Taking mammogram education to our neighborhood streets

In 2014, we made a shocking discovery. While analyzing the data for women who came to our hospital for breast cancer treatment between 2006 and 2011, we found that nearly 22 percent of them had stage 3 or 4 breast cancers—nearly double the national average of 10.5 percent.

Most of these women were African-American, and 54 percent of them lived in the District of Columbia. And of these D.C. residents, 40 percent of them lived in Ward 5, our hospital’s neighborhood. But what baffled us the most was that 97 percent of the Ward 5 patients with advanced breast cancer had health insurance.

This was especially surprising to me because of my work at the Cancer Preventorium, where we see people who have no symptoms for regular physical exams and cancer screenings such as mammograms. About 95 percent of the patients I see are Latino, most of whom are poor and without health insurance. They pay out of pocket for these preventive health visits, but do so because they know how important these screenings are.

So why were so many women who had access to preventive healthcare being diagnosed with advanced breast cancer? With help from a generous grant from the Avon Foundation for Women, we started the Get2Breast CARE (Cancer Awareness & Resource Education in Ward 5) program to find out why and to design an intervention to reverse the trend. In September 2017, we published the results of what we’ve learned so far.

Phase 1: What’s keeping women from getting mammograms?

Before we could do anything, we needed to find out why our female neighbors weren’t getting mammograms, the first line of defense against breast cancer. We sent community navigators out to survey 1,092 women in Ward 5.   

The reasons we discovered included:

  • Fear: Twenty-seven percent of women were afraid of a possible breast cancer diagnosis and the accompanying side effects and costs of treatment.
  • Personal factors: Twenty-eight percent reported that they were too busy taking care of other family members or couldn’t take time off work to get a mammogram.
  • Lack of education: Thirteen percent didn’t understand breast cancer risk factors, didn’t know when they should start getting a mammogram or that they needed them at all, or were unaware that their health insurance would cover them.
  • Access: Seventeen percent said they would be more likely to get a mammogram if it were more convenient, such as being able to go before or after work, on weekends, or if screening was available closer to home.
  • Mammogram misconceptions: The remaining reasons included myths, such as getting a mammogram is painful or that radiation from a mammograms actually could cause cancer.   

Phase 2: Getting the word out about mammograms

Now that we were armed with the knowledge of why women weren’t getting mammograms, we developed educational materials based on that information. And our community navigators headed back out to coordinate outreach activities in the neighborhood. These materials and events focused on dispelling fear and empowering women to overcome personal barriers to receive potentially lifesaving mammograms. 

Our amazing community navigators didn’t all have healthcare backgrounds, but they did have a passion to educate and a deep understanding and insider knowledge of the neighborhood. They knew the best places to reach their female neighbors, such as local businesses, churches and community centers. They also knew who they needed to talk to in order to make the event as successful as possible. For example, if they wanted to reach women from a certain church’s congregation, they knew to talk to the pastor’s wife, not the pastor. 

There’s been some confusion in past years about when and who should get a mammogram. This is due to conflicting guidelines from various health organizations. We urged women in our outreach efforts to follow their doctor’s recommendations based on their unique risk factors. We also shared the American Cancer Society guidelines, which say women at average risk of breast cancer can begin having yearly mammograms at age 40 if they choose, but definitely should begin having them by age 45. At age 55, they can start having mammograms every other year.   

Avon Get2Breast Care Community Navigators (left to right)
Janel Diaz, Lynel S. McFadden and Volunteer Community Navigator Sybil L. Smith

Time for your mammogram? Request an appointment.

The community navigators gave a short survey before and after every educational event to ensure that women were getting the message. We found a 15 percent increase in the participants who believed that “a mammogram is the safest and most effective test available for finding early breast cancer.” Along with the educational events, we offered to schedule mammograms and to help navigate the process if the test yielded suspicious findings.

What’s next: Expanding the program across the city and including other cancers

I’ve seen firsthand the effect education and awareness can have on cancer prevention. I’ve been privileged since 1989 to host a daily one-hour radio broadcast called “El Consultorio Comunitario” (“The Community Clinic of the Air”), which gives disease prevention and health promotion messages on D.C.-area Spanish-language station Radio America WACA 1540AM, Monday through Friday, and via the Internet. The wide reach of this program likely plays a big role in why we see so many of our Latino neighbors at the Cancer Preventorium, despite the fact they may need to pay two-days’ worth of salary for the exam and screening.

