From your annual mammogram to diagnosis and beyond, you have an advocate in your breast care journey.
by The Iowa Clinic on Wednesday, October 3, 2018
The dreaded call back. After years of normal mammogram results, you hear that something has changed from past exams and warrants further testing.
"What does that mean?"
"Do I have breast cancer?"
"When will I know for sure?"
The questions and concerns consume your thoughts. But you're not in this alone — you have somewhere to take them. Call your Patient Navigator.
Patient Navigator? Never heard of it.
Part advocate, part care coordinator, part sounding board, Patient Navigators are your go-to source of information for breast health. They guide you through your breast imaging journey, from a routine screening mammogram all the way through scheduling surgery, if necessary.
"The main part of being a navigator is just being a patient liaison," says Megan Gute, Patient Navigator at The Iowa Clinic Medical Imaging Department— a new patient advocacy position for Des Moines area breast cancer patients. "I'm your point of contact after you leave. You have one person to call and talk to instead of randomly getting whoever is available to answer the phone."
While additional research is needed, studies have shown Patient Navigators help improve five-year survival rates for breast cancer patients and resolve barriers to timely care. According to a 2016 study in the Journal of Clinical Oncology, patients who have an advocate working on their behalf are more likely to get treatment within one to two months of breast cancer diagnosis, and more likely to complete recommended breast cancer screenings.
Patient Navigator is a new role in the nationally-accredited comprehensive care program that The Iowa Clinic breast surgeons and radiologists helped build. And it's a new role for Gute.
"I was, and still am, a licensed Mammography and X-ray Technologist. A lot of things I'm doing now used to be done by all the technologists," she says. "My role is to make sure nobody falls through the cracks. The technologists can focus on the patients that are here while I focus on helping the patients who need additional care."
Who needs a Patient Navigator?
Anyone who gets a routine mammogram. The Iowa Clinic recommends annual mammograms for all women over the age of 40 with an average risk of breast cancer and some women under 40 who are considered high risk. All the major professional societies agree that getting a screening mammogram annually starting at age 40 saves the most lives. Screening every other year instead of annually misses or delays diagnosis of 30 percent of breast cancers.
"The point of a screening mammogram is to catch any changes in your breasts as soon as possible. Two years is a long period where you might miss something that could've been caught in the year prior," says Gute. "Unless another health issue would prevent you from obtaining treatment if breast cancer is found, you should keep getting mammograms. That's a common question as well."
6 Common Questions About Mammograms and Breast Imaging
"When can I stop getting mammograms?" is just one of the many questions Gute fields on a daily basis. A breast cancer diagnosis is frightening. Even the need for additional testing brings on anxiety. Gute does her best to ease a patient's mind. When she doesn't have the answer, she consults with a radiologist to get it. These are the most common questions she receives after that first phone call.
1. Is further breast imaging really necessary?
Unfortunately, the answer is yes. Screening mammography looks for changes in breast tissue and anything that looks different. Breast tissue is moveable, so it can look very different from one year to the next.
"Does that necessarily mean there's cancer or something wrong? No, it just means there's a change," says Gute. "Anytime there's a change, we have to bring you back for additional imaging to look at what's different."
2. But I already had a mammogram. Why do I need another one?
The second one is different. You get a routine screening mammogram every year to check out the health of the whole breast. If the radiologist sees an abnormality in that test, he or she will call for a diagnostic mammogram. Those tests zoom in on the specific area of concern to see it in more detail.
"The screening mammogram is just to find the changes. It's a preventative exam and is the same for everyone," says Gute. "The diagnostic mammogram is a more targeted study. If we're calling you back, there is something that we need to investigate further."
3. It's abnormal. But how common is it need a diagnostic mammogram?
"About 10 percent of our screening patients get called back for additional testing. I think that's about the average," says Gute.
While 10 out of every 100 women are called back for further testing, only two will end up with a biopsy. Of the other women, six will be given a benign diagnosis after additional testing and two will get the same diagnosis after a short follow-up course.
Gute also points out that there are times when you will not get a screening mammogram and go straight to a diagnostic mammogram. If you have breast pain, a lump or notice anything abnormal through your own self-exam, you've already identified a problem so a focused exam to address that problem is necessary.
4. What's the difference between a 2D and 3D mammogram?
"The procedure is the same from a patient perspective, but 3D mammograms give the doctor an extra way of looking at things," says Gute.
A conventional 2D mammogram looks at the entire thickness of the breast in a single picture. Sometimes, that results in overlapping breast tissues that falsely look suspicious or even masking a radiologist's ability to see a small cancer.
The 2D version remains the established standard of care, but 3D mammograms provide additional information. They take multiple, sequential pictures through the thickness of the breast, so the radiologist has more information about where potential issues are located and if they warrant concern.
Studies have shown that adding 3D imaging to mammograms increases the cancer detection rate for small, invasive cancers by up to 41 percent. It also decreases the chance you'll be called back for additional imaging to complete the screening mammogram by 15 to 40 percent.
5. Why am I also scheduled for a breast ultrasound?
"A lot of times when we do a diagnostic mammogram, we will also do a breast ultrasound with it," says Gute. "It's another tool and the two complement each other. They both have different ways of looking at things."
Mammograms see differences in density — the white and black on a medical image. Ultrasounds show characteristics of what that density actually is, providing more detail.
The breast ultrasound is not always necessary. But for your convenience, they are always scheduled together — just in case. After reviewing the diagnostic mammogram image, a radiologist will decide whether a breast ultrasound is needed to get more information.
6. When will I hear the results from my mammogram?
As soon as possible. The waiting game is no fun when it comes to critical news about your health. Gute makes every effort to get back to patients with screening mammography results as soon as they're available and get them scheduled for additional imaging if needed. And when you do need a diagnostic mammogram and breast ultrasound, you hear those results the same day.
"Waiting for an appointment is hard, let alone turning around and waiting for results the next day. So you get everything checked while you're here," she says. "Either way, whether you need a breast ultrasound or not, you leave with answers. You get the imaging, the results and a verbal report of what the doctor's thinking while you're in the building."
How can I schedule my mammogram?
Your Patient Navigator can help you schedule your screening and diagnostic mammograms. Gute assists patients by scheduling them at a Medical Imaging location that is most convenient for them, whether that be West Des Moines, Ankeny or downtown Des Moines at Methodist Medical Center.
Mammograms are still the gold standard in early detection of breast cancer — and the only test that’s proven to reduce resulting disability or death. Maintaining your breast health is imperative – call The Iowa Clinic today to schedule your screening mammogram. Patients over the age of 40 do not need a physician referral to schedule.