Breast Reconstruction Page 86 Clinical Trials Page 89 Complementary and Integrative Medicine Page 91

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Foreword

The Houston Affiliate of Susan G. Komen for the Cure and The University of Texas M. D. Anderson Cancer Center are pleased to provide this Breast Health Resource Directory. The directory contains information on breast health, breast cancer and a comprehensive listing of breast cancer resources. This directory is free of charge and also is available on our web sites in a searchable database at www.komen-houston.org and www.mdanderson.org.

The mission of Susan G. Komen for the Cure is to save lives and end breast cancer forever by empowering people, ensuring quality care for all and energizing science to find the cures. The Komen Houston Affiliate, established in 1990, provides breast health education and funding to Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty and Montgomery Counties. Since our inception, the Affiliate has awarded $12.4 million in grants for breast cancer education, screening and treatment. In addition, we have raised more than $4.1 million for breast cancer research.

The Komen Houston Affiliate is committed to finding a cure for breast cancer and to ensuring that no individual with breast cancer goes untreated. We believe that health care is a right, not a privilege. The Komen Houston Affiliate provides grants to organizations that help uninsured and medically underserved individuals access life-saving breast cancer treatment.

The Affiliate educates the community about breast health and early detection. Our Speakers Bureau provides trained volunteers for corporations, professional groups, schools and clubs to speak about breast health awareness and the life-saving message of early detection. To schedule an educational presentation, call (713) 783-9188.

The Komen Houston Affiliate raises funds in a variety of ways including the Komen Houston Race for the Cure® which is held every fall, the Pink Tie Gala, memorials and honorariums, memberships and general donations. Seventy-five percent of the net funds raised stay in the local community for breast health education, screening and treatment. The remaining twenty-five percent funds breast cancer research through the Susan G. Komen for a Cure Award and Research Grant Program. To learn more about how to apply for a grant or get involved in the Affiliate, visit our website at www.komen-houston.org.

If breast cancer is caught early when it is confined to the breast, the survival rate is greater than 95 percent. More and more women are not only surviving breast cancer but are thriving. If you or someone you love has recently been diagnosed with breast cancer, we hope this directory will help you in your journey.

Dora Klaff, President Michele Ostrander, Executive Director Houston Affiliate of Houston Affiliate of Susan G. Komen for the Cure Susan G. Komen for the Cure FinalPDFLayout.qxp 9/6/2007 11:06 AM Page 2

Table of Contents

HOW TO USE THIS DIRECTORY page 1

SECTION 1: BREAST HEALTH CARE Breast Health Basics page 3 Breast Self-Exam page 8 Mammography Facilities page 10 Genetic Counseling and Testing page 24

SECTION 2: DIAGNOSIS Breast Biopsy and Hormone Receptors page 26 Staging page 28

SECTION 3: TREATMENT Types of Treatment page 31 Treatment byStage page 37 Hospitals page 40 Breast Reconstruction page 86 Clinical Trials page 89 Complementary and Integrative Medicine page 91

SECTION 4: AFTER TREATMENT Prostheses and Products page 93 Home Health Care page 95 Hospice Programs page 96

SECTION 5: SUPPORT GROUPS AND COMMUNITY RESOURCES Support Resources page 99 Community Services page 109 Caregiver Information page 115

SECTION 6: GLOSSARY AND ADDITIONAL RESOURCES Information Resources page 116 Glossary of Terms page 118

SECTION 7: INFORMACIÓN EN ESPAÑOL page 129

ORDER FORM page 135

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How to Use this Directory

Breast health resources within the greater Houston area are listed in this directory. Each section also includes helpful questions to ask the doctor. Use the Table of Contents to locate page numbers for specific sections. Directory contents include the following sections:

SECTION 1: BREAST HEALTH CARE

Breast Health Basics: Information on breast cancer risk factors, early detection, types of health care providers and what to do if you have concerns about breast health.

Breast Self-Exam: Instructions, including illustrations, on how to perform a breast self-exam.

Mammography Facilities: Facilities within the greater Houston area, excluding hospitals.

Genetic Counseling and Testing: Information on populations that may have an increased risk of developing breast cancer.

SECTION 2: DIAGNOSIS

Breast Biopsy and Hormone Receptors: Information on how breast cancer is diagnosed.

Staging : Information on how breast cancer is categorized.

SECTION 3: TREATMENT

Types of Treatment: Explanations about different breast cancer treatments.

Treatment by Stage: Explanations about different breast cancer treatments organized by stage of disease.

Hospitals: Specific information on services offered by hospitals within the greater Houston area.

Breast Reconstruction: Information on the types of breast reconstruction.

Clinical Trials: Information on clinical trials, including how to participate.

Complementary and Integrative Medicine: Information describing complementary and integrative medicine and its uses.

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SECTION 4: AFTER TREATMENT

Prostheses and Products: Information on where to find prostheses or products within the greater Houston area.

Home Health Care: Organizations to contact for local home health care services.

Hospice Programs: Programs within the greater Houston area.

SECTION 5: SUPPORT GROUPS AND COMMUNITY RESOURCES

Support Resources: Information on support groups and other helpful coping resources.

Community Services: Services and information provided by state and local breast cancer-related organizations.

Caregiver Information: Information on ways caregivers and family members can support a breast cancer patient.

SECTION 6: GLOSSARY AND ADDITIONAL RESOURCES

Information Resources: List of books and other resources that includes general information about breast cancer and its treatment, coping, personal stories, risks, and support for family and friends.

Glossary of Terms: Medical terms commonly encountered in confronting breast cancer and/or pursuing breast health care.

SECTION 7: INFORMACIÓN EN ESPAÑOL Información de la salud del pecho, así como una lista de las organizaciones de la ayuda y de servicios que sirven a la comunidad de habla hispana.

SURVIVOR SENTIMENTS "What I call the four 'Fs' got me through my year of chemotherapy, radiation and surgeries - Faith, Family, Friends and Physicians. One does get one's priorities straight while fighting cancer." Ann 17-year survivor

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Breast Health Basics

Other than skin cancer, breast cancer is the most common cancer in women. Thankfully, the number of women who die from breast cancer is declining, but the battle is not over. According to the American Cancer Society, more than 40,000 women and 400 men will still die from the disease this year. An individual's best chance for surviving breast cancer is detecting it early, when it is most easily treated. Following is basic breast health information that every woman should know.

SYMPTOMS Symptoms of breast cancer may vary from woman to woman. Women should examine their breasts monthly so that they know what feels and looks normal for them. Many cancers are found by regular mammography after age 40 - before any symptoms are felt. Symptoms include: lump or mass in the breast enlarged lymph nodes in the armpit changes in breast size, shape, skin texture or color skin redness dimpling or puckering nipple changes or discharge scaliness nipple pulling to one side or a change in direction

RISK FACTORS All women are at risk for breast cancer, and that risk increases with age. Women with a family history of breast cancer have an increased risk; however, the majority of breast cancers occur in women who do not have a family history. Many factors may influence the development of breast cancer, including:

Age: Most cases of breast cancer occur in women 50 or older; it is less common in women 35 or younger. Age is the most influential risk factor.

Family history: A woman's risk for breast cancer increases with a family history (especially mother, sister or daughter) of breast and/or ovarian cancer.

Hormones / childbirth: A woman's risk of breast cancer is higher if she had her first period before age 12, began menopause after age 55, never had children or had her first child after age 30. Postmenopausal use of hormone replacement therapy increases a woman's risk of developing breast cancer.

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Previous biopsy: If a woman has had abnormal breast biopsy results or benign breast diseases requiring biopsies, her risks may increase. Other breast diseases such as atypical hyperplasia, and lobular or ductal carcinoma in situ are risk factors too.

Education / socioeconomic status: Women with a higher socioeconomic status and/or education level tend to have fewer children and start childbearing after age 30 - both of which put them at higher risk.

Weight: Women who gain weight or are obese after menopause are at increased risk.

Genetic alterations: Inherited susceptibility genes BRCA1 and BRCA2 account for about five to 10 percent of all breast cancer cases and may be a risk factor.

Other risk factors: Oral contraceptive use, high-fat diet, physical inactivity and alcohol (more than one alcoholic drink a day) are additional risk factors for breast cancer.

SCREENING EXAMS Not all breast lumps or symptoms are breast cancer. However, any change from the normal feel or appearance of the breast, or unusual discharge, should be evaluated by a health care professional as soon as possible (see page 28 for more information). A small number of breast cancers have no distinct mass or lump, such as inflammatory breast cancer, so women should be familiar with all breast cancer symptoms. The Susan G. Komen for the Cure recommends a three-step approach to breast cancer screening that includes, depending upon a woman's age, a combination of mammography, clinical breast exams and breast self-exams.

