Jamie Lewis (Host): While breast cancer affects one in eight women in America, preventable care significantly changes outcomes. Today, I'm sitting down with Dr. David Foulad, a breast cancer surgeon who's going to talk about the importance of preventative breast care and why it's crucial in breast cancer treatment.

This is Hello Healthy, a Dignity Health podcast. I'm Jamie Lewis. Hello, Dr. Foulad, thanks for joining us.

Dr. David Foulad: Hi. Thanks for having me.

Host: Let's talk about what preventative breast cancer care means. How would you define that term?

Dr. David Foulad: There are a lot of risk factors that can increase our risk for breast cancer. So, we want to do as much as we can to try to reduce that risk and prevent getting either breast cancer or a more advanced stage of breast cancer. And so, there are things that we're going to talk about that we can do to reduce this risk.

Host: Well, what are some of the lifestyle factors that can reduce the risk of breast cancer?

Dr. David Foulad: Risk factors that we can change that increase the risk of breast cancer are high body weight, obesity. So, weight loss can help, physical activity can also help. Women who drink one drink or more per day also have an increased risk. Limiting the alcohol use and then not smoking. There has been some associations with hormone replacement therapy with breast cancer, and it depends on the hormone combination, but keep in mind that that can increase your risk. And then, there are environmental exposures that could potentially be avoided.

Things that increase your risk that we can't really change, but your physician should know to make sure you're not at high risk are things like family history of breast cancer. Older age genetic mutations in you or your family members, later menopause, and some races such as the black race have increased risk of some types of breast cancer and some ethnicities such as Ashkenazi Jews. And also, if your mammogram says that you have dense breasts, that also gives you some increased risk.

Host: What should patients know about the importance of preventative breast care?

Dr. David Foulad: The most important thing to know is not to wait for a breast lump to decide to get your breast imaging. Once you have a breast lump, that significantly increases your risk of needing chemotherapy for breast cancer rather than starting out with just surgery and avoiding chemo. It's really important that you do the screening mammograms every year at minimum, and not wait for that symptom. Obviously, if you do feel a lump or a symptom, you should let your doctor know to, you know, get that breast imaging, but you shouldn't delay your annual mammograms if you feel like you're not having an issue.

Host: Right. Well, you're touching on that. So, none of us wants to be the one in eight women that discovers a diagnosis of breast cancer. So, what are some common fears and anxieties about breast cancer screenings?

Dr. David Foulad: Most commonly, women are concerned about the potential pain or discomfort from the mammograms. Keep in mind that the technology of the mammograms machines have been improved, and the technologist will do everything they can to minimize any discomfort. Many patients are also, you know, worried about the test results and try to avoid the mammograms because they're worried about a test result that will tell them that they have cancer.

But also, just keep in mind that if we find it on the mammogram and we find it early, that can definitely save your life and prevent you from needing more extensive treatments such as chemotherapy or a more extensive surgery. And then, there are some women that, you know, have had mammograms before and they've had to have additional testing and biopsies because of an abnormal result. And then, it ends up being normal, and that's very understandably a very stressful situation. But just keep in mind that, if you do have an abnormal result on the mammogram, that doesn't necessarily mean you have cancer. It just means that we need to take a closer look with more views in potentially a needle biopsy to make sure that, you know, there is no cancer in there.

And then, things that we can do to cope with the fear and anxiety of the mammogram screenings, mainly think of the screening as like maintenance, like other things that you do in your life for, you know, your regular health and wellness maintenance, like brushing your teeth or flossing. So, just thinking of it as sort of an upkeep and, you know, not something that should be causing worry and anxiety, but just the scheduled annual upkeep. During the day of your mammogram, you can use breathing techniques to help you relax. And then also, just make sure your expectations are set for when the test results will come to you. And you can plan in advance what you would be doing during that waiting period. You can consider attaching a reward to your mammogram. And then, just make sure that you follow up on the recommendations that are on the mammogram results.

Host: So, what are the screening guidelines for breast cancer?

Dr. David Foulad: There are different breast cancer screening guidelines out there, but most guidelines recommend that you perform a mammogram every year starting at age 40, okay? Some of the guidelines used to say age 45 or 50, but that's been changed to 40 because we have noticed a lot of women in their 40s that have been getting breast cancer. And you should continue those annual mammograms as long as you're healthy and as long as you're expected to live at least five or more years. Some of the guidelines suggest the potential cutoff is 75, but I don't recommend any age cutoff because I have seen breast cancer surgery done on healthy women in their 90s and I have one patient who had her breast cancer surgery. She's 104. She's been breast cancer-free for 10 plus years, 10 years doing well, going to the gym three times a week. So if you know she didn't get her surgery in her 90s, you know, she would have potentially not been doing as well at this age. So, it's very person-dependent, but as long as you feel like you're healthy, I would continue them.

And then, the screening guidelines are a little different for women, higher risk or dense breasts. So if your mammogram report mentions that you have dense breasts, it will either say extremely dense breasts or heterogeneously dense breasts. And there'll be a note on there that says because you have dense breasts, small cancers can be missed. And so, in those cases, if you have dense breasts, I do recommend that we Include a screening ultrasound every year with your mammograms and that will help find the small little masses that the mammograms can miss. It's still important that you do the mammograms in addition because the mammograms pick up something different. They pick up calcium spots that the ultrasounds don't do as good of a job as picking up. And those calcium spots can indicate an early breast cancer. So, you need the combination of both as long as the mammogram says dense breast. As you get old, as some women get older, the breasts do tend to become less dense and more fatty, and then you can switch over to just mammogram only.

So, there are some women that have been told they have a higher risk either because of their family history or pre-cancer on a biopsy or a calculated score that gives them a high risk of instead of around 12% of lifetime risk of cancer, about a 20% or higher. And then, those patients we recommend to also do a breast MRI once a year. And that's usually done about six months apart from the mammograms. So, you'll be getting some type of imaging every six months. So, it'll be mammogram and ultrasound, and then six months later, MRI, and that will continue.

Host: Well, if something abnormal is detected, what should patients expect?

Dr. David Foulad: Usually, If we see something suspicious on your mammogram or ultrasound, you'll get a call back. It doesn't necessarily mean that there's something suspicious. It could just mean that we just need extra views. So, you'll get a call back, cancer.gov is a good resource, for cancer materials. And then, breast360. ooris a website made by breast surgeons that has a lot of information in there, including sections on breast cancer prevention and, you know, it includes things like a page about diets and reducing sugar and the possibility of foods like turmeric or onions or garlic that can help. And then, CBCCUSA.com is another resource. That's where I work. We do offer screening mammograms for prevention and financial assistance for women that are not insured or need grants. We provide those. And there's also breast cancer awareness events that are coming up for October. So, you can find those at cbccusa.com/events.

Host: Well, great. Dr. Foulad, thanks so much for joining us.

Dr. David Foulad: You're welcome.

Host: That was Dr. David Foulad, a breast cancer surgeon with Dignity Health. To learn more about Dignity Health's Comprehensive Blood and Cancer Center, visit www.cbccusa.com.