October is both National Dental Hygiene Month and National Breast Cancer Awareness Month. Just as we instruct patients to improve their oral care, we should help women improve their breast care. Most health groups call for annual mammograms beginning at age 40. New research indicates that only 6 percent of women continue to get screened every year.1 Because we see patients once or twice a year, hygienists have an ideal opportunity to remind women patients, friends, and family members about the importance of annual mammograms and monthly breast self-exams.
How would you cope with a diagnosis of breast cancer?
When faced with a diagnosis of breast cancer, dental hygienists have unique concerns. Practicing dental hygiene is a physically demanding profession. Some treatment regimens can weaken the immune system and cause hygienists to become more concerned about pathogen exposure. How would you cope with the shock of a breast cancer diagnosis? How would it impact your work and life? Where would you turn for guidance and support?
The three hygienists featured here chose to face breast cancer with courage and "take charge" attitudes. Upon realizing that each breast cancer prognosis is different due to age, stage, and treatment options, these women turned a frightening diagnosis into a learning experience. Each one made choices about their treatment and remained positive, and each woman's story is inspiring and enlightening. Today, these survivors focus on giving back the gift of life they value now more than ever.
Sandra L. Boucher-Bessent, RDH
Since graduating with a bachelor's degree in dental hygiene 26 years ago, Sandra has worked in a variety of settings. She is currently a public health dental hygienist - the program manager in a community program in Kannapolis, N.C. She enjoys teaching oral health and pediatric dentistry to dental and nursing students, medical providers, and the general public.
Sandra was diagnosed with breast cancer in September 2002. Three months overdue for her annual mammogram, she had allowed her busy schedule to override her personal care. After a suspicious lump was found, she scheduled a mammogram for the following week. The radiologist recommended a biopsy.
In her own words, here is Sandra's story.
"The emotional pain became worse than the physical pain of the biopsy. The floodgates opened and the tears fell. After enduring a four-day, four-hour, and 32-minute wait, the ob-gyn called with the cancer diagnosis.
"I immediately went into denial. I minimized the seriousness of the situation by burying myself in my work. Meanwhile, my fiance did research on the Internet to educate himself about my diagnosis. He had lost his mother to breast cancer one year earlier."
Sandra's support system began with her fiance and parents.
"Upon learning my diagnosis, my fiance could have run the other way. Instead, he called me at work the day after my diagnosis to insist that I clear my calendar for the afternoon so we could meet and talk. We were in the process of planning a Thanksgiving wedding, and he still had time to bail out. At lunch, he said, 'I don't want you to be angry with me, but I have called your parents and I'm picking them up at the airport tomorrow. Do you want to get married tomorrow or Sunday?' When we got to the 'in sickness and in health' part of our vows, everyone cried. We were doing the 'in sickness' part first. We got married, moved into a new home, and began the breast cancer journey together all in the same week.
"When a person is in crisis, it's difficult to think clearly. My immediate support group was my husband, father, and mother, a retired registered nurse. At each doctor's visit I came laden with notebooks full of breast cancer information and treatment modalities. Each surgeon gave me a different surgical option. The information became overwhelming. My most valuable and useful information came by word of mouth from friends, relatives, and colleagues. I opted for a lumpectomy with sentinel node biopsy, chemotherapy, and radiation."
Prayer and meditation are important coping mechanisms for Sandra.
"For the past 20 years, I have started each day with a morning devotional that includes reading scripture, prayer and meditation. This practice has instilled an incredibly strong faith in me so that I better handle the fears in my life."
Sandra took charge of her health care decisions and encourages others to do the same.
"My advice to women regarding their health is to question authority and take charge of health-care decisions. There are so many supportive organizations at both the local and national levels that there is no excuse for any cancer patient to be alone.
"I chose to share the news of my diagnosis rather than keep it private. This enabled me to receive information and encourage others not to defer their mammograms and to remember to perform monthly breast self-exams. Prevention and early detection are as important in breast health care as they are in oral health care."
Linda Bohacek, RDH, MA
Linda Bohacek is from a small town in Illinois. She holds associate's and bachelor's degrees from Southern Illinois University in Carbondale, and a master's degree in higher and adult education from Columbia University Teacher's College in New York City. She is currently working on a certificate in public dental health from Northeast Wisconsin Technical College. She has been practicing dental hygiene for 31 years. Linda lives and works in Eau Claire, Wis. Diagnosed with breast cancer in 1994 at age 42, she is a 10-year survivor.
Here is Linda's story in her own words.
"My cancer was diagnosed by a mammogram and confirmed by a biopsy. After the initial shock, I gave myself some time to grieve, but not very long. I was very concerned about my husband and two small children and how they were going to handle this."
Linda sought information from a number of resources before making her treatment decisions.
"Educating myself about the disease was a priority. I have always found knowledge to be empowering. First, I researched information about breast cancer, I talked to breast cancer survivors through a support group, and I talked with the surgeon about treatment options. I wanted to make an informed decision. Ultimately, I chose surgery and reconstruction.
"Support is important, however, people need to understand that breast cancer is not a death sentence.
"Friends, family, and co-workers were supportive. However, I did find, surprisingly, that many of them equate breast cancer with death. I had to re-educate them about the disease.
"I scheduled surgery immediately so I would not have to dwell on it. I continued to work and do anything else that I normally did. I felt that continuing the normal routine was best for everyone, especially my children. I have always been a positive-thinker and that was very useful."
Different types of breast surgery and reconstruction require varying recovery times. Linda chose a reconstruction technique that takes longer to heal than some other techniques.
