Breast cancer is the most diagnosed cancer among women in South Carolina and the South Carolina Department of Health and Environmental Control reports it's the second leading cause of cancer-related deaths among women in the state. The MUSC Hollings Cancer Center is trying to make it easier for women to receive mammograms by driving a mobile health unit to counties across the state, inviting women to step aboard the mobile health unit and receive a mammogram.

Kevin Hughes, MD, Director of Cancer Genetics and the McCoy Rose Professor of Surgery at MUSC Health explains the importance of yearly screening for women over 40 and Tonya Perkins, MSN, a MUSC Health nurse practitioner explains how the mobile unit works.

Welcome to Advance with MUSC Health. I'm your host, Erin Spain. This show's mission is to help you find ways to preserve and optimize your health and get the care you need to live well. Breast cancer is one of the most commonly diagnosed cancers among women in South Carolina and the South Carolina department of Health and Environmental Control reports that it's the second leading cause of cancer related deaths among women in the state. The MUSC Hollings Cancer Center is trying to make it easier for women to receive mammograms by driving a mobile health unit, basically a large doctor's office on wheels, two counties around the state, inviting women to step aboard the mobile health unit and receive a mammogram. We will hear from one of the MUSC health nurse practitioners, a board, the mobile unit later in the show. But first I welcome Dr. Kevin Hughes, director of Cancer Genetics, and the MUSC department of Surgery. Dr. Hughes is here to talk about how mammograms save lives and how far breast cancer treatments have come welcome to the show Dr. Hughes.

Erin, thank you.

Dr. Hughes. There are some different recommendations when it comes to mammogram screening. What is the recommendation for who should be screened and how often?

Leave that yearly mammography starting at age 40 is essential to helping women have the least chance of having an advanced cancer and therefore would be able to have the least treatment necessary if a cancer develops so yearly mammography starting at age 40 for the average woman, is what we recommend. However, if a woman is higher risk, if she has a strong family history, she has other women in the family with breast cancer at a young age, ovarian cancer, et cetera, those women, we start screening earlier often in the twenties or thirties, we often recommend genetic testing in addition to mammography too, to better define the risk. And we'll sometimes recommend MRI in addition to mammography. So for the average woman yearly mammography at 40, if you're higher risk, have your risk assessed. Determine if you need your testing and then have a treatment schedule appropriate to your level of risk, which we can help you to

Tell me a little bit about your background and how breast cancer treating breast cancer has changed and evolved in the past several decades. Tell me about that.

So when I started out, mammography was not common. A mammography was not done for screening. Most patients coming in had advanced cancers. Most cancers were palpable. Often the lymph nodes were involved. Then as I was finishing my training, we began to get into lumpectomy became available. But at that time we went through a very long involved discussion with a patient about you did have a lumpectomy, you to have a mastectomy, you make the decision. Patients were confused. They took them very, it was very hard by the middle of the nineties. We finally realized lumpectomy was just fine. We tell patients, and if you have a lot back to me, you can have it. If you don't want a lumpectomy, we'll do a mastectomy. So we were afraid at that time of the cancer spreading. If we did surgery, we of course found that wasn't the case, but we would have the patient sign for a mastectomy before they went to sleep, whether they had a cancer or not. We didn't know. So we would take the patient to surgery, take out her lump, freeze the lump. And if it was cancer, we do a mastectomy immediately. No reconstruction. We moved away from what was called an axillary node dissection, taking out all the notes and taking out what style call a Sentinel node biopsy. Just checking out one or two nodes. Our hormonal therapies have gotten better. Our chemotherapies have gotten better. We've understood better, which patients need these different medications. But we now are doing genomic testing on the tumor to identify whether or not chemotherapy is even necessary. So we do a lot less chemotherapy now than we used to do. We've identified that women over 70 with smaller tumors often don't need radiation. So we're often doing less radiation as well. So I think what we've found is we've gone from mastectomies for everyone to now minimum amounts of surgery, minimum amounts of chemotherapy, minimum amounts of hormonal therapy, or even radiation. We've minimized that treatment for each patient. Some patients need the more aggressive therapy, but others don't. So it's individualizing. The treatment is a major advance I've seen over these this timeframe.

COVID-19 may be one reason why some women have put off getting their mammogram. Tell me about this phenomenon of women who missed mammograms and why now is a good time to get caught up and go get that screening.

This is a significant problem during COVID. When it first began, the stream mammography dropped 80 to 90% and it was months before that, that mammography level became to come, began to come back up towards a normal. Now, what you're faced with is not just your daily set of mammograms you had to do anyway. But this backlog of mammograms where women didn't get them done for months or sometimes a year, it's critical that women get in and get their mammogram done. If they've missed one year, get back in for the second year. But as soon as they get their mammograms back on track, the earlier we'll find their cancers. If they have one or the earlier, we'll tell them they're okay, so you can stop worrying. But definitely we want to get screening back up to full volume as quickly as possible.

