Screening

 There are three screening methods for breast cancer in widespread use: breast self exam (BSE); in which the patient is taught how to do periodic exams at home, clinical breast exam (CBE); in which a health care provider performs a breast exam, and mammography. BSE and CBE have not been shown to decrease the mortality from breast cancer, however are still considered useful in screening for the disease.

 
Regular mammogram screenings are associated with a reduced risk of death from breast cancer, especially for women who have been diagnosed with invasive disease, and the overall breast cancer mortality decrease since 1989 is in part attributed to the widespread use of mammography (39).   CBE and BSE teaching occurs at all health centers and clinics within the CNTJSA, and mammography is performed at the Wilma P. Mankiller Clinic in Stillwell, and at the Claremore Indian Hospital. 
 
BSE and yearly CBE with mammogram screenings are recommended by most national guidelines for all women aged 40 and older who are at average risk for breast cancer. This screening strategy is therefore being adapted by the CNTJSA. 
 
According to recent national studies, re-screening rates are below average for women enrolled in the National Breast and Cervical Early Detection program (40). Therefore for early detection, improved communication is vital in getting these women in and encouraging them to have regular mammogram screenings every 1 to 2 years.
 
In women with a family history of breast cancer, there are no national consensus guidelines on screening. Expert opinion and common practice are to teach BSE, as well as start annual CBE and mammography beginning when the patient is five years before their youngest relative was diagnosed with breast cancer.
 
In patients with hereditary breast cancer syndromes, national consensus guidelines recommend monthly BSE beginning at age 18, a CBE every three to six months; beginning at age 25, and an annual mammogram beginning at age 25 (43).
 
Diagnostic Procedures
Once a breast cancer is suspected, the diagnostic workup may include any of the following diagnostic studies:
 
Spot Compression Mammogram – A specialized X-ray of the breast to detect any irregular density or masses that may exist on mammogram.
 
Stereotactic Needle Biopsy- a specialized needle biopsy performed under mammogram guidance to biopsy where suspicious calcifications are seen.
 
Fine Needle Aspiration (FNA) – a fine needle is inserted through the surface into the possible mass or suspicious tissue, and fluid or cells are removed for cytologic examination.
 
Needle Core Biopsy – a wide needle is used to remove portions of the mass or suspicious tissue for histological examination (incision biopsy).
 
Chest X-ray – an x-ray of the chest to detect any irregular density or nodular lesions
 
Excision Biopsy – the removal of the entire mass, lump or nodule, which is then examined for histology by a pathologist.
 
Estrogen Receptor Assay (ERA) – a laboratory test conducted on breast cancer tissue to determine how it responds to endocrine therapy or removal of ovaries. ERA negative tumors will not respond to hormone therapy.
 
Progesterone Receptor Assay (PRA) – a laboratory test conducted on breast cancer tissue to determine how it responds to endocrine therapy or removal of ovaries. PRA increases the reliability of ERA results. Positive PRA tumors will respond more effectively to hormone therapy.
 

Comprehensive Cancer Control Plan

The Cherokee Nation Comprehensive Cancer Control (CNCCC) Project assists in the development of networks and collaboration that produce an infrastructure for a comprehensive approach to cancer within the Cherokee Nation. Since 2003, coalition members and partners have come together to discuss the burden of cancer in Cherokee Nation. Coalition members and partners include local, regional, state and national representatives committed to identifying areas of cancer concern, planning interventions, prioritizing greatest areas of identified need, and then implementing identified strategies and/or providing needed resources. This is the second edition of the Cherokee Nation Comprehensive Cancer Control Plan and will serve, like the first, as an information resource for health care professionals and community members, as well as a tool for the Cherokee Nation Comprehensive Cancer Control Coalition and its respective entities. The coalition is committed to the process of enhancing infrastructure for comprehensive cancer control in the Cherokee Nation with the ultimate goal of reducing morbidity and mortality among the Cherokee community.