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Your Nurse Navigator - Ramona Couteau, RN, BSN, MA

A unique part of the center is the breast care navigator. Ramona Couteau, RN, BSN, MA. Ramona has 30 years of nursing experience in a wide array of clinical settings including intensive care, surgical services and emergency medicine.

When there is an abnormal finding of any kind, the breast care navigator is immediately connected with the woman. She provides reassurance, answers questions and explains results. If the diagnosis is cancer, she will guide the patient through the entire process, every step of the way. To contact the navigator, please call: 410-414-4516 or email rcouteau@cmhlink.org.



Breast Health

The Sheldon E. Goldberg Center for Breast Care - the first of its kind in Southern Maryland - gives local women access to an experienced team of breast health experts and the most sophisticated technology available today. In one comfortable and convenient location, our experts provide comprehensive and coordinated care-from outreach and screening to diagnosis, treatment and survivorship. The dedicated space to see and treat patients makes it easy for physicians involved in the management of breast disease (general and plastic surgeons, radiologists and pathologists as well as medical and radiation oncologists) to consult with each other about a patient's treatment.

CalvertHealth Medical Imaging Center – the imaging partner for the Sheldon E. Goldberg Center for Breast Care - is one of the few facilities in Maryland that offers 3D mammography. Women in our community are so fortunate to have this technology available to them. Why? It is particularly beneficial for women with dense breasts because it allows radiologists to see through overlapping tissue much more clearly.They are also able to see lesions of the breast better. 3D allows a greater rate of cancer detection—an estimated 20 percent better than 2D alone and the “call-back” rate is much lower.

When you have your mammogram, you will be asked if you would like a 3D mammogram. There is a $30 out-of-pocket fee. The choice is up to you but the potential benefits are clear. The American College of Radiology has also designated Calvert Medical Imaging as a “Breast Imaging Center of Excellence.” Remember, early detection is the key.

Our Care Team


Members of the CMH Breast Care Team shown here are: (l-r) physical therapist Susan Dudley, breast care navigator Ramona Couteau, breast center surgeons Dr. Rubie Jackson and Dr. Wen Liang, medical oncologist Dr. Arati Patel, medical oncologist Dr. Kenneth Abbott, Johns Hopkins radiologist Dr. Nagi Khouri, medical director of breast imaging; Thomas Jefferson breast surgeon Dr. Theodore Tsangaris; medical oncologist Dr. Bilal Ahmed, radiation oncologists Dr. Kathleen Settle, Dr. Boris Naydich and Dr. Simul Parikh, plastic surgeon Dr. Wilfred Ehrmantraut, Jr., Deanna Bitner, RN, MSN, NEABC, Director of Oncology Services and Sandra Cassell-Corbin, CRNP, genetic counseling.

At the Center for Breast Care at CalvertHealth, we use a team approach in the management of cancer. This means we rely on the expertise of many professionals to diagnose, treat and care for you. We feel this improves the quality of care you receive since each phase of your treatment will be managed by a specialist in that particular field. You will meet many professionals and it may become confusing at times.To assist you, listed below is a description of the cancer care team members.

A unique part of the center is the breast care navigator, Ramona Couteau, RN, BSN, MA, with over 30 years nursing experience in a wide array of clinical settings including intensive care, surgical services and emergency medicine.

Other specialists that you may need are:

Breast Surgeon
A physician who treats cancer by operative or surgical procedures.

Medical Oncologist

A physician who treats cancer with drugs and/or chemicals.

Radiation Oncologist
A physician who treats cancer with radiation therapy.

Plastic Surgeon
A specialized surgeon, who after a surgical procedure such as a mastectomy, performs additional surgery to "reconstruct" the breast removed by a mastectomy.

Nutritionist
Good nutrition is especially important for patients that are being treated for cancer. An oncology nutrition specialist can provide practical eating tips as well as answer nutrition questions.

Social Worker
The social worker is responsible for overseeing many of your support needs. They may help with identifying your needs outside of the hospital, informing you about community resources and answering questions about finance.