Tonya Perkins is at MUSC Health nurse practitioner with a specialty in surgical oncology. She's hitting the road with the mobile health unit this fall to offer mammograms and often underserved communities. You work very closely with people who have been diagnosed with cancer. Tell me about your work and why you chose to specialize in surgical oncology.

So I think that cancer has touched practically every person and with me, especially my dad was diagnosed with mesothelioma when I was 40. He died six months later, and then a year later, my mom was diagnosed with ovarian cancer.So this has a personal message for myself, which is why I wanted to become a nurse. And then eventually become a nurse practitioner,

According to the American Cancer Society 68% of women in South Carolina over the age of 45 are up to date on their mammograms. We would like to see that number higher, of course. So what are some of the reasons women delay getting mammograms sometimes for years and years?

I think the biggest issue is people are afraid of the machine and the pain that is associated with having their breasts squeezed. Second would be cost, especially if they do not have insurance. Third would be transportation issues. I think a lot of people are scared of the results. They may be symptomatic and they just don't want to face the reality that they could have breast cancer. We have a lot of people in our country that are not from this country. So there's a language barrier. And then finally, we may have people that just don't understand how important these screenings are. And so their lack of knowledge about having the screening process.

Now, when you have patients who are nervous or fearful, tell me how do you counsel them and explain the process to them?t

I think the best is actually what my mom does. And she has a buddy and they make their mammograms together. And so that way they always go at the same time on the same day and they encourage each other to have their mammograms done that way. They always can look at each other and say, okay, today's our day. We're going to go and do this. However, if you don't have a buddy, then I prepare them for what's actually going to happen. I'm 52. I've had several mammograms. It's really not that painful a process. Is it uncomfortable? Yes it is. But it's only for a few seconds and it can save your life.

That's such a great message. I've never heard of that. Having a buddy to go with you in making your appointments together, what a great idea.

It is. It's wonderful.

So tell me about this new and improved MUSC mobile health unit. That's going to be crisscrossing South Carolina, this fall offering mammograms to women. Tell me about this mobile unit. What does it look like?

Well, it is beautiful. It's state of the art. We have a waiting room and exam room. There's of course, a bathroom, a changing area. There's a small lab area. And then of course the mammography suite.

So let's talk about the experience for a patient. Walk me through this process. How do they find out that the mobile units coming to their town? How do they book an appointment? Do they need an appointment? And what happens from the point of stepping on the bus to when the mammograms over?

So currently you do have to have an appointment. We are only accepting about 10 patients a day. I think our max is going to be 20 patients a day. So you call our outreach coordinator, they schedule the appointment and you can do self referrals. You show up for the appointment. If you are a self referral, then our outreach coordinator will fill out all the forms for you that need to be filled out in advance. If you are being referred from your primary care or from one of the clinics, such as Fetter or Cares or Shifa, they will fill out the paperwork for you. You get checked in and then your exam begins. You cross the short hallway over to the mammography suite, they do your radiology imaging, and then you come back, you get dressed and then you exit the van.

Now, do you need health insurance to use the service?

No, we do accept uninsured patients and we actually do try to help this cover through the Best Chance Network.

Excellent. Tell me about the best chance network for those who don't

Know the best chance network is actually a DHEC service and is for those people that qualify based on income and family size.

Women notified of their results, especially if they aren't a current patient with MUSC Health, or they're not affiliated with one of these clinics, how do they get the

Results? We actually mailed them a letter.

What's the followup from there? How do you stay in touch with these women to make sure that they are getting yearly screenings?

We do team them up with a primary care provider, if they do not have one so that they have someone to stay in touch with them. We also have them registered through the mobile health unit so that we can contact them through that particular industry as well. If they are self-referred, then they will make an appointment for the next year.

What happens if something is detected in the mammogram? What are the next steps? Because the mobile unit leaves town, where do they go? What do they do?

So if they have a primary care provider, then the mammogram results are sent to that provider and they would follow up with them. If they do not have a primary care provider, then Hollings Cancer Center will actually follow up with them.

Tell me about some of the success stories. When you're able to go into these communities that are underserved and offer services like mammogram screenings.

We see that every day, not just in the mobile health units, but here at the Hollings Cancer Center, just with people that are screened on a regular basis. We have people that are happy that they came in for the screening and are told that they don't have breast cancer. And then we have people that are happy that they came in that were symptomatic and actually were diagnosed, but we have a system in place to help them become cured.

If you do get the yearly screenings, the chances of catching something that's in its early stages is greater. Tell me about that. How important screening is?

We have a very high cure rate. If we can catch cancer in its early stages and our breast surgeon teams here are awesome. Their art form is amazing. And I do truly say it is an art form.

Anything aside from mammograms that will be happening with this mobile health unit while you're out and about?

If you are a member of the best chance network, we are performing pap smears as well on the mobile health unit.

For more information on this podcast, check out advance.muschealth.org.