1. Have a screening mammogram annually beginning at age 40. A screening mammogram is for women who currently do not have breast problems or symptoms. It is used to detect early signs of breast cancer. A recent study determined that women with dense breasts - as well as women younger than 50 and pre-menopausal or peri-menopausal (early-stage menopause) women - may benefit from having a digital mammogram over a film mammogram. Women should consult a health care provider regarding the benefits of digital mammography. A woman under age 40 with either a family history of breast cancer, or other concerns about her risk, should consult a health care provider regarding when to begin screening mammograms. A small number of breast cancers are not detected by mammography, but can be detected during a clinical breast examination. Therefore, it is extremely important that women have both a mammogram and a clinical breast examination about the same time each year. 2. Visit a health care professional for a clinical breast examination. Have a clinical breast exam every three years if you are a woman between the ages of 20 and 39. Have one every year after age 40.

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3. Perform monthly breast self-examination (BSE) beginning by age 20. Conduct a BSE at the same time each month. For menstruating women, it should be performed after the menstrual period has ended because the breasts are less tender. For post-menopausal women, it should be performed at the same time each month to establish a routine. Women should become familiar with the normal appearance and feel of their breasts so they can more readily detect any changes. Learn how to do a BSE (see page 8). Contact a health care professional if you notice any breast changes.

REDUCING YOUR RISKS Women can take action to reduce their risks of developing breast cancer. Suggestions include: talking to a doctor about using oral contraceptives and hormone replacement therapy maintaining an ideal weight eating at least five servings of fruits and vegetables per day following recommended screening guidelines exercising regularly eliminating tobacco use and using alcohol in moderation getting a breast cancer risk assessment by a health care provider after age 35 talking to a doctor about the benefits of tamoxifen if at increased risk

TYPES OF HEALTH CARE PROVIDERS Generally, a woman's primary care provider is a gynecologist, family practice physician or an internist. If cancer is suspected, a woman may visit with other types of physicians including:

Surgeons: Further evaluates an abnormal finding on a mammogram or clinical breast exam, and/or provides second opinions regarding a breast problem or symptom. A small number of surgeons have limited their area of practice to the breast. Many surgeons include breast surgery as an area of interest, although they also perform other types of surgeries.

Pathologists: Has special training in diagnosing disease from tissue samples.

Medical Oncologists: Specializes in the treatment of cancer using chemotherapy, hormone therapy or other non-surgical therapies. A woman may want to discuss adjuvant (additional) therapy with more than one medical oncologist.

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Plastic Surgeons: Specializes in reconstructive surgery. A woman who is considering breast reconstruction should discuss this option with her surgeon before any surgery is done.

Radiation Oncologists: Specializes in the treatment of cancer using high energy x-rays. A woman who is deciding between breast conservation (lumpectomy with radiation therapy) or mastectomy will want to discuss this further with a radiation oncologist and perhaps another surgeon.

BREAST CANCER IN MEN Breast cancer in men is rare, but it does happen. After all, men have breast tissue also. The overall ratio of female to male breast cancer in the U.S. is 100 to one. The most common symptoms of male breast cancer include a lump in the chest area, skin dimpling or puckering, or nipple changes.

Because breast cancer is so much more common in females, many men do not even realize they can develop this disease. Unfortunately, this can delay diagnosis and as a result, some cancers are not found until they have progressed to a later stage. However, when cancer is found at the same stage among men and women, the survival rates are similar. Because the male breast is much smaller than the female breast, it is more likely the disease will spread to the chest wall. For this reason, it is important to find the cancer early in order to successfully treat it.

QUESTIONS TO ASK A DOCTOR Breast lumps are actually very common, especially in pre-menopausal women. They normally go away at the end of the menstrual cycle. In fact, eight out of 10 breast lumps are not cancerous. But, a woman should not ignore a change in her breast. The best advice is to see a doctor. Following are some questions a woman may want to ask a doctor if she has found a lump in her breast:

1. Will you refer me for a mammogram? When would an ultrasound be recommended? 2. Can this lump be aspirated (fluid or cells removed with a needle)? If so, who will perform the procedure? 3. Will I need a biopsy? 4. If further tests and/or treatment are needed, will you refer me to a doctor who specializes in breast problems? 5. Do you recommend any special follow-ups? 6. What non-cancerous conditions can cause breast lumps? 7. When will I receive the results of the mammogram or ultrasound? 8. Is there anything I should do to prepare for my mammogram? (i.e., wear a two-piece outfit, not apply creams or deodorants and schedule the mammogram when the breasts are least sensitive, for example, after my period is over.)

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9. What will the mammogram show? 10. Who receives my mammography report? Can it also be sent to my other doctors? 11. How long will it take to receive the mammography report? Who will notify me of the results? (Do not assume "no call" from your doctor's office means that everything is as it should be. In most cases, you should have the results within 10 working days.) 12. What are the next steps if an abnormality is detected? 13. Will my insurance cover the mammogram? What about Medicare?

SURVIVOR SENTIMENTS "Breast cancer is not something I wanted and certainly don't want again. However, it was an experience that taught me so much more about myself and what is really important in my life. I enjoy each and every day and thank God that I have hair!"

Kathy 7-year survivor

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Breast Self-Exam

Breast self-exam is a screening method that is intended to find breast lumps early when treatment is most successful. Most health care organizations recommend that women become familiar with their breasts so that they will notice any changes and report them to their doctor without delay. The Susan G. Komen for the Cure recommends doing breast self-exams once a month, beginning by age 20. Women should look and feel for a(n): lump, hard knot or thickening swelling, warmth, redness or darkening change in size or shape dimpling or puckering of the skin itchy, scaly sore or rash on the nipple pulling in of the nipple or other parts of the breast nipple discharge that starts suddenly new pain in one spot that does not go away

BREAST SELF EXAMINATION (BSE): STEPS 1 – 5 Breast self-examination should be done as the menstrual period ends or at the same time each month. Check for any change in the normal look or feel of your breasts. Report any changes to a doctor or nurse.

STEP 1: Lie down on your back with a pillow under your right shoulder. Use the pads of the three middle fingers on your left hand to check your right breast. Press using light, medium and firm pressure in a circle without lifting your fingers off the skin. Follow an up and down pattern. Feel for changes in your breast, above and below your collarbone and in your armpit.

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STEP 2: Look for any changes from normal. Inspect your breasts in the following four steps: 1. hold arms at your sides 2. hold arms over your head 3. press your hands on your hips and tighten your chest muscles 4. bend forward with your hands on your hips

STEP 3: Feel for lumps above and below the collarbone. From the collarbone, rub down firmly with a soapy hand to the nipple of one breast. Feel for any lumps, thickening or changes.

STEP 4: Support the breast with one hand while the other hand and fingers slide across the top of the breast. Repeat exam on the other breast.

STEP 5: Check for lumps under your arm while relaxing your arm at your side. Keep fingers together and flat. Repeat exam on the other breast.

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Mammography Facilities______

The following is a list of Food and Drug Administration (FDA) certified mammography facilities located within the greater Houston area. Languages spoken, operating hours and whether low cost services are available are listed with each entry.

1) Aldine Health Center (281) 985-7767 4755 Aldine Mail Route www.hchdonline.com Houston, TX 77039 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday Low cost services are available for those who qualify.

2) Angleton Danbury Medical Center (979) 849-7721 132 E Hospital Drive www.admc.org Angleton, TX 77515 Language(s) Spoken: English, Spanish Hours: 10 a.m. to 2 p.m., Monday through Friday

3) Bayshore Medical Center (713) 359-1366 4000 Spencer Highway www.bayshoremedical.com Pasadena, TX 77505 Language(s) Spoken: English, Spanish Hours: 7 a.m. to 6 p.m., Monday through Friday Low cost services are available for those who qualify.

4) Ben Taub General Hospital (713) 873-8634 1504 Taub Loop www.bcm.edu/cancercenter Houston, TX 77030 Language(s) Spoken: English, Spanish Hours: 7 a.m. to 4:30 p.m., Monday through Friday Low cost services are available for those who qualify.

