Breast Cancer Awareness Series: October 2022

Breast Cancer Awareness: The importance of monthly self-checks

The month of October is Breast Cancer Awareness Month and while it's a great time to shine a light on the women who are fighting, have fought, and who have lost the battle to breast cancer, it's also a time to highlight the importance of prevention.
​
Katie Couric is a familiar face to many. She woke Americans up every morning on NBC's TODAY Show from 1991 to 2996, became the first woman to anchor the CBS Evening News in 2006, and has been a longtime advocate for cancer research after losing her first husband to colon cancer. On September 28th, 2022, Couric announced her own health battle, with breast cancer.

"It was June 20th and because of the pandemic, I was 6 months overdue for a mammogram." Couric was just like many other women across the U.S. and put off her yearly mammogram. When she went in for her appointment in June, she took the camera with her to document the journey, much like she did in 2000 when she got a colonoscopy on the TODAY Show. But that appointment quickly took a turn when doctors found a concerning spot on her mammogram and ultrasound.

"I had a wire put in my boob, which is basically providing guidance for the surgeon because I have a little lump situation," Couric said in the video she posted on her Instagram page sharing she had been diagnosed with HR-positive, Her2neu-negative breast cancer on June 21st.

Women over the age of 40 are encouraged to get a yearly mammogram and because of COVID, many have put off this lifesaving screening, and for some, they haven't had a mammogram since the start of the pandemic. This is why medical providers are highlighting the importance of monthly self-checks at home.

"You're going to know before anybody else." Jeanne Rasmussen is an ARNP with UnityPoint Clinics and says these monthly self-checks can be quick and easy, and the first sign that something could be wrong.

"Boobs are like bags of rice and you're looking for a pee in there," she said of the checks It's also important to remember that breast tissue can be located up into the armpit.

It isn't just adults who should be doing self-checks, but teens as well, because getting familiar with your body and its ebbs and flows are an important part of your health.

"As soon as you start getting your period you're going to have breast changes or hormones. Even when you're pregnant. All of those things stress can cause changes," Rasmussen said. "And just to be aware of those and if you find something, that's concerning them to let us know."

Dr. Adnon Qualbani is a radiologist at MercyOne's Breast Care Clinic and says spending a few minutes on each side is all it takes.

"I think it's important to conduct the self-exams kind of the right way. Check up into your axilla as well. Some women have accessory breast tissue that hides up there," he said. "You want to move a motion from the outside and in toward the nipple, kind of like spokes on a wheel."

"We always check for any dimpling of the skin, like if it looks like an orange peel. That's something that you want to let your doctor know about," Rasmussen said. "If you have any redness, any soreness, any pain."

The best time to do these self-checks is 7-10 days into your menstrual cycle.

"If you check your breasts before you have your cycle, you're going to feel a lot more lumps and pain and so forth," said Dr. Qualbani. "If you do it a day seven to day 10, meaning the day your period starts you call that day 1, seven to 10 days out there's a window where your breasts are the most sort of calm and less lumpy, less painful. That's the right time to check."

Dr. Qualbani says if you find something unusual during these monthly checks, it is perfectly okay to wait a month to see if anything changes before you call your doctor.

If you do feel something it's perfectly okay to wait one menstrual cycle and then check again and see if it changes," he said. "If you check it every day or every week you'll go nuts wondering if that thing is real or is it changing?"

As for when a woman should start getting yearly mammograms, the recommended age is once you turn 40, but there are some stipulations. If there is a history of breast cancer in your immediate family, like a mother or sister, yearly mammograms should begin 10 prior to their diagnosis age. So if your mother was diagnosed at age 42, you'd begin yearly screenings at age 32.

At the end of the day, these medical providers say, you know your body best. If you feel something is wrong or concerning, call your primary care provider and get it checked out.

​SEE THE VIDEO

---

Breast Cancer Awareness: A Siouxland woman's journey from mammography tech to patient

"I came in happy-go-lucky to see my own colleagues and have plans to have lunch with them and left thinking what's going to happen next?"

Andrea Roost turned 40 in January. in May.. she returned to MercyOne's Breast Care Center where she worked as a mammography tech for 12 years to get her first mammogram. It would also happen to be the last routine mammogram that she'd need.

Roost was diagnosed with breast cancer on May 5th. She did everything she was supposed to: self-examinations, conversations with her primary care doctor, and a mammogram at 40. Nothing led her to believe breast cancer was in her future until it was.