Home Care
This department is responsible for the coordination of any home care needs determined by your physician: nursing care, home medical equipment, infusion therapy and much more.The provider will vary depending upon health care insurance.

Schedule an Appointment

Breast Evaluation
If you have a breast lump, an abnormal mammogram, or if you have recently been diagnosed with breast cancer, you may contact our Nurse Navigator, Ramona Couteau, at 410-414-4516, or you may contact one of our breast surgeons directly.

Breast Surgeons:
Theodore N. Tsangaris, MD: 410-414-4700
Wen Liang, DO: 410-414-4700
Rubie Jackson, MD, MPH: 410-414-4700

Screening Mammogram: 410-414-4700

Diagnostic Mammogram: 410-414-4700

Breast Biopsy: Contact our Nurse Navigator, Ramona Couteau,RN, BSN, MA, who will assist you: 410-414-4516

Nurse Navigator: Ramona Couteau: 410-414-4516 or email rcouteau@cmhlink.org

CalvertHealth Medical Imaging

CalvertHealth Medical Imaging Center (CHMIC) provides breast-imaging services and is located on the lower level of the CalvertHealth Medical Arts Building where the center is located. The facility, which is recognized as a Breast Imaging Center of Excellence by the American College of Radiology, houses a private women’s imaging center with state-of-the-art imaging systems - 3D mammography digital mammography, breast ultrasound, breast MRI and stereotactic biopsy.

CalvertHealth Medical Imaging is one of the few facilities in Maryland that offers 3D mammography. Women in our community are so fortunate to have this technology available to them. Why? It is particularly beneficial for women with dense breasts because it allows radiologists to see through overlapping tissue much more clearly. They are also able to see lesions of the breast better. 3D allows a greater rate of cancer detection—an estimated 20 percent better than 2D alone and the “call-back” rate is much lower.

In addition, evidence has shown that radiologists dedicated to reading breast images find more cancers at earlier stages. A unique collaboration with Johns Hopkins brings tertiary-level breast imaging expertise to our local community. Breast imaging experts from Johns Hopkins read all screening mammograms and breast MRIs performed at CHMIC and are on-site one day a week to perform biopsies and other special procedures. Dr. Nagi Khouri, a Johns Hopkins breast imaging specialist, serves as medical director of breast imaging for the program and over sees the quality of breast imaging services.

Diagnosis

The Center for Breast Care offers advanced breast cancer screening and diagnostic services, including digital mammography, breast ultrasound, breast magnetic resonance imaging (MRI), stereotactic breast biopsy, ultrasound guided breast biopsy, and surgical biopsy.

CalvertHealth Medical Imaging Center (CHMIC) provides breast-imaging services and is located on the lower level of the CalvertHealth Medical Arts Building where the center is located. The brand new facility houses a private women's imaging center with state-of-the-art imaging systems - digital mammography, breast ultrasound, breast MRI and stereotactic biopsy. Digital mammography is especially useful for evaluating women with dense breasts, a group at higher risk for breast cancer.

Evidence has shown that radiologists dedicated to reading breast images find more cancers at earlier stages. A unique collaboration with Johns Hopkins brings tertiary-level breast imaging expertise to our local community. Breast imaging experts from Johns Hopkins read all screening mammograms and breast MRIs performed at CHMIC and are on-site one day a week to perform biopsies and other special procedures. Dr. Nagi Khouri, director of breast imaging for the Johns Hopkins Avon Foundation Breast Center in Baltimore from 2002-2012, directs Calvert's imaging program. In 2007, he was selected as one of the top five women's imaging specialists in the country.

Biopsy


At the Center for Breast Care, we strongly encourage the performance of image guided needle biopsy of breast lumps or abnormal areas noted on mammogram, ultrasound, or MRI. The majority of breast abnormalities can be biopsied accurately outside of the operating room thereby eliminating the need for surgery and anesthesia and thereby avoiding scars on the breast. Image guided needle biopsies are typically performed in the radiology department under local anesthesia either by a radiologist or a breast surgeon. Results are usually available within 24 to 48 hours.

