Transcript breast and cervical cancers

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Educational Series
Routine Breast &
Cervical Screening Post
Cancer Diagnosis
Survivor Presentation
University of Arizona Cancer Center
Selena Llamas
Educational Goals
• Being uninsured or underinsured is no
longer a barrier to receive screening after
treatment
• Annual screening is even more important
after your first cancer diagnosis
Survivorship
Although a breast cancer
diagnosis is very serious and
can cause fear, you are on
your way to complete a test
of wills… the will to survive!!
“If a blade of grass can grow in a
concrete walk and a fig tree in the
side of a mountain cliff, a human
being empowered with an invincible
faith can survive all odds the world
can throw against his tortured
soul.”
–Robert Schuller
The Survivor’s Post
Treatment Surveillance
Surveillance is most important during the first 5 years
after therapy… the risk of recurrence is highest
during this time
The goals of post-treatment surveillance are EARLY
DETECTION and treatment of other curable disease
recurrences and screening for therapy-related
complications.
Survivorship is the Main Priority Post Test ??????
Survivorship is the
MAIN PRIORITY
POST THERAPY
Second Cancers Caused
by Cancer Treatment
Increased risk of developing a new
primary cancer:
ovarian, uterus, lung, colon, rectal cancer
The most common second
cancer
second breast cancer
The risk of second breast cancer
is high regardless of type of treatment
received
Tamoxifen After
Treatment per ACS
• Taking tamoxifen X 5yrs
• Decreases s the probability that the breast
cancer will come back
• Helps to lower the risk of breast cancer in
the opposite breast by ½
• This appears to be true for women who
have been followed for 10 yrs after their
first treatment
• Increases the risk of endometrial cancer in
5-10 yr survivors
• The benefit of Tamoxifen is GREATER
than the secondary risks associates
Breast Cancer Management
& Follow-up
2006 recommendation - Journal of Clinical Oncology
All women: careful history & physical examination
(3-6 months) or first 3 years after primary therapy,
every 6 to 12 months for the next 2 years and
annually
Symptoms of recurrence:
new lumps, bone pain, chest pain, abdominal pain or
persistent headaches
Follow-up:
By a primary care physician (PCP) seems to lead to the
same health outcomes as specialist follow-up with good
patient satisfaction
• If care with PCP: 1 year after diagnosis… patient should
know the follow-up & management strategy
http://jco.ascopubs.org/content/24/31/5091.full#sec-8
Breast & Cervical
Cancer Screening
for
the Uninsured
or Underinsured
What is Well Woman
Healthcheck?
Established in 1993
WWHP: Is the local name for the National
Breast and Cervical Cancer Early
Detection Program in Arizona
Since 1995: Provided over 73,595
mammograms and 40,563 pap tests
What is Well Woman
Healthcheck?
The Goal is to provide low-income,
uninsured and underserved women access
to timely, high quality screening and
diagnostic services to detect breast and
cervical cancers at the earliest stage
What is Well Woman
Healthcheck?
Services Provided by the program include: Clinical
Breast Exam (CBE), Screening and diagnostic
mammography, Pap test, pelvic exam, colposcopy,
biopsy, HPV testing, and case management
WWHP Breast Cancer
Screening Services
1. Clinical Breast Exam (CBE)
CBE is a physical exam of the breast done by a licensed
healthcare professional to look for changes. An annual CBE will be
administered by a provider.
2. Mammography
Mammography is an examination of the breast using an x-ray that
provides an image of the breast tissue
•Screening Mammogram: are done on women who have no
symptoms. The purpose is to screen cancer at an early stage. Two
pictures are taken during a screening mammogram.
•Diagnostic Mammogram & Ultrasound: done on women who
either have a symptom such as a lump or discharge or for a
woman who had an abnormal screening mammogram.
