Vital Views

Unknown Speaker 0:31
Good morning, good afternoon. Hello everybody. Welcome to vital views. I am Dr Janice Henriquez. I am an assistant professor at the School of Nursing here at UNLV, and today I have with me, Minnie wood,

Unknown Speaker 0:45
hi everyone. It's great to be here. My name is Minnie wood, and I'm a senior lecturer at UNLV School of Nursing and also a breast cancer survivor.

Unknown Speaker 0:54
So today we want to acknowledge that breast cancer can affect a wide range of individuals, while breast cancer is mostly associated with individuals assigned female at birth, it is important to acknowledge that anyone with breast or memory tissue can be at risk. In this episode, we will be discussing some sensitive topics, and we'll be using words like breast cancer and mammary tissue. This information is not meant to replace medical care, and we encourage you to speak with your providers. So Minnie, I really want to take the time to thank you for coming out today and having this chat with me. I've had some time this weekend to reflect about our breast cancer awareness presentations and talks, and I have to say that what an amazing group of people that we've had the pleasure of meeting, from our interactions with these individuals, I got a sense that they value the importance of education about breast cancer awareness. I am sure that there are many listeners today that are in the same boat and want to gain the knowledge and information regarding their own breast chest health. So for our listeners, can you share some of the highlights of what we shared with our groups.

Unknown Speaker 2:01
Sure, absolutely, it's also it's wonderful to be here, and I have really enjoyed being out in the community with you, talking and meeting with people, answering questions and just talking about breast self awareness. So yeah, I'm happy to share a little bit about that. So you know, part of what we talked about during a session this week was breast, breast self awareness and breast, breast self exam. So I wanted to talk a little bit about how we can become aware of our breast tissue, what to look for and changes and what to report to to our providers. If that sounds like a good place to start. Yeah, that's excellent. Okay, great. So, so, so first, we always talk about looking and observing, so picking a time, probably around once a month, ideally around the same time each month. And if you're a person who has a menstrual period, maybe about seven days or week after that period, so that hormonal changes have kind of slowed down a little bit. And you can start off by looking in the mirror and just looking in the mirror at your breasts, and what we're looking for is symmetry and size and texture and color and the appearance of the skin of the breast tissue. So we're looking for if one breast appears bigger than the other, or more swollen, if we notice any dimpling or retraction, which would be like a sense of something pulling in on the breast, like sort of an indentation. I'm using my hands, and that doesn't work too well on a podcast. So So you know, sort of being, yeah, pushed in a little bit, or indented, and we can shift positions, sort of move forward and let the breast hang down and see if we notice any of that. Also looking for changes in color, so redness or inflammation or hyper pigmentation. You know your skin color being you know even more so and then changes in texture that, especially looking for this orange peel, like changes in the skin. So those things, especially with with looking, then when we also talk about palpation or touching, and so a good time to do this is in the shower. When your your hands are nice and soapy, it's easy to move the hands over the skin, and we can do that in a systematic way, trying to make sure that we're getting all of the breast tissue, either by moving in circles, from the nipple outwards all the way out throughout, throughout the breast, we could go up and down, treating the whole breast area as like kind of a big rectangle or square. We can also do it like the hands of a clock, starting with the nipple at the center and going outward. But really important to make sure we're feeling and touching all of the breast tissue, including way up into the armpit. Now we suggest doing that with three fingers to make sure that we're not missing any breast tissue. So using the pads of three fingers and kind of alternating from a light touch to a deeper touch and what we're feeling for. So we're feeling for lumps or masses normal breast tissue or your usual breast tissue, and the big thing is changes from what you felt from one month to the next. Does my breast tissue feel any different? Do I notice anything new? So feeling for maybe rock like or marble like, masses feelings that are hard, pee like, and anything that's different, all of that is reportable to your provider. And then we also want to make sure to feel for lymph nodes, so that would be way up into the armpit and a little bit down the upper arm, and then above and below your collarbone as well. And there we're feeling for again, lumps, for swelling, for tenderness, and any lymph nodes that we feel there. Those are also reportable. So all of those things, Janice, I hope you might want to add something if you have anything to add, because you always have such great insight about all this too. Thank