Image guided biopsies performed at the Center for Breast Care include MRI guided needle biopsy, stereotactic breast biopsy, and ultrasound guided breast biopsy.

Ultrasound guided placement of a biopsy needle in a breast mass

Treatment

The Center for Breast Care encourages a multidisciplinary approach to the management of breast cancer.This means that most patients will meet with a number of specialists during the course of their treatment. These may include breast surgeons, plastic surgeons, medical oncologists, radiation oncologists, physical therapists, nurses, and others. Regular multidisciplinary tumor board conferences are held which are attended by members of all specialties. Recent cases are reviewed and strategies are discussed to arrive at the best treatment plan for each patient.

Surgery
The majority of breast cancer patients will undergo some type of surgical procedure for removal of their tumor. At The Center for Breast Care, surgeons meet with patients to map out an individualized plan which is most appropriate for that particular patient's tumor. Surgical options include:

  • Lumpectomy
  • Sentinel Lymph Node Biopsy
  • Modified Radical Mastectomy
  • Simple Mastectomy
  • Skin Sparing Mastectomy
  • Prophylactic Mastectomy
Breast Reconstruction
When appropriate, a plastic surgeon will meet with the patient prior to surgery to outline various methods of breast reconstruction. Most patients undergoing a mastectomy will be candidates for reconstructive surgery should they so desire. Breast reconstruction can be performed with implants or with the patient's own tissues (autologous reconstruction).The latter includes such procedures as TRAM flaps or latisimus flaps.

Chemotherapy
Medical Oncologists may recommend chemotherapy (drug therapy) to kill cancer cells which might have spread beyond the breast to other areas of the body. The medication is usually administered intravenously at The Infusion Center at Calvert Memorial Hospital. Most patients receive a combination of two or three medications.The choice of medications is individualized to patient's specific tumor, stage, and the patient's age. Most treatment regimens which are utilized have been found to be effective based on the results of large national and international studies.

In most cases, the chemotherapy will be administered after the patient has healed from surgery. In the case of a very large tumor, extensive lymph node involvement, or what is termed Inflammatory Breast Cancer, the chemotherapy may be started prior to surgery.

Endocrine Therapy
The majority of breast cancers are estrogen receptor positive. This means that the cancer cell expresses an estrogen receptor on its surface. Such cancers are often receptive and sensitive to estrogen and may stop growing or die when they are treated with medications which stop the binding and/or the availability of estrogen. Such medications are administered orally and taken by the patient at home, usually for a number of years.

Tamoxifen is a drug which blocks the effects of estrogen on the breast and other estrogen sensitive tissues in the body. It is typically administered for five years although research is ongoing to determine if a longer duration of treatment is more beneficial.This drug can be used by women both before and after menopause. Common side effects include hot flashes, headaches, and vaginal discharge or dryness.

Arimidex (Anastrozole) and Femara (Letrozole) are examples of a class of drugs referred to as aromatase inhibitors. These drugs stop the production of estrogen in postmenopausal patients. This means that less estrogen is available to stimulate the growth of estrogen sensitive breast cancer cells. They are not appropriate for women who are still having menstrual periods. Common side effects include hot flashes, joint pain and stiffness, and bone thinning.

Diagnostic Imaging

Diagnostic imaging refers to technologies that doctors use to look inside your body for clues about a medical condition. A variety of machines and techniques can create pictures of the structures and activities inside your body. The technology your doctor uses will depend on your symptoms and the part of your body being examined.
Resource: radiologyinfo.org

When imaging the breast, doctors almost always use mammography. The American Cancer Society recommends screening mammography annually for women over the age of 40. If the radiologist identifies an abnormality or area that requires closer study on a screening mammogram, or if your primary care physician identifies a lump or other concern during your clinical exam, you will usually need a diagnostic mammogram. It is important for both screening and diagnostic mammograms that the radiologist has access to any prior mammograms you may have had so he/she can evaluate breast changes over time.

