Think Pink2 | The Daily News | Think Pink | October 2021 (800) 917-8906 | utmbhealth.com/womens With Breast Cancer Awareness at the forefront every October, UTMB Health would like to remind you that staying on top of your health takes more than a once-a-year mammogram. It requires regular visits with a women’s health specialist you trust to care for your complex needs in the areas of: The University of Texas Medical Branch is in-network for most major insurance plans. Women’s Health Care. Close to Home • Breast Health & Mammography • Gynecology • Hormone Therapy • Menopause • Obstetrics/Prenatal care • Pelvic Health & Continence • Psychology • and more With clinics located throughout the Bay Area & Southeast Texas, our qualified and capable providers are in communities near you, including: • Angleton • Clear Lake • Lake Jackson • Webster • Friendswood • Galveston Scan to find a provider near you today. breast cancer prevention tips AVOID ALCOHOL EXERCISE EAT HEALTHY AVOID SMOKING PERFORM SELF BREAST EXAMS KNOW THE SIGNS SOURCE: Breastcancer.orgOctober 2021 | Think Pink | The Daily News | 3 T hree to four times per week, the members of the mobile mammography team with the University of Texas Medical Branch start their day bright and early around 6 a.m. They then drive the van to vari- ous sites across Galveston County, set-up and begin seeing patients for their annual screening mam- mogram. On a typical day, the van will host appoint- ments for 15 to 20 people — women who would otherwise lack access to their routine screenings. “Our patients typically will not have a mammo- gram unless we provide this mobile service,” said Suzanne Spudis, senior radiology manager for the UTMB breast imag- ing department. “They are just not able to get to the clinics or hospitals for their annual mammo- grams. Rides and insur- ance are barriers to their care. With the mobile van and kindness of the Moody Foundation, these women will get the ser- vices they need.” To be eligible for a mobile mammogram, one must be uninsured or, if insured, have insurance coverage that does not cover the service or has high deductibles; be over the age of 40; not have any current breast pain, discharge or abnormali- ties; not be pregnant; not have a personal history of breast cancer in the last five years; and have not received a mammogram in the last 12 months. Patients are often re- ferred to the mobile unit through other organiza- tions and partners, such as local churches, Coastal Health and Wellness and St. Vincent’s House, Spudis said. More recently, the program has started work- ing with the Texas Depart- ment of Criminal Justice to provide mammograms at local prison units. “That helps with no- shows and getting those ladies in,” Spudis said. “We go to them. It’s convenient and easy for these women to complete their annual screenings without the trip to Galveston.” Once a patient arrives, she registers and then gets in the van for her screening. From start to finish, it takes less than 15 minutes. “They get their exam done, and they’re on their way,” Spudis said. “It’s the easiest 15 min- utes and then you’re good for a whole year — don’t ignore your health.” Not only does the program provide mam- mogram screenings, but also it will help connect individuals to additional services if an abnormali- ty is found. “I’ve heard stories from ladies that said, ‘I wouldn’t have come,’ and some have had to come back for additional images,” MAMMOGRAMS ON-THE-GO Story by Anna Lassmann | Photos courtesy of UTMB Spudis said. “If you find it early enough, there’s a chance, there’s a cure, there’s help. If some- thing is found, we will follow-up and find them services to help them on their journey to get well. “We’re there for the community; we’re avail- able. Get your care done early. Get your mammo- gram. Do some preventa- tive maintenance and put yourself first.” Individuals who do not meet the requirements for the mobile mammog- raphy van can schedule their annual screening mammogram at a UTMB Health location. For more information, visit www.utmb.us/60a or call 409-772-7150. ABOVE: The current UTMB mobile mammography van debuted in 2018 after receiving a grant from the Moody Foundation. The van goes to three to four community locations every week, serving 15-20 women per site. BELOW: A UTMB imaging technologist prepares the 3D mammogram machine onboard the UTMB mobile mammography van. When the mammogram van goes out into the community, it typically has a technologist and a driver.4 | The Daily News | Think Pink | October 2021 Story by Anna Lassmann | Photos courtesy of UTMB A fter more than a year of isolation, the COVID-19 vaccine seemed like the light at the end of the tunnel. Since December 2020, more than 170 million people have been vaccinated fully across the United States, accord- ing to data from the Cen- ters for Disease Control and Prevention. While the COVID-19 vaccine has provided an added layer of protection for many, it