Unknown Speaker 6:23
you, Minnie. I to keep it easy, like sometimes I'd have patients who tell me, You know what? That's really intimidating. I get in there and I feel and it's already lumpy, so what exactly am I feeling for? So usually when I teach, I tell them, you know, have the expectation that your tissue feels a lot like oatmeal. So that way you get to know that your oatmeal. And it's funny how we I don't know why we know that oatmeal feels lumpy. I guess maybe when we wash out our bowls, right? So then I tell them. So if you're washing out your bowl of oatmeal, or you're feeling around in your bowl of oatmeal, and all of a sudden you feel a rock or marble or something that doesn't belong in there, you definitely want to let us know, because that's a huge change from what your normal was. So that's also, like, the way that I explain it, to make it relatable. And then dimpling. Sometimes, dimpling is a little bit of a concept that's a little hard for folks to get so the best way that I explain it, too, is like, you know, babies are really cute with dimples in their cheeks, and we expect them to be like, you know, deeply indented. So dimples in the cheeks are cute, but dimples in the breast, not so much. Yes,

Unknown Speaker 7:22
I love the way you explain these things. It's always so it's just always so wonderful. And I think the oatmeal analogy is just perfect. And you reminded me that I forgot to mention things relating to the nipple. So we if the nipple itself is retracting or changes, or if you have discharge from the nipple, especially if it's bloody or different. You, I know you'll probably want to add some things about lactating breasts that are lactating, but yeah, discharge from the nipple, bloody discharge, nipple retraction or moving in. We want to report those things too.

Unknown Speaker 7:55
Yes, agreed. So usually, if it's clear, like water, if it's bloody, it's a really big red flag, but if all of a sudden you start lactating, and you haven't done that for years, you should still see your provider, because that might mean hormone levels are off. There might be a tumor in the brain somewhere, something causing that, or your medications, you might need an adjustment in medications, because sometimes certain medications can cause that lactation. So it's definitely worthy of a conversation with the provider, if it's a new finding for you. So yeah, those are great points that you made. There many thank you for

Unknown Speaker 8:28
that, absolutely.

Unknown Speaker 8:30
So let's talk about risk factors. That's one thing that I think we sometimes forget about. And again, like these are things like lifestyle changes and and different risk factors that can impact your breast health. Now, when we talk about these things, we always say that if you identify that some of these risk factors exist in your life, these are things that you may want to talk to your provider about, because there are definitely risk factors that are things that we can change, such as diet, and there are things that we can't change, like being assigned female at birth. So do you want to share with our listeners some of those risk factors they want to be aware of and perhaps share with their with their providers?

Unknown Speaker 9:10
Yeah. I mean, I think that the biggest one, especially is family history. So if you have cancers in your family, breast cancers, especially in first degree relatives, or some other cancers, especially colon cancers, pancreatic cancers. Those are really important risk factors to bring up, because, you know, it could be that it raises your risk for breast cancer, and we might want to change the typing, the type and the timing of screening that we do for you. So that's the biggest one that I can think of. Lifestyle related stuff, most of it we talk about it relates, it's the risk factors are very similar to what would be healthy for your heart is also healthy and protective for preventing cancers as well. So healthy Mediterranean. Diet, not smoking, really limited or no alcohol use, keeping your weight under control, all of those things are really protective.

Unknown Speaker 10:09
I love it perfect. We also encourage purposeful activity. It's our AKA, for exercise. No one likes that word. So we always say, you know, if you're already accustomed to moving your body. Like nurses like to say, well, I work, you know, I walk a million steps every day. Well, your body's become accustomed to that, so we always encourage you to push yourself a little bit further for your usual or on your days off, to also try to achieve those step goals that you were making when you were working. So purposeful activity is also something I think we can add to the list of like lifestyle. So inactivity would be like a lifestyle of inactivity would be a risk factor as well.

Unknown Speaker 10:47
Yeah. And then I also wanted to add about, we talk about exposure to hormones over time. So if somebody has been on estrogen, progesterone for various reasons, or has late, a late, later menopause or an earlier menarche, or when your period starts, so just the time period that you've been exposed to to, you know, sort of those, those hormones circulating in your body can impact your risk for breast cancer, whereas breast or chest feeding is actually protective against breast cancer, correct?

Unknown Speaker 11:26
Yes, yes, I love that you shared that. So with that said, in addition to knowing your risk factors and doing your own breast self awareness techniques, we also talk about like screening and imaging for screening. So our our lovely mammogram, so absolutely, so many can you share with our audience about the modalities for screening via imaging? Yeah, absolutely.

