Shiny Pink Van Brings Priceless 'Gift' to Busy Working Women

Story by Rae Miller

Whether a company is big or small, in the boonies or in the heart of the city, the shiny pink van will come. It may not come with a ribbon on top, but it should, because the gift it brings to women is priceless.

After all, when breast cancer is detected early, the survival rate is 98 percent. Yet studies show that up to 30 percent of insured women put off their annual mammograms, because they simply feel too busy. So why not bring mammograms to them?

The Rose Mobile Mammography Program covers an 11-county area: Austin, Brazoria, Brazos, Chambers, Fort Bend, Galveston, Harris, Liberty, Matagorda, Montgomery and Waller.

Last year, The Rose vans visited 82 companies, including Randalls, Continental Airlines, Halliburton, American National, and Shell FCU. That's in addition to several churches and schools.

Most companies have insurance plans that cover the cost of mammograms for employees and spouses, making it a win-win situation – because every time a woman who has insurance gets her mammogram at The Rose – whether mobile or on-site – it covers the cost of a mammogram for a woman who does not.

There are other mobile mammogram programs out there, but The Rose is a little different. The mammograms do not take place in a vehicle.

"A lot of them will go to the van first, knock on the door, then find out we're in the building," said Angie Weems, supervisor of The Rose Mobile Mammography Program.

The team sets up on site at the location, so it feels more like a doctor's office. Weems said they visit the site ahead of time to make sure certain criteria are met. Each site must have a wheelchair ramp for loading and unloading equipment, parking for the van and patients, a private screening room of at least 9-feet by 9-feet, wide hallways for maneuvering equipment, an elevator if the screenings are not taking place on the first floor, and three grounded outlets per room.

Once everything is clear, Sophie enters the building. "She has wheels and a little motor," Weems said. "Everywhere the van goes, she goes." The Rose has three mobile "Planmed Sophie Classic" units, each one inspected yearly and fully maintained to provide high-quality breast imaging. Weems said the team remains on-site for the day, or even up to one week, depending on how many women have scheduled mammograms. Each mammogram takes approximately 15 minutes, Weems said, so they can do a maximum of 25 to 30 a day.

Women receive two images of each breast – one from the top and one from the side - which is exactly the same as an in-office visit. The film is read by a radiologist back at The Rose.

"We can't tell when we read a mammogram if it's from the mobile unit or from down the hall," said Dr. Ward Parsons, The Rose clinical breast imager. "Everything is done exactly the same way. The only difference is that instead of you coming to us, we come to you."

Women will receive a letter in the mail letting her know her exam was normal, or suggesting further testing with her physician. Mobile mammograms are not for everyone. Women who are under the age of 35, have breast implants, a diagnosis of breast cancer within the last two years, or have been breastfeeding within the last three months are not eligible for the mobile program.

But they can still make an appointment for a mammogram at one of The Rose's two mammography centers, The Rose Southeast at 12700 N. Featherwood in Houston, and the new Rose Galleria at 5420 West Loop South in Bellaire.

When the mobile mammogram program launched in 2006, it had one van, one technologist and one coordinator. Now they've got two vans, four technologists and six coordinators. "We needed it," Weems said. "As word got out, more people wanted us, and we were booking up really fast."

The vans are sponsored by Susan G. Komen for the Cure, Pink Ribbons Project and Randalls. The organization is seeking a corporate sponsor for a third van.
Last year, more than 6,200 women had mobile mammograms through The Rose.

As the program continues to grow, plans are underway to expand coverage to additional counties, including Walker, said The Rose Technical Director Amy Rigsby.

Anything that gets women to schedule and keep their mammogram appointments is welcome to The Rose. "Providing mobile mammograms sometimes means the difference between not getting a mammogram and getting a mammogram," Parsons said. "That to us is the most important thing."

To schedule an appointment for mobile screening, call 281-464-5138 or email aweems@therose.org. To schedule an on-site mammogram at either of The Rose's two locations, call 281-484-4708 or visit www.the-rose.org.

