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Educational Series

Routine Breast & Cervical Screening Post

Cancer Diagnosis

Survivor Presentation University of Arizona Cancer Center

Selena Llamas

• 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

Educational Goals

Survivorship

“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 invinciblefaith can survive all odds the world

can throw against his torturedsoul.” –Robert Schuller

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!!

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 ??????

The Survivor’s Post Treatment

Surveillance

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

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?

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. MammographyMammography 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 Screening1. 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 liquid-based 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

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

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 Screening2. 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

• 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

Abnormal Area in Cervix

HPV Infection

Pre-cancerInfection Progression Invasion

RegressionClearance

Persistence

NormalCervix

Cancer

Natural History of HPV/Cervical Cancer

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)

Cervical Cancer High-Grade Dysplasia

(CIN 2 or 3)

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

Congress

Speedway

Grant Rd.I-10

I-19

Kolb Rd

Theresa Lee Clinic

332 S. Freeway

El Pueblo/ El Rio

101 W. Irvington

St. Elizabeth’s Clinic 140 W. Speedway

Irvington Rd.

I-10

N

S

EW

I-19

Providers Direct

2122 N. Craycroft Rd, Ste 102

Cray

croft

Golf LinksEl Rio SE Clinic

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 CoordinatorVictoria 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