IBCORA Project
The IBCORA Project is Appalachian Medical Professionals' effort to Improve Breast Cancer Outcomes in Rural Appalachia. It relies on providing women and their Primary Care Providers current and trustworthy information upon which to base their health care decisions. It incorporates recommendations about breast imaging, genetics evaluation and how to acquire the "Goldilocks ABC Plan", Appalachian Breast Care that's: Not too little. Not too much. Just right for you!
A Patient's Perspective
A Doctor's Perspective
To bring this approach to life, meet Goldilocks, a 38-year-old virtual breast cancer survivor and advocate for The Goldilocks Screening Plan. Inspired by real-life stories of women whose cancers were found through proactive screening, and the profound impact early detection can have on them and their families, Goldilocks shares her story to show why taking small, proactive steps can make a life-changing difference. Read more about Goldilocks, her family, and the story on our Goldilocks page.
Your 3-Step Assessment
-
Take The Goldilocks ABC Plan Assessment below to determine your risk category.
-
Within the assessment, follow the Protocol recommended based on your risk category.
-
Based on your answers, you may qualify for Free Genetic Counseling. We have partnered with Finch Genetics and Natera to offer this to our clients at no cost. Follow the prompts as directed and reach out to our office with any questions you may have.
Need help determining your risk category or finding the right resources? Visit our Contact page and we’ll be happy to help.
Breast Symtoms: What to Report and What to Expect
Call your doctor's office if you notice any of these:
-
A lump or thickened area in the breast or underarm
-
One breast getting larger, or a change in its shape
-
New pulling-in of the nipple (nipple turning inward), if that is new for you. Some women have always had one or both nipples invert, especially with stimulation. So don't freak out if this applies to you
-
Fluid leaking from the nipple on its own, especially if it is clear or bloody, comes from one breast, and comes from one spot
-
Skin changes: redness, swelling, dimpling like an orange peel, scaling or eczema-like rash on the nipple, or a sore that will not heal
-
New breast pain in one specific spot
Important: A screening mammogram is for women with no symptoms. If you have a symptom, you need a different, more detailed evaluation — do not simply wait for your next routine mammogram. Ask your healthcare provider if you should see a breast care specialist.
If You Feel a Lump
If you are 30 or older: you will usually get a diagnostic mammogram (3-D) plus an ultrasound of the area.If you are under 30: ultrasound is usually done first. If the lump does not seem worrying on exam, your doctor may suggest watching it for one or two menstrual cycles first. If it does not go away, imaging is done.If the imaging looks suspicious, the next step is a needle biopsy, where a small sample of tissue is taken with a needle, usually guided by imaging.If the imaging looks normal or benign but your doctor is still concerned, further evaluation is still done. Trust your instincts and speak up.
Hover to Read
If Your Nipple is Newly Turning Inward
If you have always had inverted nipples and nothing has changed, this is not a concern.
A new change does need imaging: ultrasound if you are under 30, or a mammogram plus ultrasound if you are 30 or older.
Hover to Read
If You Have Nipple Discharge with No Lump
Discharge that only comes out when you squeeze, or comes from several openings, is usually not a sign of cancer. You will be told to stop squeezing the breast and to report any discharge that happens on its own. If you are 40 or older, a mammogram is done if you have not had one in the past year.
Discharge that happens on its own, from one breast, from a single opening, and is clear or bloody does need testing: ultrasound if you are under 30, or a mammogram plus ultrasound if you are 30 or older. A breast MRI or a referral to a breast surgeon may follow.
Milky discharge from both breasts may be related to hormones or certain medicines rather than the breast itself, and may need blood tests. Some medicines can cause discharge, including certain mental health medicines, blood pressure medicines, opioid pain medicines, birth control pills, and estrogen.
Hover to Read
If You are Pregnant or Breastfeeding
Breast symptoms still need to be checked. Mammograms are safe during pregnancy and breastfeeding. Ultrasound is also used. MRI with contrast dye is not done during pregnancy but can be done while breastfeeding if needed. If you are breastfeeding, nurse or pump right before imaging — it makes the test more comfortable and more accurate. Some bloody nipple discharge can be normal in pregnancy, but if it happens more than once or twice, get it checked.
Hover to Read
What Follow-Up Looks Like After a Test
-
Normal or benign result: You go back to your regular screening schedule.
-
"Probably benign" result: This means the finding is very likely harmless, but your team wants to be sure. You will usually have a repeat exam and imaging at about 6 months, then again at 12 and 24 months. Report any change in between visits.
-
Suspicious result: Usually a needle biopsy can be done to find out what it is. Most biopsies turn out not to be cancer.
-
If a cyst is drained and the lump goes away with clear fluid, you return to routine screening. If the lump stays or the fluid is bloody, more testing is needed.
-
Getting your follow-up testing done on time matters. Delays can allow a cancer to grow. If you are having trouble scheduling an appointment or getting it covered, visit our Contact page and tell us how we can help.
Questions to Ask Your Health Care Provider
-
What risk group am I in, and why?
-
What is my breast density, and does it change my plan?
-
Should my family history be reviewed by a genetic counselor?
-
When should I have my next mammogram, MRI, or CEM?
-
Does it make any difference where I've had mammograms in the past or where I go now?
-
Are there medicines or other steps that could lower my risk?
You do not need a referral to schedule a screening mammogram. Medicare and most insurers allow you to book it yourself and we're here to help if you need us. Remember to reach out by visiting our Contact page. A real person will contact you to help.
Important Reminders
-
If you cannot have an MRI (for example, because of a metal implant, severe claustrophobia, or a reaction to the contrast dye), other options include contrast-enhanced mammography (CEM). A whole-breast ultrasound may be used if those are not available, but screening ultrasound finds fewer cancers than MRI, so it is not the first choice.
-
A note on thermography: This test is not recommended for breast cancer screening. There is no good evidence that it works.
-
Breast awareness simply means being familiar with how your breasts normally look and feel, so you notice when something changes — and then telling your doctor promptly. Some women find it helpful to check their breasts regularly. If you still have periods, the best time to check is at the end of your period in the shower. Breast awareness is part of every plan, at every risk level.
Breast Cancer
Resources
-
American Cancer Society: https://www.cancer.org/
-
Targetbreastcancer.org: https://www.targetbreastcancer.org
-
Women’s Health.gov: https://www.womenshealth.gov/
To view more breast cancer-related resources, visit our Resources page or click the button below.