September 1, 1997
Maureen Sintich is the first to admit that few women look forward to their annual mammogram. "Having a mammogram can be somewhat of an anxiety- provoking experience," says the director of the Breast Health Center at the Tulane University Hospital and Clinic and clinical instructor of medicine. However bothersome, a mammogram is one of the most effective ways to spot early signs of cancer, Sintich says.
Making the experience more comfortable and informative for women could help catch more cancers in the earliest stages, when chances of survival are highest. "If breast cancer is caught mammographically, it's more than 90-percent curable," Sintich says. "If it's caught when it's the size of a golf ball, you may only have a 50-percent chance to be cured."
The Breast Health Center aims to provide a "one-stop-shopping" approach to breast cancer screening and prevention. A component of the Tulane Cancer Center and Tulane's Center for Women's Health, the center opened to the public in June 1996 after a pilot-study period that began in April of that year. Sintich estimates that the center has seen more than 1,200 women since its inception.
Between April 1996 and April 1997, 51 of those women were referred to physicians for further consultation and eight women were found to have breast cancer. One of the benefits of the center is its ability to provide women with mammography results during their office visit, usually 30 to 40 minutes after the X-rays are taken, Sintich says.
"In the past, a woman didn't get her results back immediately," she says. "She would have her mammogram, go home and wait for the physician to call and tell her whether or not it was normal. Even when we're not anticipating a problem, it's nice for women to get their results back as soon as possible."
The American Cancer Society recommends that all women over 40 have a mammogram annually, and most health maintenance organizations and preferred provider organizations will cover the expense, Sintich says. The cost of an exam and mammogram at the center is $50. The center is designed with close links to specialists in all areas related to cancer care.
Radiologists, surgeons, medical oncologists, psycho-social support staff and social workers are all on call for appointments and consultations. For further analysis of breast irregularities, the center also has ultrasound equipment and is in close contact with physicians who can perform fine needle aspirations of a breast mass to study the cells microscopically.
"It's very patient focused," Sintich says. "We've actually had a woman come in and have her exam, mammogram, ultrasound, surgical consult, fine needle aspiration and get a diagnosis within two hours. The woman stays in our exam area. The surgeon and the pathologist come to her."
Another goal of the clinic is to educate women about breast self-examinations and increase the number of women who regularly perform them.
"Women should be doing breast self-examinations monthly," Sintich says. "But the literature shows that only between 14 and 40 percent do."
All visits to the center include a breast examination, usually performed by the center's staff nurse, Kelly Fay. The exam may be a bit different from the exams women are used to having in the gynecologist's office, Sintich says.
"It's an extensive exam," she says. "When the woman is having the exam she is also being instructed at the same time on how to do her own exam. Then, she gives a return demonstration to show that she knows how to do it."
Also included in a visit to the center is a discussion about health risks and lifestyle choices. The clinic mails out a questionnaire to all women when they make their appointments at the center. Questionnaire topics include breast cancer risk factors as well as information about other health habits, such as nutrition.
"We ask questions like, 'Do you exercise? Do you smoke? When was your last pap smear?,' " Sintich says. "If there are any unmet needs--if she doesn't have a primary care physician, for example--we can get her referred to someone. A visit here is a bit more holistic than just having a breast exam and mammogram."
Another aspect of the center is community outreach. "During our pilot program, we had predominantly Caucasian women," Sintich says. "Since then, we've done a lot of community outreach, and we've increased the numbers of African-American women who come to the clinic. It's important that we reach out to all of the communities in the area."
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