Unknown Speaker 11:50
So the record the current recommendation, so that over time, there have been a lot of different agencies and organizations who have recommended different timing for screening, but now they're pretty much all aligned. So that screening with mammogram for anybody with breast tissue should start at age 40 and happen at the very least by biennially, so every other year at least. Okay, so starting at age 40, screening with mammogram. It is possible that for people with denser breast tissue, that there might be ultrasound added on to that, but at the very least screaming with mammogram, which is a form of X ray. Yeah, I don't know what else would you like me to share about that? Yeah,

Unknown Speaker 12:36
no, that's perfect. So I know that with our audience on Friday, we talked about why mammogram was the gold standard. So just to share with you guys why the gold standard is mammogram, because there can be certain types of cellular changes that are only apparent on a mammogram. So we don't utilize ultrasound as a screening tool first, right off the bat, so we can use it complementary to a mammogram, but not as a primary source. And for some folks who may be at high risk, we also would include an MRI, so the magnetic magnetic resonance imaging, that would be something also they that we would use, but again, that would be something talking to your provider would reveal for you if you're that person who needs that.

Unknown Speaker 13:23
And I think the thing about the the ultrasound not being standalone, is really important to remember. I know I've been seeing a lot of stuff pop up on social media about ultrasound only, screening for Mama, screening for breast cancer, and it's just important for people to realize that that's not the gold standard. The gold standard would include mammography plus ultrasound created Correct,

Unknown Speaker 13:45
correct. I always say, like, when we use the ultrasound, it's, it's kind of like using the or looking for the needle in the haystack. So it's a little difficult to really find things. It's, if there's something apparent on a mammogram, we can use that ultrasound to find whatever it is the radiologist is looking for. So that's that's a great point. So in all of this talk, let's talk about empowering patients. Okay, so what happens when a patient has an experience that they feel they aren't being heard like someone says to you, you know what? You're the second provider I've been going to all these providers, and you know, now I have a lump before we get to the point of them seeing us. What would you maybe like say to them when they feel like, when a patient feels like they aren't being heard and and what might you share with patients and future providers about how we navigate these sticky waters when a patient doesn't feel heard? Yeah,

Unknown Speaker 14:37
I think that's a really great question. I'm really glad that you answered it, and I'm gonna, I'm gonna answer it from a couple of different perspectives. One is as a provider myself. I am an Adult Nurse Practitioner, and so I do refer people for diagnostic testing and for screening. But also, you know, as a patient, and I think probably the most important thing to remember is that we know. Our bodies, and we do know as as people, as patients, we know when changes are important and when we have concerns about things. And so I think it's really important to advocate for yourself and to be persistent in that advocacy, and that that could include having some difficult conversations with your provider, so I would be very clear in my communication and say is so. And I guess part of why I'm saying this is because things come up in between screenings, right? Maybe you've had a screening and maybe you feel a lump or something concerning in your self breast exam in between the next mammogram that's reportable and that's really important. And if your provider is not listening to you, I would be, you know, more persistent about that. And if necessary, I would say the most, you know, the most extreme thing would be to say, Okay, so I've asked I would like to, you know, get another mammogram or to have an ultrasound or some kind of screening to investigate what's going on here, biopsy, etc. And if you don't think that's necessary, I'd like for you to document that in the record that I asked for something and you decided that wasn't the case. And I feel like that can usually nip it in the bud. As a provider, I always want to partner with my patients, and I always want to make sure that, you know, we're feeling like we are collaborating on the treatment plan, and that we're partners in their care. And so if somebody comes in because they're concerned about something, even if I my level of worry may not be the same. I also want to appease their worry. I want to make sure that we rule out whatever it is that they're concerned about, and so I do want to refer them for testing. I always want that, do you have anything to add to that? Is there anything that you would, you know, you would also include? Because I feel like that's generally my approach. But I do think sometimes people have to be really persistent, you know, especially sometimes if they're younger and they have, you know, they notice a mass, and they may not be in that screening age, but we have to remember that screening and diagnostic are two different things. You know, screening is recommended age 40 and up, but people younger than 40 can have a breast mass and have a cancer, and even though we don't screen the whole population at large, when there is a symptom, it needs to be investigated. Completely

