HJAR Sep/Oct 2023

HEALTHCARE JOURNAL OF ARKANSAS I  SEP / OCT 2023 57 Shyann Renfroe, MD Breast Imaging Specialist The Breast Center at CARTI the expense. So, the real issue here is a lack of awareness on how to cover the cost of the screening. • Lack of transportation. In some areas of the state, particularly in more ru- ral areas, there are fewer places to get screened. Combine that with a lack of public transportation, and people who either have no vehicle or are unable to drive have limited (or no) options. And when they do have access to transpor- tation?They are likely going to use that opportunity to take care of an essential task, such as getting groceries or tak- ing care of an immediate medical need, rather than getting a screening. • Not enoughmammographymachines . Not enough mammography machines. In Arkansas, availability is a real issue. If everybody got a mammogram like they should, there would not be enough machines to get it done — especially outside of Little Rock. NEXT STEPS Yes, the barriers can feel overwhelming. But promoting breast cancer risk assess- ment based on the new ACR guidelines is a great place to start. As healthcare profes- sionals, we have an opportunity to share information, provide resources, and meet patients wherever they are: hospitals, clinics, health fairs, churches, gyms, and more. Let’s change the future for women inArkansas. n Shyann Renfroe,MD, is a board-certified breast imag- ing specialist atThe Breast Center at CARTI.Renfroe is passionate about promoting breast cancer aware- ness and educating women about their risks. would actually be considered high risk and could have benefitted from those earlier or more intensive screenings. That’s why it is so important for us, as healthcare profes- sionals, to help educate patients on breast cancer risk in accordance with the newACR guidelines. ADDITIONAL BARRIERS Widespread awareness of breast cancer risk is an important goal to work toward, but we can’t neglect the very real barriers that make it difficult for manyArkansas women to get their recommended screenings, even if they want to — challenges like: • Concerns about pain. Many women assume that a mammogram is painful — and for some women, a mammogram is uncomfortable — so they talk them- selves out of going. What can we do to mitigate that concern? Do our best to set patients at ease, create a warm and welcoming environment, use curved paddles for a more comfortable pro- cedure, etc. • Fear that it will cause cancer. If a fam- ily member got a mammogram and was later diagnosed with cancer, that’s enough to convince some women of a causal effect. Yet mammography is the only modality yet proven to reduce breast cancer mortality. These screen- ings are critically important, far out- weighing any potential risk. • Cost. This is a big one. Some patients are unaware that insurance covers rec- ommended screenings. And if a patient is uninsured?There are programs and grants available to cover some or all of to have MRI surveillance starting at ages 25 to 30. These women should start annual mammography at ages 25 to 40, depending on type of risk. • Women diagnosed with breast cancer prior to age 50 or with personal his- tory of breast cancer and dense breasts should have annual supplemental breast MRI. • High-risk women who desire supple- mental screening, but cannot undergo MRI screening, should consider con- trast-enhanced mammography (CEM). RISK ASSESSMENT: SIMPLE, EFFECTIVE, AND FREE Risk assessment can be as simple as a free online questionnaire designed to deter- mine a person’s lifetime risk of developing breast cancer based on personal, family and genetic history. One of the most popular is the Tyrer-Cuzick Risk Assessment Calcu- lator (https://ibis-risk-calculator.magview. com). Although patients can certainly an- swer these questions with their primary care physician or gynecologist, filling out an online questionnaire can actually be a great starting point because it often prompts patients to talk with family members to fill in gaps. For instance, patients might need details on cancer diagnoses, menstruation information, etc. — things that aren’t always openly discussed (But should be!). Of course, every time a patient comes to see us for a screening mammogram, we complete a risk assessment. The problem is that most of our patients are coming in at age 40, which is fine for someone with average risk. But many of our patients