Cervical Cancer Screening
1. Pelvic
Exam & Pap Smear
While a woman lies on an exam table, a
health care professional inserts an
instrument called a speculum into her
vagina to widen it so that the upper
portion of the vagina and the cervix can
be seen. This procedure also allows the
health care professional to take a
sample of cervical cells. In a liquidbased Pap test, cervical cells are
collected with a brush or other
instrument and are placed in a vial of
liquid preservative for laboratory
analysis in one of two ways
Cervical Cancer Screening
It is an essential part of a woman's routine
health care. The main purpose of a Pap
Smear is to detect cancer or abnormalities
that lead to cancer of the cervix. The Pap
test is a screening test, not a diagnostic
test
Cervical Cancer Screening
• As of March 2012, current guidelines for
cervical pathology recommend a Pap
test every 3 years beginning at age 21.
• Women ages 30 to 65 should have HPV
and Pap co-testing every 5 years or a
Pap test alone every 3 years.
• Women with certain risk factors need to
have more frequent screening or
continue screening beyond age 65.
Cervical Cancer Screening
2. HPV Testing
•
Unclear (ASC-US) or abnormal, this indicates that
your cervical cells look like they could be abnormal
•
Human Papilloma Virus is a sexually transmitted
disease
•
Over 100 strands from low to high grades
Primary cause of cervical cancer
Since the results are unclear or abnormal, HPV
testing may be done to rule out if HPV infection is
present on the cervix
3. Colposcopy
• exam table & speculum (to see the cervix)
colposcope used by MD (outside the body)
that has magnifying lenses (like binoculars)
• It lets the doctor see the cervix more
closely and clearly. The doctor will apply a
weak solution of acetic acid (similar to
vinegar) to your cervix to make any
abnormal areas easier to see
Abnormal Area in Cervix
•
•
•
•
•
Biopsy (a small piece of tissue is removed)
The sample is sent to a pathologist
Results: pre-cancer, cancer, or neither
The colposcopy procedure is not painful
Cervical biopsy can cause discomfort,
cramping, or pain in some women
Natural History of HPV/Cervical Cancer
Persistence
Progression
Invasion
Normal Infection
HPV
Pre-cancer
Cancer
Cervix
Infection Regression
Clearance
All types may go away on their own, but there is no way
to predict if the types you may have will go away
Normal Cervix
Low-Grade Dysplasia
(CIN1)
High-Grade Dysplasia
(CIN 2 or 3)
Cervical Cancer
Well Woman Target
Population
• Women 40 years old and older. The
program will provide service to
women younger than 40 if
symptomatic. (history of breast
cancer & breast pain is not
considered a symptom)
•Uninsured or underinsured
•Not AHCCCS eligible
•Fall between 0% and 250% of
federal poverty level
Well Woman Healthcheck
is a Screening Program…
Therefore, if you are a Breast or Cervical
Cancer survivor, your treatment MUST
be complete in order to seek WWHP
screening services
Well Woman Pima County
Provider Sites
I-10
St. Elizabeth’s Clinic
140 W. Speedway
Grant Rd.
Providers Direct
Speedway
2122 N. Craycroft Rd,
Ste 102
I-19
Golf Links
El Rio SE Clinic
Irvington Rd.
N
W
El Pueblo/ El Rio
101 W. Irvington
I-19
Kolb Rd
Theresa Lee
Clinic
332 S. Freeway
Craycroft
Congress
E
I-10
S
How does a woman
become a
Well Woman patient?
Call (520) 628-3591
for screening
By the end of the
call she will:
• Know if she qualifies for the
WWHP
• Receive an appointment
• Or be directed to a Well Woman
satellite office near her
Future WWHP
Questions:
The Pima County WWHP administration staff is happy
to assist you with any and all questions you may have
regarding the WWHP program:
Eligibility, clinical, case management, etc.
Program Coordinator
Victoria Altamirano
(520) 628-3591
WWHP Staff:
• Lilly Thorndal, Case Manager
• Selena Llamas, Program Specialist
• Clementina Daniel, Social Services Aide
Thank you for coming!
Have a great day