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Young Woman Thought It Could Never Happen to Her

By Rae Miller

Nothing makes time stand still like finding a lump in your breast.
Even though you're frozen, your fingers are still pushing, prodding, palpating.
But you're young. You're busy. It's probably nothing you tell yourself.
So you wait.

"I found a lump, and I didn't deal with it," said Spring Branch resident Melissa Strong, 29. "I waited a whole year. And then found out I had cancer." Not only did Strong, who is the mother of a four-year-old boy, think she was too young to have breast cancer, she thought she was too young for a mammogram.

According to The Rose, a Houston nonprofit organization that provides screening, diagnosis and access to treatment regardless of a patient's ability to pay, you might be too young for a mammogram, but you're not too young for breast cancer.

That's why The Rose established the Young Women's Clinic, specifically for females 35 and younger. According to the American Cancer Society, there are more than 250,000 women living in the United States who were diagnosed with breast cancer at age 40 or younger. Next year, 10,000 more will be diagnosed.

Last year, of the 335 women The Rose diagnosed with breast cancer, 37 were under the age of 40. Of those, 34 had no insurance. Strong was one of them. Her physician referred her to The Rose – a perfect fit because that's where Strong met Dr. Janet Hoagland, who believes "if we save the mother, we save the family."

Hoagland said patients need a physician's referral before coming to the Young Women's Clinic, but if she does not have a primary care physician, The Rose has a network of physicians who will provide a referral at little cost. "Most young women are uninsured," Hoagland said. "Young people figure they don't need insurance yet. So even if they have the ability to insure themselves, they often don't."

Once at the Young Women's Clinic, the patient receives a clinical breast exam and an ultrasound. Hoagland said ultrasound is a better screening tool for younger breasts, which due to density can cause a mammogram to look like "a snowstorm," not providing enough detail.

But that's not to say a mammogram won't be ordered. Strong had an ultrasound and a mammogram, both on the same day. "My rule of thumb is that the breast is mature after the first full pregnancy," Hoagland said. "We do a mammogram if the patient fits into that category, or is over the age of 30 or has family history."

Strong's grandmother died of breast cancer. "Family history is a big, red flag," Hoagland said. "A red flag cannot be ignored." Yet almost 80 percent of breast cancer occurs in women who do not have any genetic factors. If it's cancer, Hoagland puts her uninsured patient in the care of a Patient Navigator at The Rose.

"Some doctors will tell you 'yeah you have cancer, figure it out yourself,'" Strong said. "The Rose, they don't do that. I didn't have to get in that long line to get Medicaid and get denied 300 times. And I didn't have to wait 500 years to get in to M.D. Anderson. It was very soothing and eased my mind a lot."

Strong underwent six months of chemotherapy, followed by a double mastectomy, because she tested positive for the BRCA 2 cancer gene and also underwent radiation. "I think if I had gone when I first felt the lump, it still would have been small enough that I wouldn't have needed radiation," Strong said. "Not to get on my soapbox or anything, but if you feel something, go to your doctor. If the doctor brushes you off, go to another doctor."

Hoagland couldn't agree more. "The woman knows her own breast the best," Hoagland said. "If she says something is different, it's different."

But different doesn't necessarily mean cancer. Ultrasound will show whether a lump is solid or filled with fluid. If it's fluid-filled, it's generally a cyst, which will collapse the moment Hoagland aspirates it with a thin needle. Hard nodules that stick around might be fibroadenomas, a type of noncancerous tumor that is quite common in young women.

"Some women are just fibroadenoma-makers," Hoagland said. "If the fibroadenoma is less than three centimeters, and there are no other risk factors, we follow them every six months for two years to make sure it's not growing. You have them your whole life unless they are surgically removed."

