I often think back to an evening in August 2019 when I hopped in the shower after getting home from work. For some reason I decided to give myself a breast exam and found a lump that ended up being stage 2 breast cancer. I was my own lifesaver that day; if I had waited any longer, my aggressive tumor could have spread beyond permanent repair.
Because my tumor was big enough to feel, I was able to act early. However, for many others, it’s an annual screening test, like a mammogram, most often prescribed by a Primary Care Provider (PCP), that identifies not-yet-palpable breast cancers.
Since my diagnosis, I’ve heard stories about the role a PCP played in people’s diagnosis that have been eye-opening. After skipping a mammogram because of COVID, one woman’s Primary Care doctor urged her to schedule one ASAP—she ended up having a small tumor that, by the time it got big enough to feel, could have wreaked major havoc. Another had strange, not-obvious symptoms and went straight to their PCP who quickly ordered an ultrasound then biopsy to diagnose the cancer. Another shared that during her annual visit that she had enlarged armpit lymph nodes, and after undergoing testing, found out it was breast cancer. The message: Your PCP can be your North Star when it comes to cancer.
Every day, I get to work with hundreds of trained PCPs who practice on the K Health platform and treat hundreds of chronic, urgent, and mental health conditions remotely. One of the most important things they do is practice preventative medicine. However, studies show that even before the pandemic only 23% of office-based doctor’s visits were for preventative care. Furthermore, 25% of Americans don’t even have a PCP.
Now, with annual wellness visits and routine health screenings being effectively done remotely, PCPs have an even bigger opportunity to help prevent and diagnose cancers and other chronic diseases early—before it’s too late.
Early Detection (and Primary Care) Saves Lives
Early detection is one of the best ways to improve chances of survival. It can lead to a 99% chance of survival in the first five years post-diagnosis.
One of the most impactful ways PCPs can benefit their patients is by ensuring they keep up-to-date with all of their recommended screenings, to help catch any disease early. Seeing a PCP every year for a wellness visit is key for detecting cancer early, and preventing other chronic conditions. People with PCPs are more likely to get their annual mammograms. In fact, most cancers are diagnosed in the primary care setting.
“Patients who see a primary care physician regularly will be educated and counseled on when cancer screening should begin and how often it should be repeated,” said Dr. Heather Martin, Medical Director of the Primary Care program at K Health. “If a patient does not see a primary care physician, reminders for screening for breast cancer may not be provided to the patient, and early detection can improve outcomes.”
Visits to PCPs are also associated with lower overall mortality for cancer patients, likely because PCPs are generalists who, in addition to promoting preventive services, are able to manage a range of comorbid illnesses, including mental health conditions, which occur in many cancer patients.
“A patient can be ‘sick’ without any symptoms,” said Dr. Martin, who conducts annual wellness visits with patients on the K Health app.
“I’ve found that for people without a PCP who come to the ER with symptoms, it is likely later stage disease,” said Dr. Holli Hill, Director of Clinical Affairs and Quality Assurance and a practicing clinician at K Health.
A regular wellness visit is a scheduled time for your doctor to make sure you’re up-to-date on all recommended health screenings as well as administering vaccines, and to help catch disease early through exams, labs, and other tests before patients fall ill.
Being able to do wellness visits remotely is a game-changer for the many people who can’t afford to take time off work, or struggle to fit going to the doctor into their schedule.
Remote Management of Breast-Related Issues
Can remote clinicians effectively manage breast health-related issues without physically seeing a patient in-person? In short, yes.
“Many people in both the remote and in-person setting are ordered mammograms based on age rather than a physical exam,” said Dr. Hill. “If a patient presents with a lump, a virtual PCP can order a mammogram and then follow up by ordering an ultrasound if the findings from the mammogram were concerning.”
“At K Health, when a mammogram is ordered, the patient will receive the order in their personal email and can take the order to their preferred imaging facility,” said Dr. Martin. Patients can find imaging locations and schedule an appointment through RadiologyAssist online in many states. For patients who are uninsured, K Health can provide resources for finding low-cost facilities (for example, National Breast and Cervical Cancer Early Detection Program at 1-888-842-6355, which provides low-cost or free cancer screenings for women without health insurance).
“Many breast lumps are benign, however it is always best to have any new lumps evaluated,” said Dr. Martin.
PCPs can also remotely refer patients to specialists, and keep up-to-date on their patients’ treatment and journey through the sharing of medical records, all of which can be done remotely on the K Health app.
Navigating the World of Increased Risk of Cancer
Some women are more at risk than others for breast cancer. A woman may be considered high-risk for developing breast cancer if there is a history of genetic mutations causing breast cancer in relatives (for example, the BRCA gene) or a family history of breast cancer, especially when a first-degree relative is diagnosed at a young age.
“Although the United States Preventive Services Task Force recommends starting screening mammograms at age 50 in women of average risk, patients with an increased risk of developing breast cancer should discuss having mammograms done earlier with their primary care provider,” said Dr. Martin. “Even without increased risk, some patients may prefer to start mammograms sooner.” If there is a lump or lymph node at any age, it should be fully evaluated.
If a woman without increased risk desires a mammogram, PCPs may be able to order it, but there is the possibility of insurance not covering it. This makes some early screening cost-prohibitive. The average out-of-pocket cost for a mammogram not covered by insurance can cost as much as $350.
The stress of having or being at risk of breast cancer—or even just the thought of it—often can lead to other symptoms, many of which a PCP can help address.
“The exact cause of health anxiety is unknown, but there are several risk factors that can increase the risk of developing the disorder, such as having a parent or sibling who suffers from a serious medical condition,” said Whitley Lasson, PsyD, Clinical Director at K Health.
Providing reassurance to patients that they have done everything that’s needed to screen for breast cancer, assuring them of their last normal mammogram and reminding them of when the next one is due can be helpful. For patients experiencing health anxiety, PCPs can also provide other options to help you feel better.
“A PCP can help the patient connect with therapy services and can prescribe medications if needed as well,” said Dr. Martin. “It is empowering for patients to know they are doing all they can do to detect breast cancer as early as possible.”
Have you had your wellness visit this year? Do it remotely at a time that works for you.
Sign up for Primary Care today—everyday disease prevention and management, annual wellness visits, 24/7 Urgent Care, medication management, and more—all on your schedule, all from your phone. Less than a dollar a day.