Screen Queens: Taking the Scary out of Mammograms

Hopefully, by shining a light on how easy this process is, on the amazing team of people serving our Veterans, and the advanced technology here at VA Greater Los Angeles Healthcare System, getting screened will feel a lot less scary.

The screen queens include Genevie Domingo, mammography coordinator; Dr. Stephanie Lee-Felker, dedicated breast imaging radiologist; Sarah Viboolkitvorakul and Candice Williams, mammography technologists; and Dr. Fatma Batuman, women’s health director. All of these women are serious about prevention and detection! Together they ensure patients are up to date on their annual screenings, facilitate getting in the door for their appointments, and guide Veterans through their mammograms and results.

Once in the door, Veterans receive VIP treatment at the VA. Viboolkitvorakul and Williams lead you through the mammogram process, which can be a little awkward and uncomfortable because you’re having your breasts compressed between two mammogram paddles, but it is over relatively quickly, and uncomfortable is a far cry from painful. If you have questions or concerns throughout the process, Viboolkitvorakul, Williams, and Lee-Felker are happy to address them.

“We explain the mammogram step by step, so they know what's to be expected throughout the procedure,” said Viboolkitvoraku. “We know that having a mammogram, some patients may feel anxious, so it's very important to put them at ease and make sure they feel relaxed. We want patients to return every year for their mammogram, so it's really important to build patient rapport and make them feel comfortable.”

After the mammogram is completed, there is a short wait, then Veterans receive a verbal communication of their results. If additional pictures are needed, they take them then and there, so Veterans don’t have to return within a short time frame for a follow-up appointment.

“I feel like this approach is a little bit more with the patient experience in mind,” said Lee-Felker. “The anxiety goes up with leaving and then finding out two days later that you have to go back. You have no idea why you have to come back, and your mind just goes to the worst [scenario].”

Finding out results a few days later is standard in private health care facilities where they typically cannot accommodate same-day results and additional images.

“Many Veterans travel from far away locations to obtain their screening mammograms. So, I don’t want to put any additional barriers up for them to have any additional imaging done, ” said Lee-Felker. “We just try to do as much as possible while they are already here for their appointment.”

In addition to VIP customer service, the VA also provides Veterans with the latest technology in mammography machines, which is 3D mammography, at both the West LA and the Sepulveda screening sites.

“It increases cancer detection by allowing us to look through the breast tissue slice by slice. It’s like if you had to interpret a book. The old mammogram was like looking at the book front to back with all the text on the pages in between superimposed on one rectangle. But with the 3D mammogram you can leaf through the breast one page at a time and see what’s on the medial side of the breast, what’s right behind the nipple, what’s right on the armpit side,” said Lee-Felker. “You can go slice by slice through the breast tissue and better figure out what’s just overlapping tissue versus a real finding. So, the false positive rate is lower for the 3D mammography and the cancer detection rate is higher. It’s still not 100% sensitive, but it gives us our best chance.”

Lee-Felker said that even though additional images may be requested, but that doesn’t mean that it’s cancer. It usually means more investigative work and problem solving, which can be more commonly needed if a Veteran comes in without prior mammograms to which they can compare. If you do have prior mammograms, Lee-Felker recommends bringing them to your appointment at the VA.

“It’s helpful for us to look at things because if there is an oval structure in the right breast, but [if] it’s been there for 10 years and it hasn’t changed, it makes a huge difference. [This] versus, if she just walks in and I don’t have any of those old mammograms to know that it’s been there and is stable. We kind of have to reinvent the wheel and start raising red flags for things that really didn’t need to have any flags raised,” said Lee-Felker.

All the screen queens want you to know that screening enables them to find something (if there is something to find) as early as possible for the best possible outcome. Please do not delay your screening.

“With mammography, we are able to find things on the scale of pre-cancer, even,” said Lee-Felker. “The mammogram can show tiny clusters of calcium called micro-calcifications, where you might find a pre-cancer cell or a cell that shows atypical features, that if left alone, could potentially evolve into an invasive cancer. By finding it early and removing the area that is showing those changes we can stop everything in its tracks.”

So, even though mammograms may be stressful, and a little bit scary, the screen queens do everything they can to make the process easier and less frightening, and they encourage you to make an appointment and see them soon.

The American Cancer Society recommends women with an average risk for breast cancer to start screening with a mammogram every year starting at age 45, with the option to start at age 40. For screening purposes, average risk means they don’t have a personal history or strong family history of breast cancer, don’t have a genetic mutation known to increase the risk of breast cancer (such as the BRCA gene), and have not had chest radiation therapy before the age of 30. Please speak with your doctor about your risk factors, and when to begin screening.

Mammography appointments for our Veterans are available at West Los Angeles VA Medical Center and Sepulveda Ambulatory Care Center. Female and male Veterans should speak with their doctors about a diagnostic order to evaluate a symptom such as a lump, or for a patient scheduling their annual mammography without symptoms, Veterans can call the radiology department at West Los Angeles Medical Center at 310-268-3458 or Sepulveda Ambulatory Care Center at 818-891-7711 extension 32964.

Although walk-ins officially ended after the COVID-19 pandemic, Women’s Health will have walk-in events assigned on a specific date. Events are promoted on our VA Greater Los Angeles events webpage and our Facebook and Twitter accounts.  If there is no event, the team will still try to accommodate walk-ins if there is availability in their schedule.