Breast tissue changes that are cyclical, meaning lumps and bumps that come and go on a monthly basis, can often be treated by limiting caffeine intake. Hoagland always enjoys the opportunity to educate young women about breast health.
"There are no silly questions; there are no stupid questions," Hoagland said. "We don't treat people like hypochondriacs.
"While we don't know how to prevent breast cancer, we do know how to detect it early. And women who are proactive are the women who do better."

The Young Women's Clinic is open from noon to 4 p.m. weekdays at The Rose Galleria, 5420 West Loop South, Suite 3300, Bellaire; and from noon to 3 p.m. every Friday and every other Thursday at The Rose Southeast, 12700 N. Featherwood, Suite 260 in Houston.

For more information, call 281-484-4708 or visit The Rose website, www.the-rose.org.

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Beauty and the Breast: Evaluation of the Younger Woman

by Janet Hoagland, MD

As a young woman , have you ever been told that your breasts were "lumpy" or that you had "fibrocystic disease" making your clinical exam difficult? Evaluation of the younger breast may be sometimes difficult due to the fact that younger breasts have more dense glandular tissue. Glandular tissue may produce "cyclical" lumps, that is lobules of breast tissue which may be stimulated by higher levels of estrogen and progesterone at different times in the menstrual cycle. Sometimes these lumps are tender. We do know that the best time to examine your breasts is the week after your cycle ends, not the week before it starts. You want to check your breasts when they are the least tender and the least lumpy. Awareness about your own breasts and how they feel is one of the best guides for deciding what is normal for you.

Occasionally, you or your doctor may feel tissue that feels like a lump but really is normal glandular tissue. It could be a prominent breast lobule, or a fat lobule. We certainly have to rule out "real" lumps, like cysts, benign tumors (fibroadenomas,) and cancers. A cyst may feel compressible, that is it may flatten out or feel soft. A solid benign tumor, like a fibroadenomas, may be firmer and mobile. Cancer usually will be thick, immobile and/or hard, although not always. Cancer in a young woman sometimes grows quickly and has pushing margins, so it can feel like a fibroadenoma in shape, texture and movement.

Breast pain can be cyclical or noncyclical. Breast pain in both breasts is a common complaint and is usually related to the timing of the menstrual cycle. This is called cyclical breast pain. Occasionally the pain will be located only in one spot in one breast. This is called focal breast pain. In general, the remedy for most breast pain is to give up the coffee, soda, tea, including green tea and chocolate (oh no!) for 3 months. It could certainly be the fault of being large breasted or even the way your underwire bra fits. We always have to rule out the presence of a cyst (a fluid filled blind milk duct) as the reason for pain. If a cyst is large, inflamed and/or painful, a cyst aspiration with a skinny needle will drain the cyst so it collapses and the walls stick together so it doesn't come back! If the fluid is yellow or green, we just throw it away. If the wall of the cyst was irregular or there is blood in the fluid, we can send it to the lab for evaluation. Some fibroadenomas, benign tumors of young women, can also be painful. It is a myth that breast cancer doesn't hurt. Breast cancer in young women can be associated with tenderness or discomfort.

The tools are very limited when it comes to the evaluation of the younger woman's breasts. Mammography uses low energy radiation to evaluate breast architecture. Mammograms are extremely useful in the older post reproductive fatty replaced breast because the x-rays can easily penetrate the fatty tissues, exposing the outlines of any remaining glandular tissue or abnormal "lump" in the breast. However most, not all, young women have dense breasts. Mammography does not penetrate dense tissue well and the dense tissue may hide any lesions in the breast. Although radiation exposure is small , the equivalent of flying from NY to Los Angeles while sitting in the window seat of an airplane, it is felt that younger immature tissue is more susceptible to genetic injury from the radiation. We know that the breast tissue does not completely mature until a woman goes through a full term pregnancy. These reasons, in addition to the lower incidence of breast cancer in younger women, is why the American College of Radiology recommends Screening Mammography begin at age 40. If a young woman under the age of 40 requires a mammogram, it must be for a very good reason and then it is called a Diagnostic Mammogram. I personally feel that age recommendations are in general arbitrary, and that the need for mammographic evaluation should be decided on an individual basis, based on risk factors, reproductive or prior birth history, clinical breast exam and the specific nature of the problem (i.e. pain, nodularity, mass, etc).

