Riverside Healthcare Podcasts

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Screening and Risk Assessment Program

Guest Bio: Julie Sieling, APRN, NP-C, CN-BP
After receiving her Master of Science in Nursing at Rush University, Julie Sieling joined the Riverside Medical Group in Family Medicine. Julie Sieling is a member of the American Association of Nurse Practitioners and is currently serving as Certified Nurse Practitioner for Riverside Healthcare's Screening and Risk Assessment Program.
    Screening and Risk Assessment Program
    Julie Sieling, APRN, NP-C, CN-BP discusses the screen and risk assesment program at Riverside Healthcare.

    Kaleb Miller (Host): Hello and thanks for listening from wherever you are, and this is Riverside Healthcare’s Well Within Reach podcast. My name is Kaleb Miller and I’ll be hosting today, and today I’m joined by Julie Sieling who is a nurse practitioner with Riverside Medical Group and Julie helps us lead the Riverside Screening and Risk Assessment Program, so I’m excited for you all to get to hear a little bit about that program at Riverside. So Julie, tell us a little bit about yourself and then what your specialty is here at Riverside Health Care.

    Julie Sieling (Guest): As you said, I’m a nurse practitioner. I have been a nurse 25 years this year, hard to believe. I am local, grew up here. This is my hometown and I’ve raised my family here. I’ve worked at Riverside in this capacity as a nurse practitioner about 8 years now and I’ve been in this role for almost 4 years. The screening and risk assessment program is mainly based out of the mammography department through Riverside, so that’s sort of where my office is and where most people can find me.

    Host: Great, so Julie tell us a little bit more about the screening and risk assessment program that you lead at Riverside and why it’s so important for our community.

    Julie: Sure, it’s a newer idea, the Screening and Risk Assessment Program, some people call it the genetic program, whichever they might think of it. It’s mainly a program to help identify patients that may be at increased risk for cancers. It’s important just because finding cancer early as you know gets the best outcomes, and if we can help women or men get appropriate screenings to help look for those cancers a little bit sooner, then we can help people live longer.

    Host: Yeah absolutely, and so one of the things that’s so great about the screening and risk assessment program is that when a patient is getting this testing done, it’s really equipping them with the knowledge of what they need to be aware of or what they need to be concerned for so tell us a little bit about why knowledge is so powerful for these individuals who are undergoing genetic testing.

    Julie: A lot of people or women mainly that I see are really afraid because of their family history, so their mom might have had cancer, their grandma might have had breast cancer, so coming in and asking questions and having testing gives them the power to figure out where they need to go on their path for the rest of their life, whether that test comes back positive or negative. A lot of women are surprised their test is negative, but yet we still look at their family history and can give them some recommendations. Actually 85% to 90% of those people I test are negative. On the opposite side, those women that come back positive, many of them have been begging for increased screenings or something just to help them, like some women will say I have this breast cancer, I’d like to have this surgery to take care of that, but they can’t find anybody to do that surgery for them just because of their family history, but if their test comes back positive, then they can decrease their risk for breast cancer by 95% for having their breast removed, so that’s very empowering for that women to say, you know what I can make a change that’s going to help me live longer for my children.

    Host: How empowering is that for those people to be able to have that knowledge just simply by going through and doing the testing, so if I’m someone who lives in the community and I’m curious about this program, I might be thinking you know is this something that’s right for me? So who may benefit from doing genetic testing?

    Julie: There’s a lot of rules, but the easiest way to think about it is if you have a personal or family history of breast cancer, ovarian cancer, pancreatic cancer, metastatic prostate cancer, a young colon cancer, or a young uterine cancer, that’s basically where we start to have the conversation to figure out where we fall. There’s plenty of other things but that’s sort of where our program starts for people.

    Host: Got it, so if I have signed up for testing and I’m ready to go, what can I expect from the test? What all does this genetic test include that I should be aware of?

    Julie: The test itself is blood or saliva. I mainly do blood but for someone who has difficultly with that, we do have a saliva test. There’s more than one test that’s out there, so I really try and customize it depending on what’s appropriate for that patient. Most of the time it’s a panel of different tests according to what their family history shows so there are panels that are specifically for breast and ovarian cancer, other panels that are specifically for colon cancer, so it’s really hard to know. The other thing is that there are some direct consumer tests out there right now. People might be familiar with those. There are some pros and cons to them and I like to talk about those in addition when I see people to let them know why it may not be appropriate for them to go that route even though they’re being advertised to everybody.

    Host: Yeah, so what’s one of the things you tell a patient when they’re considering using one of those alternative testing methods for genetic testing? What’s the benefit of coming to you as opposed to maybe a third party testing?