5) Christus St. John Hospital (281) 333-8866 18300 St. John Drive Nassau Bay, TX 77058 Language(s) Spoken: English Hours: 8 a.m. to 5 p.m., Monday through Friday

6) Clear Lake Regional Medical Center Breast Diagnostic Center (281) 338-1684 200 Medical Center Blvd, Suite 106 www.clearlakermc.com Webster, TX 77598 Language(s) Spoken: English, Spanish Hours: 7 a.m. to 5:45 p.m., Monday through Friday

7) Conroe Regional Medical Center - Women's Imaging Center (936) 539-7100 504 Medical Center Blvd. www.conroeregional.com Conroe, TX 77304 Language(s) Spoken: English, Spanish Hours: 7:30 a.m. to 4:30 p.m., Monday through Friday

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8) Cypress Fairbanks Medical Center (281) 897-3121 11302 Fallbrook, Suite 203 www.cyfairhospital.com Houston, TX 77065 Language(s) Spoken: English, Spanish Hours: 7:30 a.m. to 5 p.m., Monday through Friday, and 8 a.m. to 3 p.m., Saturday

9) Diagnostic Clinic of Houston, P.A. (713) 797-9191 1200 Binz Suite 140 www.diagnosticclinic.com Houston, TX 77004 Language(s) Spoken: English, Spanish Hours: 8:30 a.m. to 5 p.m., Monday through Friday

10) East Houston Regional Medical Center (713) 393-2510 Diagnostic Imaging Center www.easthoustonrmc.com 13111 East Freeway Houston, TX 77015 Language(s) Spoken: English. Spanish Hours: 8 a.m. to 3:30 p.m., Monday through Friday

11) East Side Imaging (713) 451-2900 10912 East Freeway Houston, TX 77029 Language(s) Spoken: English, Spanish, Vietnamese Hours: 8 a.m. to 5 p.m., Monday through Friday Low cost services are available for those who qualify.

12) East Side Imaging, Inc. (713) 451-2900 10912 East Freeway Houston, TX 77029 Language(s) Spoken: English Hours: 8 a.m. to 4:30 p.m., Monday through Friday

13) EHG Medical Group of Texas (713) 622-9900 5555 San Felipe Rd., Suite 800 www.executivehealthexams.com Houston, TX 77056 Language(s) Spoken: English Hours: 7 a.m. to 4 p.m., Monday through Friday

14) Excel Diagnostic Imaging (713) 781-6200 9701 Richmond Avenue, Suite 120 www.exceldiagnostics.com Houston, TX 77042 Language(s) Spoken: English Hours: 9:15 a.m. to 4 p.m., Monday through Thursday, and 8 a.m. to 2 p.m., Friday

15) Executive Health Exams International (713) 622-9900 5555 San Felipe Road, Suite 800 www.executivehealthexams.com Houston, TX 77056 Language(s) Spoken: English, Spanish Hours: 7:45 a.m. to 1 p.m., Monday through Friday

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16) Fort Bend Imaging (281) 242-5800 14835 Southwest Freeway www.usitexas.com Sugarland, TX 77478 Language(s) Spoken: English, Spanish, Vietnamese Hours: 8 a.m. to 5 p.m., Monday through Friday

17) Healthsouth Diagnostic Center - Baytown (281) 420-3000 3711 Garth Rd www.healthsouth.com Baytown, TX 77521 Language(s) Spoken: English Hours: 8 a.m. to 5 p.m., Monday through Wednesday, Friday

18) Healthsouth Diagnostic Center - Clear Lake (281) 218-7251 205 East Medical Center Blvd. www.healthsouth.com Webster, TX 77598 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

19) Healthsouth Diagnostic Center - Katy (281) 579-9086 575 Mason Rd. www.healthsouth.com Katy, TX 77450 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

20) Healthsouth Diagnostic Center - La Branch (713) 528-6000 5445 La Branch www.healthsouth.com Houston, TX 77004 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

21) Healthsouth Diagnostic Center - Memorial (713) 464-0900 8333 Katy Freeway, Suite 106 www.healthsouth.com Houston, TX 77024 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday Discounts and payment plans are available for those who qualify.

22) Healthsouth Diagnostic Center - Willowbrook (281) 970-8288 7915 FM 1960 West, Suite 108 www.healthsouth.com Houston, TX 77070 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

23) Heights Diagnostic Imaging Center (713) 869-6296 427 West 20th St., Suite 401 Houston, TX 77008 Language(s) Spoken: English, Spanish Hours: 9 a.m. to 5 p.m., Monday through Friday

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24) Houston Breast Center (281) 359-3886 22999 US Hwy 59 North, Suite 136 Kingwood, TX 77339 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

25) Houston Medical Imaging (713) 797-1919 3303 Audley www.houstonimaging.com Houston, TX 77098 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 4 p.m., Monday through Friday

26) Houston Medical Imaging (713) 797-1919 7000 Fannin #M-40 www.houstonimaging.com Houston, TX 77030 Language(s) Spoken: English, Spanish Hours: 7 a.m. to 6 p.m., Monday through Friday, and 8 a.m. to noon on Saturday

27) Houston Northwest Medical Center The Breast Center (281) 440-2545 Women's Atrium Diagnostic Center www.hnmc.com 710 FM 1960 W Houston, TX 77090 Language(s) Spoken: English, Spanish Hours: 7:15 a.m. to 6:30 p.m., Monday through Thursday, and 7:15 a.m. to 4 p.m., Friday, 8 a.m. to 3:30 p.m., Saturday

28) Houston Town and Country Hospital (713) 467-4824 1120 Business Center Dr. www.hhospital.com Houston, TX 77043 Language(s) Spoken: English, Spanish Hours: 9 a.m. to 3 p.m., Monday through Friday

29) Jacinto Medical Corporation (281) 427-3700 2800 Garth Rd. www.jacintomedicalgroup.com Baytown, TX 77521 Language(s) Spoken: English Hours: 7 a.m. to 5 p.m., Monday through Friday Low cost services are available for those who qualify.

30) Kelsey Seybold Clinic - Main (713) 442-1161 2727 West Holcombe www.kelsey-seybold.com Houston, TX 77025 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

31) Kelsey-Seybold Clinic - Clear Lake Medical Center (713) 442-1161 17448 Hwy 3, Suite 200 www.kelsey-seybold.com Webster, TX 77058 Language(s) Spoken: English Hours: 8 a.m. to 5 p.m., Monday through Friday

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32) Kelsey-Seybold Clinic - First Colony (281) 442-1161 16659 Southwest Freeway www.kelseyseybold.com Sugarland, TX 77479 Language(s) Spoken: English Hours: 8 a.m. to 5 p.m., Monday through Friday

33) Kelsey-Seybold Clinic - West (713) 442-1161 1111 Augusta St. www.kelsey-seybold.com Houston, TX 77057 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday, and Saturday, 9 a.m. to 2 p.m.

34) Kelsey-Seybold Clinic - Willowbrook (713) 442-1161 18220 Tomball Parkway #400 www.kelsey-seybold.com Houston, TX 77070 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

35) Kelsey-Seybold Clinic-Spring (713) 442-1161 15655 Cypress Woods Medical Drive www.kelsey-seybold.com Houston, TX 77014 Language(s) Spoken: English Hours: 7:30 a.m. to 4:30 p.m., Monday through Friday, and 8:30 a.m. to 12 p.m., Saturday

36) Kelsey-Seybold Clinic-The Woodlands (713) 442-1161 17350 St. Lukes Way, Suite 175 www.kelsey-seybold.com The Woodlands, TX 77384 Language(s) Spoken: English Hours: 8 a.m. to 4 p.m., Monday through Friday

37) Kelsey-Seybold Fort Bend Medical and Diagnostic Center (713) 442-1161 11555 University Blvd. www.kelsey-seybold.com Sugar Land, TX 77478 Language(s) Spoken: English Hours: 8 a.m. to 4 p.m., Monday through Friday

38) Kelsey-Seybold Women's Center (713) 442-7300 7900 Fannin, Suite 2100 www.kelsey-seybold.com Houston, TX 77054 Language(s) Spoken: English Hours: 8 a.m. to 5 p.m., Monday through Friday

39) Kingsland Diagnostic Center (281) 395-7459 777 South Fry Rd., Suite108 Katy, TX 77450 Language(s) Spoken: English, Spanish Hours: 8:30 a.m. to 3:30 p.m., Monday through Friday, and Saturday, 9 a.m. to noon

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40) Lyndon B. Johnson General Hospital (713) 566-5477 Radiology Department www.lbj.uth.tmc.edu 5656 Kelley Street Houston, TX 77026 Language(s) Spoken: English, Spanish Hours: 7 a.m. to 3 p.m., Monday through Friday Low cost services are available for those who qualify.