Another imaging technique used is ultrasound. Ultrasound technology uses sound waves to create an image of the inside of your breast. Ultrasound is frequently used in combination with diagnostic mammography and gives the radiologist a better idea of the size and shape of a breast lump. It can also be used when performing a needle biopsy of the tissue or removing fluid (aspirating) a probable cyst.

In addition, breast MRI, is sometimes used to locate lesions that can not be seen with other imaging techniques, to evaluate the extent of disease, or to screen certain very high risk women.

Breast MRI


Magnetic resonance imaging (MRI) is a noninvasive medical test that helps physicians diagnose medical conditions. MR imaging uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures.

Breast MRI offers valuable information about many breast conditions that cannot be obtained by other imaging modalities, such as mammography or ultrasound. It is not a replacement for mammography or ultrasound imaging but rather a supplemental tool for detecting and staging breast cancer and other breast abnormalities.

During a MRI examination, you will be positioned on the moveable examination table. Straps and bolsters may be used to help you stay still and maintain the correct position during imaging.

For an MRI of the breast, you will lie face down on your stomach with your breasts hanging freely into cushioned openings. It is important to remain very still throughout the exam. This is best accomplished by making sure you are comfortable and can relax rather than trying to actively hold still tensing your muscles. Be sure to let the technologist know if something is uncomfortable, since discomfort increases the chance that you will feel the need to move during the exam. Even very small movements can limit the ability to get a quality exam.

If a contrast material will be used in the MRI exam, a nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm. You will be moved into the magnet of the MRI unit and the radiologist and technologist will leave the room while the MRI examination is performed.

If a contrast material is used during the examination, it will be injected into the intravenous line (IV) after an initial series of scans. Additional series of images will be taken during or following the injection. When the examination is completed, you may be asked to wait until the technologist or radiologist checks the images in case additional images are needed. Your intravenous line will be removed.

MRI exams generally include multiple runs (sequences), some of which may last several minutes. The imaging session lasts between 30 minutes and one hour and the total examination is usually completed within an hour and a half.

Resource: radiologyinfo.org

Breast Ultrasound


Ultrasound imaging involves exposing parts of the body to high frequency sound waves to produce pictures of the inside of the body.The primary use of breast ultrasound is to help diagnose breast abnormalities detected by a physician during a physical exam (such as a lump or bloody or spontaneous clear nipple discharge) and to characterize potential abnormalities seen on mammography.

Ultrasound imaging can help to determine if an abnormality is solid (which may be a non-cancerous lump of tissue or a cancerous tumor) or fluid-filled (such as a benign cyst) or both cystic and solid. Ultrasound can also help show additional features of the abnormal area.

The ultrasound examination is painless, fast and easy and usually completed within 30 minutes. After you are positioned on the examination table, the radiologist or sonographer will apply some warm water-based gel on your skin and then place the transducer firmly against your body, moving it back and forth over the area of interest until the desired images are captured. There is usually no discomfort from pressure as the transducer is pressed against the area being examined.

You may be asked to change positions during the exam. Once the imaging is complete, the gel will be wiped off your skin. After an ultrasound exam, you should be able to resume your normal activities immediately.

If you have any questions regarding your procedure, please feel free to call our Nurse Navigator, Linda Walton @ 443-436-1046.

Resource: radiologyinfo.org

Digital Mammography


Digital mammography is a mammography system in which the x-ray film is replaced by solid-state detectors that convert x-rays into electrical signals, similar to those found in digital cameras. Benefits include optimal image quality, reduced need for retakes and return visits, and instant image sharing and storing. Digital mammograms are beneficial for all women, especially those under age 50 and those with dense breast tissue. From the patient's point of view, having a digital mammogram is essentially the same as having a conventional film screen mammogram.