"Because of the type of breast reconstruction I chose, a six- to eight-week recovery was advised. I was back at work in four weeks, working a few hours a day and building from there. Physical therapy helped me heal and I never experienced any range of motion problems. I never worried about my ability to give 100 percent to my patients and family because I'm a determined individual, a fighter."
Linda advocates preventive breast health practices and encourages other hygienists to do the same.
"I found that taking a patient's medical history opens the door for discussion about the last time a woman had a mammogram or breast examination. When I share my experience, I suggest that women practice prevention with respect not only to oral health, but also to breast health. It is true that early prevention and detection saves lives."
Marianne Feeney, RDH
Marianne has practiced dental hygiene for 24 years. She graduated from Farleigh Dickinson University in 1980 and married her high school sweetheart, who was in the military. After 17 years, nine moves, and two children, she earned her bachelor's degree from Montclair State University. She practices hygiene in Fairfax, Va. Marianne was diagnosed with breast cancer on her husband's birthday, July 31, 2001, just weeks before her 41st birthday.
Here is Marianne's story. Marianne's positive attitude about hygiene transferred to how she responded to her breast cancer diagnosis.
"In one of my business classes, the professor asked the students to raise their hand if they enjoyed their job. I was the only one who did. When the teacher found out my profession, he asked how I could enjoy cleaning teeth. I explained that one of the things I love most about dental hygiene is instant job gratification. After removing the plaque and calculus one can almost see the tissue healing. During treatment I answer questions, educate patients, and really help people."
Support groups, Dr. Susan Love's Breast Book, and access to the National Institutes of Health Library all helped Marianne become better educated about her treatment options.
"I had just had my gynecology exam a few months earlier and both the doctor and I had missed my lump, but the mammogram picked it up. Two of the best things I did was to call Y-ME (Y-ME National Breast Cancer Organization(tm) has a 24-hour breast cancer HOTLINE at 800-221-2141.), and to research breast cancer at the medical library at Georgetown and the National Institutes of Health. Dr. Susan Love's Breast Book was invaluable. One of the things I had a hard time dealing with is that there is no single best treatment. Women have to make decisions based on their diagnosis and the latest information. After my biopsy, I had surgery, reconstruction, chemotherapy, and a complete hysterectomy. I am currently taking tamoxifen hormonal therapy. "
The whole family is impacted by a diagnosis of breast cancer. Marianne learned that support groups for her family members were very helpful.
"When you are diagnosed with a life-threatening disease, you quickly find out who will support you and who can't handle it. I had a husband, friends, and relatives who were indispensable. In addition to counseling, I joined Y-ME and a group in our area called Life with Cancer. My daughter attended support sessions for children of cancer patients."
Chemotherapy treatment can sometimes make people feel as though they aren't thinking clearly. Among breast cancer survivors this is called "chemo-brain." This factor plus the potential for pathogen transmission caused Marianne to take extra time for herself.
"I've always been very open about my cancer diagnosis. My boss was extremely supportive. Even though my oncologist said I could continue to work, I decided to take some time off. I never regretted the seven months I spent with surgery and chemotherapy recovery time. My brain was so fuzzy during chemo that I don't think I could have safely practiced, and I was concerned about being exposed to germs while immunocompromised. It was also a time for me to be a little selfish and think only about myself.
"After chemotherapy when my hair was growing in, I returned to work. I worried about how patients would feel being treated by me. Most patients just thought I had cut my hair really short."
Marianne found advocacy and volunteering to be an important part of her new life as a cancer survivor.
"I now volunteer at health fairs to spread the word about self-exams and mammograms. I've also shared my experience with some of my patients. It feels good to tell people I'm a cancer survivor, and it's hard for me to hear people complain about little things. For my own health, I no longer absorb all the patients' tensions. One of my daughters gets her hair cut once a year to donate to Locks of Love (www.locksoflove.org), which makes wigs for children undergoing chemotherapy.
"For anyone who is diagnosed with breast cancer, I would like to say that knowledge is power, and it is not what you lose but what you have left that counts."
Authors' note: Sincere thanks to Sandra L. Boucher-Bessent, RDH, Linda Bohacek, RDH, MA, and Marianne Feeney, RDH, for sharing their stories.References
1 American Cancer Society, Women Skip Lifesaving Mammograms, July 6, 2004, Atlanta, GA 2004
2 John. W. Nick Foundation, www.johnwnickfoundation.org, Vero Beach, FL, 2004
3 American Cancer Society, Breast Cancer Facts and Figures 2003-2004, Atlanta, GA, 2003
Naomi Rhode, RDH, CSP, CPAE Speakers Hall of Fame(r), is a graduate and alumni of the year of the University of Minnesota Dental School, has spoken before thousands of health-care professionals and their team members in 50 states and 15 foreign countries. She is a member of Speaker's Roundtable, a recipient of the prestigious Cavett Award, and past president of the Arizona State Dental Hygienists' Association and the National Speakers Association. Naomi received the 2003 Legend of the Speaking Profession Award and was recently named Global President of the International Federation of Professional Speakers, 2005-2006. Naomi Rhode is co-founder of SmartPractice, headquartered in Phoenix, Ariz. Naomi can be reached at (800) 522-0595, extension 214, or [email protected] or visit her website at www.smarthealth.com/rhode.
Karen Baillie holds a bachelor's degree in humanities from the University of California, Berkeley. She completed postgraduate work in communication at Florida Atlantic University in Boca Raton, Fla. She has worked in the dental industry for 25 years, currently as health affairs writer for SmartPractice. Karen was diagnosed with breast cancer in 1998 and is a six-year survivor. She is a recipient of Macy's Heart and Soul Award for Excellence in the Fight Against Breast Cancer. She can be reached at 1-800-522-0595 x 273, or [email protected].