The success of our intervention program in Ward 5 left us wanting to expand it further into the city. The Avon Foundation for Women stepped up again, helping to extend the experience to women in Wards 7 and 8. Nearly 70 percent of all women treated with breast cancer at our hospital come from the three wards in which we’re now working. We’re also excited to be talking with the Department of Health in D.C. about adopting our approach and taking it city-wide. And after finding the same disparity (insured people with advanced colorectal cancer) we started a similar approach to tackle colorectal cancer from the neighborhood.

We hope, through these intervention efforts, to see fewer women in D.C. diagnosed with advanced breast cancer in the future. Instead, we want to see more women for regular mammograms to detect breast cancer early, when the disease is easier to treat.

How surgery can improve the lives of patients with lymphedema

There are many options available to patients for treating breast cancer. Unfortunately, a significant portion of patients will face the complication of lymphedema after their treatment. About 20 percent of patients diagnosed with breast cancer will develop lymphedema.

About 20% of patients diagnosed with #breastcancer will develop #lymphedema. via @MedStarWHC

Historically, there hasn’t been much doctors could do for lymphedema. Our treatment options focused on helping people deal with symptoms and adjust to the realities of having this condition, not addressing and eliminating the cause. But we now have surgeries that treat the root cause of lymphedema, not just symptom control.

Lymphedema surgery can open up many possibilities for patients to do things they weren’t able to before. If you want to wear a fancy dress to an event, or if you want to play basketball or a game of tennis, you might not have to wear a compression sleeve anymore.

Dr. David Song discusses lymphedema surgery further on the Medical Intel podcast.

I’m one of the only doctors in Washington, D.C., and the East Coast who offers these advanced surgeries, and I’m happy to talk with patients and their family members about their potential benefits. Request an appointment with me through our secure online form, or contact me at (202) 444-8751 so we can discuss whether lymphedema surgery is right for you.  

What is lymphedema?

Lymphedema is a condition in which lymph accumulates in the body, leading to swelling in the areas where it builds up. Lymph contains white blood cells, which help the body fight infections, as part of the immune system. Lymph vessels carry lymph that drains from the body’s tissues and organs to lymph nodes. Lymph nodes filter lymph and produce more white blood cells.  

There are two kinds of lymphedema: primary lymphedema and secondary lymphedema. Primary lymphedema is a condition people are born with. Patients who have breast cancer may be at risk for secondary lymphedema, which happens when lymph vessels are damaged or blocked because of another condition.  

Treatment for breast cancer may involve the removal of the axillary, or underarm, lymph nodes. Even if these lymph nodes aren’t removed as part of a patient’s breast cancer surgery, they may still be damaged during the procedure. Removed or damaged axillary lymph nodes can keep lymph from draining properly from the arm, which causes the arm to swell.  

Patients who have had any of the following procedures to treat their breast cancer may be at risk for lymphedema if their treatment involved the axillary lymph nodes:

  • Lumpectomy
  • Radiation therapy
  • Simple or radical mastectomy  

If left untreated, lymphedema can lead to bacterial or fungal infections of the skin. Loss of mobility and flexibility in the affected arm are additional risks the condition carries.  

Sometimes the swelling of lymphedema is easy to see. But it’s sometimes more difficult to notice right away. Watch for these lymphedema symptoms if you’ve had breast cancer surgery:

  • Feeling like the arm or hand is too tight, heavy or full
  • Pain or redness in the arm or hand
  • Thickened skin in the arm or hand
  • Tighter fit for shirts, watches or rings

How we treat lymphedema

People who have lymphedema may be able to manage the condition with treatments such as:

  • Compression bandages, pumps or sleeves
  • Physical therapy
  • Special massage techniques  

But if the condition gets worse or doesn’t respond to these treatments, surgery may be a good option.  

In the past, lymphedema surgery was limited to the removal of excess tissue and fluid in the arms. But modern techniques allow us to actually treat a patient’s lymphedema with surgery, rather than just addressing the symptoms. Our microsurgical procedures can help relieve the pain and swelling of lymphedema.