"I am the reason this is why we start screening at 40," she said, "because the cancer that I have would have killed me if I would have waited until 45. Or even 50."

Roost is grateful to have the team at MercyOne's Breast Care Center next to her through this journey, something these women do for all who walk through their doors, and a team she was part of for more than a decade.

"The heart behind every staff member in this office is 100% pure," she said. "They understand what these patients are going through. And they kind of change and flow with that patient with their needs."

For women needing a mammogram, the fear and anxiety of what the scans may show is real and something those in the breast cancer community calls scanxiety.

"It's in reference to the anxiety that you have before, during and after your scans, whether it's you know, engaging in chemo response or your follow-up," Roost said. "I think that's really relevant in the screening and diagnostic world as well. I counseled people on this when I was an active technologist."

Once holding the hand of those coming to the clinic, she is now leaning on her former colleagues to guide her through her own journey with breast cancer.

"It's okay to be scared. That's why we're here is to get you through that to talk you through that," Roost said. "The unknown is scary, but ignorance is worse. That's the best way I can put it."

Roost's cancer journey is just beginning but she hopes that sharing her story can shine a light on the importance of breast care.

"I still have a rough road ahead of me. I've finished chemo. I've had one surgery to remove the tumor and my lymph nodes. I still have a bilateral full mastectomy to do. So it's the worst is yet to come," she explained. "But I'll be looking back on this in a year and be smiling in here to continue to tell my journey."
SEE THE VIDEO

---

Breast Cancer Awareness: Breast Care Coordinators bring unique care to Midlands clinic

Receiving the news that you have breast cancer is shocking leaving most wondering, what do I do next? At Midlands Clinic in Dakota Dunes, they have a pair of dedicated women whose job is to help women through their breast cancer journey.
​
"I would say the unique part about our offices, the coordinators, and the role they play in navigating care for those women from start to finish," said Dr. Craig Nemechek, a general surgeon at Midlands Clinic.

"We just help patients navigate through their journey," Nicole Trudeau is one of the Breast Care Coordinators at Midlands Clinic. She and Sophia Summervold play a key role in helping women navigate their new reality.

"We basically start the process of getting them post-diagnosis, getting everything lined up so that they can go through the next process or next part of the process," said Summervold. "They have so many different doctors that they're seeing. They don't know who to call, what do I do next? Who do I call? What's the next step? So we kind of take that and we do all of that in the background so that they don't have to worry about that."

They help women through the emotional journey the diagnosis brings, too.

"It's a big diagnosis, people are overwhelmed," Trudeau said. "It's a lot of terminologies that they don't know. It's a lot of tests that they've never had done before."

Trudeau and Summervold carry a cell phone, one that their breast cancer patients have a direct line to. "They can call a direct number instead of kind of going through the rigmarole of going through the office. So they can call us directly or text so we can talk to them directly and answer their specific questions," said Trudeau.

"Women are very different in how they react to that news," said Nemechek about the diagnosis, "and I think the nice part is that with our coordinators, they've seen all types of different reactions and they know very well how to handle those emotions."

"Everybody's breast cancer is completely different. So it's hard because some people know so and so who had it but they can't always rely on what that person had because it's very different for everybody," said Summervold.

"I just think it's important for people in Siouxland to know that there is a strong support system at many of our medical facilities dealing with breast cancer, not only as their physician but there's also other support staff who can help everyone through their journey," said Trudeau.

And for the month of October, their biggest message is this.

"Do your monthly screenings no matter what age you are," said Summervold, "and then also working with your primary care doctor to make sure you're getting your screenings is super important. Because the sooner that you can get that diagnosis, the sooner you can kind of get through it."

SEE THE VIDEO

---

Breast Cancer Awareness: June E. Nylen Cancer Center at forefront of treatment advancement

The treatment for breast cancer has changed a lot over the years, and a Sioux City medical center has played a key role in that development.
​
"We have actually been involved in trials that have actually changed how we treat breast cancer patients," Dr. Donald Wender, a physician at the June E. Nylen Cancer Center in Downtown Sioux City, has been one of the doctors on the leading edge of those advancements.

"There's a study looking at a test that who we should give chemotherapy or who doesn't need chemotherapy," said Dr. Wender. There's been a shift in treating certain types of breast cancer which have also led to a common misconception. "We're using less chemotherapy after surgery, so a lot of people think they are going to get chemotherapy and they don't."

