By Stacey Stapleton

For most women, even those with relatively simple medical backgrounds, their anxiety increases as the day of their scheduled mammogram inches ever closer. For women with significant family histories of breast or ovarian cancer—and even more so for women who have had personal experiences with either disease—a mammogram can be downright terrifying. If you’ve ever wished for on objective shoulder to lean on or a hand to hold, the Breast Center at Overlook Hospital and its team of specialists provide the support you need to get through not only the screening process, but also diagnosis, treatment, recovery—and beyond.

It Starts With Screening

The National Cancer Institute recommends yearly mammograms for all women over 40 (earlier if a woman has a significant personal or family history of breast or ovarian cancer). Although you may not be looking forward to your screening, choosing a facility that’s concerned about the whole person—not just the images—can make a world of difference. It was this philosophy that shaped the Breast Center at Overlook Hospital, now celebrating its second year. “The entire center has a soothing, spa-like feeling with carefully selected colors and artwork, all aimed at helping patients relax,” says Breast Center Coordinator Lisa Cuocco, RN, BSN.

If you’re visiting the Center for a regular screening mammogram, you’ll return to your normal routine immediately after the test; over the next few days, images from the mammogram will be read by a radiologist. If the radiologist detects a questionable image, further testing is necessary. You’ll be contacted for a “call back” and asked to return as soon as possible for a diagnostic mammogram, breast ultrasound, or MRI. The results of these diagnostic tests are returned almost immediately. If these images look fine—and that’s true of most cases—you’ll be asked to come back for another mammogram in six months or a year. But if the radiologist is still concerned, he or she will suggest a biopsy.

This is where Jasmin Torres, the Breast Center’s patient navigator, becomes key in a woman’s care. “The role of the patient navigator is to advocate for patients at one of the most frightening times of their lives,” explains Cuocco, “as well as translate physicians’ medical jargon, explain treatment options, and refer women to appropriate support resources.”

Often it’s the radiologist who alerts Torres that her services are needed. “If the radiologist sees something abnormal on a patient’s test and is recommending a biopsy, that’s when I step in,” she says. “Normally I come into the room with the radiologist so I can be there while he or she explains the situation to the patient.” After the radiologist leaves, Torres typically remains with the patient to review what the physician said and answer any questions. “I also take some time to explain the next steps,” adds Torres, “and offer a list of surgeons to consult with, as well as an information sheet with everything they’ll need about biopsies.” Torres becomes the patient’s point person throughout the biopsy process and is available to address any questions or concerns. In many cases, women are too overwhelmed to ask questions on the spot but end up reaching out to Torres several days later when they’ve had a chance to digest the news.

Receiving a Diagnosis

To confirm the presence of cancer, a breast biopsy is performed and part or all of a suspicious growth is removed and examined. The biopsy sample is either suctioned out through a needle or removed using a surgical procedure, and is then examined under a microscope by a pathologist to identify non-cancerous (benign) or cancerous(malignant) tissue. If the biopsy comes back positive (meaning cancerous tissue was found), Breast Center patients are then referred to a cancer navigator to help explain this diagnosis and discuss treatment options. “The Breast Cancer has so many components that no two cases are alike, explains Sarah Mandel, RN, LSW, a certified breast patient navigator at The Carol G. Simon Cancer Center at Overlook Hospital, “so my role is to respond to each patient’s unique needs.” Typically cancer navigators like Mandel provide medical information and education, and recommend support services and resources. “I also help women coordinate all aspects of their care, since it often involves several different physicians: the medical oncologist, the radiation oncologist, the breast surgeon, and even a plastic surgeon if any reconstruction is planned,” says Mandel.

Tackling Treatment

Although the survival rates for breast cancer have encouragingly skyrocketed upward in recent years, beating the disease is still a tough task and patients continue to need support as they go through a variety of treatments—everything from chemotherapy and radiation to surgery and reconstruction. Fortunately, cancer navigators like Mandel continue to support patients throughout treatment by addressing not only their medical questions and concerns, but also a wide variety of other needs. For Mandel and her navigator colleagues, a typical day may mean securing a wig for a chemotherapy patient (through a partnership with The American Cancer Society) and calling in the services of an oncological dietician to help another patient heal faster after surgery or manage the side effects of chemotherapy. Mandel often provides referrals for oncology massage, makes recommendations for genetic counseling for women with strong family histories of breast cancer, and directs women to appropriate support groups like the ones held at the Breast Center. “This October we will be starting a wonderful support group for women from diagnosis though one year post-treatment,” says Mandel. “And there are also groups for women in all stages of survivorship who still have questions and need support.” Educational resources are also available for patients’ caregivers and their families. “In many cases a woman’s partner is stressed out as well,” explains Mandel. “Chances are, he’s not only caring for her but taking on all the housekeeping and childcare tasks.” For the young children of women undergoing treatment, Mandel is able to suggest age-appropriate books to help kids understand what Mom is going through and how they can help.

Sustaining Survivorship

Many people think that surviving breast cancer means being cancer-free, but the definition has changed in recent years thanks to advances in testing as well as targeted therapies that have elevated survival rates to an all-time high. “Today we believe that survivorship begins with the diagnosis and continues through a patient’s treatment,” says Mandel. “And of course there are also other stages of survivorship, like the post-treatment phase and the celebration of being five or even ten years cancer-free.”

But that doesn’t mean that women don’t continue to need support. “I have several survivorship packets and care plans that I offer my patients,” says Mandel, “and I continue checking on them every few months to see if they have any questions or new concerns.” Having emerged through cancer treatment, some women still find themselves handling maintenance therapies that can be confusing and difficult to manage; hormone-replacement therapy, for example, can leave patients feeling worn out and sick while they adjust. “Many times women think because they’ve beat cancer they’re going to feel like their old selves right away,” says Mandel. “I’m here to address their questions and fears about not feeling 100 percent.”

The navigator’s role doesn’t just end there. “Many patients still call me just to talk or tell me how they’re feeling,” says Torres, “and I welcome these calls and their stories of survival.” Agrees Mandel, “I’m always amazed at the depth of women’s strength and their ability to harness all their coping skills, even those gained from past hardships, in their fight to live.”

For more information on the Breast Center at Overlook Hospital, call (888) 572-5868.

Making Mammograms Easier

Your annual mammogram might not be something you look forward to, but it should be a high priority on your to-do list. “Think about what could happen if you don’t have one,” says Lisa Cuocco, RN, BSN, coordinator of the Breast Center at Overlook Hospital. “Early detection is the key to survival.”

• Choose a facility that specializes in breast health and does many mammograms a day. These offices tend to offer more sensitive, female-centered care.


• When visiting a new facility, bring a list of the places and dates of your past mammograms in case those records are needed. Or better yet, bring copies of those mammograms with you.


• If you’re pleased with your mammogram experience, continue visiting the same facility each year so the radiologists can easily compare your results.


• Skip deodorant on the day of the test, since it can sometimes show up on the X-ray as a suspicious white spot.


• If you’re still menstruating, don’t schedule your mammogram the week before your period, when your breasts are most swollen and tender.


• Before your mammogram, discuss with your doctor or nurse any new findings or problems in your breasts. At the time of your mammography appointment, discuss with the technician any breast symptoms or problems you are having, as well as any related medical information: surgeries, hormone use, personal or family history, etc.


• Before the test, let the technologist know if you are nursing or could be pregnant.


• “If you’re especially nervous, try scheduling your mammogram with a friend,” says Cuocco. “That way it’s more fun and you have each other to rely on for support.”