The procedure will be performed by a specially qualified radiologic technologist who will position your breast in the mammography unit. Your breast will be placed on a special platform and compressed with a paddle (often made of clear Plexiglas or other plastic).The technologist will gradually compress your breast. You will be asked to change positions between images. The routine views are a top-to-bottom view and an oblique side view. The process will be repeated for the other breast.

You must hold very still and may be asked to keep from breathing for a few seconds while the x-ray picture is taken to reduce the possibility of a blurred image.The technologist will walk behind a wall or into the next room to activate the x-ray machine.The examination process should take about 30 minutes.

Image-Guided Biopsy


A biopsy is an operation in which a needle is passed into a tumor to take small samples to send for analysis in order to determine a precise diagnosis. Image-guided refers to the use of scans and a computer to precisely locate and target the lesion (abnormal tissue).

An image-guided biopsy is performed when the abnormal area in the breast is too small to be felt, making it difficult to locate the lesion by hand. Image-guided needle biopsy is not designed to remove the entire lesion, but most of a very small lesion may be removed in the process of biopsy.

MRI-guided Biopsy

Lumps or abnormalities in the breast are often detected by physical examination, mammography or other imaging studies. However, it is not always possible to tell from these imaging tests whether a growth is benign or cancerous. In MRI-guided breast biopsy, magnetic resonance imaging is used to help guide the radiologist's instruments to the site of the abnormal growth.

This procedure is most often performed by a specially trained breast radiologist and done on an outpatient basis. You will lie face down on a moveable exam table and the affected breast or breasts will be positioned into openings in the table. A nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm and contrast material will be given intravenously.

Your breast will be gently compressed between two compression plates, one of which is marked with a grid structure. Using computer software, the radiologist measures the position of the lesion with respect to the grid and calculates the position and depth of the needle placement.

A local anesthetic will be injected into the breast to numb it. A very small nick is made in the skin at the site where the biopsy needle is to be inserted. The radiologist then inserts the needle, advances it to the location of the abnormality and MR imaging is performed to verify its position.

Tissue samples are then removed. This procedure is usually completed within 45 minutes. You will be awake during your biopsy and should have little or no discomfort. Most women report little or no pain and no scarring on the breast. Some women find that the major discomfort of the procedure is from lying on their stomach for the length of the procedure, which can be reduced by strategically placed cushions.

Resource: radiologyinfo.org

Stereotactic Biopsy

If an area of concern on mammogram cannot be felt or is very small, a stereotactic biopsy may be recommended for you. A stereotactic biopsy is often recommended to biopsy microcalcifications seen on mammogram. The biopsy is performed by a radiologist or a surgeon using a specially designed table, which has a mammography machine (using two cameras, hence the name "stereotactic" biopsy), a biopsy device and a computer. The procedure is an outpatient procedure and takes about 45 minutes. You may eat and drink normally prior to the procedure. Most patients return to their normal activities afterwards.

You will be comfortably lying on your stomach with your breast tissue coming through an opening in the table. The biopsy and imaging equipment is located below the table. Your breast in compressed with paddles similar to a mammogram to stabilize the breast tissue. It is very important to stay as still as possible throughout the procedure. The compression needed is not as tight as is necessary for a mammogram. One of the paddles has a "window" through which the biopsy is performed. After the area of concern is identified, the radiologist enters information into a computer that calculates where the needle should be directed to obtain the appropriate tissue and the area is cleaned with antiseptic and injected with a local anesthetic. Once the anesthetic takes effect, an instrument moves the biopsy needle into position and removes several samples of the tissue. A very small stainless steel clip is placed to mark the area of biopsy and several films may be taken after the biopsy, to confirm that the appropriate tissue was obtained and the clip is visualized.

After the biopsy is completed, a small bandage/band-aid will be placed over the biopsy site and you will be given a small ice pack and post-procedure instructions.

The biopsy sample will be sent to the pathology lab for evaluation. The pathologist will send the referring physician a full report and your physician will be in contact with you so that you can be informed as quickly as possible regarding your results.