also has led to false positive mammo- gram screenings due to lymph node enlargement — also known as axillary lymphadenopathy. “Your lymph nodes could react to the vac- cine and become en- larged,” said Dr. Anne Lee, breast imaging radiologist at the Uni- versity of Texas Medical Branch. “We’ve seen this in patients who have got- ten a screening mammo- gram within four weeks of their vaccination.” This phenomenon has led the Society for Breast Imaging to release rec- ommendations, stating to schedule your annual screening mammogram either before you get the COVID-19 vaccine or four to six weeks after receiving your second dose. UTMB schedulers are informing patients of this recommendation, Lee said. However, Lee said it is important that people don’t delay care if they are having an issue, such as feeling a breast lump, pain or nipple discharge. “If a patient is having symptoms, we don’t want them to wait to come in,” Lee said. “For asymptomatic patients who did have a recent vaccination, we let them know that they may be called back for further evaluation if we see enlarged lymph nodes on the screening mam- mogram.” The lymph node enlargement due to the COVID-19 vaccine typ- ically occurs in the un- derarm area on the side where you received your shot, and it is a normal sign that your body is building protection. This also isn’t the first time that a vaccine has caused lymph node enlargement — it’s been seen with the influenza and shingles vaccines as well. “You can have enlarged lymph nodes for a vari- ety of reasons,” Lee said. “But if there is nothing abnormal in the breast and there’s a history of recent illness, vaccination or infection, the lymph nodes are likely reactive, and we’re comfortable recommending a short- term follow-up ultra- sound.” HOW COVID-19 VACCINES CAN IMPACT MAMMOGRAMS Dr. Anne Lee is a breast imaging radiologist at the University of Texas Medical Branch. She reviews screening and diagnostic mam- mogram images to look for malignancies.October 2021 | Think Pink | The Daily News | 5 If the lymph nodes appear normal when the patient returns for a follow-up, then she can return to her annual screening mammogram schedule. However, if the lymph nodes are still abnormal, the breast im- aging radiologist typical- ly would recommend a biopsy as there is a risk for malignancy, Lee said. The follow-up ultra- sound is typically sched- uled 4-12 weeks after the initial screening, in align- ment with the Society of Breast Imaging recom- mendations. Lee said the recommendations are in place to avoid unneces- sary biopsies. At the end of the day, Lee wants every woman aged 40 and older to keep up with their an- nual screening mammo- gram because catching breast cancer early is the key to saving lives. “When COVID first happened, people de- layed their care or even skipped their mammo- gram that year,” Lee said. “We encourage people, if they haven’t had their mammogram, to get their screening mammo- gram because things can change even in a year.” Do your research. Schedule an appointment. It doesn’t just happen to women. Look out for the signs of breast cancer. Look out for the signs of breast cancer. GRAPHIC: LIZ DAVIS/THE DAILY NEWS “We encourage people, if they haven’t had their mammogram, to get their screening mammogram because things can change even in a year.” DR. ANNE LEE Lee reviews mammogram images in a radiology reading room at the University of Texas Medical Branch in Galveston. | Think Pink | October 2021 S oon after Belinda Escamilla returned home from cele- brating her 60th birthday on a Carnival cruise ship in 2016, she got some disturbing news. At the time, Escamilla was the administrative director of radiology at the University of Texas Medical Branch. She recalls every slow-motion detail of that moment on a warm morning July 14, 2016, that changed her life. “The call came in as I was walking to my office from the parking ga- rage,” she said. Her office was next to the breast imaging department. Dr. Angelica Robinson, director of breast imag- ing at UTMB, was the one calling Escamilla. She had the pathology report for a tomogra- phy-guided breast biopsy Escamilla had before her cruise. “Belinda, your biopsy report came back pos- itive for breast cancer,” Robinson told her. Esca- milla stopped walking. “I couldn’t believe it,” she said. “I only said yes to the biopsy because I wanted to play it safe.” Escamilla’s mammo- gram only showed ques- tionable architectural distortion, but there was no mass. The ultrasound didn’t show any abnor- mality either. She won- dered how it could be cancer. “I was in shock and denial,” Escamilla said. “I didn’t tell anyone that day. Not even my hus- band. I actually went through the entire Elisa- beth Kubler-Ross griev- ing process that day: denial, anger, bargaining, depression and accep- tance.” Kubler-Ross was the psychiatrist who came up with the five stages of grief. “I told my husband the next day, but it took me one full