41) M. D. Anderson Cancer Center (713) 745-4050 1515 Holcombe Blvd. www.mdanderson.org Houston, TX 77030 Language(s) Spoken: English, Spanish Hours: 7 a.m. to 4 p.m., Monday through Friday

42) M. D. Anderson Cancer Center, Mobile Mammography Unit (713) 745-4000 1515 Holcombe Blvd. www.mdanderson.org Houston, TX 77030 Language(s) Spoken: English, Spanish

43) Mainland Medical Center Hospital (409) 938-5137 6801 EF Lowry Expressway www.mainlandmedical.com Texas City, TX 77591 Language(s) Spoken: English Hours: 8 a.m. to 5 p.m., Monday through Friday

44) Mammography Ultrasound Specialists (713) 668-7481 6611 South Rice Ave. www.houstonmammo.com Bellaire, TX 77401 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

45) Medical Clinic of Houston LLP (713) 526-5511 1707 Sunset Blvd. Houston, TX 77005 Language(s) Spoken: English, Spanish Hours: 8:30 a.m. to 5 p.m., Monday through Friday

46) Memorial Hermann Friendswood Imaging (281) 929-6485 341 E Parkwood www.memorialhermann.org Friendswood, TX 77546 Language(s) Spoken: English and Spanish Hours: 8 a.m. to 5:30 p.m., Monday through Friday

47) Memorial Hermann Healthcare System (713) 242-3700 921 Gessner Rd. www.memorialhermann.org Houston, TX 77024 Language(s) Spoken: English, Spanish Hours: 6:30 a.m. to 7:45 p.m., Monday through Friday

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48) Memorial Hermann Imaging and Breast Center (713) 704-1205 6410 Fannin, Suite 143 www.memorialhermann.org Houston, TX 77030 Language(s) Spoken: English, Spanish, Other Hours: 7:30 a.m. to 5 p.m., Monday through Friday

49) Memorial Hermann Katy Hospital (281) 395-7459 5602 Medical Center Dr. www.memorialhermann.org/locations/k.html Katy, TX 77494 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5:15 p.m., Monday through Friday

50) Memorial Hermann Outpatient Imaging Pearland (281) 997-5235 5022 W. Broadway www.memorialhermann.org Pearland, TX 77581 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 4:30 p.m., Monday through Friday

51) Memorial Hermann Southeast Hospital (281) 929-4478 11800 Astoria Blvd. www.memorialhermann.org/locations/SE.html Houston, TX 77089 Language(s) Spoked: English, Spanish Hours: 8 a.m. to 5:30 p.m., Monday through Friday

52) Memorial Hermann Southwest Hospital Breast Care Center (713) 456-8205 7600 Beechnut www.memorialhermann.org/locations/SW.html Houston, TX 77074 Language(s) Spoken: English. Spanish Hours: 8 a.m. to 5:30 p.m., Monday through Friday

53) Memorial Hermann Sugar Land Hospital Imaging Center (281) 403-8302 17510 West Grand Parkway South www.memorialhermann.org Sugar Land, TX 77479 Language(s) Spoken: English Hours: 8 a.m. to 6 p.m., Monday through Friday

54) Memorial Hermann SW Women's Imaging Center (713) 270-5665 8200 Wednesbury Lane, Ste. 105 www.memorialhermann.org Houston, TX 77074 Language(s) Spoken: English, Spanish Hours: 7:30 a.m. to 4:30 p.m., Monday through Friday

55) Memorial Hermann The Woodlands Hospital (281) 364-4172 Breast and Bone Health Center www.memorialhermann.org 9200 Pinecroft The Woodlands, TX 77380 Language(s) Spoken: English Hours: 7 a.m. to 5:45 p.m., Monday through Friday

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56) Methodist Sugar Land Hospital (281) 274-7170 16655 Southwest Freeway www.methodisthealth.com Sugar Land, VA 77479 Language(s) Spoken: English, Spanish Hours: 7 a.m. to 6 p.m., Monday through Friday

57) Methodist Willowbrook Hospital (281) 477-1000 18220 Tomball Parkway www.methodisthealth.com Houston, TX 77070 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

58) Northeast Diagnostic Breast Center (281) 358-3006 2300 Green Oak Dr., Suite 100 Kingwood, TX 77339 Language(s) Spoken: English Hours: 8 a.m. to 5 p.m., Monday through Friday

59) Memorial Hermann Northeast Hospital Diagnostic Breast Ctr (281) 540-7995 18951 Memorial North www.nemch.org Humble, TX 77338 Language(s) Spoken: English, Spanish Hours: 7:45 a.m. to 5:30 p.m., Monday through Friday

60) Northwest Women's Center (281) 444-3440 18220 Tomball Parkway Suite 200 Houston, TX 77070 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

61) Park Plaza Outpatient Imaging (713) 527-3500 Plaza Medical Center www.parkplazahospital.com 1200 Binz, Suite 220 Houston, TX 77004 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

62) People's Health Center (713) 272-2607 6630 DeMoss Street www.hchdonline.com Houston, TX 77074 Language(s) Spoken: English, Spanish, Chinese, Vietnamese, Other Hours: 8:30 a.m. to 4:30 p.m., Monday through Friday (open two Saturdays per month) Low cost services are available for those who qualify.

63) Quentin Mease Mammography Center (713) 873-4857 3601 N. McGregor Way www.hchdonline.com Houston, TX 77004 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday Low cost services are available for those who qualify.

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64) River Oaks Imaging & Diagnostics (713) 512-6000 2900 Richmond Ave. www.riveroaksimaging.com Houston, TX 77098 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

65) River Oaks Imaging & Diagnostics (713) 512-6040 7515 South Main, Suite 360 www.riveroaksimaging.com Houston, TX 77030 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

66) River Oaks Imaging & Diagnostics (713) 960-7904 7520 FM 1960 West www.riveroaksimaging.com Houston, TX 77070 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

67) River Oaks Imaging & Diagnostics (281) 964-3530 9767 FM 1960 www.riveroaksimaging.com Humble, TX 77338 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

68) River Oaks Imaging & Diagnostics (936) 442-2633 1150 Loop 336 West www.riveroaksimaging.com Conroe, TX 77301 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

69) River Oaks Imaging & Diagnostics (713) 512-6000 3620 Spencer Highway www.riveroaksimaging.com Pasadena, TX 77504 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

70) River Oaks Imaging & Diagnostics (281) 295-8030 16550 B Southwest Freeway www.riveroaksimaging.com Sugarland, TX 77479 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

71) River Oaks Imaging & Diagnostics (713) 512-6000 16915 El Camino Real www.riveroaksimaging.com Webster, TX 77058 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

72) River Oaks Imaging & Diagnostics (713) 442-1173 9180 Old Katy Rd., Suite 100 www.riveroaksimaging.com Spring Valley, TX 77055 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday 18

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73) River Oaks Imaging and Diagnostic (713) 363-2400 13525 East Freeway www.riveroaksimaging.com Houston, TX 77015 Language(s) Spoken: English, Spanish Hours: 8:30 a.m. to 3:30 p.m. Monday through Friday

74) San Jacinto Methodist Hospital (281)-420-8500 4401 Garth Road www.sanjacintomethodist.com Baytown, TX 77521 Language(s) Spoken: English, Spanish Hours: 7:30 a.m. to 4 p.m., Monday through Friday

75) South Texas Medical Clinic, P.A. (Rosenberg) (979) 532-1700 ext 227 2520 B F Terry Blvd. www.stxmc.com Rosenberg, TX 77471 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

76) South Texas Medical Clinics, P.A. (Wharton) (979) 532-1700 2100 Regional Medical Dr www.stxmc.com TX 77488 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

77) Southwest Women's Imaging Center (713) 270-5665 8200 Westbury Lane, Suite 105 www.memorialhermann.org Houston, TX 77074 Language(s) Spoken: English Hours: 8 a.m. to 5 p.m., Monday through Friday

78) Space Center MRI and Diagnostics (281) 335-8824 Roger C. Willette, M.D., P.A. 1322 Space Center Park Dr., Ste. B100 Houston, TX 77058 Language(s) Spoken: English, Spanish Hours: 8:30 a.m. to 2 p.m., Monday through Friday

79) Spring Branch Medical Center (713) 984-3666 8850 Longpoint www.springbranchmedical.com Houston, TX 77055 Language(s) Spoken: English Hours: 8 a.m. to 5 p.m., Monday through Friday

80) Srini Malini, M.D. (713) 795-5672 1709 Dryden Rd., Suite 809 www.malini.net Houston, TX 77030 Language(s) Spoken: English Hours: 8:45 a.m. to 4:30 p.m., Monday through Friday

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81) St. Catherine Health and Wellness Center (281) 599-5763 701 South Fry www.christusstcatherine.org Katy, TX 77450 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

82) St. Joseph Hospital (713) 757-7416 St. Joseph Pavilion 1401 St. Joseph Parkway Houston, TX 77002 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 4 p.m., Monday through Friday

83) St. Luke's CMC The Woodlands (936) 266-2000 17200 St. Lukes Way www.stlukeswoodlands.com Conroe, TX 77384 Language(s) Spoken: English Hours: 8 a.m. to 5 p.m., Monday through Friday

84) St. Luke's Episcopal Health System Women's Center (832) 355-0000 6624 Fannin, 10th floor www.sleh.com Houston, TX 77030 Language(s) Spoken: English, Spanish Hours: 8:30 a.m. to 4 p.m., Monday through Friday

85) Steeplechase Diagnostic Imaging, Inc (281)955-0440 10694 Jones Rd www.usi.texas.com Suite 150 Houston, TX 77065 Language(s) Spoken: English Hours: 8 a.m. to 5 p.m., Monday through Friday, and Saturday, 8 a.m. to 2 p.m.