Infection is rare with stereotactic biopsy; however, there is a small possibility a hematoma (bruise - a collection of blood under the skin) may occur. It is very important that you stop taking any ibuprofen, aspirin containing products or blood thinners for 4-7 days prior to your biopsy.

If you have any questions regarding your procedure, please feel free to call our Nurse Navigator, Linda Walton @ 443-436-1046.

Ultrasound-guided Biopsy

If an area of concern on mammogram cannot be felt or is very small, an ultrasound-guided biopsy may be recommended for you. Sometimes an ultrasound-guided biopsy is recommended for a larger mass to obtain the best sampling. The biopsy is performed by a radiologist or a surgeon. The procedure is an outpatient procedure and takes about 30 minutes. You may eat and drink normally prior to the procedure. Most patients return to their normal activities afterwards.

You will be comfortably lying on your back. A gel will be applied to the skin of the breast over the area of concern and a transducer (a small handheld instrument) is passed over the breast to obtain images of the area. Once the ultrasound locates the area of concern, the area is cleansed and injected with a local anesthetic. The doctor then makes a small nick in the skin and inserts a needle into the area. This is done several times to make sure to obtain an appropriate sample of tissue. The biopsy device used sometimes makes a clicking sound. The last pass of the needle device places a very small stainless steel clip to mark the area of biopsy.

After the biopsy is completed, a small bandage/band-aid will be placed over the biopsy site and you will be given a small ice pack and post-procedure instructions.

The biopsy sample will be sent to the pathology lab for evaluation. The pathologist will send the referring physician a full report and your physician will be in contact with you so that you can be informed as quickly as possible regarding your results.

Infection is rare with an ultrasound biopsy; however, there is a small possibility a hematoma (bruise - a collection of blood under the skin) may occur. It is very important that you stop taking any ibuprofen, aspirin containing products or blood thinners for 4-7 days prior to your biopsy.

If you have any questions regarding your procedure, please feel free to call our Nurse Navigator, Linda Walton @ 443-436-1046.

Breast Cancer

The earlier that breast cancer is detected, the greater the chances for treatment to be effective. That is why regular breast self-examination, exams by your healthcare provider and regular mammograms are so important. They are the most powerful tools available to us today.

Infusion Therapy Center


CalvertHealth's Infusion Therapy Center combines warm, personalized care with the latest technology. Situated in a bright and spacious suite in CalvertHealth, the center is designed to provide the utmost in comfort and convenience.

The space dedicated for this service allows for more privacy and faster service. The unit includes eight reclining chairs, individual TVs, piped-in music, and its own separate blood draw and testing station for oncology patients. A separate area is provided for private consultations with a dietitian, nurse or social worker.

In the Infusion Therapy Center, we've brought together a team of skilled professionals who provide our cancer patients with comprehensive care and genuine caring. Our team includes three full-time medical oncologists.

They're backed by a lineup of highly qualified healthcare providers, including diagnostic radiology, surgery, radiation oncology, plastic surgery, pathology, nursing and counseling. This "team approach" means that you can access the services you need in the most convenient, timely way.

A 16-member committee oversees our cancer program. They review patient care evaluations, reports from the CalvertHealth and Maryland tumor registries and quality assurance reports. The tumor registry at CalvertHealth tracks the care of cancer patients from their initial visit and continues to monitor their after care.

For more information about the Infusion Therapy Center at CalvertHealth, call 410-535-8276 or 301-855-1012, ext. 8276.

Radiation Oncology


CalvertHealth has joined forces with local and metropolitan hospitals to offer you the highest quality radiation therapy available today, close to home. The Chesapeake Potomac Regional Cancer Center is a joint venture between CalvertHealth, Civista Health and St. Mary's Hospital that make up the Chesapeake Potomac Heathcare Alliance and Maryland Regional Cancer Care which includes Adventist HealthCare and Holy Cross Hospital.