week to tell my family and friends that I had cancer,” Escamilla said. Her diagnosis was ductal carcinoma in situ, stage 0, grade 3. “Stage 0 means it was caught very early, but grade 3, also known as high grade, means it is fast-growing, and it is more likely to spread,” Escamilla said. Robinson recommend- ed a breast MRI. “The MRI demonstrat- ed two more areas of suspicion on the same breast, so they per- formed two more biop- sies while I was on the MRI table,” Escamilla said.” “One of the suspicious areas was also ductal carcinoma in situ. “At this point, I was extremely scared and felt I needed to go to MD Anderson,” she said. “After all — ‘cancer is all they do,’ right?” She made an appoint- ment and saw her team at MD Anderson immedi- ately. They were knowl- edgeable and profession- al and sent Escamilla to the radiology department for the same imaging procedures done at UTMB. “I wasn’t having a very good experience during the ultrasound proce- dure, so I left MD Ander- son,” Escamilla said. “The personal touch I was so used to experiencing at UTMB was missing. I wanted to go back to UTMB for my health care needs.” Because she worked at UTMB, she knew the faculty and staff well. “They go above and beyond to ensure pa- tients receive excellent patient care,” Escamilla said. “When you are told you have cancer, your mind spins 100 miles per hour, and you feel very desperate.” Her desperation disap- peared as she met with her UTMB breast cancer team. “They were compas- sionate, caring and made me feel that I was not alone in my journey,” Escamilla said. She praised Dr. Colleen Silva, her breast sur- geon; Dr. Avi Markowitz, her medical oncologist; and Dr. Sandra “Sunny” Hatch, her radiation on- cologist. “They presented all my options and answered all of my questions,” Esca- milla said. “The choice was mine to make. Do I have a lumpectomy with radiation therapy? Do I have a mastectomy with no radiation therapy? I wasn’t a candidate for chemotherapy because my cancer was not BELINDA ESCAMILLA’S JOURNEY “I told my husband the next day, but it took me one full week to tell my family and friends that I had cancer.” BELINDA ESCAMILLA Story by Valerie Wells | Photo courtesy of UTMB Every 74 seconds, someone around the world dies from breast cancer. Every 19 seconds, a woman is diagnosed with breast cancer somewhere around the world. 74 Seconds 19 Seconds October is Breast Cancer Awareness Month SOURCE: Susan G. Komen for the C ure Breast cancer around the worldOctober 2021 | Think Pink | The Daily News | 7 caused by hormones. No matter what the decision was, it was going to be life changing.” Visiting Dr. Silva was always an encouraging experience, Escamilla said. “It’s like she was part of my support group,” she said. Since she had a couple of areas with ductal car- cinoma, Escamilla decid- ed to have a mastectomy. “I wanted the cancer completely out of my breast since it was a Grade 3,” she said. “That is when I met Dr. Linda Phillips, a plastic sur- geon. She, too, alleviat- ed my anxiety and was extremely helpful.” “Several work acquain- tances reached out to Escamilla once word got out about her breast cancer. “I felt a sisterhood with the co-workers who reached out to me,” she said. “They, too, had breast cancer and gave me a lot of insight of what to expect as a pa- tient. But, no matter how much information you have and how much you feel you are ready for the journey, it is still very difficult.” Escamilla had three surgeries during her seven-month rollercoast- er ride with good days and bad days. Five years later, she still appreciates what got her through the worst times. “I am fortunate to have a great husband, family and friends,” she said. “They were my support group.” Seven months after her diagnosis, Escamilla was able to return to work. “But I decided I would stop working so hard and enjoy life to its full- est,” she said. “I retired from UTMB after 43 years of service. I now invest my time in my health and my family.” In her role as ad- ministrative director of radiology, Escamilla had acquired the 3D tomography mammog- raphy equipment for the department. Tomography creates detailed imag- es of a cross section of tissue. Later, that same equipment would detect her breast cancer. “I am so thankful to Dr. Robinson for her exper- tise in breast imaging,” Escamilla said. “She is truly amazing. And so is Dr. Silva. Also, I believe that the 3D tomogra- phy equipment used to perform my mammogram made a difference.” “They (the UTMB breast cancer team) were compassionate, caring and made me feel that I was not alone in my journey.” BELINDA ESCAMILLA In the U.S. in 2021, there will be an estimated 281,550 new cases of invasive breast cancer diagnosed in women. SOURCE: www.bcrf.org | GRAPHIC: Liz Davis/The Daily News8 | The Daily News | Think Pink | October 2021 C heron Hillmon, on- cology social work- er at the University of Texas Medical Branch, handles everything from finding payment