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Welcome! We will be begin shortly Please complete the surveys, go to: id=24099. Need Assistance? Viewing via internet (520) 626-0167 Videoconferencing (520) 626-6978. Educational Series.

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Welcome!We will be begin shortlyPlease complete the surveys, go to:

Need Assistance?

Viewing via internet (520) 626-0167

Videoconferencing (520) 626-6978

Educational Series

routine breast cervical screening post cancer diagnosis

Routine Breast & Cervical Screening Post Cancer Diagnosis

Survivor Presentation University of Arizona Cancer CenterSelena Llamas

educational goals
Educational Goals

Being uninsured or underinsured is no longer a barrier to receive screening after treatment

Annual screening is even more important after your first cancer diagnosis


Although a breast cancer diagnosis is very serious and can cause fear, you are on your way to complete a test of wills… the will to survive!!

“If a blade of grass can grow in a concrete walk and a fig tree in the side of a mountain cliff, a human being empowered with an invinciblefaith can survive all odds the world can throw against his torturedsoul.” –Robert Schuller


Surveillance is most important during the first 5 years after therapy… the risk of recurrence is highest during this timeThe goals of post-treatment surveillance are EARLY DETECTION and treatment of other curable disease recurrences and screening for therapy-related complications.Survivorship is the Main Priority Post Test ??????

The Survivor’s Post Treatment Surveillance


Survivorship is the



second cancers caused by cancer treatmen t
Second Cancers Caused by Cancer Treatment

Increased risk of developing a new primary cancer:

ovarian, uterus, lung, colon, rectal cancer

The most common second cancer

second breast cancer

The risk of second breast cancer

is high regardless of type of treatment


tamoxifen after treatment per acs
Tamoxifen After Treatment per ACS
  • Taking tamoxifen X 5yrs
  • Decreases s the probability that the breast cancer will come back
  • Helps to lower the risk of breast cancer in the opposite breast by ½
  • This appears to be true for women who have been followed for 10 yrs after their first treatment
  • Increases the risk of endometrial cancer in 5-10 yr survivors
  • The benefit of Tamoxifen is GREATER than the secondary risks associates
breast cancer management follow up
Breast Cancer Management & Follow-up
  • 2006 recommendation - Journal of Clinical Oncology
  • All women: careful history & physical examination (3-6 months) or first 3 years after primary therapy,
  • every 6 to 12 months for the next 2 years and
  • annuallySymptoms of recurrence:
  • new lumps, bone pain, chest pain, abdominal pain or
  • persistent headachesFollow-up:
  • By a primary care physician (PCP) seems to lead to the same health outcomes as specialist follow-up with good patient satisfaction
    • If care with PCP: 1 year after diagnosis… patient should know the follow-up & management strategy

what is well woman healthcheck
What is Well Woman Healthcheck?

Established in 1993

WWHP: Is the local name for the National

Breast and Cervical Cancer Early

Detection Program in Arizona

Since 1995: Provided over 73,595 mammograms and 40,563 pap tests

what is well woman healthcheck1
What is Well Woman Healthcheck?

The Goal is to provide low-income, uninsured and underserved women access to timely, high quality screening and diagnostic services to detect breast and cervical cancers at the earliest stage

what is well woman healthcheck2
What is Well Woman Healthcheck?

Services Provided by the program include: Clinical Breast Exam (CBE), Screening and diagnostic mammography, Pap test, pelvic exam, colposcopy, biopsy, HPV testing, and case management

wwhp breast cancer screening services
WWHP Breast Cancer Screening Services
  • Clinical Breast Exam (CBE)
  • CBE is a physical exam of the breast done by a licensed healthcare professional to look for changes. An annual CBE will be administered by a provider.
  • 2. Mammography
  • Mammography is an examination of the breast using an x-ray that provides an image of the breast tissue
  • Screening Mammogram: are done on women who have no symptoms. The purpose is to screen cancer at an early stage. Two pictures are taken during a screening mammogram.
  • Diagnostic Mammogram & Ultrasound: done on women who either have a symptom such as a lump or discharge or for a woman who had an abnormal screening mammogram.
cervical cancer screening
Cervical Cancer Screening