86) Sugarland MRI & Diagnostics (281) 494-7874 1211 Highway 6 South, Suite 50 Sugarland, TX 77478 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 7 p.m., Monday through Friday

87) Texas Gulf Coast Medical Group - Clear Lake (281) 604-1300 1300 Bay Area Blvd., Building B www.txgulfcoastmed.com Houston, TX 77058 Language(s) Spoken: English Hours: 7:30 a.m. to 5:30 p.m., Monday, Wednesday, and Friday, 7:30 a.m. to 7 p.m., Tuesday and Thursday

88) The Breast Center - ObGyn Associates (713) 512-7500 7900 Fannin, Suite 1500 www.obgynassociates.com Houston, TX 77054 Language(s) Spoken: English, Spanish Hours: 8:30 a.m. to 5 p.m., Monday through Friday

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89) The Breast Imaging Center for Women (281) 592-4545 301B Sleepy Hollow Drive Cleveland, TX 77327 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

90) The Methodist Hospital Breast Care Center (713) 798-4484 6565 Fannin www.methodisthealth.com Houston, TX 77030 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 4 p.m., Monday through Friday

91) The Rose - Breast Imaging Center (281) 484-4708 The Rose Diagnostic Center www.the-rose.org 12700 North Featherwood, Suite 260 Houston, TX 77034 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday Low cost services are available for those who qualify.

92) The Rose - Joan Gorden Center (713) 668-2996 3400 Bissonnet, Suite 185 www.the-rose.org Houston, TX 77005 Language(s) Spoken: English, Spanish, Chinese, Vietnamese, Other Hours: 8 a.m. to 5 p.m., Monday through Friday Low-cost services are available for those who qualify.

93) The Woman's Hospital of Texas (713) 791-7176 7600 Fannin St. www.womanshospital.com Houston, TX 77054 Language(s) Spoken: English Hours: 8:30 a.m. to 2:30 p.m., Tuesday, Wednesday and Thursday

94) The Women's Place - Kingwood (281) 359-5711 1330 Kingwood Dr. www.womanshospital.com Kingwood, TX 77339 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

95) The Women's Place - Pearland (713) 791-7176 10223 Broadway, Suite E www.womanshospital.com Pearland, TX 77584 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

96) The Women's Place for Breast Care (713) 791-7176 7600 Fannin www.womanshospital.com Houston, TX 77054 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

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97) The Women's Place of Clear Lake (281) 480-3315 411 Bay Area Blvd. www.womanshospital.com Houston, TX 77058 Language(s) Spoken: English Hours: 8 a.m. to 5 p.m., Monday through Friday

98) Tomball Regional Hospital (281) 401-7893 605 Holderrieth Blvd. www.tomballhospital.org Tomball, TX 77375 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 6 p.m., Monday through Friday

99) Tomball Regional Hospital (281) 401-7893 13426 Medical Complex Dr. www.tomballhospital.org Tomball, TX 77375 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 6 p.m., Monday through Friday

100) TOPS Comprehensive Breast Center - The Woodlands (936) 539-2323 111 Vision Park, Suite 230 Shenandoah, TX 77384 Language(s) Spoken: English Hours: 8 a.m. to 5 p.m., Monday through Friday

101) TOPS Specialty Hospital (281) 539-2900 17080 Red Oak Drive www.tops-hospital.com Houston, TX 77090 Language(s) Spoken: English Hours: 7:30 a.m. to 5 p.m., Monday through Friday

102) Twelve Oaks Medical Center (713) 964-8837 4200 Twelve Oaks Drive www.twelveoaksmedicalcenter.com Houston, TX 77027 Language(s) Spoken: English, Spanish Hours: 9 a.m. to 3 p.m., Monday through Thursday

103) University of Texas Medical Branch Galveston (409) 772-2496 301 University Blvd. www.utmb.edu Galveston, TX 77555 Lanuage(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday Low cost services are available for those who qualify.

104) University of Texas Medical Branch Galveston (409) 772-2013 Mobile Mammography www.utmb.edu 301 University Blvd. Galveston, TX 77555 Language(s) Spoken: English, Spanish Low cost services are available for those who qualify.

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105) West Houston Medical Center (281) 588-8047 12141 Richmond Ave. www.westhoustonmedical.com Houston, TX 77082 Language(s) Spoken: English, Spanish Hours: 7 a.m. to 4:30 p.m., Monday through Friday

106) West Houston Medical Center's Sugar Land (281) 274-6630 15300 SW Freeway www.westhoustonmedical.com Sugar Land, TX 77478 Language(s) Spoken: English Hours: 7:30 a.m. to 3:30 p.m., Monday through Friday

107) Westchase Imaging (713) 781-6200 9701 Richmond Ave www.exceldiagnostics.com Suite 124 Houston, TX 77042 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

108) Women Care - St. Joseph Hospital (713) 757-7460 1315 St. Joseph Pkwy, Suite 120 www.christusstjoseph.org Houston, TX 77002 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

109) Women's Healthcare Imaging Center (936) 539-2323 800 Riverwood Ct., Suite 101 Conroe, TX 77304 Language(s) Spoken: English, Spanish Hours: 8 a.m. to 5 p.m., Monday through Friday

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Genetic Counseling and Testing

Every cell in a person's body contains genetic material, or genes. Scientists have found two genes that are key in the development of breast cancer called BRCA1 and BRCA2 (BReast CAncer Gene 1 and BReast CAncer Gene 2 ). Sometimes, people are born with a defect in one of these genes, an inherited mutation that can be passed on to children. Inheriting a mutated breast cancer gene may increase a woman's risk of breast and/or ovarian cancer. However, it is important to remember that only five to 10 percent of all breast cancers are inherited.

GENETIC COUNSELING AND TESTING It is important for people who are considering genetic testing to have counseling first. Issues related to testing, such as how one's family will react, or the potential for insurance to be denied should be discussed at length. A risk management plan can be developed that is based on one's level of risk. Strategies for cancer screening and recommendations for a healthy lifestyle also can be created. For more information regarding genetic counseling, visit www.nsgc.org. Those who may benefit from genetic testing are people who: Have been diagnosed with breast cancer before the age of 50 and have a relative who had ovarian cancer at any age, or breast cancer before the age of 50. Have been diagnosed with breast and ovarian cancer, ovarian cancer at any age, or with breast cancer before the age of 50, regardless of family history. Have a relative who has a BRCA mutation. Come from a family in which breast and/or ovarian cancer has affected multiple relatives in the same bloodline across several generations. Have two or more relatives on either the mother's or father's side of the family who had breast cancer before the age of 50 or ovarian cancer at any age. (Note that breast cancer susceptibility genes can be passed to daughters by fathers who have no cancer.) Have a close male relative with breast cancer. Are of Ashkenazi Jewish heritage (nearly two and a half percent of this population carry alterations of the BRCA1 and BRCA2 genes).

QUESTIONS TO ASK A DOCTOR 1. Do you recommend genetic counseling/testing? If yes, why? How is the test performed? 2. What are the benefits and risks of genetic testing? 3. How much does genetic testing cost? Does my insurance cover it? 4. What are the confidentiality issues? 5. What are my options if I am at higher risk for breast cancer? Or if I am found to have a mutation in a breast cancer gene? 26

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6. Are my family members (i.e., daughter, sister, mother) at a higher risk for breast cancer? 7. What precautions do you recommend? Where can we/they go for breast cancer risk assessment and preventive therapy? 8. What does it mean if I am told that my test was non-informative? What are my options if this occurs?

SURVIVOR SENTIMENTS “Take one day at a time, it's amazing how much better you'll feel. Focus on the end result of your treatment plans and set some goals to achieve along the way. For weeks I had a goal to just walk to the end of the driveway, when I accomplished that I set a goal to walk to the stop sign!"