and insurance resources for patients who are unin- sured to creating and delivering goodie bags to individuals coming in for chemotherapy. “Helping has always been part of me,” Hill- mon said. “I think that, in a word, it was what I wanted to do for a long time — I always knew I wanted to be in the help- ing profession.” While she knew she wanted to go into social work, Hillmon didn’t know she would end up working in oncology until the opportunity presented itself, she said. “It’s been really re- warding,” Hillmon said. “It’s watching patients at their worst and going through that process with them of how they were before diagnosis, how they are during diagnosis and, if they end up in remission, how they are after. It’s been quite eyeopening, but I’ve enjoyed every minute of it.” Patients who are uninsured are typically referred to Hillmon as soon as they are diag- nosed, before beginning a care plan; however, any patient can be referred to Hillmon at any point in their cancer journey. “Sometimes a patient is just venting to their physician; they’re not necessarily asking for help,” Hillmon said. “But anything can happen during this process and then, when it’s appro- priate, the physician or the nurse will put in that referral for me.” But, much like the journey of a cancer pa- tient, Hillmon’s job isn’t always easy — there’s highs and lows. Hillmon said she gets through the difficulties by knowing her limitations and using coping skills. “When I have a patient who dies, I try to process it the best I can. I will try to talk about it because I need to be able to move on to the next one,” Hillmon said. “And there are some victories. There are times when that pa- tient gets to ring that bell of finishing their treat- ment and being done.” Not only does Hill- mon provide one-on-one support to patients, she also facilitates a breast cancer support group, called Reconstruction of a Survivor. Through this support group, patients at all stages of their breast cancer journey — and across multiple health systems — meet once a month to talk, ask questions and connect with those who have similar experiences. “I just let them talk as long as they need to because it’s on their minds and they need someone who knows what this journey is like to talk to,” Hillmon said. “Family is fine, friends are fine, but a lot of them are like ‘you’ll be okay,’ ‘you’re going to get through this,’ and that’s not what they want to hear. They want to hear the cold hard facts about breast cancer and what chemo is going to look like, what can help with radiation burns and, if it’s Stage 4, what is that going to look like for me.” “All of these things are questions that these women in this group can answer for them,” Hillmon said. “I can’t; I have not walked in their shoes, but I’m there to facilitate and, if they are patients of UTMB, then I’m happy to have that conversation away from the group as well; they know they can always call me if they need to.” Members of the sup- port group often support each other outside of the monthly meetings as well by showing up to each other’s appointments and in the hospital, Hillmon said. “The amount of love and support from this group has just been phenomenal,” Hillmon said. “You’re not going to find that everywhere, but they have been so good for me, and I’m not done learning from them.” Reconstruction of a Survivor meets on the third Tuesday of every month at 6:30 p.m. via Zoom. The support group is open to all breast cancer patients, and more information can be found at www. utmb.us/5yb. SUPPORTING SURVIVORS THROUGHOUT THEIR JOURNEYS Story by Anna Lassmann | Photos courtesy of UTMB ABOVE: Oncology social worker Cheron Hillmon puts togeth- er new patient kits for UTMB breast cancer patients. The kits contain information on what to expect, care team contacts and other goodies, all in a bag that patients can carry their belong- ings between appointments. RIGHT: An oncology social worker, Hillmon, helps patients with payment resources, creating che- motherapy bags and facilitating a breast cancer support group. “I just let them talk as long as they need to because it’s on their minds and they need someone who knows what this journey is like to talk to.” CHERON HILLMONOctober 2021 | Think Pink | The Daily News | 9 NAVIGATORS GUIDE BREAST CANCER PATIENTS THROUGH COMPLEX JOURNEYS Story by Valerie Wells | Photos courtesy of UTMB “Some are in total denial. We have to reassure them. We reiterate what the doctors say if they didn’t get it the first time. We let patients know they are in good hands.” STELLA TURRUBIATE A breast cancer diag- nosis brings shock, confusion and a long, complex to-do list. “We know it’s over- whelming,” said Sherry Bogar, a certified medical assistant and a patient nav- igator at the UTMB Health Breast Cancer Care Center at the League City campus. “We try to listen.” Compassion plays a large part in navigating a breast cancer journey from the beginning, said Stella