    Julie: Specifically for cancer, the one product that’s on the market right now advertises that they do BRCA testing for breast and ovarian cancer, but they really only look at three specific problems in the BRCA gene that are mainly found in the Ashkenazi Jewish population, which is not the majority of the population here, so it’s really misleading. So it may tell somebody that yes they’ll get a negative test, when they’re really positive for something that may affect them, so they don’t know so we do talk about that particular test itself. There are some other people who are interested in their ancestry and other things and those really completely separate tests from what I’m doing.

    Host: So once the patient’s got through this, how long is the turnaround from when the test results will be available and how do you share these results with the patient?

    Julie: Most of the time the test takes about 3 to 4 weeks to come back. There are some exceptions, to the point where I’m seeing some surgery candidates that we need to have these results sooner, so that’s about a 7 day turnaround time. I do meet with the patients face to face to give them those conversations. Some because it’s really nice paperwork. I hand them their results so they can keep it with their medical records. In addition, a lot of them, even if their testing is negative, has medical management guidelines that we need to go over. They need to be having extra screenings, even though their genetic testing is negative. So it’s a very important conversation.

    Host: So obviously this probably a pretty – can feel like a pretty nerve wracking step for a patient to take to find out some of these things. Julie, what are some of the things that you do to almost reassure patients as they’re going through this process? Do you have some kind of things that you usually go through to help ease some of your patients if they’re doing testing?

    Julie: Some of it is just providing as much information as I can for them depending on their family history, so what can we do for those women with ovarian cancer? What can we do for those family history of breast cancer? What do we need to try and help them along the path? What age actually starts screening? I have some young women that come in that we don’t actually start extra screenings until 25, so they don’t need to worry about it until then. So we have that conversation. In addition, these people who test negative tests – negative genes to their children, so we have that conversation, which relieves some of their nervousness in addition. It’s just to answer any questions that they may have.

    Host: Right, so if someone has gotten their results back and you find out that they’ve tested positive for one or more of these genes, what’s that next step?

    Julie: Some of it depends on the specific gene, so interestingly there’s more than one gene that can cause breast cancer, and two of those, the BRCA I and II gene have a little bit stronger recommendations than some of the other breast cancer genes, but really it’s individualized for that. It could be anything from a surgical management change to increasing screenings to other blood tests to having some other conversations, but it’s mainly what can we do to try and prevent these cancers and find them the earliest.

    Host: If someone is looking for more information about genetic testing, what are some good resources, and not only good resources, but good credible resources for people who just want more information about genetic testing?

    Julie: I actually like Facing Our Risk Empowered. It’s probably one of the better websites out there that’s specifically for the type of screening that I do. It breaks it down very easily. They also offer individual support for women who may need it, so it’s hard to find somebody else that might be positive for the same gene as this person I’m speaking to, but yet this organization has that available, so it’s great. Their website is www.facingourrisk.org. I also like the American Cancer Society website and there is a lot of information depending on lots of cancers, and they’re just www.cancer.org, and then the Susan G. Coleman Breast Cancer Foundation is very well known organization and their website is also very knowledgeable and it’s credible. You can take that information to heart.

    Host: Great, and so if someone wants to do Riverside screening risk assessment program and they want to see you and start talking about maybe starting their journey down getting testing, doing the genetic testing program, how can they access this at Riverside?

    Julie: There’s a few different entry points. All women who have their mammogram here at Riverside at any location get offered a survey questionnaire, and if they meet requirements at that time, then they automatically get offered a 5 minute window and can talk to a genetic counselor at that time if I’m not available, and then I see them for follow up. Some people have questions and want to talk to their primary care first and that’s completely fine. They can send a referral over and then we’ll contact them -or they don’t necessarily need a referral, they can just call me for an appointment, and my number is 815-935-7250.

    Host: Great, thanks for sharing that Julie. Julie this has been some incredible information, and how empowering to be able to do this test and to have that knowledge at your side for something that’s obviously it’s so important to many individuals and their families. Julie is there anything else you’d like any of our listeners really to know about screening and risk assessment program at Riverside or genetic testing?

    Julie: Just that it’s out here and if you’re not sure, you’re better of asking. I do find women come in with history and they’re not as high a risk as they think they are, so asking as many questions to get yourself educated is the best option.

    Host: Great, again thanks, this is Julie Sieling. She’s a nurse practitioner at Riverside Medical Group and helps lead our Riverside Screening and Risk Assessment Program. Again, if you didn’t catch that number the first time, the number to contact our screening and risk assessment program is 815-935-7250. Julie, thanks again for joining us today.

    Julie: Thanks for having me.

    Host: And thank you once again for listening to the Well Within Reach podcast by Riverside Healthcare. Have a great one.