Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Title slide Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Breast cancer knows no prejudice and affects Native women just as it does other women. Most Non-Native women are diagnosed with breast cancer after the age of 50. However, based on women in the “National Native American Cancer Survivors’ Support Network” about half of Native women diagnosed with breast cancer were younger than age 50. Although most American Indian and Alaska Native women who are diagnosed with breast cancer are 40 years old and older, some younger Native women have also been diagnosed. These three photos are of women enrolled in the National Native American Breast Cancer Survivors’ Support Network (1-800-537-8295). These and others have helped Native American Cancer Research (NACR) develop cancer education support resource materials. We hope this product is of use to you and your community. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

All four are employees of NACR. Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Lisa Harjo, MA (Choctaw) took the leadership role in modifying this education product. Terri Rattler (Oglala) helped to refine the product and assisted Ms. Harjo in the focus group evaluation and pretesting. Linda Burhansstipanov (Linda Bee) (Cherokee) helped refine and added the scientific and cultural-specific information and layout of the product. Rick Clark helped modify graphics to respond to focus group members’ suggestions and expert reviewers’ comments. All four are employees of NACR. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 NACR staff have wanted to develop culturally relevant resources such as this material for many years. However, to do so in a conscientious, scientific, and culturally respectful manner requires funding. We are very thankful to the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation for supporting our local NACR program, “Native American Women’s Wellness through Awareness” (NAWWA). Through their support in 2002, NACR staff were able to develop, pretest, and disseminate this product. NACR is a partner with Mayo Clinic’s Native American Programs (“Spirit of EAGLES”, the Native CIRCLE, and the Native WEB). “Spirit of EAGLES” funding partially supported the refinement and dissemination of this product. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Linda Krebs, RN, AOCN, PhD, provided a very detailed review of scientific accuracy. Catherine A. Offutt, was the Project Coordinator of the Pathways to a Healthy Life project, which was supported by the national Susan G. Komen Breast Cancer Foundation in 1999 (grant #9820). This was a partnership among the women’s Health Coordinators from the Navajo Nation, Hopi Tribe, Indian Health Service, the New Mexico Breast and Cervical Cancer Program, Zuni and Apache Nations. The graphics from their lovely and effective booklet were used or modified for use within this product. The Rocky Mountain Cancer Information Service Partnership Program developed the original flip chart which served as the model for this product, Spread the Word about Mammograms and the Pap Test: An Educational Resource for Health Care Professions. Pub. No. 844. This product is limited to breast because NACR is awaiting approval to use graphics from another American Indian program within the Cervix Health product. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 This is an introductory slide with a focus of the message we want to leave with them. It is presented here in case the women are unable to take part in the entire health education session. NAWWA is the name of our local Denver program. It stands for Native American Women’s Wellness through Awareness. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Since so many of the women enrolled in the “National Native American Cancer Survivors’ Support Network” have identified their own cancer through breast self exam, NACR continue to encourage the use of all three early detection techniques. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 If you are afraid of breast screening, what are your concerns. I may be able to help reduce those fears (example: Indian woman healer who blessed the mobile van, mammography machine and the women during their screenings in southern California community) Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Early detection is the best protection against breast cancer. Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Early detection is the best protection against breast cancer. Breast Self Exam helps women become familiar with their own breasts so they can detect any changes from month to month. Clinical breast exam allows a health professional to check for any lumps, or unusual changes in your breasts. This does not substitute for a monthly Breast Self Exam or yearly mammogram. A mammogram can detect a lump as small as a grain of rice which cannot be felt by the Breast Self Exam or the Clinical Breast Exam. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Females may begin doing monthly breast self exams once they begin their moon (menarche / menses / periods). Breasts change during the monthly menstrual cycle and also as you grow older. But if you are feeling your breasts monthly, you are more likely to notice changes or anything that is unusual for your breasts. During your annual checkup, all females should have a clinical breast exam which is done by a trained health provider. Your provider does thousands of these exams each year and will not remember what your breasts felt like last year. If you have noticed any changes in your breasts while doing your breast self exam, you need to tell your provider what you have noticed and have the provider check that area of your breasts carefully. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 If a woman has a close family member who has been diagnosed with breast cancer, her provider may recommend that she begin to have mammograms when she is younger than 40 years old. Typically mammograms take better pictures of the breast when there is a lot of fatty tissue present. This is why younger women, who usually have firm breasts, are not recommended for mammograms. They may be recommended to have an ultrasound. Studies by Marilyn Roubidoux, MD, and Judith S. Kaur, MD, found that many Native women who were younger than 40 years old had enough fatty tissue in their breasts to have accurate mammography films of their breasts. There are some other screening tests which may be even more accurate at finding small growths in the breasts, like three dimensional MRIs. But this equipment is very costly and is currently not available in Indian Country. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Women who are large breasted will need to take longer. Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 The fatty tissue on the top portion of three fingers are used so that you are covering a large enough surface of the breast to find a small tumor or growth. The woman needs to press down firmly. She is searching for lumps, not giving herself a massage. The breast self exam usually takes about 15 minutes to complete on each breast. Women who are large breasted will need to take longer. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 By doing this BSE monthly throughout your life, you know what is and is not usual in the appearance of your breasts. If you notice anything unusual, you want to contact your health care provider. You also lean forward slightly and pinch your shoulders forward. This allows your breasts to fall forward and helps you see if there are any dimples or changes in the skin texture. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Place a towel under your shoulder, raise your arm and with the opposite hand, begin to do the vertical paths (shown in next slide) from your armpit to your breast bone. Women who are large-breasted will need to shift their position when lying down to do the BSE to be able to feel all of the breast tissue. You will need to try different positions and angles to make certain you are reaching all sections of your breasts. Move the towel to the other side and thoroughly check the other breast. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

