New Breast Health Center coordinates care, launches initiatives

Breast cancer doctors, including surgeons and radiologists, meet at Carroll Hospital Center to discuss patient treatment. (The patient's identifying personal information has been removed from the photograph.)
Breast cancer doctors, including surgeons and radiologists, meet at Carroll Hospital Center to discuss patient treatment. (The patient's identifying personal information has been removed from the photograph.) (KEN KOONS/STAFF PHOTO , Carroll County Times)

Open the door. There's calm music playing through a set of speakers. There's carpeted floor and off-white walls. There's a bathroom decorated with kitschy items and a waiting area.
Wander through the hallway. There's a conference room and some offices and an exam room - just one, so the patient knows the doctor's attention is all on them.
That's because the hospital's new Center for Breast Health aims to be a homey spot where the patient feels cared for in a compassionate, coordinated way.
"One of the keys is we want people to feel as comfortable as they can through a bad situation," Dr. Dona Hobart, the center's medical director, said. "I want them to feel a little bit, for a short period of time, like we're a part of their family."
The concept of a breast health center isn't new. They've been cropping up around the nation for years and are known to raise the standard of care, Hobart said.
"We want the people of Carroll County to feel well cared for, and I think there's been a sense of disjointedness of breast care," Hobart said. "There wasn't a breast center, and there wasn't a place to go where you could get comprehensive care. They were getting very good care, very good surgery - it was just a little disjointed."
The patient would float from office to office. They'd go to the radiologist for a mammogram, the surgeon to discuss options and yet another space for navigation services.
That's since changed. The hospital designated an office tucked inside its Fisher building on Stoner Avenue as its Center for Breast Health, which officially opened during the summer and is near Advanced Radiology, which performs mammograms. Center officials are working toward becoming an accredited breast center, a step-by-step process that's already begun.
And hospital officials have also used this as the impetus to launch several initiatives aimed at helping a woman battling breast cancer.

Just across the hall
The farthest a woman has to travel for breast care consultation and services is down the hall.
She'll start her journey at Advanced Radiology, located inside the Fisher building almost across from the hospital's new Center for Breast Health. While there, a digital mammogram will record images of the breast, which Advanced Radiology's website states takes about seven minutes to complete.
Sometimes, a woman will be called back to Advanced Radiology for a diagnostic mammogram if a possible abnormality was detected on the original screening. This typically consists of more pictures of the breast taken from different angles, and less than 10 percent of women who have additional tests are diagnosed with breast cancer, according to the American Cancer Society.
If abnormalities persist, a small amount of breast tissue must be removed and examined, a process called a biopsy.
That's when Advanced Radiology enlists the Center for Breast Health's services. They'll call over Marcia McMullin, a health navigator, who'll help schedule the biopsy. But that's not all she'll do. McMullin generally brings the woman to the center's small conference room, and they'll sit down at a circular table and chat.
They'll go over educational material and pamphlets explaining biopsies. They'll talk about the new breast center and comprehensive care.
"That's what we're here to do," Hobart said. "If we didn't have that service, [the woman] would have been out in her car by herself with nobody to process that with."
They'll come back to the center to receive the biopsy results inside the center's single exam room. Hobart, a surgeon, will pull them up on a flat-screen monitor and explain. She'll then lay out options if the patient is one of the 12 percent of women who will be diagnosed with breast cancer during their lifetime, according to the American Cancer Society.
Then back to the small conference room the patient goes. The scheduler sits down with her to nail down times and dates for surgery and follow-up appointments.
The scheduler exits, and McMullin walks in the room.
"Sometimes it's a big, huge shock," McMullin said, "and they just need to sit in here for a little bit."
She'll figure out any help the woman might need, such as transportation to the hospital and resources on how to tell her young children about her new diagnosis. She'll sit and chat with the woman for as long as the patient needs.
"They just leave with, I think, a little bit better sense of calm," Hobart said. "They don't get out to the parking lot with as many unanswered questions."


Questions: answered
Inside a classroom-like space, two doctors and a nurse sat at a table facing two patients and a friend.
"The concept is everything's on the table for an hour," Hobart said Sept. 10, launching the hospital's inaugural Q&A-style support group meeting for women recently diagnosed with breast cancer.
"It's a scary path to go down. It's a hard time, but we're trying to make it as easy as we can," Hobart said, then paused. "So, shoot."
What ensued was a 45-minute casual conversation. Patients asked questions, which the doctors, dressed in street clothing, answered frankly.
The doctors fielded questions about what a biopsy actually is and the difference between recovery times from a mastectomy and lumpectomy. They discussed radiation and chemotherapy, and that there's no one-size-fits-all treatment for breast cancer.
"Everybody has a slightly different path depending on the type of breast cancer that it is," said Dr. Johanna DiMento, a hospital oncologist and hematologist. "As I tell my patients, not all breast cancers are treated equally. Some are more aggressive than others; some respond better to chemo than others; some respond better to those anti-estrogen pills than others."
And it can get confusing, Hobart said, which is why she started the Breast Cancer: Beginning the Journey support group for newly diagnosed patients, which meets the second Tuesday of every month from 6 to 7 p.m., right before the breast cancer support group.
The doctors told the women not to get caught up in statistics, that the hospital center's medical team coordinates the care for each patient, that the reality is nobody has guarantees in life and now you just know it a little bit sooner, that the hospital staff is there for them every step of the way.
"Our job here is to figure out how to make that walk as easy as possible - give you what you need when you need it," Hobart said.
"I tell patients that's our job, to get you through what you need," DiMento echoed.

Coordinating the care
They gather every Thursday at 7 a.m. Oncologists, pathologists, surgeons and more - they're all seated together with the sole purpose of discussing patients undergoing breast cancer treatment.
These breast cancer multidisciplinary conferences began in January. During these weekly meetings, a patient's breast cancer treatment course is often hammered down, allowing different medical professionals to bring their varying expertise to the table.
And having everyone sit together in that room, Hobart said, really does result in better care.


Taking the information home
In the future, patients will be able to take home a three-ring, informational-inspirational binder. Its design will be akin to Hobart's healing philosophy: mind, body and soul.
"The organization of that binder is a little bit different," she said, "and reflects the fundamentals of the center, [which] in my mind are not just focused on the illness itself but on the whole patient."
There will be a sheet with Center for Breast Health officials' cell phones and email addresses. There will be information on nutrition, stress relief therapies and more inside the binder, a project that is still in the works.


Affecting outcomes
Education can help prompt change, and that's exactly what Hobart is looking to do.
About 83 percent of Carroll women aged 50 and over received a mammogram in the past two years, according to 2010 Maryland Behavioral Risk Factor Surveillance System data. This percentage is up nearly 10 percent from 2008 data.
Carroll County has a high average stage of diagnosis, meaning many women are diagnosed with breast cancer at advanced stages of the disease, Hobart said. By tracking data and increasing awareness, she hopes to combat this trend. She hopes education about the center can spur more women to receive mammograms.
Because it's not about the center with its calming aura, off-white walls, kitschy bathroom items, soft background music and one exam room. It's about the patients, Hobart said. They are truly the center's focus.

Recommended on Baltimore Sun