Liz 6-year survivor

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Breast Biopsy and Hormone Receptors

If a woman has a lump in her breast, a doctor may further evaluate the lump using a diagnostic mammogram, MRI or ultrasound. It may be necessary to cut out a small piece of it and look at it under the microscope to see if there are any cancer cells present. This is called a biopsy.

Biopsies are usually done by inserting a needle into the breast and drawing out some of the tissue or fluid. If the biopsy shows that there is cancer, it is important that certain tests (called estrogen and progesterone receptor tests) be done on the cancer cells. Common types of biopsy procedures include: Fine-needle aspiration: The doctor uses a thin needle to remove fluid from a breast lump. A pathologist checks for cancer cells. Core biopsy: The doctor uses a thick needle to remove breast tissue. A pathologist checks for cancer cells. This procedure is also called a needle biopsy. Surgical biopsy: A surgeon removes a sample of tissue. A pathologist checks the tissue for cancer cells. There are two types of surgical biopsies: An incisional biopsy takes a sample of a lump or abnormal area. An excisional biopsy takes the entire lump or area.

HORMONE RECEPTORS Estrogen and progesterone receptor tests may tell whether hormones affect how the cancer grows. They also may give information about the chances of the tumor coming back. The results help the doctor decide whether or not to use hormone therapy to stop the cancer from growing. A woman's chance of recovery (prognosis) and choice of treatment depend on the: stage of the cancer (whether it is confined to the breast or has spread to other places in the body) type of breast cancer characteristics of the cancer cells age general state of health

QUESTIONS TO ASK A DOCTOR Following are questions to ask a doctor if he/she recommends a breast biopsy: 1. What type of biopsy will I have? Why do you recommend this type? Will the entire lump be removed or just part of it? 2. Can the lump be aspirated (the fluid drained or a small number of cells removed) with a needle? How reliable is a needle biopsy?

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3. How long will the biopsy or aspiration take? 4. Can the biopsy be done on an outpatient basis? Will I be awake? What will I feel during the procedure? 5. What medications should I avoid before the biopsy and for how long? When can I resume my usual medications? 6. Will the biopsy scar be visible? 7. Are there any aftereffects of a biopsy? If so, what are they? (i.e., tenderness, pain, numbness along the scar). 8. When will I be able to return to my normal routine? (i.e., drive, go back to work, do household chores). 9. After the biopsy, how soon will I know the results? 10. If cancer is found, who will talk to me about my treatment options? When must I make a decision on my treatment choices? 11. What are the results of my hormone receptor tests? How does this affect my treatment options?

SURVIVOR SENTIMENTS "I hung on to the thought that thousands of women and men before me made it through surgery and chemotherapy, and I know I would too. Most of all, I constantly asked God to give me strength, comfort and calmness. It worked for me!"

Brenda 2-year survivor

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Staging

Once breast cancer has been diagnosed, more tests will be done to find out if the cancer has spread from the breast to other parts of the body. This is called staging. The doctor needs to know the stage of the disease to plan the most effective treatment. The following stages are used for breast cancer:

STAGE ZERO OR BREAST CANCER IN SITU About 15 to 20 percent of breast cancers are detected very early. They are sometimes called carcinomas in situ. There are two types of carcinomas in situ - ductal and lobular.

Ductal carcinoma in situ is a noninvasive condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, ductal carcinoma in situ may become invasive cancer and spread to other tissues, although it is not known at this time how to predict which lesions will become invasive. Also called intraductal carcinoma.

Lobular carcinoma in situ is not cancer, but for the purpose of classifying the disease, it is called breast cancer in situ, carcinoma in situ, or stage 0 breast cancer. Lobular carcinoma in situ is found on some occasions when a biopsy is done for another lump or abnormality that was found on the mammogram. Patients with this condition have a 25 percent chance of developing breast cancer in either breast in the next 25 years.

STAGE I A breast cancer is classified as stage I if the cancer is no bigger than two centimeters and has not spread outside the breast.

STAGE II A breast cancer is classified as stage IIA if any of the following are true: No tumor is found in the breast, but it is found in the lymph nodes under the arm (called the axillary lymph nodes). The cancer is no bigger than two centimeters, but has spread to the lymph nodes under the arm. The cancer is between two and five centimeters and has not spread to the lymph nodes under the arm. A breast cancer is classified as stage IIB if any of the following are true. The cancer is between two and five centimeters and has spread to the lymph nodes under the arm. The cancer is bigger than five centimeters, but has not spread to the lymph nodes under the arm.

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STAGE III A breast cancer is classified as stage IIIA if any of the following are true: The cancer is bigger than five centimeters, it has spread to the lymph nodes under the arm, and the lymph nodes have grown into each other or into other structures. The cancer is bigger than five centimeters and has spread to lymph nodes under the arm. A breast cancer is classified as stage IIIB if any of the following are true: The cancer has spread to tissues near the breast (skin, chest wall, including the ribs and the muscles in the chest). The cancer has spread to lymph nodes inside the chest wall along the breastbone. A breast cancer is classified as stage IIIC if any of the following are true: The cancer has spread to the lymph nodes, inside the neck, near the collarbone.

STAGE IV A breast cancer is classified as stage IV if any of the following are true: The cancer has spread to other organs of the body, most often the bones, lungs, liver or brain.

INFLAMMATORY BREAST CANCER Inflammatory breast cancer is a special class of breast cancer that is very rare. The breast looks as if it is inflamed because of its red appearance and warmth. The skin may show signs of ridges and wheals (raised areas) or it may look pitted. This type of cancer tends to spread quickly.

Because inflammatory breast cancer is difficult to diagnose and is not typically identified through a mammogram, ultrasound or MRI, M. D. Anderson Cancer Center has opened an inflammatory breast cancer clinic specifically to diagnose and treat patients with inflammatory breast cancer. Contact the askMDAnderson service at 1-877-MDA-6789 for more information.

RECURRENT BREAST CANCER Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the breast, in the soft tissues of the chest (the chest wall), or in another part of the body.

QUESTIONS TO ASK A DOCTOR Following are questions to ask a doctor if you have been diagnosed with breast cancer: 1. What kind of breast cancer do I have? What is the stage of my disease? What is the size of the tumor? Has the cancer spread to my lymph nodes or other parts of my body?

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2. What tests were done on the tumor and what were the results? (i.e. estrogen and progesterone receptor, and HER2 positive status.) What effect will the results of these tests have on my treatment options? 3. Who will coordinate my care? 4. Will the lymph nodes under my arm be checked for cancer? If so, how will this affect my treatment options? 5. What tests will I have before surgery to see if the cancer has spread to any other organs (liver, lungs, bone)? 6. What do you recommend for treatment? Will you refer me to an oncologist for treatment recommendations? 7. How can I get a copy of my pathology report? 8. What is my prognosis (chance for recovery)?

SURVIVOR SENTIMENTS "Keep channels open with your family. Allow them to be your main support group. They love you."

Rose 15-year survivor

SURVIVOR SENTIMENTS

"The diagnosis of breast cancer made me realize just how fragile and precious each day is. Now I love and live each day to the fullest. I'm a better person." Laura 1-year survivor

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Types of Treatment

A woman's treatment options depend on many factors, such as age, tumor stage and estrogen receptor (ER) status. Deciding on a treatment plan is as much a personal matter as it is a medical one. Treatment should be based on the treatment's risks and benefits and how these relate to the patient's personal values and lifestyle. The types of treatments usually used for breast cancer are: Surgery: An operation to remove the cancer Radiation therapy: Using high-dose x-rays to kill cancer cells Chemotherapy: Using drugs to kill cancer cells Hormone therapy: Using hormones to stop the cells from growing Biological therapy: Using your body's immune system to fight cancer Bone marrow transplantation: Used so that very high doses of chemotherapy may be given

QUESTIONS TO ASK A DOCTOR BEFORE TREATMENT Listed below are some questions a woman may want to ask her doctor before a treatment plan is developed. 1. What are my treatment options? What are recommending for me and why? 2. What is your opinion about breast-conserving surgery (lumpectomy) followed by radiation therapy? Am I a candidate for this type of treatment? (Anyone considering this option should also consult with a radiation oncologist). Will a sentinel lymph node biopsy be done? 3. Will I need additional (adjuvant) treatment (radiation therapy, chemotherapy and/or hormonal therapy) following my surgery? Can you refer me to a radiation oncologist for radiation therapy and a medical oncologist for discussing the possible need for chemotherapy or hormonal therapy? 4. Can breast reconstruction be done at the time of surgery, as well as later? Can you refer me to a reconstructive surgeon before my initial surgery? 5. If I choose not to have reconstruction, what types of breast prostheses are available? Where can I obtain a breast prosthesis? It is covered by my insurance? 6. How long do I have to make a treatment decision? What will my insurance cover? 7. Is there a clinical trial that is enrolling patients with my type of breast cancer? If so, how can I learn more?

