Deborah Howell (Host): October is Breast Cancer Awareness Month, so let's add to our knowledge during this important time. Today, we'll find out what high risk breast advanced practice providers do, and we'll become more aware of how best to protect ourselves and our loved ones. I'm Deborah Howell, and my guest today is Claire Sutherby, a high-risk breast advanced practice provider with Deaconess, the Women's Hospital. Welcome, Claire.

Claire Sutherby: Thank you.

Host: So, let's start at the beginning. When should women start breast cancer screening?

Claire Sutherby: On average, our guidelines that we follow, so National Comprehensive Cancer Network guidelines, would recommend that women begin screening mammograms at age 40 and have these annually.

Host: And what can women do to screen for breast cancer?

Claire Sutherby: Women can do several different things to screen for breast cancer. So, that annual screening mammogram, an annual breast exam with their primary care provider or their gynecologist, as well as self-breast awareness.

Host: Oh, okay, which leads me to my next question, what is breast self-awareness?

Claire Sutherby: So, breast self-awareness is knowing your normal. So in the past, people used to really call this self-exam and this kind of encompasses self-exams at home as well as looking at yourself in the mirror and being familiar with what you look like. So, what your normal skin looks like, the color and texture, so that if there were any changes, you could report those as well as any difference in your breasts that are new, that have never been there. Or any changes to your nipples, such as inversion or a discharge that is new or has never been evaluated.

Host: Sure. Don't just ignore it. Make sure and pay attention. if women have questions regarding screening or when they should begin screening, who should they contact?

Claire Sutherby: They should contact their provider. So, whoever they feel comfortable discussing these screenings with, that's who I would recommend they begin talking to.

Host: And how would someone know if they might have an increased lifetime risk of developing a breast cancer?

Claire Sutherby: So in order to truly know their lifetime risk, a formal risk assessment should be completed utilizing Validated Risk Assessment. So when we do these, we evaluate family history, such as family history of breast cancer, including their age at diagnosis of their loved ones, as well as any personal history, so have they had a prior breast biopsy, as well as their prior breast density. So, that is a really hot topic at this time. Genetic testing also factors into risk assessment. So if we know someone has undergone genetic testing and is positive for a high risk gene, then they have increased lifetime risk.

Host: Now, if a woman has a family history of cancer or a genetic syndrome that increases their breast cancer risk, who should they contact?

Claire Sutherby: So, they should contact their provider to discuss a referral to the High Risk Breast Program. We can sit down together and have a conversation regarding their history. They will then get a five-year risk estimate, a lifetime risk estimate. And we will ultimately have a lot of conversation and develop an individualized screening plan for them, so that maybe they're screening more frequently or earlier than the average population. So that hopefully we are going to monitor them closer and if we are going to find anything, we have an opportunity to find it sooner.

Host: And what kinds of screenings are offered for those who might have an increased lifetime risk?

Claire Sutherby: So, mammogram is definitely going to be one of those screenings as long as they are aged 30 or older. And then, beast ultrasound, breast MRI and that clinical exam are the main screenings that we think about.

Host: Now, what about people who know they have dense breast tissue? Should they go more often?

Claire Sutherby: That is really being talked about at this point in time. There's, I think, even some legislation that's being worked on with dense breast tissue. So, there are four different categories of breast density: almost entirely fatty replaced, scattered fibroglandular densities, heterogeneously dense breast tissue, and then extremely dense breast tissue. And so, those with heterogeneously dense breast tissue or extremely dense breast tissue should probably be evaluated with an ultrasound in addition to their mammogram.

Host: This is because the physicians need to be able to see the area as best as they possibly can, correct?

Claire Sutherby: Correct. And that density could obscure something that's small in there that they're unable to see on mammogram.

Host: Okay. This is so fascinating. Is there anything else you'd like to add to our conversation?

Claire Sutherby: I think it's very important to know your risk and be very aware of your body and be your own best advocate.

Host: I love that information. This has been so great, Claire. Thank you so much for all the good info around breast cancer awareness and for being with us today. We really appreciate it.

Claire Sutherby: Yeah. Thank you so much.

Host: And that wraps up this episode of the podcast series from Deaconess the Women's Hospital, a place for all your life. For more information, go to deaconess.com. Please remember to subscribe, rate and review this podcast and all the other Deaconess Women's Hospital podcasts. For more health tips and updates, follow us on your social channels. I'm Deborah Howell. Thanks for listening and have yourself a great day.