You need to make at least seven paths up and down your breasts. Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 The BSE actually begins in your armpit so that you can feel changes in your lymph nodes. You begin with a downward/vertical path without letting your fingers lift up. You do not want to miss a growth by lifting your fingers and replacing them. You need to make at least seven paths up and down your breasts. You go as high as your collar bone because the are breast cells in that section of the chest. You go as low as your ribs below your breasts because there are breast cells there as well. You continue with your vertical paths until you cover your breast bones. Make sure you do in all 3 “positions” – in the shower, standing in front of the mirror, on your back Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Lumps occur for many different reasons. The most common is a cyst or infection. But these usually go away. Fatty lumps usually move around as you press on them. But you still need to have the provider feel those lumps. Some women notice more lumpiness in their breasts when they drink (coffee / tea, cola sodas) or eat foods (chocolate) that have a lot of caffeine. If you notice these changes, you may want to reduce these types of caffeine drinks and foods. If the woman does notice more breast lumps when she has caffeine, she may want to stop having any caffeine for 1-2 weeks before her mammogram. Many Native women ask questions about breast cancer being caused by being beaten up in the chest. Although there is likely to be more calcium deposits from physical beatings, there are no studies that show an increase in breast cancer caused by physical beatings. But there are services available to help you get out of a household where you are being beaten. It has never been “traditional” to mistreat Native women and no woman nor her children should remain in such an unsafe environment. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 During pregnancy and breast feeding, obviously you will have discharge from the breast milk. Some discharge is brownish, other greenish. You need to tell the provider the color of the discharge because they will mean different things to the provider (e.g., greenish may be from an infected cyst). Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Some women who had this sign said that their nipple began to look flat, then like a dimple rather than the way the nipple usually looks. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

The skin may change in color …. orange-tinted or reddish Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 The skin may change in color …. orange-tinted or reddish The skin may change in texture … rougher, orange peel texture. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Sometimes the dimples only show while looking in the mirror, leaning forward with shoulders rolled forward or pinched forward. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

For breast health you really need to do all three exams. Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 For breast health you really need to do all three exams. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