Our microsurgical procedures can help relieve the pain and swelling of #lymphedema. via @MedStarWHC

We offer two forms of lymphedema surgery: lymph node transfer and lymphovenous bypass. Both of these tend to be more helpful and effective for patients who are in the early stages of lymphedema, rather than patients who have had lymphedema for a long time.

Lymph node transfer

In lymph node transfer surgery, we take healthy lymph nodes from another part of the body and transplant them to the area of swelling in a patient with lymphedema. These healthy lymph nodes then can improve the drainage of lymph in the patient’s arm and reduce swelling.

We normally take healthy lymph nodes from a patient’s groin. Our microsurgical techniques mean we only need to make tiny incisions on the hand, as well as an incision on the groin that’s easily hidden by underwear or a bikini.

Patients who live in the Washington, D.C., area stay in the hospital about 23 hours after surgery and go home. If a patient comes in from outside the region, they stay in the hospital for about two days, stay in the area but not in the hospital for a week, and then go home for care from their regular doctor.

Lymphovenous bypass

In lymphovenous bypass surgery, we lower lymph buildup and pressure by connecting blocked lymph vessels to nearby veins. This lets lymph drain away from the swollen arm to reduce swelling.

This is an outpatient procedure, meaning patients can have the surgery and go home the same day. Lymphovenous bypass only requires tiny incisions and involves very little blood loss.

Achieving goals for treating lymphedema

Before I came to MedStar Health, I was chief of plastic surgery and associate dean at the University of Chicago, where I built a lymphedema surgery program from scratch. When I left, that program was the busiest in the country for the surgical treatment of lymphedema. I plan to do the same at MedStar Washington Hospital Center and MedStar Georgetown University Hospital.

Our main focus is on how we can help our patients achieve their goals. Curing lymphedema is, I think, at the top of the list for every patient with lymphedema, and these surgeries can do that. But even if we can’t cure it completely in some cases, we can dramatically improve patients’ quality of life and help them manage the condition better.

Treating patients for lymphedema is one of the most rewarding things I do as a surgeon. I love getting to help my patients reduce or even eliminate painful swelling and improve their mobility. And I love seeing the nearly immediate positive benefits these surgeries can have on my patients’ lives. I’m hopeful that we’ll be able to help more patients enjoy life without the pain and discomfort of lymphedema.

Celebrated Physician: Brooke M. Wolvin, MD

Brooke Wolvin, MD, an attending physician for MedStar Medical Group Radiology, also serves as assistant director of MedStar Washington Hospital Center’s Breast Imaging Center, and director of Breast MRI.

That may seem like a long title, but it’s illustrative of imaging technology’s critical role in breast health. And it’s a field well-suited to Dr. Wolvin’s personal and professional interests. The Potomac, Md., native earned her medical degree at New York Medical College, followed by a radiology residency at New York Presbyterian Hospital-Weil Cornell campus. She then completed a breast imaging fellowship at Memorial Sloan Kettering Cancer Center before returning “home” to the Hospital Center in 2008.

Why Radiology?

“I chose radiology because you get to deal with a wide variety of patients,” Dr. Wolvin says. “Breast imaging is a particularly interesting niche, as it also involves a lot of patient interaction. It starts with the mammogram—still the best way to initially detect a potential breast health issue—and continues across a variety of tools to treat patients who need extra care.”

Among those valuable technologies is 3D imaging, also called tomography, which Dr. Wolvin calls “the greatest innovation in past 20 years.” She likens tomography to a CAT scan of the breast, allowing physicians to scroll through each layer of a scan to spot even the tiniest hint of a tumor or other condition.

“Along with increasing the cancer detection rate, tomography also lowers the number of patients who need to be called back for additional tests,” adds Dr. Wolvin, who has been instrumental in implementing tomography across MedStar. “It’s wonderful that we’ve been able to bring this capability to so many of our breast imaging centers.

Yet another of Dr. Wolvin’s responsibilities is serving as assistant medical director of Radiology at the new MedStar Health at Lafayette Centre in downtown Washington, D.C. There, she says, “we work with a different set of patients and issues, which enhances both our experience and the quality of our services.”

