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                      Educational Series
   Routine Breast &
Cervical Screening Post
   Cancer Diagnosis
        Survivor Presentation
 University of Arizona Cancer Center

           Selena Llamas
         Educational Goals
• Being uninsured or underinsured is no
  longer a barrier to receive screening after
• Annual screening is even more important
  after your first cancer diagnosis
  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!!

 “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 invincible
faith can survive all odds the world
   can throw against his tortured
   soul.”              –Robert Schuller
          The Survivor’s Post
        Treatment Surveillance
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

 Survivorship is the Main Priority Post Test ??????
Survivorship is the
Second Cancers Caused
 by Cancer Treatment
Increased risk of developing a new
          primary cancer:
 ovarian, uterus, lung, colon, rectal cancer

      The most common second
           second breast cancer

The risk of second breast cancer
  is high regardless of type of treatment
    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

                                    Symptoms of recurrence:
                                   new lumps, bone pain, chest pain, abdominal pain or
                                   persistent headaches

                                  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
Breast & Cervical
Cancer Screening
  the Uninsured
 or Underinsured
      What is Well Woman

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
     What is Well Woman

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

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. Mammography
  Mammography 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 Screening
1. PelvicExam & 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
  Cervical Cancer Screening
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
  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 Screening
2. 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
•   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
      Abnormal Area in Cervix

•   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
Natural History of HPV/Cervical Cancer


Normal Infection   HPV
                           Progression         Invasion
                                     Pre-cancer         Cancer
Cervix           Infection Regression

  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

High-Grade Dysplasia
     (CIN 2 or 3)
                        Cervical Cancer
    Well Woman Target
• 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
                   I-10                   St. Elizabeth’s Clinic
Grant Rd.                                  140 W. Speedway
                                                                                              Providers Direct
                            Speedway                                                        2122 N. Craycroft Rd,
                                                                                                  Ste 102
    Theresa Lee

                                                                                                                        Kolb Rd

   332 S. Freeway                                                                              El Rio SE Clinic
                           I-19                                    Golf Links
     Irvington Rd.

                                                                                                   W                E
                      El Pueblo/ El Rio                             I-10
                      101 W. Irvington                                                                       S

       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
• Receive an appointment
• Or be directed to a Well Woman
  satellite office near her
Future WWHP
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 Coordinator             WWHP Staff:
Victoria Altamirano
(520) 628-3591                  • Lilly Thorndal, Case Manager
                                • Selena Llamas, Program Specialist
                                • Clementina Daniel, Social Services Aide
Thank you for coming!
  Have a great day

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