Sonography or ultrasound is utilized to evaluate dense breast tissue in that it uses sound (sonar) to differentiate between different densities in the breast. For example: the fluid in a cyst has a different density than the wall of the cyst. This allows us to tell whether the wall is smooth or irregular. Some cystic fluid may have oil, or fat or debris or thick fluid floating within the cyst, and this will also show up as a different densities on ultrasound. Solid benign tumors, such as fibroadenomas, appear as dense solid masses, some with gentle lobulations. Cancer can look like a black thundercloud without margins because it is so dense it blocks all sound. Sometimes they can resemble benign tumors. Because
of certain characteristics on clinical breast exam, mammography, ultrasound, age greater than 30 years old or high risk factors, a biopsy might be recommended.

Sampling the mass may be the best way to be sure it is benign, if there is any question. I always say, like your hairdresser, only your pathologist knows for sure! Needle biopsies for solid masses are fairly benign procedures. A little local anesthetic in the skin and all around the lump might sting a bit, but make you perfectly comfortable for the needle biopsy. Results should be called or mailed to you and your doctor. Always get a copy of the report for your records! Any truly solid mass not biopsied, or any mass biopsied and found to be benign should be followed every 6 months for 2 years.
Finally, a few facts to raise your awareness:

Facts:
· Women of all ages are at risk for breast cancer. We are seeing an increasing number of women under 40 diagnosed with breast cancer. The incidence of breast cancer increases with age: 1 out of 2,212 by age 30, 1 out of 233 by age 40 and 1 out of 58 by age 50 (SEER 2007)
· Since the national guidelines for women starts at age 40, no standard services are available to younger women who may be at risk
· Risk may be increased by family history, young age at 1st menstruation, no full term pregnancies before the age of 30, history of a previous biopsy, or history of a previous biopsy demonstrating atypical cells
· A breast cancer can be missed or discovered later due to a lack of awareness about the prevalence of breast cancer in young women and the lack of awareness about a normal breast self exam
· Only a small number of breast cancers, between 5% and 10% are due to an abnormal breast cancer gene that may be inherited from the mother OR the father
· 80% of women diagnosed with breast cancer have absolutely no risk factors, other than being a woman
· Per American Cancer Society: 10,000 of the 182,460 new cases of breast cancer will be under the age of 40 and 23,000 under the age of 43
· Breast cancers in young women are in general more aggressive, exhibit faster growth and result in lower survival rates.
· Breast cancer in younger women may be biologically different than that in older women
· The younger dense breast is limited and more difficult to evaluate without a standard and effective screening tool
· Younger women are underrepresented in many research studies

Dr. Janet Hoagland-Sorensen has been associated with The Rose since 1998. She earned her Bachelor of Science degree from the University of New Mexico in Albuquerque. She attended Tulane University School of Medicine in New Orleans, Louisiana and was awarded her Doctor of Medicine degree in 1978.

Dr. Hoagland-Sorensen completed her five-year internship and residency in General Surgery at the University of Texas Health Science Center and Affiliated Hospitals in the Texas Medical Center in Houston, as well as an additional research year in Immunology of Tumor Suppressor Cells from 1982-1988. She was a Surgical Oncology Fellow at the University of Texas M.D. Anderson Cancer Center in Houston from 1998-1989. In 1989, she entered private practice specializing in surgical diseases of the breast at Memorial Southwest Hospital.

Dr. Hoagland-Sorensen is married to James Sorensen, C.P.A., and together they happily share 6 children, ages 16 to 28. She has a personal and family history of breast cancer and is a lung cancer survivor.