1. Pelvic Exam & Pap Smear

While a woman lies on an exam table, a health care professional inserts an instrument called a speculum into her vagina to widen it so that the upper portion of the vagina and the cervix can be seen. This procedure also allows the health care professional to take a sample of cervical cells. In a liquid-based Pap test, cervical cells are collected with a brush or other instrument and are placed in a vial of liquid preservative for laboratory analysis in one of two ways

cervical cancer screening1
Cervical Cancer Screening

It is an essential part of a woman's routine health care. The main purpose of a Pap Smear is to detect cancer or abnormalities that lead to cancer of the cervix. The Pap test is a screening test, not a diagnostic test

cervical cancer screening2
Cervical Cancer Screening
  • As of March 2012, current guidelines for cervical pathology recommend a Pap test every 3 years beginning at age 21.
  • Women ages 30 to 65 should have HPV and Pap co-testing every 5 years or a Pap test alone every 3 years.
  • Women with certain risk factors need to have more frequent screening or continue screening beyond age 65.
cervical cancer screening3
Cervical Cancer Screening
  • 2. HPV Testing
  • Unclear (ASC-US) or abnormal, this indicates that your cervical cells look like they could be abnormal
  • Human Papilloma Virus is a sexually transmitted
  • disease
  • Over 100 strands from low to high grades
  • Primary cause of cervical cancer
  • Since the results are unclear or abnormal, HPV
  • testing may be done to rule out if HPV infection is
  • present on the cervix

3. Colposcopy

  • exam table & speculum (to see the cervix)

colposcope used by MD (outside the body) that has magnifying lenses (like binoculars)

  • It lets the doctor see the cervix more closely and clearly. The doctor will apply a weak solution of acetic acid (similar to vinegar) to your cervix to make any abnormal areas easier to see
abnormal area in cervix
Abnormal Area in Cervix

Biopsy (a small piece of tissue is removed)

The sample is sent to a pathologist

Results: pre-cancer, cancer, or neither

The colposcopy procedure is not painful

Cervical biopsy can cause discomfort, cramping, or pain in some women


Natural History of HPV/Cervical Cancer













All types may go away on their own, but there is no way to predict if the types you may have will go away

normal cervix
Normal Cervix

Low-Grade Dysplasia (CIN1)

High-Grade Dysplasia (CIN 2 or 3)

Cervical Cancer

well woman target population
Well Woman Target Population
  • Women 40 years old and older. The program will provide service to women younger than 40 if symptomatic. (history of breast cancer & breast pain is not considered a symptom)
  • Uninsured or underinsured
  • Not AHCCCS eligible
  • Fall between 0% and 250% of
  • federal poverty level
well woman healthcheck is a screening program
Well Woman Healthcheck is a Screening Program…

Therefore, if you are a Breast or Cervical Cancer survivor, your treatment MUST be complete in order to seek WWHP screening services

well woman pima county provider sites
Well Woman Pima County Provider Sites


St. Elizabeth’s Clinic 140 W. Speedway

Grant Rd.

Providers Direct

2122 N. Craycroft Rd, Ste 102



Theresa Lee Clinic 332 S. Freeway

Kolb Rd

El Rio SE Clinic



Golf Links

Irvington Rd.




El Pueblo/ El Rio

101 W. Irvington





How does a woman become a

Well Woman patient?

  • Call (520) 628-3591
  • for screening
  • By the end of the
  • call she will:
  • Know if she qualifies for the WWHP
  • Receive an appointment
  • Or be directed to a Well Woman satellite office near her

Future WWHP Questions:

The Pima County WWHP administration staff is happy to assist you with any and all questions you may have regarding the WWHP program:

Eligibility, clinical, case management, etc.

Program Coordinator

Victoria Altamirano

(520) 628-3591

  • WWHP Staff:
  • Lilly Thorndal, Case Manager
  • Selena Llamas, Program Specialist
  • Clementina Daniel, Social Services Aide