Unknown Speaker 17:27
agree with that. I'm very much the same way. If it's concerning enough for you to wait in my waiting room with all those people, it's definitely something I should address. And like you said, even if, if my level of suspicion is not there. Doesn't matter what I suspect. With that said, can you share with the audience? I'm sorry to lead it this way, but it just it occurred to me that when you went through your own diagnosis, you were right after a screening, correct. That's true. That's true. So, yeah, so it's super important. I mean, can you share with us, like your experience when you came to your when they came to your diagnosis? Yeah, absolutely. So

Unknown Speaker 18:05
I had, this was in 2023 when I was diagnosed with breast cancer. I actually had had a mammogram in April of that year and around November, so about seven months later, I felt a mass in the shower on my right breast, and it definitely had never been there before. It wasn't something I had ever felt before. And so I made an appointment with my primary care provider and went in and he did a breast exam, and was as concerned as I was, thankfully I didn't have to do much advocacy. He did, and he sent me for a diagnostic mammogram, right? That's not a screening mammogram, that's a mammogram looking at a specific symptom and a specific concern. So I went for diagnostic mammogram, and it actually turned out that that that lump that I felt was a cyst, but underneath the cyst was was cancerous. So there was about a, you know, less than a centimeter cancerous mass underneath. So I call it like the cyst, that I'm grateful for. You know, who knows exactly why or how that happened, but the cancer was there. So I'm so glad that not only was I doing having that breast self awareness in between mammograms, but that my provider was right on top of it and referred me once that diagnostic mammogram happened, then the biopsy happened pretty quickly after that, and then the cancer was diagnosed.

Unknown Speaker 19:38
That's amazing. So that's this, I think part of why, you know, doing these talks and having these conversations with people, I want them to feel empowered, you know, and know that they do have, you know, every, every ounce of you know, power to say something or to mention something, so they can seek the care and coverage they need. For whatever concerns they might have.

Unknown Speaker 20:01
Yeah, absolutely. And part of that, and part of the reason why that's so important, is because when we catch these things early, the treatments are better and more successful. So we want to catch breast cancers in the early stages. Mine was in stage one a so it's like the earliest, well, it's not necessarily, there's some before that, but it is in a very early stage, and so is considered to be very treatable. And so that's part of why that's important. You know, if we let things go for a longer time, you know, we can be less successful with treatment.

Unknown Speaker 20:33
Agree, Agree. Earlier you were talking about that, how, with all the changes in technology and medicine and medicine like, what you know, the outcomes are with breast cancer, how it's, you know, we can actually survive it more so than we did back in the day. So, like, in your own support groups and stuff,

Unknown Speaker 20:50
yeah, absolutely, you know. And I always want to preface this by saying, like, you know, I'm not an oncologist or, you know, a breast surgeon, so I don't have all those statistics and stuff at my fingertips, but I am a primary care provider, and I am as a breast cancer survivor. I talk to a lot of people who are in breast cancer treatment, and I participate in online support groups, and people are living with stage four breast cancer. It's stage four breast cancer is a really different situation than it was, say, when I was growing up, or maybe for older people in our community with what they've heard, a lot of people are living with stage breast cancer, stage four breast cancer, for much longer time than before, and are living with and it may not be curable, but it can be treatable, and people can live sometimes for many years with stage Four breast cancer, and so I it's really amazing that we're, you know, in a time period when there are so many potential treatments involved.

Unknown Speaker 21:47
Thank you, Minnie, so much for sharing. Was there anything else you wanted to add to tell our audience or share about your experience with your treatments? I

Unknown Speaker 21:57
guess maybe the only other thing that I'd add is that, for some people, the initial stages of breast cancer treatment are over after chemotherapy and surgery and radiation. But for a lot of people, treatment actually continues for years to prevent recurrence with medications like Tamoxifen and aromatase inhibitors and so those medications block hormones that could feed the cancer. And so there might be sort of an invisible treatment that's going on for people that continues for a while impacts their lives. And I just think it's important to be aware of as well. Yeah, so I just wanted to share that.

Unknown Speaker 22:38
Thank you so much, Minnie. It's been great having you and being able to share with with vital views.

Unknown Speaker 22:44
Thank you so much. Janice, it's been a pleasure to be here. Have a great day. You, too. You

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