Traveling van brings mammography to women across a wide area

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

As a screening tool to detect breast cancer early, mammograms are part of routine health care for many women, but life sometimes gets in the way, making it difficult to find time to get an appointment at an imaging center. To help with that, Upstate offers a mobile health clinic with mammography throughout the greater Central New York region. Here to talk about what is known as the "mammo van" is program manager Wendy Hunt. Welcome to "The Informed Patient," Ms. Hunt.

Wendy Hunt: Thanks for having me.

Host Amber Smith: I've seen the mammo van in person, and it's way bigger than a typical van. It's the size of an RV. What all is inside the van?

Wendy Hunt: The looks are deceiving because inside, it seems small. there's a waiting area, there's a check-in area, there's an exam room, which is actually the front part of the van, where the driver sits. So it's all windows, but we have, blinds that, block everything out that are pulled down when it's time for a patient to go in -- that's where the nurse does her exams. There's the mammo room in the back, with all the equipment in it, where the mammograms occur. And then there's two dressing areas, there's a work-area-slash-kitchen over behind the mammography area so that the tech has a space to work. And then they have a place to heat up lunch when they're working and that kind of stuff. And there's a restroom on there, but we don't encourage the use of that.

Host Amber Smith: So it sounds like, a big office on, wheels that you can move around from location to location.

Wendy Hunt: Yeah.

Host Amber Smith: Where all do you go? Where does the mammo van travel?

Wendy Hunt: So when we started, we were under a grant from the state Department of Health, and they prescribed our region to include Onondaga County, Oswego, Jefferson, Lewis, St. Lawrence, Oneida, Herkimer and Madison counties. So we've been traveling within those eight counties. We will continue with some of those counties, but now that the grant has ended, we can go anywhere we want. So we ventured a little bit into Cayuga and Cortland counties and hope to do more of that as we go.

Host Amber Smith: Is the van on the road year-round?

Wendy Hunt: Yeah, we are year-round. It just depends on the weather in the winter. We don't go as far north.

Host Amber Smith: OK. What about handicap accessibility?

Wendy Hunt: We have a lift that goes right into the mammography room, and the patient is then assisted with whatever they need help with in terms of getting ready for the mammogram.

Host Amber Smith: Now, do people need to have appointments ahead of time?

Wendy Hunt: Yes, right now, that is how we're doing things. That will change, hopefully, in the near future -- we could take walk-ons. However, on a day when we're not super busy, if someone shows up to the van and has an order with them and is due for a mammogram at that point, if we can, fit her into the schedule, we do it if we can.

Host Amber Smith: So they would need to have a prescription from their doctor to get this. You can't just walk in and say, I'd like one.

Wendy Hunt: Correct, yes.

Host Amber Smith: How would someone know, or be able to predict, when the mammo van is going to be near where they live or work?

Wendy Hunt: We try to keep somewhat of an annual schedule of places. So if we're in, say, Oswego in October, then we try to go back there annually so that we're there, but we also have a website through Upstate that we list all of our dates on. We post up on our social media, and then the hosts that we work with, they quite often will be able to promote and post things as well, to help people know what's going on, when we're going to be there.

Host Amber Smith: And we ought to tell people that website, upstate.edu/mobile-mammography.

Wendy Hunt: Either that or upstate.edu/noexcuses. Either one of those would work.

Host Amber Smith: All right. Well, let me ask you some basic questions. Can you please explain what a mammogram is for?

Wendy Hunt: Mammography is a cancer screening to find cancer early. And, the earliest earlier it is found, the better treatment options are for people. So that is why it's encouraged on a yearly basis.

Host Amber Smith: How has it done?

Wendy Hunt: It's done with the machine. It compresses the breast and takes pictures. And right now we're using what's known as 3D imaging, which allows the machine to take what -- it's been described to me as slices of pictures, so that there's multiple pictures taken and they're all put together and create one 3D image of the breast, which allows the doctors to see more than the traditional 2D imaging has been, becausethere's more images to look at. It's looked at different areas of the breast.

Host Amber Smith: Do you know who is recommended to have a mammogram and how often?

Wendy Hunt: Yes. Women who are 40 and older, average risk, should probably be going on a yearly basis.

Women who maybe have an increased risk, if they have a genetic mutation or they have a family history, that's something that they would want to talk with their doctor about and make a decision with the doctor as to how often they should be screened.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith, talking with Wendy Hunt. She's the program manager for Upstate's mobile mammography van.

Now let's talk about how someone goes about qualifying to make an appointment.

Wendy Hunt: We do screening mammography only on the van at this time. Women who have breast issues, maybe they're feeling some pain, they felt a lump, they have some skin dimpling. Those are all things that we couldn't see them on the van at that point. They would really need to go to one of our fixed sites, have a mammogram there, because then if there is something that needs to be looked at more closely, they can do that right then and there instead of us having tobring the patient back.

So yes, it would be women who, again, average risk, aren't having any problems with their breasts at this point, women who are 40 and older, women who haven't had a mammogram in 365 days, because most insurances require you to wait 365 days in between mammograms in order for them to cover that service for you. Well, I think that's about it.

Host Amber Smith: Do women need to have health insurance in order to come to the mammo van?

Wendy Hunt: No, there is a program, called the Cancer Services Program, that is through the state Department of Health, but there's one in each county in New York state. They provide screening mammograms for women who don't have health insurance, or maybe are under-insured.

