By Laura Ostrowsky, RN, CCM, MUP
October is Breast Cancer Awareness Month. After skin cancer, breast cancer is the most common cancer diagnosis in women. Although not limited to women, breast cancer is a woman’s disease. The incidence of breast cancer in women is 13% or about 1 in 8 women. In men, the incidence is less than 1% or 1 in over 833 men.
As case managers one of our most important roles is educating. We need to make our clients aware of the need for routine screening and prevention whether we are talking about the need for regular checkups, vaccinations, self-care including self-examination, risk factors and more. We also need to follow our own advice.
I started getting mammograms at 40 because that was the recommendation at the time. In 2009 that was changed to 50 years of age. This was controversial and many doctors continued to recommend that screening start at 40. Breast cancer diagnoses rose among younger women and mortality rates remained high among black women. This led the U.S. Preventative Services Task Force to reverse the 50 years of age recommendation and lower the start of routine screening back to 40.
I spent 20 years of my career as the Director of Case Management at a cancer specialty hospital. As a case manager, a nurse, and an informed consumer I have tried to follow medical advice. I got my first mammogram at 40, my first colonoscopy at 50. I get a flu shot every year and have gotten my Covid vaccinations. When my employer offered annual biometric screenings, I participated. I am not bragging, and I am not perfect. While I try to eat a healthy diet, I must admit that chocolate and ice cream are my favorite food groups, and I am very familiar with stress eating.
Living a good life does not protect you from conditions like cancer, diabetes, or hypertension but it does help to lower your risk. Working at an institution dedicated to preventing, treating and curing cancer does not protect you. It does, however, provide you with access to excellent preventative and screening care and to experts in the field if things do not go your way.
I worked in a department made up primarily of women, a typical CM department. As it happens, a considerable number of the staff members have had breast cancer or were diagnosed with it during their employment. I remember when yet another staff member was diagnosed, (it seemed to be a yearly event), I turned to a colleague and said, “Maybe it’s time we take our breasts and get out of here.” When I received my diagnosis a year later, I reminded her of that conversation and said I guess I should have listened to my own advice.
My gynecologist found a concerning lump at my annual checkup. She sent me for a mammogram even though I was not due for another few months. A biopsy followed along with a diagnosis of breast cancer transforming me from a case manager to a patient. It is never easy being a patient. It is a “job” you do not want. It is important to remember that just because you work in healthcare does not mean you are or have to be better, stronger, or smarter than the average patient. You should not “go it alone” and I did not. My sister accompanied me to appointments, took notes and asked questions. A couple of my team members also offered the same services. It is easy when you do this work to think this is just part of your routine and you can take care of everything yourself. That is not necessary, and not a clever idea.
It is five-plus years later and I am cancer free. Lessons learned (or reinforced), regular screening is essential. Screening can mean early intervention; we all know that is effective. It saves lives and provides opportunities for education and spreading the word to others. That is why I tell my story. Support is essential. If you have someone to share the journey with you do not refuse. Bring your scribe, second set of ears, emotional support companion. Health literacy and the ability to hear what is being said drops dramatically when you are the patient. Practice and lead by example. Share your story.
This is your mission should you choose to accept it. Take care of yourself. You know the numbers, you know the importance of screening, you know that early detection saves lives. Are you over 40? When was your last mammogram? Being a healthcare provider does not make you immune to cancer, COVID-19, or a myriad of other conditions. It is time to practice what we preach. Go forth and get screened.
Find your tribe! Feel connected to your fellow case managers in new ways by participating in one of the many events CMSA will host during CM Week! The full schedule can be found here: https://cmsa.org/about/national-cm-week/
Bio: Laura Ostrowsky, RN, CCM, MUP, spent 20 years from 1999-2019 as the Director of Case Management at Memorial Sloan-Kettering Cancer Center (MSKCC) and is currently teaching with the Case Management Institute and consulting on all things case management. Laura was the 2012 CMSA Case Manager of the Year. Her program at MSKCC was nominated by Case in Point for excellence in Utilization Management, Discharge Planning and Transitions in Care. She created a patient advocacy program to assist patients in obtaining access to specialty care despite network restrictions. The program has been featured in articles in Advance for Nursing, The Wall Street Journal, Case in Point, and Case Management Monthly. Laura holds a master’s degree in Health Planning and Policy from Hunter College. She has been a CMSA member since 2005, and has served on the Board of Directors of the NYC Chapter since 2011, and CMSA National from 2016-2018 and is a current board member of CMSA. Laura has over 30 years of health care experience, including time as a staff nurse, QA Coordinator, Director of UR and QA at Montefiore, followed by directorships in CM at New York Presbyterian(NYP) and Memorial Sloan Kettering Cancer Center. She also spent 3 years in information services at the NYP Network overseeing the selection, acquisition and implementation of an integrated hospital information application for UR, QA, Credentialing and Risk Management at 5 network hospitals. Laura has published articles on Case Management in CMSA Today, Professional Case Management, Case in Point, The Patient Flow Journal and other periodicals. She regularly presents at national conferences including CMSA, the Patient Advocate Institute and others on topics ranging from case management, patient flow and payer provider collaboration to advocacy, collaborative practice and case management’s role in the changing health care environment. She is also a past member of the Genentech speaker’s bureau where she presented on topics in oncology case management, palliative care and hospice.