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TREATMENT DESCRIPTIONS The following information explains various types treatments used for breast cancer. At the end of each section is a list of questions to discuss with a doctor when planning treatment.

SURGERY Surgery has a role in the treatment of most patients with breast cancer. Usually, along with the tumor, some of the lymph nodes under the arm also are taken out and looked at under the microscope to see if cancer cells are present. If the doctor removes all the cancer that can be seen at the time of the operation, a patient may be given radiation therapy, chemotherapy, or hormone therapy after surgery to try to kill any cancer cells that may be left. Following are five common surgeries for breast cancer. 1. A lumpectomy (sometimes called excisional biopsy or wide local excision) takes out the lump in the breast and some of the tissue around it. It may be followed by radiation therapy to the part of the breast that remains. Doctors may also take out some of the lymph nodes under the arm. 2. A segmental mastectomy takes out the cancer and some of the breast tissue around it. In addition, there may be an axillary node dissection to take out some of the lymph nodes under the arm. In most cases, radiation therapy follows. 3. A total or simple mastectomy removes the breast. Sometimes lymph nodes under the arm are also taken out. 4. A modified radical mastectomy removes the breast, some of the lymph nodes under the arm, and the lining over the chest muscles, and sometimes part of the chest wall muscles. 5. Sentinel node biopsy (SNB) is a new advance in breast cancer treatment. It is a simple procedure that may reduce the amount of surgery needed. In some cases, SNB can replace a formal axillary node dissection with fewer side effects and provide the physician with the necessary information he or she needs to make a prognosis (the chances of getting better).

QUESTIONS TO ASK A DOCTOR ABOUT SURGERY 1. What type of surgery do you recommend and why? 2. Can breast reconstruction be done at the time of surgery, as well as later? Can you refer me to a reconstructive surgeon before my surgery? 3. How long will I be in the hospital? Will I need someone to help me when I return home from the hospital? 4. How should I expect to feel after the operation? What restrictions will I have on my normal activities? 5. Where will the surgical scar(s) be located? Will I experience any change in sensation after the surgery? 6. Will I have a surgical drain in place when I go home? If so, how will I care for it? When will it be removed? 34

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7. When should I return for a follow-up appointment? 8. What side effects might I expect after surgery (i.e., pain, tenderness, bruising, scarring, numbness)? 9. What are my risks of long-term complications or side effects from surgery? 10. Will I need any other treatments? If so, which ones and how long after surgery will I begin the other treatment? 11. Are there any precautions I should take? (For example, if lymph nodes were removed, should I avoid having an injection in that arm or shaving under that arm?) How does the removal of some lymph nodes affect my chances of developing lymphedema? How can I reduce my chance of getting lymphedema? 12. Are there special exercises I should be doing? Which? When should I start? How long should I do them? Are they any exercises that I should avoid? 13. What problems should I report to the doctor? 14. Where can I find a breast cancer or cancer support group led by a qualified professional? 15. Who will be responsible for my follow-up care after my treatment? 16. How often should I return for an exam? For lab tests or other X-rays? What tests should be done at these times? What will the next tests tell us? When should I have my next mammogram?

RADIATION THERAPY Like surgery, radiation therapy is a local treatment for breast cancer. Using targeted, high-energy x-rays to stop cancer cells' ability to grow and divide, radiation therapy aims to get rid of cancer from the breast, chest, and axillary lymph nodes and to lower the risk of recurrance.

Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).

QUESTIONS TO ASK A DOCTOR ABOUT RADIATION THERAPY 1. Why are you recommending radiation therapy? Will other therapies be needed? 2. How long will each treatment take? How many treatments will I have? How soon should treatment begin? Who will be responsible for my radiation treatments? Who will administer them and where? 3. How is radiation given and how long does it take? 4. Can I come alone or should a friend or relative accompany me? 5. What can I do to prepare for my treatment? (i.e., wear a two piece outfit.) 6. Will the costs of the treatment be covered by my health insurance? 7. What side effects may I expect and how long might they last? 35

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8. What are the long-term risks of this treatment? 9. What are the precautions or restrictions during treatment? After treatment? (i.e., skin creams, lotion, underarm shaving, etc.) 10. Can I continue normal activities (work, sex, sport, etc.) during treatment? After treatment? 11. How often are checkups and tests required after treatment is completed and which specialist will manage my care?

CHEMOTHERAPY Chemotherapy is the use of special drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells outside the breast area.

QUESTIONS TO ASK A DOCTOR ABOUT CHEMOTHERAPY 1. Why is chemotherapy recommended for me? 2. What is the significance of cancer found or not found in the lymph nodes? How many lymph nodes do I have under my arm and how many are involved (have cancer cells in them)? 3. If my lymph nodes are not involved, should chemotherapy or hormone therapy still be considered? 4. What drugs will I be taking? Why have you chosen these drugs for me? Are there other combinations that are also considered effective? 5. What are the possible side effects of this type of chemotherapy? Are they permanent? What are the long term risks? How can I prevent or treat these side effects? 6. Which side effects should I report to you immediately? 7. How soon should chemotherapy be started? 8. In what form and how often will the treatment be given? Will I need someone to go with me? 9. How long will each treatment take? How many treatments will I have? 10. Will I still be able to work, exercise, etc. during these treatments? Are there special precautions I should I take while on chemotherapy or afterwards? 11. Will the cost of the treatment be covered by my health insurance?

HORMONE THERAPY If tests show that the breast cancer cells contain estrogen and progesterone receptors, the patient may be given hormone therapy. Hormone therapy is used to change the way hormones in the body help cancers grow. This may be done by using drugs that change the way these hormones work or by surgery that removes organs that make hormones, such as the ovaries. 36

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Hormone therapy with tamoxifen or estrogen can act on cells all over the body and may increase the chance of getting cancer of the uterus. Therefore, a woman should be checked regularly for this type of cancer and immediately report any uterine bleeding to a doctor.

QUESTIONS TO ASK A DOCTOR ABOUT HORMONE THERAPY 1. Which hormone treatment are you recommending for me and why? What does hormone therapy do? 2. What are the short and long-term side effects of this hormone treatment? 3. Is there a generic form of this hormone? Is it as effective as the name-brand? 4. How soon after surgery should the hormone therapy be started? How long will I be on the therapy? 5. In what form and how often will the treatment be given? 6. Will I be given the hormone therapy along with other forms of treatment? 7. Will my insurance cover the hormone treatment? If not, are there financial assistance programs that will help cover the costs? 8. Will more tests or exams be required ? If so, which tests and how often will they be needed? 9. What signs or symptoms should I report to you?

BIOLOGICAL THERAPY Biological therapy tries to get a patient's own body to fight the cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.

One example of biological therapy is Herceptin (trastuzumab). Herceptin is a monoclonal antibody. Antibodies are substances the body produces to help fight infection or other foreign particles. Monoclonal antibodies are made in the laboratory, and some are designed to attack specific cancer cells.

BONE MARROW TRANSPLANTATION Sometimes breast cancer becomes resistant to treatment with radiation therapy or chemotherapy. In clinical trials, very high doses of chemotherapy may then be used to treat the cancer.

Because the high doses of chemotherapy can destroy bone marrow, marrow is taken from the bones before treatment. The marrow is then frozen and the patient is given high-dose chemotherapy with or without radiation therapy to treat the cancer.

The marrow that was taken out is then thawed and given back through a needle in a vein to replace the marrow that was destroyed. This type of transplant is called an autologous 37

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transplant. If the marrow is taken from another person for the transplant, it is called an allogeneic transplant. Peripheral blood stem cells may also be used.

LYMPHEDEMA The removal and/or radiation treatment of axillary lymph nodes as part of treatment for breast cancer can lead to lymphedema. Lymphedema is a sometimes chronic and painful swelling of the arm or hand on the side of surgery. Lymphedema can develop weeks, months or many years after treatment, and can vary in its severity. To prevent lymphedema, precautions can be taken, such as avoiding an infection or injury to the affected arm.