They will also provide follow-up for those women, and then they have a specialized Medicaid program, so if a woman is diagnosed with cancer and needs treatment, they would help get her enrolled in that program too, if she's eligible. So no, insurance is not required.

We do bill insurance. It's technically not a free service. I've heard people say that they consider it to be free service. It's free to the patient for the most part because insurances don't charge a copay for a mammogram. And like I said, if the patient is uninsured, then we can work with the Cancer Services Program to get them covered.

Host Amber Smith: So if a woman has a prescription for a mammogram from their doctor and they make an appointment to come to the mammo van at a certain time and location, beyond that, how do you recommend that women prepare for their mammography appointments?

Wendy Hunt: There's just a few things women should keep in mind when they're scheduling their appointments. There's a couple of weeks out of the month, if women are still menstruating, that their breasts will be more tender, usually the week before their period and the week during. So if you're able to schedule that at maybe the week after, when you're done menstruating, your breasts will be less tender. That's one of the things to take into consideration.

Another thing is COVID vaccinations and booster shots. We're all going through this right now. Those vaccines, you need to wait four to six weeks after your vaccine or booster. They're given in the upper arm, which is close to the armpit and is known to have shown up as enlarged lymph nodes on a mammogram.

If that happens, then, we bring you back for further imaging, and that can cause anxiety for people. So in order to avoid that, we ask you to wait four to six weeksafter any COVID vaccination or booster.

Like you mentioned, Amber, the order, um, if the patient does not have an order, we can help them obtain that order. We will work with their physician to get that. If the patient doesn't have a physician, we can also work with them to get that mammogram ordered through one of our doctors here at Upstate.

Prior images, that's something that's very important because the radiologist will want to review prior images from previous mammograms and compare them to the current mammogram. And so we ask that people know where they went previously for that imaging and when they went, because we will request them. And that's not a problem; it's what we do, but we just need to know where you went and when, because otherwise it's kind of hard. Sometimes it can be a lot of detective work.

And then the final thing, the day of, we suggest no deodorant, lotions, powders in the breast area before you come for your mammogram, because there's metallic particles in these items that can interfere with the imaging.

Host Amber Smith: About how long do the appointments last?

Wendy Hunt: The mammogram itself, for a woman who doesn't need to see our nurse, is about 15 minutes. There'll be a few minutes prior to thatdoing paperwork, getting changed, so for someone just coming for a mammogram, I would plan for about a half an hour at the most.

Like I mentioned earlier, for some women who maybe don't have a medical provider, there's a provider at Upstate that provides an order for patients, and in that situation, they will see our nurse before their mammogram, and she'll do a clinical breast exam, which is the hands-on manual breast exam. And along with that, just some breast health education with the patient. And once that's done, the doctor will provide an order, and then the patient can get the mammogram, but the doctor will only do that once. We can't have people coming back every year. The goal is to have them find a doctor that they can establish with. And we do give them information about that and can help facilitate that for them if they want to.

Host Amber Smith: Now, once the mammogram is done, who goes over the images?

Wendy Hunt: The radiologist will read the images. She'll look at the priors. Like I said, we request those priors. That's very important. For people who have had previous mammography, she needs to see those to make sure that if there is something on this current mammogram that maybe it was something that's been there before, and it's unchanged, so it's not a problem. Or maybe it's something new, and we've never seen it before. So the radiologist will review them. They are required by law to do that within 30 days after the mammogram, and then a letter goes out to the patient within that 30 day time frame, letting them know what the results are.

For patients that have MyChart (an online medical record), once that report is done, it goes right into MyChart, and the patient can access it.

Host Amber Smith: What happens if something unusual is discovered?

Wendy Hunt: If that's the case, we have a nurse on staff that will help patients facilitate additional imaging if they need it, but she will generally contact the patient's provider first, whoever referred the patient, to make sure that the provider's aware that they've received the report and they know what's going on. And if the provider wants to make those arrangements, the provider will reach out to the patient and do that. But if they want our nurse to do it, she does that, too. And for those patients thatget an order from our Upstate provider, the nurse takes care of that with them and gets them set up.

Host Amber Smith: Now, you mentioned MyChart. Can the nurse help someone enroll in MyChart; that's an online medical records thing, right?

Wendy Hunt: Yes, I'm sorry. Correct. It's the patient portal. I believe any one of our staff would be able to help with the information on how to do that. They can get the patients the information, and we do give them, a brochure or pamphlet regarding MyChart and how to use MyChart, so they do get that information, but contact any one of us for help with that.

Host Amber Smith: Before we wrap up, let's make sure people know, once again, how to make an appointment and how to find information on where the mammo van is going to be. The website: upstate.edu/mobile-mammography.

Wendy Hunt: Uh-huh.

Host Amber Smith: And is there a phone number?

Wendy Hunt: Yes. They can actually request an appointment through the website, so there's a page on there that allows them to do that, but they can also call 315-464-2588 and schedule their appointment through that phone number.

Host Amber Smith: Thank you so much for this information.

Wendy Hunt: Yes, you're very welcome. Thanks for having me.

Host Amber Smith: My guest has been Wendy Hunt. She's the program manager for Upstate's mobile mammography van. "The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe.

Find our archive of previous episodes at upstate.edu/informed. This is your host, Amber Smith, thanking you for listening.