Instead, thanks to clinical trials and medical advancements over the last several years, many types of breast cancers are being treated with more immunotherapies and fewer chemotherapies."

"And in the most recent advance in there as with immunotherapy," said Dr. Wender, "we know that there's with chemotherapy and immunotherapy we can get another a lot of them to get a complete response with chemotherapy before surgery."

Dr. Wender has been working with breast cancer patients throughout his career and involved in some major advancements in breast care. In fact, the way we standardly treat breast cancer patients we were involved in most of those trials.

According to the State Health Registry of Iowa, over 14% of all new cancer diagnoses in Iowa this year are projected to be breast cancer, the largest percentage for any type of cancer statewide. Sioux City is the lowest metropolitan area in Iowa with women age 40 and up who have skipped getting a yearly mammogram. And looking at data from a 12-year study from 2004 to 2015, the risk of developing late-stage breast cancer is higher in the Sioux City area compared to the 12-year state average. Which is why these new therapies and clinical trials are important.

The June E Nylen Cancer Center has played a big part in the advancement of breast cancer treatment and while there aren't as many clinical trials as in the past, Dr. Wender says the ones that are available, are working to answer the even harder questions.

"There are not as many trials but there are a bunch of trials looking at new approaches. And then, of course, we try to add immunotherapy," Dr. Wender said. "The clinical trials have slowed down. Before we had a lot of big questions that needed answered, you know, do you give chemotherapy, what chemotherapy do you give? Now we're trying to refine them down to new agents looking at things in metastatic disease."

The treatment for breast cancer has come a long way and the standard of care is constantly evolving. Thanks to the dedicated work of physicians like Dr. Wender and the team at the June E. Nylen Cancer Center.

SEE THE VIDEO

---

Breast Cancer Awareness: Breast cancer doesn't end when the pink ribbons come down

As the month of October of comes to an end and the pink ribbons come down, it's a good moment to remember what they stand for: our mothers, daughters, sisters and friends fighting breast cancer.
​
"I also think it's a good month to remember the women that have done that had been through a battle with breast cancer or other breast ailment or disease and kind of remember those women as well and what they've gone through," said general surgeon, Dr. Craig Nemechek with Midlands Clinic.
Siouxland has a vast array of resources for women from breast cancer prevention to treatment to post-cancer care.

"I just think it's important for people in Siouxland to know that there is a strong support system at many of our medical facilities dealing with breast cancer," said Nicole Trudeau, a breast care coordinator at Midlands Clinic, "not only as their physicians, but there's also other support staff who can help everyone through their journey."

"We try to provide support, we try to answer questions as best we can. We try to give women a path, some knowledge that tries to ease their concerns," said Dr. Nemechek. "We can't obviously answer every question, but I think and I hope that women after that first visit have a better bit better understanding of what they're going to go through and what they can expect, and hopefully that can ease their mind."

One of the biggest pushes during the month of October is the importance of yearly mammograms for women beginning at age 40, or for some, sooner.

"Typically we start at age 40 unless there's a first-degree relative, that would be like your mother or sister," said Jeanne Rasmussen, an ARNP with UnityPoint Clinics. "And they begin having their (yearly mammogram) done 10 years prior to when they had breast cancer. So if Mom was 42 when she got diagnosed, at age 32 you would start getting screening mammograms."

Many women skip their yearly mammograms, and that is especially true after the COVID-19 pandemic.

"Some people, I think just kind of put it off because they're scared, but I think it's important to kind of face that fear because not everybody ends up having breast cancer," said Sophie Summervold, another breast care coordinator at Midlands Clinic, "but if you have a lump or a bump, it's important to address that with your primary care doctor or ask for that referral. Kind of be your own advocate to move on to the next step to see if you do need to be concerned."

There is also one piece of preventative care women of all ages can do right at home each month: self-checks.

"Get to know what your breast feels like, what your normal lumpiness feels like, what your cyclical changes feel like, and then you'll know if there's a change therein," said Dr. Adnan Qualbani, a radiologist at MercyOne's Breast Care Center. "There are all these things available for dealing with lumps that are even benign and sometimes just even getting a benign lump assessed to see what it is and then you know it's benign. It doesn't have to always be a suspicious lump you want to be checked, anything that bothers you is worth getting checked."

And if you feel something concerning it never hurts to get it checked out.

​SEE THE VIDEO