If desired, ask for a female health provider for your annual checkup. Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Many tribal and IHS clinics have a limited number of providers. For this reason, your clinical breast exam may be done by a male provider. More and more of our clinics are hiring or training female health care providers on CBE. If desired, ask for a female health provider for your annual checkup. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 The health care provider should be trained to do CBE, but some do a better, more thorough job than do others. You may request a specific provider to do your CBE. Of course many of our tribal health clinics do not have more than one provider and there may be no choice. If you have noticed any changes in your breasts, you need to tell your provider what the change is and where you have noticed it. The provider is not likely to remember what your breasts felt like a year ago. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Don’t wait for the provider to notice the change. You need to tell the provider what you are concerned about. Some women have complained that their provider did not followup on their expressed concerns. As for another provider if you have a choice. Or, as soon as feasible, go to another tribal health clinic and request another exam. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Since mammograms are not fool-proof, they need to be done annually. Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Since mammograms are not fool-proof, they need to be done annually. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Some people still confuse a chest x-ray with a mammogram. A mammogram is done with a specific machine that is/should be “dedicated” for mammograms only Mammograms are more accurate in older women or in women whose breasts are more fatty than they are dense / firm. Although mammograms are not perfect, they remain one of the better ways to identify a breast cancer tumor while it is small and more likely to be responsive to treatment. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 “Mammie – o –test” is how a lot of elders refer to the mammogram. You may want to ask them to say the word so that you can help reduce their discomfort or fear of mispronouncing the word. This is to help reduce their embarrassment. Most tribal health clinics will know what should be included in a women’s health exam and can tell the woman what is and is not included. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Since the mammogram occasionally misses a tumor because it is too small or doesn’t show up, having an exam every year may “catch” a growth that was missed previously. Also, it is very important that if you have a lump, you must get follow-up with a healthcare provider even if you have a mammogram and it does not show anything that might be cancer Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 The NAWWA program staff have found a fairly high percentage of women who have been asked to come back in for another screening test. Sometimes this just means that the radiologist did not get a good film and has nothing to do with a problem with your breasts. Almost all of the women who have needed to be rescreened, have not been diagnosed with cancer. But the providers and radiologists are the ones who are qualified to make those types of decisions. The NAWWA program staff have found that most of the women do not want to go back in for the rescreening because they are so frightened that the results may be cancer. But if it were cancer, the sooner you have it treated, the more likely you are to have a full, healthy life. Worrying about the possible results does not reduce the likelihood of it being cancer. But it does result in a lot of fretting and loss of sleep than is unnecessary. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 For a young woman, the provider is likely to recommend ultrasound or an MRI rather than a mammogram because it is very difficult to be able to see through firm breast tissue to find a tumor. Drs. Roubidoux and Kaur reviewed over 500 mammograms from Indian women and determined that many of our women could have good pictures of their breasts using mammograms even though they were very young (40). Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 This was taken from a product from the national Susan G. Komen Breast Cancer Foundation. The comparison with coins makes it easy-to-understand for most community members. The bead necklace shows even smaller tumors and can be used in conjunction with this slide to illustrate sizes. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

The remaining topics will be covered on the next set of slides Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 The mammogram does not use any anesthesia or pain relief that would interfere with your ability to operate a car or truck. If you feel uneasy, invite a family member or a friend to accompany you. The Native Sisters may also meet you at the clinic if desired. Exposure to radiation during a mammogram is less than if she were outside in the sunshine taking a 30-minute walk. The remaining topics will be covered on the next set of slides Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