Turrubiate, an oncology nurse who is also a patient navigator at the League City Campus. While taking medical histories, Turrubiate can sense people’s grief as it starts to emerge. “They are scared,” Turrubiate said. “Some are angry. Some are fearful. Some are smiling, but un- derneath they are scared.” The two navigators make the process flow a little smoother. “The process starts when we receive a refer- ral,” Turrubiate said. Patients might be miss- ing necessary tests, such as a mammogram or an ultra- sound. Before doctors can develop a treatment plan with the patient, they’ll need those test results and medical records from other institutions. Patient navigators gather all that information. They also want to make sure the patients are getting good facts, so they give them lists of reliable resources and reputable websites. All this informa- tion goes in a folder along with biographies of staff members. The navigators explain the patient’s individual plan of care and why each step is necessary. They also want to make sure they are not wasting a patient’s time. For one thing, patients might have financial issues, and extra trips can mean spending extra mon- ey on gas. Some patients drive from out of town for additional appointments for imaging, genetic coun- seling, echocardiograms or follow-ups. Navigators understand the problems appointments create for the average person. “Are they still working?” Turrubiate said. “They don’t want to take five different days off.” So instead, the naviga- tors schedule five appoint- ments for one day in one place at the League City Campus. The navigators created a room just for their patients and filled it with books, mannequins, wigs and Knitted Knockers—hand- made breast prosthetics. Bogar and Turrubiate col- lected scarfs, hats, lanyards and organized all the items in bins. They decorated the walls and got extra copies of children’s books about breast cancer. They created manne- quins to demonstrate the proper way to drain a tube placed during surgery. A surgeon will place a tube to drain the healing wound. The patient uses a draining bulb to clear out that tube. Bogar and Turrubiate took tubes and drainage bulbs and attached them to the man- nequins in the right places. They also make take- home kits for surgery pa- tients. They put in lanyards for the bulbs so post-op- erative patients don’t have to worry about holding on to all that while taking a shower. The two naviga- tors also include collection bottles for patients so they can accurately measure the drainage and record the data. This personalized room is also a place they can talk about difficult sub- jects. On a patient’s first visit, they discuss possible plastic surgery options if a mastectomy is necessary and offer reading material. “We tell them to read this information in the safety and privacy of their home,” Bogar said. The navigators encour- age patients to record their doctor visits so they can listen to the details again or share it with their loved ones. They even have re- cording devices to lend to patients who can’t record on a cell phone. One patient fought the idea of chemotherapy, Bogar said. “She missed an appoint- ment, and sadly she went on an alcohol binge,” Bogar said. “She was very emotional, borderline suicidal. I got her to come back in. We cried together.” When the patient re- turned for her three-month follow-up, she reminded Bogar it was because she had taken the time to share and go through her emotions, Bogar said. After patients get a breast cancer diagnosis, they can feel as if they have no control. “Some are in total de- nial,” Turrubiate said. “We have to reassure them. We reiterate what the doctors say if they didn’t get it the first time. We let patients know they are in good hands.” They encourage patients to call anytime about any concern. “I find it an honor to be here when a patient is at their most vulnerable time,” Turrubiate said. “This is what we do. We want to know what’s go- ing on with them, why are they crying, why are they angry. We see the inside of their family.” Bogar’s own mother was diagnosed with breast cancer in 2012. “The surgeon told her the breast cancer was cookie-cutter medicine,” she said. The comment appalled Bogar. It also inspired her to get the patient advocate certification so she could help cancer patients with their individual needs and specific differences. Every breast cancer patient at UTMB Health gets person- alized care. “We do a lot of hug- ging,” Bogar said. “We’re not a hands-off clinic.” ABOVE: Stella Turrubiate, left, and Sherry Bogar are patient navigators at UTMB Health Breast Cancer Care Center at the League City Campus. Both women have spent their own money to buy and create educational materials for this education room. RIGHT: Turru- biate and Bogar demonstrate to a co-worker how to use a drain- age bulb for post-operative patients. They created a man- nequin with a drainage tube to help explain the process. Next >