Outside the Hospital

What gives Dr. Wolvin the greatest sense of pride is setting a positive example for her two children, ages 4 and 18 months.

“My mother was a full-time professor, and proved to me that a working Mom can successfully balance work and family,” she explains. “I want my kids to have the same sense of possibility I did.”

Improving Breast Health: One Ward at a Time

Screening tests are a powerful weapon in the fight against breast cancer. Mammography is a breast cancer screening tool used to help doctors pinpoint when a change has occurred in a woman’s breast. In spite of these benefits, and in spite of having health insurance, too many women in Washington, D.C. are forgoing their annual mammograms out of fear. For the last two years, breast health navigators at MedStar Washington Hospital Center have been working passionately to reverse the trend. After first focusing on women in the District’s Ward 5 neighborhood, the hospital’s Get2Breast CARE program is expanding across the city into Wards 7 and 8, thanks to a generous $100,000 grant from the AVON Breast Cancer Crusade.

“Early detection and early treatment of breast cancer increases the chance of survival,” said Elmer Huerta, MD, MPH, director of the Cancer Preventorium at the Washington Cancer Institute at MedStar Washington Hospital Center. “It is shocking to see that 97 percent of women with advanced breast cancer treated at the Hospital Center have health insurance. This validates the need to offer breast health education in the community.”

Research led to a Successful Partnership

During Phase I of the program, as part of the Get2Breast CARE (Cancer Awareness & Resource Education in Ward 5) program, which was funded by the Avon Foundation for Women, breast health navigators surveyed 1,091 women over the course of a year, to find out what they know about breast cancer and breast cancer services and to know why they were postponing their mammograms in spite of having health insurance. Of the 1,336 personal opinions that were analyzed from the 31-question survey, 22.7 percent noted fear and 23.5 percent noted personal factors as reasons for delaying or skipping routine mammograms, the first line of defense to look for early signs of breast cancer. In their opinions, many respondents indicated fear of cancer, treatment, receiving bad news and abandonment, as well as personal reasons such as a busy lifestyle, no time to see a doctor, laziness and lack of preventative health education in their answers.

During Phase II of the study, also funded by the Avon Foundation, women told us that having more access to mammography facilities and more educational programs were important factors to increase the number of women getting checked.

Those successful outreach efforts have led the Avon Breast Cancer Crusade to award the Washington Cancer Institute another grant for the third year in a row, to provide more education, screening and patient navigation services to women not only in Ward 5, but also in Wards 7 and 8. The team will host educational events, mammography services and follow up care, if needed.

“Empowering women with life-changing knowledge about prevention, and teaching them how to use their health insurance coverage will make a difference,” added Dr. Huerta.

Have any questions?

For more information, please call 202-525-9281.

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A Breast Cancer Diagnosis: It Takes Your Breath Away

Breast Cancer Can Affect Anyone 

My name is Heidi Kirby. (Photo L to R:  Dr. Sandra Swain, former medical director of Washington Cancer Institute and current Associate Dean for Research Development at Georgetown University Medical Center and Heidi)  I am young. I am healthy. I have no family history of breast cancer, yet, somehow I found myself with the phone against my ear, being told that's what I had. For anyone touched by this disease, you know how powerless you can feel.  For anyone being told they have cancer, it takes your breath away.

My story is nothing special.  In fact, my story happens every day and can happen to anyone at any age. When I first felt something different in 2014, I was preparing to run in the annual Race to Beat Cancer 5K, sponsored by my former employer, The Four Seasons Hotel Washington, D.C. All the proceeds benefit cancer research at MedStar Washington Hospital Center. I was focused on the run, therefore not that concerned. But when I was diagnosed with breast cancer in October of that year, I went from denial to anger and back to denial over and over. During this stressful period, I reached out to my close work family, and because of their long-standing relationship with the Washington Cancer Institute at MedStar Washington Hospital Center, I was put in touch with an oncologist so that I could start treatment right away. The wonderful doctors and medical professionals were determined to make me well. I'm happy to say that I am now cancer free and I know that my risk of recurrence is low.

