Holy Cross Cancer Blog

Understanding Mammograms: The process & possible next steps

  • Posted Jun 26, 2015
  • hchadmin

I have always thought of mammograms as similar to fingerprints. If you see a fingerprint on a glass or a tabletop you recognize it as a fingerprint. But that fingerprint is different from all other fingerprints. Likewise, when a radiologist looks at a mammogram it is recognizable as a mammogram but it is different from every mammogram he or she has ever seen before. The radiologist must therefore determine whether that mammogram falls within a range of normal, or if there is some feature that makes it abnormal.

The first thing the radiologist considers is comparing it to an earlier mammogram. It is extremely valuable to see a mammogram of the same patient from one, two, or even three years earlier to determine if there has been a change over that period of time. If there has been no change, there is a high level of confidence that that mammogram is normal for that patient. If, on the other hand, there has been a change, further investigation is typically warranted.

Sometimes the mammogram may be the first the patient has ever had or previous mammograms are simply not available. The radiologist must then decide whether further imaging is warranted at that time. Further imaging with more focused diagnostic mammography,  ultrasound or MRI may lead to a recommendation for a biopsy or possibly a recommendation to repeat the mammogram after a short interval -- typically six months.

Radiologists use a shorthand number system called BIRADS. This stands for Breast Imaging, Recording and Data System. Radiologists can vary significantly when they describe something they see on a mammogram. To overcome this variability, the American College of Radiology asked the radiologist to assign a number to the mammogram after they have completed their description.

BIRADS 1 means that the image is entirely normal and there is essentially little to say. BIRADS 2 means that there is something specific to comment on but it is entirely normal. BIRADS 3 means that there is a feature to comment on but the radiologist feels that it is probably benign. BIRADS 4 means the feature that the radiologist is describing is causing concern and that the abnormality may be cancer. BIRADS 5 means the radiologist is quite certain a the abnormality is cancer. When the radiologist feels the imaging is incomplete and more studies are necessary at that time a BIRADS 0 will be assigned. BIRADS 6 means the image contains a biopsy proven cancer and the imaging is actually being done for some other reason.

The BIRAD numbers one through five are associated with recommended actions. BIRADS 1 and 2 are considered normal and annual follow-up is recommended. BIRADS 3 is probably benign and when the radiologist uses the term "probably" it means that there is a 98% certainty that the lesion is benign. Due to the very small element of doubt, a six-month interval to repeat the image is recommended. The concern is not at a high enough level to recommend a biopsy.

BIRADS 4 means there is enough suspicion to recommend a biopsy. When the lesion is felt to be BIRADS 5 it means the radiologist thinks it is cancer and therefore a biopsy should certainly be performed. 

Radiologists are extremely careful when they read mammograms. They never want to miss a cancer. As a result, if they have any concerns about the image, they may ask the patient to return for further studies. This may be a more focused mammogram called a diagnostic mammogram. This may involve special views with magnification or a different type of compression. Sometimes an ultrasound examination is recommended to further define an abnormality. Occasionally an MRI of the breasts is recommended.

When a patient is called back for further testing it typically provokes anxiety. 90% of the time however the subsequent studies will result in a benign reading. Less than 10% of the time will the subsequent studies result in a recommendation for a biopsy and only a small percentage of those biopsies will result in a diagnosis of cancer.

Joseph J Casey, M.D.,FACS
Guest Blogger  

 

Recertified for Cancer Care from Largest Oncology Society in the U.S.

  • Posted Jun 16, 2015
  • hchadmin


The Holy Cross Michael and Dianne Bienes Comprehensive Cancer Center has received reaccreditation from the Quality Oncology Practice Initiative (QOPI®) Certification Program, an affiliate of the American Society of Clinical Oncology (ASCO).  The QOPI® Certification Program (QCP™) provides a three-year certification for outpatient hematology-oncology practices that meet nationally recognized standards for quality cancer care.


“This recertification from ASCO and QOPI is a testament to our commitment to safe, comprehensive and quality care. We are very proud to meet core standards in areas of treatment that include treatment planning; staff training and education; chemotherapy orders and drug preparation; patient consent and education; safe chemotherapy administration; and monitoring and assessment of patient well-being,” said Stan Meadows, executive director, Michael and Dianne Bienes Comprehensive Cancer Center.


The Bienes Cancer Center first achieved QOPI certification in March 2012 and is recertified through March 2018. In applying for recertification, the Bienes Cancer Center participated in a voluntary comprehensive site assessment against clearly specified standards that are consistent with national guidelines and was successful in meeting the standards and objectives of the QOPI Certification Program.


