OTTUMWA — Alice Brinegar doesn’t just preach about regular breast cancer screenings. She helps people live it.
“I was recruited while still in college to do mammography,” said the lead staff mammographer at Ottumwa Regional Health Center of her start about 40 years ago. At the time, radiology programs were just getting their start. “They didn’t really do screenings before then. In the early ‘70s, you just didn’t do screenings. You didn’t do it.
“Mammography has come a long way. So has breast cancer treatments. I’ve seen a lot of changes.”
One of the changes she mentioned is the 3-D component to mammograms. “I love it. It gives us layers” to the image.
But what’s key about getting a mammogram, she said, is the opportunity to catch the development of breast cancer early. “It’s the easiest screening tool we have at the time of finding breast cancer. She said the recommendations currently call for a baseline screening between the ages of 35-40 with yearly mammograms after age 40.
Brinegar said the most recent statistics say women have a one in eight chance of getting breast cancer in their lifetime.
“History affects some of the odds of having breast cancer,” she said but at this time only 10 percent of breast cancers are genetic. “Hormones in our diet and everyday things in our environment play a role, too.”
To begin the process of a mammogram appointment, she brings patients into a room to simply have a discussion. She goes through family and personal history with the patients and explains what the process entails.
“I always like to talk to my first-timers,” Brinegar said. “It’s kind of a frightening thing. We’re all just a bit nervous that we have something wrong.” And, for first-timers, it’s not unusual for having more tests done. “It’s not a bad thing. We just don’t know what’s normal for them.”
To prepare for the exam, Brinegar says that patients need to get undressed and remove any powder, lotion or deodorant they might be wearing. Those items can show up on the images and make them harder to read, she said.
In addition, it’s important to not wear any type of cologne. “This is a very personal exam. I can’t do it without touching you,” she said. The cologne would then have to possibility of lingering on her and affecting future patients with possible allergies.
Then comes the mammogram itself. Brinegar said she takes at least four projections of the breast. “There is going to be some compression, but it’s not as bad as you think it’s going to be. It’s pretty fast — it takes longer to talk.”
Brinegar said the first mammography appointment is usually the longest — about a half hour. For repeat patients, from check-in to departure is probably “about 20 minutes.”
Once the mammogram is complete, it goes in for a reading. ORHC has a room dedicated just for mammography. There, results are read by two people as well as a computer.
“Having the ability to compare results to old ones is important,” Brinegar said. “You want to find changes before you can feel them. Most breast cancers are treatable if you catch them early enough.
In fact, she said, the five-year survival rate of early detection is almost 100 percent. “The earlier it’s found, the better your chances of surviving are.”
Once the readings are complete, letters with the results are sent to the patients, usually within a few days. A new component to those results came in 2017, when the state Legislature passed a law that the letters must also contain information on what the patient’s breast density is.
“That’s not a bad thing,” Brinegar said. “It just tells you how hard it is to see through the breast tissue.”
She said their are four classifications. She said the easiest to see through are almost entirely fatty. She compares those to a Jell-O salad, where you can see everything that’s included. The far range, extremely dense, she compares to a chocolate cake — if you put nuts or candy in it, you can’t really see them.
“Those with heavy breast density sometimes need something more to tell them if there’s something hiding in there,” Brinegar said.
“If there’s an issue, their doctor will call them,” she added.
Even after 40 years in the field mammography, Brinegar’s dedication to the process shows through. “I like what I do. It’s something that I feel passionate about.”