The woman needs to remove her bra for the picture. Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Note for women that the mammography machine is different from an x-ray machine and that women only want to have a mammogram done by a machine that is dedicated to mammograms (some rural doctors offices have x-ray machines that they use to do mammograms – this is not safe as it gives too much radiation and does not give a good picture. The woman needs to remove her bra for the picture. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 She will be covered by the nightgown top while walking from the dressing / changing room to the mammography waiting room or directly into the room with the mammography equipment. Some large-breasted Native women have worn a shawl over the nightgown for modesty. No health clinic has objected to such behavior. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 The breasts are pressed as flat as is possible to provide a better chance for the provider to find a lump or abnormal growth. There should be some discomfort for a few minutes, but this should not be “painful”. If there is no discomfort, the provider may not have squeezed the breasts well enough to get a good picture. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Some women complain about discomfort. If a woman still has menstrual flows/moons, she may choose to move the date of her appointment to more than a week away from her blood flow. The breasts are too tender. If a woman is concerned about discomfort, she may take an over-the-counter pain reliever of her choice (e.g., aspirin. Ibuprophen, acetaminophen) about 20 minutes before the mammogram for pain relief. Make sure there is no contraindication to taking aspirin, acetaminophen or ibuprofen Some technicians are a little rougher than others. Tell your Native Sister if you have any bruising and she will talk with the provider about the problem. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 If a woman has had experience with painful mammograms, she may take an over-the-counter pain relief medication. The mammogram is usually uncomfortable for only a few seconds. Many Native women have said that they didn’t feel it was uncomfortable at all, but had been warned that it would hurt. It is very individual. Some discomfort (but not severe pain) is expected. In order to fully view the breast, particularly the axillary fold (upper armpit area), there will be some pulling/pressure and discomfort as the area is “caught” between the plates (if there is no discomfort, the film may not show a full view of the breast. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Some programs receive supplemental funding to pay for screening tests (like through NACR’s NAWWA program funded by the Denver Affiliate of the Susan G. Komen Foundation). Most of the women have needed assistance filling out the Medicare paperwork. But for the women 65 and older, there are additional benefits to completing the eligibility requirements for Medicare. The Medicare paperwork used to be thrown out by federal employees who insisted that Native women were covered by Indian Health Service and should not seek services through Medicare. If this should happen, contact Linda B and let her handle it. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 About 1/3 of Native women have private health insurance. The Native Sister/Navigator needs to find out if it is catastrophic insurance ... which does not cover screening / checkups. For those women the tribal or state Breast and Cervix Cancer Early Detection Programs (BCCEDP) will pay for their annual breast health exam. Many Native women have insurance one year, but not the next (change in job status or mobility). There are alternative programs to provide mammograms during those times the woman is without private health insurance. Almost all of the states, but only 12 (out of over 564) of the tribal organizations have BCCEDP. These programs pay for the mammogram and clinical breast exam for women who meet the local program’s eligibility criteria (e.g., poor, under-insured, and between the ages of 50-64). Treatment dollars are much more difficult to find than are screening dollars. For those women initially screened through the tribal or state BCCEDP, treatment may be provided if their state approved the treatment bill. Colorado legislation did approve this legislation which means they have agreed to match CDC in treatment dollars. State programs should also be accessible to support the cost of screening. Some tribal programs must negotiate to receive such benefits from the state programs. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Mammography is still limited throughout Indian Country. Some tribal / IHS providers are reluctant to recommend a screening test that is not available locally. You may need to ask for a referral. Some tribal programs use Contracted Health Service (CHS) dollars for referral to mammograms. There are usually more cost-effective alternatives, rather than using very limited CHS dollars. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Some women do not experience breast tenderness. Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 For many women, this is challenging to do since our periods/ moons vary so much, but if possible, do so. Your breasts are less tender if more than 7 days from when your period ended. Hormonal changes in your breasts that may increase tenderness are less about 1 week after your period. Some women do not experience breast tenderness. Some women find the exam painful regardless of the timing. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 The deodorants, etc. may contain chemicals that look like calcium deposits or other tissue on the mammogram. This may interfere with accurate reading / reviewing of the mammogram. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 It is best to wear a top that is easy to remove and to get back on without help. The blouse, shirt, sweater, and bra will be removed for the exam and exchanged for a nightgown top for modesty. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Write down your concerns or questions and bring your list with you. Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 It is easy to forget questions or concerns when you are sitting with your provider. Write down your concerns or questions and bring your list with you. If you need help, have the Native Sister read your questions to the provider while all three of you are together in the exam room. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Your Native Sister may go with you to your appointment. Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Rather than worry, contact your provider and schedule to have the recommended followup tests. Your Native Sister may go with you to your appointment. It is helpful to write down questions you want to ask the provider. Your Native Sister can help you make up the list. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Lisa Harjo and Terri Rattler answer both the local Denver number and the toll free number. The CIS number goes to whichever CIS is closest to your location. For example, in Denver, we reach the Rocky Mountain CIS offices. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 Brochures Breast Cancer Cervical Cancer Endometrial Cancer Prostate Cancer Lung Cancer Dietary Needs of Cancer Patients Cancer Control Materials Smoking and Smoking Cessation Dietary Habits and Healthy Eating Healthy Living Styles Videos Wellness Native Nutrition PAP Smear/Cervical Cancer Tobacco and Health Stories of AI/AN Cancer Survivors Smoking Cessation Online Resources American Indian Resource Center Association of American Indian Physicians Center for American Indian Research and Education (CAIRE) Native American Resources on the Internet Native American Cancer Initiatives, Inc Indian Health Services Minnesota Indian Affairs Council Susan G. Komen Breast Cancer Foundation American Cancer Society Center for Disease Control and Prevention (CDC) Native American Women's Health Education Resource Center Northwest Portland Area Indian Health Board Other Resources Extensive Bibliography Access to Medical Journals and Reference Materials Grant Information Speakers Bureau Introduction.10 Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 These are the local public health educators and Native Sisters and are available to help local women take part in screening, receive personalized breast health education, and similar related functions. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives

Get on the Path to Breast Wellness -- Denver NAWWA Program (303-837-7163) of NACR (303-838-9359); Survivors’ Network 800-537-8295 This is the national headquarters for any queries from women within or outside of Colorado. Thank you for taking time to visit with us and talk about breast health. Be well. Supported by the Denver Affiliate of the Susan G. Komen Breast Cancer Foundation; Mayo Clinic’s Spirit of EAGLES, and Native American Cancer Initiatives