“Practices that achieve recertification through QOPI continue to demonstrate a strong commitment to providing patients with high quality care,” said ASCO President Julie M. Vose, MD, MBA, FASCO. “The QOPI Certification Program allows oncology practices to engage in lifelong learning by providing not only the measures to assess the level of care they provide, but also the information and resources needed to help maintain quality.”


QOPI is a voluntary self-assessment and improvement program launched by ASCO in 2006 to help hematology-oncology and medical oncology practices assess the quality of the care they provide to patients. Through the QOPI program, practices abstract data from patients’ records up to twice per year and enter this information into a secure database. More than 900 oncology practices have registered for the QOPI program. 


The QCP was launched in January 2010, with more than 250 practices already certified. This certification for outpatient oncology practices is the first program of its kind for oncology in the United States. Oncologists can achieve certification by participating in a voluntary comprehensive site assessment against clearly specified standards that are consistent with national guidelines. The QCP seal designates those practices that not only scored above the threshold on the key QOPI quality measures, but met chemotherapy safety standards established by ASCO and the Oncology Nursing Society (ONS). 


QOPI® analyzes individual practice data and compares these to more than 160 evidence-based and consensus quality measures. The information is then provided in reports to participating practices.  Individual practices are also able to compare their performance to data from other practices across the country. Based on this feedback, doctors and practices can identify areas for improvement.  


To become certified, practices have to submit to an evaluation of their entire practice and documentation standards. The QCP staff and steering group members then verify through on-site inspection that the evaluation and documents are correct and that the practices met core standards in various areas of treatment.


The QCP is a project of ASCO’s Institute for Quality, an ASCO affiliate dedicated to innovative quality improvement programs. For more information, please visit: http://qopi.asco.org/certification.html.



About Holy Cross Hospital
A part of Trinity Health, Fort Lauderdale, Fla.-based Holy Cross Hospital is a full-service, non-profit Catholic hospital operating in the spirit of the Sisters of Mercy. Since opening its doors in 1955, the 557-bed hospital has offered progressive services and programs to meet the evolving healthcare needs of individuals and families we serve.  Today, Holy Cross has more than 600 physicians on staff representing more than 40 specialties and more than 3,000 employees. To learn more about Holy Cross Hospital, visit holy-cross.com, “like” Holy Cross Hospital, Fort Lauderdale on Facebook at facebook.com/holycrossfl, or follow @holycrossfl on Twitter.


About ASCO:
Founded in 1964, the American Society of Clinical Oncology (ASCO) is the world’s leading professional organization representing physicians who care for people with cancer. With more than 35,000 members, ASCO is committed to improving cancer care through scientific meetings, educational programs and peer-reviewed journals. ASCO is supported by its affiliate organization, the Conquer Cancer Foundation, which funds ground-breaking research and programs that make a tangible difference in the lives of people with cancer.  For ASCO information and resources, visit www.asco.org. Patient-oriented cancer information is available at www.cancer.net.


About ASCO Institute for Quality, LLC
The ASCO Institute for Quality is an ASCO affiliate dedicated to innovative quality improvement programs for ASCO members and their patients. Committed to providing oncologists with the necessary resources to provide every patient with high-level cancer care, the Institute carries out ASCO’s clinical quality improvement programs. The Institute is a wholly-owned subsidiary of ASCO.


 


Celebration of Life: June 7

  • Posted Jun 02, 2015
  • hchadmin

The annual Celebration of Life party is right around the corner and promises to be another wonderful event in honor of our cancer survivors and their guests.  Anyone who has been diagnosed with cancer is invited to attend the event on June 7 as we honor cancer survivors. Please, join us! RSVP to Christina Austin-Valere, PhD, LCSW at 954-267-7770.

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Questions to ask about Genetic Testing

  • Posted May 19, 2015
  • Carol Brudenell

An April 21 article in the New York Times entitled "New Genetic Tests for Breast Cancer Hold Promise" discussed the following: 

"A Silicon Valley start-up with some big-name backers is threatening to upend genetic screening for breast and ovarian cancer by offering a test on a sample of saliva that is so inexpensive that most women could get it. At the same time, the nation’s two largest clinical laboratories, Quest Diagnostics and LabCorp, normally bitter rivals, are joining with French researchers to pool their data to better interpret mutations in the two main breast cancer risk genes, known as BRCA1 and BRCA2. Other companies and laboratories are being invited to join the effort, called BRCA Share."

