by Marcy Rushford
National Breast Cancer Awareness Month observes its 25th anniversary this year. While we haven’t eradicated breast cancer (it is still the second leading cause of cancer-related deaths for American women), real strides have been made in the area of earlier detection, leading to more effective treatments and longer, more productive, lifetimes for breast cancer survivors.
Until recently, different medical associations were recommending different time frames for when women should start getting screened for breast cancer on a yearly basis. Some were recommending age 40 while others suggested 50. Now the American College of Radiology, the American College of OB/GYN’s and the American Cancer Society are in agreement that women should have a baseline mammogram at age 40 and then an annual mammography from that point forward. Unfortunately, as the Susan G. Komen for the Cure Foundation’s chief scientific adviser Eric P. Winer, M.D. pointed out in a 2009 statement, “Our real focus, however, should be on the fact that one-third of the women who qualify for screening under today’s guidelines are not being screened due to lack of access, education or awareness.” This fact holds true for women living in Southern New Hampshire and Vermont, where an estimated 27-32% of women who should be having annual screening Mammograms do not.
To emphasize the importance of annual mammography, Brattleboro Memorial Hospital’s Comprehensive Breast Care program is hosting an open house next Friday, October 21, from 2:00 – 4:00 p.m. to allow the public to learn more about its screening capabilities and other available services. October 21st is also National Mammography Day, and Kelly McCue, the program’s nurse navigator, intentionally scheduled the open house on that day because, if you’re a woman age 40 or older, the importance of getting an annual mammogram cannot be over-emphasized.
There are a lot of tests we can do to detect and define breast cancer and learn how it is affecting the patient, but mammography is still the gold standard. For most patients, it is going to give us the information we need. For example, a fair amount of the cancers we see have some kind of calcification associated with them, which wouldn’t show up at all on an ultrasound. So while a mammogram isn’t the only imaging test we would use it’s the best starting point. Annual mammograms are also where most cancers are first detected, when they are too small to be felt and early enough that, if treated, patients have a very good prognosis.
Mammography has evolved over the last 15 years with the advent of digital technology. Digital imaging gives the radiologist more shades of gray to evaluate; based on the appearance of structures on the mammogram and the different classifications they have for those shades and shapes, a radiologist can define whether something looks suspicious and requires further tests.
In addition to quality, digital technology has also reduced a 45-minute test down to about 15 minutes. Many hospitals, including BMH, have a radiologist who does dictation daily in order to provide completed reports with an official interpretation in less than 24 hours for most imaging. This process used to take several days. Speeding up the procedure and diagnostic process is critical for a patient’s peace of mind during what is a very anxiety-ridden experience. We understand the reason a person is here is to look for something serious and it can be a frightening time. We also want to decrease the time between diagnosis and treatment of a cancer; we know that the earlier a cancer is caught, the better the outcome for the patient. At BMH, the Comprehensive Breast Care Program helps us to better coordinate care to do this by tying together imaging services with Nursing, Surgery, Genetics and Oncology, for example.
Digital mammography also reduces the radiation dose a patient receives by a third from the film-screening mammography. We are always considering minimizing patient dose when looking at new equipment, recognizing that there is a cumulative effect over a patient’s lifetime, especially if an abnormality is detected that requires testing beyond the annual mammogram.
Moving to digital mammography at BMH was a huge deal. If you come through the Women’s Imaging area at any time, you will notice there aren’t a lot of people waiting, and that’s what we want. Our scheduling is set up to make it as comfortable as possible for the patient with as short a wait as possible to minimize their fears. The technologists are very supportive of patients—they know this is a very anxious time for people. Sometimes just completing the test is enough for people to have an emotional release. The atmosphere needs to be open and friendly so a patient feels they are getting their questions answered and that there is an individualized plan for their care.
While the technologist will try to set people at ease as much as possible, if we have a patient who needs to return for extra-imaging, they are scheduled to return at a time when the suite will have a radiologist readily available to sit down with the patient, one-on-one, and go over a study to give them a better understanding of what’s going on if necessary. We also notify the patient’s primary care provider of the need for further evaluation and often schedule follow-ups before the patient leaves the imaging suite. We’ve also put the nurse navigator’s office right next to the breast suites. If a patient has a concern, Kelly, our nurse navigator, can immediately start providing the support the patient may need, guiding patients through any diagnostic testing and treatment they may require, and be a resource for any needs the patient might have. Two things I know the Breast Care Team will emphasize at next Friday’s open house are not to let money come between you and your mammogram. There are resources available to help people cover those costs. And we want people to know the nurse navigation services and programs are free to all patients. Even if all a woman needs is someone to talk with, that’s worth its weight in gold.
Marcy Rushford, CRA, MBA, RDMS, RT(R,M) is the Director of the Radiology and Cardiology Unit at Brattleboro Memorial Hospital. She is one of less than 700 radiology administrators in the U.S. to have passed the Certified Radiology Administrator (CRA) exam, which measures skills and expertise in medical imaging management.