Advances in Breast Cancer Treatment

I'm constantly amazed by the advances in cancer research, science and technology. I recently learned the Washington Cancer Institute at the Hospital Center offers intraoperative radiation therapy for a select group of breast cancer patients with small tumors, in which a single dose of radiation is delivered after lumpectomy, as opposed to standard radiation treatment over several weeks. In addition, physicians are studying chemotherapy–free options for metastatic breast cancer patients. Progress like this is possible thanks in large part to public and private donations.

I never imagined having to ask so many people to help me.  I never thought I would celebrate a genetic test result. Of course, I never thought I would need a genetic test at all. The simple part of my story is this: I'm going to live and love longer because so many people who I’ll never meet selflessly gave their time and resources - to beat this disease.

Contribute to Breast Cancer Research

I will continue to support the annual Race to Beat Cancer 5K, and the ongoing fundraising efforts of  the wonderful volunteers and donors who support cancer research at the Washington Cancer Institute at MedStar Washington Hospital Center. I urge everyone to sign up for this year’s race.  There’s also the annual Drive Four the Cure Golf Classic at TPC Potomac at Avenel Farm, which is another opportunity to support the Washington Cancer Institute's cause. Together, we must continue to fight this disease so that we give friends, family, colleagues and many others the same opportunity! 

 

Have any questions?

We are here to help! If you have any questions about the Washington Cancer Institute or cancer treatments at MedStar Washington Hospital Center Call us at 202-877-3627.

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Avon Foundation Grant Allows for Breast Health Services in Ward 5

Too Many DC Women Diagnosed with Late-stage Breast Cancer

Screening tests can be a powerful weapon in the fight against breast cancer. Mammography is a breast cancer screening tool used to help doctors pinpoint when a change has occurred in a woman’s breast. In spite of these benefits, too many women in the Ward 5 neighborhood of Washington, D.C. are forgoing their annual breast cancer mammograms out of fear. It’s not just fear, according to our MedStar Washington Hospital Center researchers, but also personal factors such as having a busy lifestyle and putting other relatives’ health before their own are other reasons why women in the District’s Ward 5 are diagnosed with late-stage breast cancer, in spite of having health insurance.

The finding is based on an assessment of personal opinions from mostly African-American women who live in Ward 5. Over the course of a year, breast health navigators from the Washington Cancer Institute canvassed the community, in order to learn why insured women from Ward 5 come to the hospital’s Washington Cancer Institute for treatment with advanced breast cancer, data previously reported by the hospital.

A Partnership to Save Lives

The navigators surveyed 1,091 women to find out what they know about breast cancer and breast cancer services, as part of the Get2Breast CARE (Cancer Awareness & Resource Education in Ward 5) program, which is funded by a grant from the Avon Foundation for Women. Of the 1,336 personal opinions that were analyzed from the 31-question survey, 22.7 percent noted fear and 23.5 percent noted personal factors as reasons for delaying or skipping routine mammograms, the first line of defense to look for early signs of breast cancer. In their opinions, many respondents indicated fear of cancer, treatment, receiving bad news and abandonment, as well as personal reasons such as a busy lifestyle, no time to see a doctor, laziness and lack of preventative health education in their answers.

With this knowledge in hand, breast health navigators are continuing their outreach activities with events in the community. In addition to educating women on the importance of early detection, four breast health navigators will offer follow-up care to women who are found to have suspicious findings after obtaining a screening mammogram. The navigators will also work to ensure timely treatment is offered to the women, if necessary. This is the second year that Avon has provided a $100,000 grant to fund the GET2Breast CARE program.

Bringing CARE to the Community

Early detection of Breast Cancer begins with YOU! Gain life-changing knowledge about breast cancer prevention and learn about navigation services provided by breast health educators. Meet with navigators from the Washington Cancer Institute's Get2Breast CARE program. The next event will be Saturday, February 27th from 12-5 pm at Old Engine 12 Restaurant, 1626 North Capitol St, NW. Admission is free. Participants will enjoy food and prizes, and free navigation services will be offered.  

For more information about our outreach in the community please click here.

Have any questions?

For more information about the GET2Breast CARE program or RSVP for the next event,call us at 202-515-9281.

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