QUESTIONS TO ASK A DOCTOR ABOUT LYMPHEDEMA 1. What are my chances of getting lymphedema? 2. If I do get lymphedema at some time, is it likely to recur? 3. What signs or symptoms of lymphedema should I watch for and report to my doctor? 4. If I get a shot or get my blood pressure taken from the affected arm, will I cause lymphedema? 5. What exercises should I do (or avoid) to prevent lymphedema? 6. What else can I do to avoid lymphedema? (i.e., use sunscreen, insect repellant, and garden gloves.) 7. If I get a cut, burn, or insect bite on my affected arm, what can I do to protect myself? 8. What is the first step for treating lymphedema? 9. Should I wear a compression sleeve? Do I have to wear it at all times, even at night? 10. What is manual lymph drainage (MLD)? When is wrapping used to treat lymphedema? Please explain how these treatments work. Will my insurance company cover these treatments?

SURVIVOR SENTIMENTS " Do something that makes you feel wonderful. Started doing my nails - felt gorgeous! " Ethel 13-year survivor

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Treatment by Stage

Treatment for breast cancer depends on the type and stage of a woman's disease, her age and her overall health. Following are treatment options for each stage of breast cancer.

STAGE ZERO (BREAST CANCER IN SITU) Treatment for breast cancer in situ depends on whether a woman has ductal or lobular carcinoma in situ. Since it is difficult to distinguish between these two possibilities, it may be helpful to get a second opinion and have biopsy preparations (slides) observed through the microscope by pathologists at another hospital.

For ductal carcinoma in situ (DCIS), treatment may be one of the following: surgery to remove the whole breast (total mastectomy) surgery to remove only the cancer (lumpectomy), followed by radiation therapy

Rarely, some of the lymph nodes under the arm may also be removed during the above surgeries.

Women diagnosed with lobular carcinoma in situ (LCIS) may have a higher risk for invasive cancer in both breasts. This gives women about a 25 percent chance of developing breast cancer in both breasts over the next 25 years. Many women with LCIS never develop an invasive breast cancer.

A large clinical trial found that women at high risk for developing breast cancer who were treated with the hormonal therapy drug tamoxifen were almost 50 percent less likely to develop cancer than women at high risk who did not receive the drug. The treatment options for LCIS are varied and quite controversial. Treatment may include: a biopsy to diagnose the LCIS, followed by regular examinations and mammograms to make sure invasive cancer does not develop surgery to remove both breasts (prophylactic mastectomy)

STAGE I Your treatment may be one of the following: Surgery to remove only the cancer and some surrounding breast tissue (lumpectomy) or to remove part of the breast (partial or segmental mastectomy). Both types of surgery are followed by radiation therapy. Some of the lymph nodes under the arm also are removed. This treatment, lumpectomy followed by radiation, provides identical long-term cure rates to those from a mastectomy. The doctor's recommendation on which procedure to have is based on tumor size, location and the tumor's appearance on a mammogram. Surgery to remove the whole breast (total mastectomy) or the whole breast and some of the lymph nodes under the arm (modified radical mastectomy).

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Adjuvant therapy (given in addition to the treatments listed above): Chemotherapy Hormone therapy Clinical trials of adjuvant chemotherapy or hormone therapy Clinical trials of no adjuvant therapy for patients with a good chance of recovery.

STAGE II Your treatment may be one of the following: Surgery to remove only the cancer and some surrounding breast tissue (lumpectomy) or to remove part of the breast (partial or segmental mastectomy). Some of the lymph nodes under the arm are also removed. Radiation therapy is given following surgery. This treatment provides identical long-term cure rates to those from a mastectomy. Your doctor's recommendation on which procedure to have is based on tumor size and location and the tumor's appearance on mammogram. Surgery to remove the whole breast (total mastectomy) or the whole breast and some of the lymph nodes under the arm (modified radical mastectomy). Adjuvant therapy (given in addition to the treatments listed above): Chemotherapy Hormone therapy Clinical trial of chemotherapy before surgery (neoadjuvant therapy). Clinical trials of chemotherapy and/or hormone therapy after surgery (adjuvant therapy). Clinical trial of no more therapy after surgery for patients with a good chance of recovery.

STAGE III Stage III breast cancer is further divided into stage IIIA (can be operated on) and IIIB (surgery cannot take place until chemotherpy or hormonal therapy shrinks the tumor). Treatment for stage IIIA breast cancer often includes surgery, radiation therapy, and systemic treatment with chemotherapy or hormone therapy. Treatment will include surgery and radiation therapy as local treatments, and systemic treatment with multi-agent chemotherapy for most patients. Clinical trials are testing new chemotherapy with or without hormonal drugs; they also are testing chemotherapy before surgery (neoadjuvant therapy) and high-dose chemotherapy with bone marrow or peripheral stem cell transplantation. The treatments you receive will provide the greatest potential for keeping your cancer

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from spreading and killing the cancer cells (throughout your system) that can not be seen. Stage IIIB cancer is considered to be inoperable even though surgery may be performed. Initial treatment is generally with combination chemotherapy, followed by surgery, additional chemotherapy, and comprehensive radiation therapy. Clinical trials are testing new chemotherapy with or without hormonal drugs; they are also testing chemotherapy before surgery (neoadjuvant therapy) and high-dose chemotherapy with bone marrow or peripheral stem cell transplantation.

STAGE IV For stage IV breast cancer, one or more of the following treatments will take place. Radiation therapy, or, in some case, a mastectomy to reduce your symptoms Hormonal therapy Chemotherapy Clinical trials of new chemotherapy and hormonal drugs and new combinations of drugs and biological therapy Clinical trials of high-dose chemotherapy with bone marrow or peripheral stem cell transplantation

INFLAMMATORY BREAST CANCER Treatment will probably be a combination of chemotherapy, hormonal therapy, and radiation therapy, which may be combined with surgery to remove the breast. The treatment is usually similar to that for stage IIIB or stage IV breast cancer.

RECURRENT BREAST CANCER Breast cancer that comes back (recurs) can often be treated but usually cannot be cured when it recurs in another part of the body. Some patients with recurrence in the breast or chest wall can be cured, however. A patient's choice of treatment depends on hormone receptor levels, the kind of treatment before it recurred, the length of time from first treatment to when the cancer came back, where the cancer recurred, whether the woman still has menstrual periods, and other factors. Treatment may be one or more of the following: Hormonal therapy Surgery and/or radiation therapy for the small group of patients whose cancer has come back in only one place Radiation therapy to help relieve pain due to the spread of the cancer to the bones and other places Chemotherapy A clinical trial of new chemotherapy drugs, new hormonal drugs, biological therapy, or bone marrow transplantation

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Hospitals

The following is a list of hospitals that provide breast cancer treatment located within the greater Houston area.

INDEX Angleton-Danbury Medical Center page 42 Bayshore Medical Center page 43 Ben Taub General Hospital page 44 Brazosport Memorial Hospital page 45 Christus St. Catherine Hospital page 46 Christus St. John Hospital page 47 Clear Lake Regional Medical Center page 48 Conroe Regional Medical Center page 49 Cypress Fairbanks Medical Center page 50 Doctor’s Hospital – Parkway page 51 Doctor’s Hospital – Tidwell page 52 East Houston Regional Medical Center page 53 Houston Northwest Medical Center page 54 Kingwood Medical Center page 55 Liberty-Dayton Community Hospital page 56 LBJ General Hospital page 57 Mainland Medical Center page 58 M. D. Anderson Cancer Center page 59 Memorial Hermann Hospital page 60 Memorial Hermann Fort Bend Hospital page 61 Memorial Hermann Katy Hospital page 62 Memorial Hermann Memorial City Hospital page 63 Memorial Hermann Northeast Hospital page 64 Memorial Hermann Northwest Hospital page 65 Memorial Hermann Southeast Hospital page 66 Memorial Hermann Southwest Hospital page 67 Memorial Hermann Sugar Land Hospital page 68 Memorial Hermann The Woodlands Hospital page 69

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Methodist Hospital page 70 Methodist Hospital – Sugar Land page 71 Methodist Hospital – Willowbrook page 72 Oak Bend Medical Center page 73 Park Plaza Hospital page 74 Riverside General Hospital page 75 San Jacinto Methodist Hospital page 76 Spring Branch Medical Center page 77 St. Joseph Medical Center page 78 St. Luke’s Episcopal Hospital page 79 St. Luke’s Episcopal Hospital – The Woodlands page 80 Sugar Land Medical Center page 81 Tomball Regional Hospital page 82 Twelve Oaks Medical Center page 83 University of Texas Medical Branch page 84 West Houston Medical Center page 85

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Angleton-Danbury Medical Center 979-849-7721 132 E. Hospital Drive www.admc.org Angleton, TX 77515 Language(s) Spoken: English