This is a very thought-provoking article and attractive to a population that is interested and concerned about hereditary mutations and cancer risk.  The cost is affordable to many and the company, Color, is working on a financial assistance program for those who cannot pay even the $249.00 cost of testing.  As a cancer risk assessment professional who counsels, evaluates, educates and recommends testing to men and women who have personal/family histories of cancer on a daily basis, these are my concerns and questions I would ask:

  • What is the platform or technology they are using to do the testing at this price? 
  • How deep and wide do they sequence the DNA, do they test for deletions and duplications of the DNA? 
  • Does their testing compare with the major genetic laboratories that have been establish for years and have a known track record?
  • Is this test even necessary?
  • Can I trust an employee of the lab to order the test that is right for me? Isn’t this a conflict of interest?
  • Will there be counseling to help the patient understand the need and advisability of testing and will it be done before or after the testing or both?
  • Who will help the patient interpret the test results?
  • Who will make the recommendations for follow-up?
  • Who will follow the person long term to carry out the recommendations made?
  • Will the recommendations be sound, considering the lack of information we currently possess about some of the more rare mutations? 
  • Will unnecessary procedures/surgeries be done that endanger lives?

Most of these questions were asked in the article but bear serious consideration before embarking on this hereditary journey. There are medical and genetic professionals here in our community who can walk with you in making decisions about genetic testing and guide you to  established and reputable genetic labs in this country who offer genetic testing though your insurance or with financial assistance if your insurance does not cover the testing.


Mother's Day Special: Discounted Mammograms

  • Posted May 05, 2015
  • hchadmin




In honor of mothers everywhere, the Dorothy Mangurian Comprehensive Women's Center and the Holy Cross Urgent Care and Imaging Center in Boca Raton have a special offer for women.


Special rates available only to patients without insurance. Same day results available:


Screening Mammogram: $90  |  Bone Density Screening: $150
Rates available in May and June 2015
Download printable flyer.


These special rates are conveniently available at the following locations: 


Holy Cross Dorothy Mangurian Comprehensive Women's Center
1000 NE 56th St., Fort Lauderdale, FL 33334 

Holy Cross Urgent Care and Imaging Center - Boca Raton Location
1799 S. Federal Hwy., Boca Raton, FL 33432 


To make an appointment at one of the above locations, call 954-202-0277.


Restrictions: Screening Mammogram only (excludes Diagnostic Mammogram). No implants. Available only to patients without health insurance. Includes Radiologist's Reading Fee.


 


I Can Cope Spring Session May 2

  • Posted Apr 28, 2015
  • hchadmin
Those living with cancer, cancer survivors and their caregivers are invited to join us for our Spring 2015 I Can Cope program, a free cancer support seminar presented in conjunction with the American Cancer Society, on Saturday May 2 on the second floor of the Bienes Cancer Center: 
 
8:15 a.m. - 8:45 a.m.
Registration & Continental Breakfast
 
8:45 a.m. - 9:00 a.m.
Welcome & Opening Prayer
 
9:00 a.m. - 10:30 a.m.
Understanding Cancer Treatment
 
10:30 a.m. - 10:40 a.m. BREAK
 
10:40 a.m. - 11:30 a.m.
Communicating Concerns and Feelings
 
11:30 a.m. - 12:00 p.m.
Managing the Side Effects of Illness and Treatment
 
12:00p.m. - 12:30p.m.
Lunch & Survivor Story
 
12:30 p.m. – 1:15 p.m.
Mobilizing Resources and Support
 
1:15 p.m. – 2:00 p.m.
Keeping Well In Mind & Body Part I
 
2:00 p.m. - 3:00 p.m.
Keeping Well In Mind & Body Part II
 
3:15p.m. - 3:30p.m.
Evaluations & Celebration
 
Breakfast and lunch will be provided. Flyer attached.
 
Registration required. Please call 954-267-7770.
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Bienes Cancer Center Social Worker Receives National Honor

  • Posted Apr 16, 2015
  • hchadmin

The Michael and Dianne Bienes Cancer Center's Christina Austin-Valere, PhD, LCSW, is one of seven outstanding cancer care providers who received the 2015 American Cancer Society Lane W. Adams Quality of Life Award, a prestigious national award for cancer caring. The Lane W. Adams Quality of Life Award recognizes individuals who help extend what long-time American Cancer Society Executive Vice President Lane W. Adams referred to as the “warm hand of service.” Based on Adams’ own memories of the comfort and caring given by nurses to those facing serious illness, the award honors professionals whose compassion and dedication go far above and beyond the call of duty. Dr. Austin-Valere was honored for her extraordinary efforts to deeply impact the quality of life of the people she cares for and her focus on treating the “whole person.”

