teaching the patient how to do a self breast exam if patients don’t really know how to do it and they're nervous that they're not doing it right.
Melanie: Why don’t you walk us through how to do a self-exam properly? What should we do?
Boyer: The first thing about self-exam that’s really important is really examining your breasts in the mirror, looking for any changes, any lumps, any swelling, any skin irritation. Or there may be a dimple in the breast, and that can be of some concern. If there's any pain, if there's turning upward of the nipple, redness, scaling, and certainly, any kind of discharge from the nipple is something of concern. And just knowing what’s normal for you. So if you get to the habit of examining your breasts once a month, if there is a change from month to month, you’ll know what’s normal for you, and you should seek help when there is some type of a change.
Melanie: Now, should we be giving ourselves that self-exam? We’re looking in the mirror, should we be feeling for lumps? Would we even feel one, Carol? That’s something I've always been confused about. Would I feel anything?
Boyer: Well, if you examine your breasts regularly, when we teach breast exam, we teach someone to recognize what their own breast feels like. So dense breasts, for instance, they can feel lumpy and bumpy and they feel like it may be something. But that is normal for you and that’s always been there. It’s usually not a problem. However, if you're still examining your breast once a month and suddenly, you feel a new bump or you see a new change, that’s when we ask you to seek advice of a healthcare professional.
Melanie: So what happens after the mammogram? Suppose you have dense breasts or you’re prone to cysts, then there's that diagnostic that goes on.
Boyer: Right.
Melanie: Women really don’t want to hear that they have to come back. But what happens next?
Boyer: Okay. So what we do is the screening mammogram, and that’s where the physician literally reads many different mammograms, one after another. You go in, you might be there for 10 minutes, and you leave. The physician, after the fact reads your mammogram. If you come back for a diagnostic or you’re called back for a diagnostic mammogram—we call them call-backs—we really tell patients, “It’s really no time to panic.” It varies with different centers, but up to 20 percent of screening mammograms lead to a call-back for one reason or another. It’s not necessarily a bad thing, but it is a time it does create a lot of anxiety. So, why are you called back? What reasons are you called back for? Sometimes the radiologist wants to really take a closer look at an area, and they want the patient to be there. They actually may do the scanning themselves to take a look. Sometimes, if we have very dense breast tissue, it’s hard in a screening film to look at things more thoroughly. We like to magnify the area and take a closer look at that dense breast tissue to see if we see anything. Sometimes there's overlapping tissue, and coming back for a second exam may smooth out an overlapping tissue and it’s fine and you're sent on your way. Another area that patients are often called back for is for calcifications, and these are tiny little -- they look almost like grains of sand on the breasts, but they can be a sign of very early breast cancer. Another reason would be asymmetry. So the right breast doesn’t match the left breasts. What we’re seeing if there's an asymmetry, it means that there could be a problem with one of the breasts and, certainly, we want to look at that further.
Melanie: Okay. Now, nobody ever wants that call-back, and women do, as you say, panic. What words of advice? You just gave so many other reasons that are not breast cancer that women would be called back. So what words of advice would you give women that are really panicky? If you're somebody with dense breasts, you get used to that call-back, because maybe the picture isn’t clear or they didn’t squish you enough or something. But for women out there that panic, whenever they go to get a mammogram, what words of advice would you offer them?
Boyer: Right. Well, the best advice I have is to call and actually find out the reason for the call-back. Some women are afraid to do that. They think they're going to hear bad news. But often, they’ll call back to their gyn or they’ll call back to their primary care doctor, and it’s a very simple explanation. It takes a healthcare professional several minutes to just review the report and give them the rationale for the call-back, and sometimes that gives women peace of mind. As a matter of fact, our navigators here often get those calls from other departments, and we’re asked to help explain somebody’s initial mammogram and help them to understand why they're being called back. Secondly, you will be meeting with the physician, the radiologist, at that time. So, that should give you peace of mind that you're going to leave the call-back or the diagnostic imaging with results in hand, and then you can take it from there. Now, here at Summit Medical Group, you will meet with the breast nurse navigator, who will guide you every step of the way from that point on. So you walk out of our office with a plan. You know what you're doing next. You know what this all means. You understand what they saw and what needs to happen to resolve the issue.
Melanie: Well, then I think it does make women feel better to know they're meeting with the radiologist, nurse navigators, and breast specialists are there and you leave with results in hand. It’s the waiting, Carol, that really makes people so anxious sometimes. Now, why don’t you speak about general breast health for women? What would you like us to know about keeping healthy breasts? Is there anything we can do to sort of prevent problems from beginning?
Boyer: Well, again, it goes back to a three-fold approach, making sure that you do your imaging every year. If you have a family history or if your mom has breast cancer, you should start your imaging 5 to 10 years before the age of her diagnosis. So really, understanding what you need to do on the imaging and do you need an ultrasound. Your doctor will tell you. If you have dense breasts, sometimes we’ll do an ultrasound. Do you need an MRI? Not all patients qualify for MRIs, but if that will provide more information, that might be a modality that will be useful for you. The second part of that is making sure you do get your clinical breast exams on a regular basis, that you go to your gyn, that you go annually over 40 and every two to three years under 40, and that you understand what your clinician is doing. Last but not least is really knowing your own breasts. Self-exam, observation, knowing what changes are occurring, and making sure that you report those and you keep a log of what you see and that you’d take action when there are any changes. That three-fold approach is probably my best advice to most women. As far as women ask us all the time, what can we do to prevent breast cancer? Certainly, we know that keeping your weight down, exercising, all the things that are important for general health are also important for breast health in addition to detection, the imaging. And also, another thing, it’s important to know your family history. If you have a family history and you’re in a higher risk pool, you go more frequently for your exams, you do careful surveillance and understand clearly what the plan for surveillance is and follow that plan. That’s also very important.
Melanie: So general breast health are the same kinds of things we would do for, really, any of our health concerns we do for our breast health. And make sure to have our mammograms yearly, do the self-exams, don’t panic if you get that call-back. These are all great pieces of advice from Carol Boyer, Clinical Program Manager and Certified Breast Nurse Patient Navigator for the SMG Breast Care Center. You’re listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. Download these podcasts. This is important information. Share it with your friends, share it with other ladies that you know, because at Summit Medical Group, they have great information for breast health and a breast care center. So thank you so much for listening. This is Melanie Melanie for SMG Radio, Summit Medical Group. Have a great day.