Radiation therapy uses high-energy rays to kill cancer cells and the center's sophisticated technology offers unprecedented precision in cancer treatment. Now it is possible to treat tumors with higher doses of radiation while sparing surrounding healthy tissue.

The center's radiation oncologists are well regarded for their expertise, dedication and commitment to providing the finest radiation oncology care. They work with your primary physician or medical oncologist to provide coordinated, comprehensive cancer care that is precisely tailored to your unique needs.

Two convenient locations feature flexible hours to fit busy schedules, ample parking and friendly, welcoming staff. One is at 3007 Business Center Drive in Charlotte Hall, Maryland. Free transportation is available daily to and from the center. For more information, call 301-884-2508. The other is at 11340 Pembrooke Square, Suite 201, Waldorf , Maryland. For more information, call 301-705-5802. The two sites are electronically linked so that a patient's medical record is accessible at both locations.

Surgical Services


Over 6,000 surgeries are performed a year at the CalvertHealth Surgery Center. We have 21 surgeons on active staff encompassing many different medical specialties. They are assisted by a special team of nurses who are experienced, highly trained professionals with extensive knowledge in surgical care.

At CalvertHealth, quality, service, comfort and compassion are the focus of our surgical team. The Surgery Center has six state-of-the-art operating rooms and a digital state-of-the-art cystoscopy suite. While laparoscopic surgery has been in place at CalvertHealth for several years, our operating rooms now incorporate laser technology for prostate, vascular and kidney stones. This means patients spend less time in the hospital and recover faster.

The overall design of our surgery center - including a dedicated parking lot near the hospital's front entrance - facilitates a positive, comfortable patient experience. Additionally, pre-admission testing, Same Day Surgery and recovery are close to the operating rooms - enabling staff to collaborate regarding a patient's care without leaving the area.

A separate area allows parents to stay with their children before surgery. Toys, books and other games are arrayed in a bright, spacious, child-friendly room.

Special Services


In order to help women better understand, prepare for and possibly prevent the complications that may arise after breast surgery, our affiliate, Calvert Physical Therapy offers a complimentary assessment and education program to any woman diagnosed with breast cancer in the previous three months. Call 410-535-8180 or 301-855-1012 ext. 8180.

Our Breast Cancer Support Group meets the first Tuesday of each month in the Center for Breast Care, Suite 201, 2nd level of the Calvert Medical Arts Center from 6:00 pm until 7:30 pm.

The Support Group welcomes all people who are starting treatment, those who have been in treatment, as well those who have been survivors for years. We share encouragement and information on topics that promote our highest level of health and well being. Whether you have received treatment at CalvertHealth or not, you are welcome and we hope you drop in even if you can attend a short part of this evening.

For more information about programs and services offered at the center, call the breast care navigator at 410-414-4516. Women interested in a screening mammogram can also call this number.

To schedule your outpatient surgical procedure, call 410-414-APPT

FAQs


How should I be checked for breast cancer?
The American Cancer Society recommends that women in their 20s and 30s have a breast examination by a health expert at least every three years. After 40, women should be examined yearly. Breast self-examination is also important. By becoming familiar with the usual appearance and feel of your breasts, you are more likely to notice a change and promptly bring it to your doctor's attention. Yearly screening mammograms are recommended for all women 40 and older. Women who are at increased risk may be advised by their doctor to begin having them sooner.

When should I perform my breast self-exam?
Examine your breasts about a week after your menstrual period. If you no longer have menstrual periods, examine yourself on the same day each month.

What is digital mammography?
This procedure uses an electronic process to collect and display X-ray images on a computer screen. This allows the radiologist to manipulate the image (to adjust the darkness/contrast or to magnify the image), which can make it easier to identify subtle differences in tissue. The images can also be transmitted electronically (like an email) so they can be reviewed by an expert who might be located elsewhere. Digital mammography has been found to be especially useful for evaluating younger women with dense breast tissue. Digital mammography is now available in the Calvert Medical Arts Center on the main hospital campus.