 Photo: From left: Susan D. Henry, LCSW, member of the American Cancer Society Board of Directors and chair of the American Cancer Society Lane W. Adams Award Workgroup; Dr. Christina Austin-Valere, Lane W. Adams Award Recipient; Robert E. Youle, vice chair of the American Cancer Society Board of Directors


Cancer Community invited to "Speak for Yourself"

  • Posted Apr 14, 2015
  • hchadmin

The Wellness Hour: Speak for Yourself
Wednesday, April 15 | 3-5p | Sister Innocent Conference Center, Holy Cross Hospital 

The time to think about important healthcare decisions is before you find yourself in the hospital. Who speaks for you if you’re in the hospital and ill enough that you are unable to speak for yourself? 90% of Americans have heard of a living will, yet only 29% have one. This – along with other important healthcare decisions you may not even be aware of – is the topic of next week’s panel discussion.

This is a 2-part event
From 3-4p: You can get information on home healthcare, community resources, emergency response systems and more from community representatives who will have vendor displays in our conference center Atrium.

Vendors include: Home Health Services, Private Duty Nursing, Guardian Monitoring Services, Hospices, Skilled Nursing Facilities, Aging and Disability Resource Center of Broward County (SHINE), Meals on Wheels, Light of the World Clinic, Holy Cross Community Outreach Program and more!

From 4-5p: Join our panel of experts (Dr. Coopersmith, spiritual care, social worker, ethicist, etc.) as they discuss important healthcare decisions and answer questions about advance directives. Spanish and Creole speaking panelists will be present.

RSVP for this free event by calling 954-351-5886 or register online by CLICKING HERE to access the registration form. Light refreshments will be served.

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Below is a commentary from Maureen G. Mann, MS, MBA, FACHE, Executive Director of the Michael and Dianne Bienes Cancer Center at Holy Cross Hospital, urging lawmakers to oppose House Bill 169. 

"...I am a very involved volunteer with the American Cancer Society...so this particular bill causes me great concern. Please see the notes below and VOTE NO when this bill comes to the floor...


Oppose House Bill 169
Nicotine Products & Nicotine Dispensing Device

Background
Originally, the intent of HB 169 was to prohibit the sale of nicotine products and nicotine dispensing devices (e-cigarettes) to minors. However, added amendment language would strip local governments of their ability to regulate all tobacco products and e-cigarettes, overturn existing ordinances, and block future opportunities to protect kids in the retail environment. For example, many of the product placement ordinances we currently have in Florida go beyond the minimum standards set by the US Food and Drug Administration (FDA), requiring that ALL tobacco products are placed behind the counter at retail stores, not just cigarettes and smokeless tobacco. With the preemption language, the bill now does more harm than good in the fight to keep Florida’s children tobacco free.


Key Points
Many of the ordinances we currently have in Florida deal with product placement, requiring that all tobacco, not just cigarettes and smokeless tobacco, are placed behind the counter at retail stores. They are stronger than the minimum standards required by the FDA and are all meant to keep tobacco
products out of the hands of children.

In-store tobacco displays serve to increase product availability, visibility and brand awareness and stimulate trial and purchase of products.1 Product placement laws limit youth access to tobacco via illegal sales and shoplifting.
Proponents for preemption claim that we need a uniform state law that covers all businesses rather than a patchwork of local ordinances. The fact is retailers are used to complying with a variety of local laws, including zoning, traffic restrictions, health regulations and even alcohol sales. Tobacco regulations
are no different than other regulations that vary from jurisdiction to jurisdiction.        
Local governments are more flexible and responsive than state government in effectively dealing with emerging problems and finding innovative solutions. Local governments are closer to the community and have been more effective than the state or federal government in addressing the problem of
tobacco use.

My Position
State laws should serve as a minimum standard for a policy objective while allowing communities to enact stronger ordinances to protect their youth and residents in the most appropriate manner. The American Cancer Society Cancer Action Network, American Lung Association, American Heart Association, Campaign for Tobacco-Free Kids and our partners ask that you oppose HB 169 and prevent the dismantlement of effective local tobacco ordinances around the state."


 


About the Center

The Michael & Dianne Bienes Comprehensive Cancer Center in Fort Lauderdale, Florida is the Cancer Care Leader in Broward County. Dedicated to providing patients with precise diagnosis, the latest and most advanced treatment and aftercare options, we offer a multidisciplinary approach to care, a compassionate and spiritual healing environment, and an affiliation with the National Cancer Institute. We are also working together with Massachusetts General Hospital Cancer Center to provide South Florida residents with rapid access to specialized cancer care and genetics counseling.

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