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Sleepless nights filled with anxiety and apprehension used to be the norm as
local women waited the weeks and often months it took for the follow-up evaluation,
core biopsy sampling (tissue diagnosis) and potential treatment of suspicious
findings seen from a breast screening mammogram. This problem plagues the country.
The process to diagnosis and treatment is slow. Fewer breast centers remain
open (eleven percent closed since 2000) as fewer physicians are entering the
mammography field, compounding the problem.
Often, until recently, sleepless nights also plagued Dr. Christine A. Granfield,
Medical Director Breast Imaging for Baptist Health. “The high anxiety suffered
by many of our patients weighed heavy on my heart,” said Granfield. “There
had to be a solution. There had to be a way to provide more rapid, continued
high quality breast healthcare.”
In 2005, Granfield pulled together a group of dedicated medical professionals,
most of them women, to come up with a new model for breast imaging. The new
centralized Breast Health program, which debuted at Baptist Health in October
of 2006, was the result of that collaboration. Since the program was established
at Baptist Downtown, Baptist Beaches and Baptist South, the wait time for mammograms
has nearly been eliminated and the numbers of women served has nearly doubled.
The centralization model required that Baptist Health become one of only ten
percent of medical facilities in the nation to invest in digital mammography
units. Like a digital camera, Granfield reasoned, the expensive new digital
mammography units can record an image and send it instantly to a central location
— in this case, the Pavilion Breast Center at Baptist Downtown. There,
four interventional breast radiologists are on duty daily to read images, review
findings together and report on screening results immediately.
Prior to centralization, there was a 172-day backlog of women waiting for screening
mammograms. Now, at all three Baptist Health screening locations (Beaches, Baptist
South, and San Marco/downtown) women can get a screening mammogram within a
day or two. In fiscal 2005-2006, diagnostic mammograms (those that follow a
suspicious finding on a screening mammogram) numbered 8,280. As of August 2007,
12,135 diagnostic mammograms had been done at the Center. A similar increase
occurred in the number of pre and post-centralization core biopsies, increasing
from approximately 1,000 patients between 9/1/05 and 8/31/06 to 1,800 patients
by 8/31/07.
“To my knowledge, we’re the first center in the United States to
implement this high tech, high volume system,” said Granfield, noting support
of her fellow physicians at Mori, Bean and Brooks was integral to the realization
of her vision. “I have absolute admiration for Hugh Greene and Baptist
Health,” she said. “They knew it was the right thing, despite the
incredible expense involved in converting to all digital mammography. We hope
it will become a model for other health systems across the country.”
In fact, the dramatic increase in advanced diagnostic and interventional breast
services in the single, dedicated location has prompted Baptist Health to initiate
planning and design of a future 20,000 foot comprehensive breast center of excellence.
With images now just a computer click away and no film storage or film tracking
issues, the new digital technology has changed the face and the pace of breast
services with phenomenal results.
“The required breast compression during the mammogram is less,” Granfield
said, “making it more comfortable for women.” More importantly, digital
mammography is more accurate compared to traditional film screening, particularly
in women under fifty, women with dense breasts and women in the pre-menopausal
or peri-menopausal stages. And, in addition to it being a “green”
technology that requires no film-developing chemicals, the radiation dosage
is forty percent less than that of conventional mammography.
Granfield is most gratified, however, about the new program’s ability
to quickly respond when breast cancer is diagnosed. “The increased efficiency
expedites care to those who need it most,” she said. For the ten to fifteen
percent of women with abnormal screening mammograms, the follow-up is immediate.
“If a diagnostic mammogram indicates the need for a biopsy, it can be done
that same day. This was unheard of in the past.”
Even compassionate, individual attention has been enhanced with the new program.
“We have gone from one to three dedicated breast health nurse coordinators
to help women navigate through the process,” said Granfield. “Every
woman diagnosed with cancer has a nurturing angel by her side.”
Baptist Downtown Clinical Breast Care Coordinator Marian Bender, RN, talks
of the stacks of touching cards and letters of gratitude that she and fellow
nurse coordinators, Cynthia Carrasco, RN, at Baptist Beaches and Marcelle Marie,
RN, at Baptist South have received from patients. “This center encouragese
women to become pro-active about their breast health,” she said. Covering
Beaches, Baptist South and San Marco (downtown), the nurse navigators are intimately
involved in nearly every aspect of the breast cancer journey for the small percentage
of women diagnosed, most of them ranging in age from 48 to 68.
Because breast cancer predominantly strikes women over age fifty, Bender notes
that the Center serves many women who are well up into their seventies and eighties.
She recalls one “lovely lady in her late seventies who came in from out
of state for treatment.” She had been given a report of an abnormal mammogram,
lived alone, didn’t drive and had family living in Jacksonville. “Her
daughter found me on the Baptist Medical Center website (e-baptisthealth.com)
and called to ask if I could help,” Bender said.
Bender spoke to the patient prior to her arrival, advising her to bring mammogram
films with her. She accompanied the patient and her family to a meeting with
one of the radiologists. When it was determined that she needed a core biopsy,
Bender arranged for her to see a surgeon, accompanied her to the appointment
and stayed with the family when she had a lumpectomy performed — all within
a very short time-frame. “She is now cancer-free,” said Bender. “Her
family couldn’t say enough about the help they received.”
Families are important, Bender added. “It’s not just about the woman
being treated,” she said. “There are so many wonderfully supportive
families out there who are less stressed now.” Often, Bender said, the
instant consultation with a radiologist and the possibility of a core biopsy
being done the same day catches people off guard. “They say things like:
‘Gosh, you can do this today? That would be wonderful!’”
Once the biopsy is done, tissue is immediately sent to Dr. Dayan Sandler, Director
of Pathology for Baptist Health (and a visionary of the centralization task
force).
“Dr. Sandler is great! She has read close to 10,000 core biopsy pathologies.
Dr. Sandler has a fabulous consultation service. Dayan reads the whole picture
— the family history, the mammogram findings, the pathology and what it
means in terms of patient outcome, and talks to the family and patient about
options. “She empowers them with information to help them make these very
critical and personal decisions.”
“We did a lot of education with patients and physicians prior to this
change in model,” said Linda Hansen-Allen, director of Women’s Imaging
at Baptist Health, “and there was some initial skepticism in the community
about whether this would represent a great improvement in services. Six months
ago, we checked with those same physicians and every single one was thrilled.
Their patients are happy. They’re being seen faster, getting better service,
being worked up in a very short window of time, and they love the breast health
navigators. To say this program has been well received is an understatement.”
While the concept and state-of-the-art technology is unique, the passion of
the dedicated multi-disciplinary staff at Baptist Health’s new Breast Health
program is what Hansen-Allen considers the key to its success. “This program
has a tight-knit, top-tier caring and passionate team, most of whom have had
personal experience with breast cancer.”
“Without a doubt, this program is the proudest accomplishment in my life,”
said Dr. Christine Granfield. “It’s what happens when you get a group
of women together who are determined to do the right thing for other women in
our community.”