What other tests are available?
Breast ultrasound is sometimes used to evaluate an abnormality seen on a mammogram or found on a breast examination. This test uses sound waves to produce images of structures within the body. It can be useful to determine whether a breast lump is solid or cystic (fluid filled).

Breast MRI captures detailed images of the breast using a computer with magnetic and radio frequency waves. It is very expensive and is not routinely used as a screening test. It can be useful when more routine diagnostic methods (examination, mammograms and sonograms) are inconclusive. It also can be used to evaluate women with dense breasts and to screen those women who are at very high risk for the development of breast cancer.

When is a breast biopsy performed?
A biopsy is used to determine whether an abnormality seen or felt within the breast is cancerous or benign. Most biopsies are performed by withdrawing a specimen of tissue through a needle inserted into the breast under local anesthesia. Usually either ultrasound or a computer combined with a mammography unit (stereotactic unit) is used to guide the placement of the needle into the suspicious area. Occasionally, biopsies are still performed by surgical removal of all or part of a breast lump.

How do I choose between a lumpectomy and a mastectomy?
The majority of patients with breast cancer undergo a surgical procedure known as a "lumpectomy." This refers to removal of the malignant tumor with a surrounding margin of normal breast tissue. Most patients undergoing this procedure are advised to also receive a course of radiation treatment to the breast. This has been shown to reduce the chance of cancer reappearing in the treated breast. The other surgical choice is a mastectomy; a procedure that removes the entire breast.

The breast surgeon will help guide the patient through the decision-making process. For most small tumors, a lumpectomy permits removal of the tumor while allowing the breast to retain an acceptable appearance. A mastectomy may be a better choice when removal of a large tumor would result in a significantly deformed breast. Many patients undergoing a mastectomy also opt for breast reconstruction, which can often be started at the time of the mastectomy.

Every patient is unique and, therefore, the final decision should take into account the specific features of the tumor while also addressing the individual concerns and wishes of each patient.

What is a sentinel lymph node biopsy?
Sentinel lymph node biopsy (SLNB) has been performed at CalvertHealth for many years. It is a minimally invasive procedure in which a lymph node near the site of a cancer is first identified as a sentinel lymph node and then removed for microscopic analysis. This technique was developed after research demonstrated that the lymphatic system could be mapped with radioactive tracers and/or blue dye. This allows the identification of the lymph node (s) closest to the tumor, which serve to filter and trap cancer cells. The detection of cancer in these lymph nodes warns the doctor that the patient's cancer is spreading, hence the term "sentinel" lymph node. If the sentinel lymph node (s) is clear of tumor, it is not necessary to remove the other lymph nodes in the armpit, thereby minimizing the occurrence of arm swelling (lymphedema) and other side effects.

Will I need radiation therapy and/or chemotherapy after surgery?
Patients undergoing a lumpectomy are usually advised to receive radiation therapy at some point following their surgery. Patients undergoing a mastectomy usually do not receive radiation unless their cancer is large, has invaded the skin or the chest wall or has spread into several lymph nodes.

Chemotherapy utilizes drugs to kill cancer cells. The size of the tumor, characteristics of the cancer cells and extent of spread of the cancer as well as other considerations help determine the need for chemotherapy. If the cancer has a high chance of returning or spreading to another parts of the body, chemotherapy may be advised to diminish the chance that the cancer will recur. These decisions are made in conjunction with a medical oncologist.

What are my options for breast reconstruction?
Some women choose to undergo breast reconstruction immediately following a mastectomy. Methods to reconstruct the breast include: using tissue expanders and implants, using your body's own tissue or a combination of the two. Breast reconstruction is a complex procedure performed by a plastic surgeon. It may require more than a single surgery to obtain a correctly positioned and symmetrical breast. Often, surgery will be performed on the opposite healthy breast so it more closely matches the size, shape and position of the reconstructed breast. Since the need for the surgery is related to breast cancer, the cost for reconstruction is usually covered by insurance.