Transcription:
When Should I Get Checked? Making Sense of Breast Screening Guidelines

Amanda Wilde (Host): Breast cancer screening is crucial for every woman because as we know, early detection is key. So what age should women start screening? How often should we be screened, and what is the screening process exactly? We'll make sense of current screening guidelines and answer questions with Dr. Laura Hanson, medical oncologist hematologist at First Health. Welcome to First Health and Wellness Podcast, connecting you to the people in medical services that make your life healthier. I'm Amanda Wilde. Dr. Hanson, great to have you here.

Dr Laura Hanson: Hi. Yes, thank you. It's great to be here.

Amanda Wilde (Host): Well have breast cancer guidelines changed significantly in recent years. It seems like different organizations have different guidelines?

Dr Laura Hanson: Yeah, that's a really, great point. So I would say the core of the guidelines have not changed so much as, it has become a little bit more nuanced. We have a lot more information now on breast cancer and who's at risk and who's at higher risk than average. And so that's where the guidelines have become a little bit more detailed. There's a little bit more information that goes into determining who's at high risk. And so I think that there is a little bit of confusion among women. Am I at high risk or these guidelines suggest that I start getting my mammograms at age 40, but the other guidelines say 45. And so I think that's where there is a little bit more of the confusion now.

Amanda Wilde (Host): So that leads me to my next question. How often should a woman have her breast checked?

Dr Laura Hanson: So in general, at least from the guidelines that we use in the medical oncology field, we recommend that women starting at age 40 should get an mammogram and that should be done once a year. And that sort of for women who are at average risk. So you're just general. you go in to see your primary care doctor for your yearly checkup, and when you turn 40, that's when you should start your yearly mammograms.

Amanda Wilde (Host): And what should we know about mammograms? How long do they take? Do they hurt? You said we should get them annually, but how do we know if we might be high risk?

Dr Laura Hanson: I would say mammograms can be uncomfortable and it depends on the density of the breast, the size of the breast, and whether you have any other underlying issues with pain to begin with. So they can be a little bit uncomfortable. The whole mammogram process itself does not take very long. I would say maybe about 10, 15 minutes or so. And the good thing about the screening nowadays is that, for the most part, if there is something that is found when a woman goes in for the mammogram, they will tell you while you're still there.

So it's not like other procedures where you have to wait days and days to get your results. So for the most part, if there is something that is concerning that they find. You will know before you leave. So if they do find something and they say, you know, okay, well it looks like there is a lump or there is a mass or something that we need to look at more closely, then they will alert your provider who at that point would need to order the additional testing that you might need.

Amanda Wilde (Host): And what are those latest advancements in breast screening? I mean, I've heard of the 3D breast, the breast MRI, the, I think the 3D is the tomosynthesis?

Dr Laura Hanson: So we have 2D and 3D mammograms, and there's also breast MRIs. And so those are three different modalities. For an average risk American woman, the 2D mammogram is sufficient. For people who are at a higher risk of getting breast cancer, there are some times where we would recommend doing the breast MRI. And MRI in general is helpful in people who are at a younger age. So typically women who are younger than 40 are the ones who would be getting a breast mri. A lot of that is just due to the density of the breast tissue. So younger women tend to have, dense or breast tissue, and so an MRI is just able to see through that tissue a little bit more clearly than what you can see on a mammogram.

Amanda Wilde (Host): How do we know if we're high risk?

Dr Laura Hanson: That's a really great question and I think that's where a lot of the newer information, in newer research as being focused, on breast cancer now is sort of how do we determine who is at high risk? And so there are a lot of risk calculators that we have if you're a female, your provider can put your information into one of these risk calculators to determine what your risk percentage is of being high risk. In general concept, the women who have a strong family history of breast cancer or ovarian cancer, that is one of the factors that goes into the risk category. If you have a known genetic mutation, the most common for breast cancer is the BRCA mutation.

So if you have a family history of having a BRCA mutation, then that would potentially put you in the high risk category. And then if you have a history of radiation treatment to the chest or to the face. And so we see that probably most commonly in people who have a history of a thyroid cancer or a Hodgkin's lymphoma where they end up getting radiation treatment to the chest at a young age. Those are people that we often recommend that they start getting breast cancer screening around age 30. And then again, if you're starting at age 30, you would start with an MRI, and then when you turn 40, you would switch over to mammogram.

Amanda Wilde (Host): So the mammograms still really the gold standard for people over 40?

Dr Laura Hanson: Correct. I always count my patients and tell them that, you go and see your primary care physician, if you have questions about when you should start your breast cancer screening, then definitely ask your primary care physician. Or if you already have an oncologist, certainly ask your oncologist about that. And the other things that are important to tell your provider about. whether you have children, whether you have a history of taking any hormone replacement therapy. Obviously we always ask our patients about smoking history, alcohol use, physical activity, diet, exercise habits, things like that because all, of those things we know now are, involved in sort of overall health and also in risk of getting not only breast cancer, but other types of cancers as well.

Okay.

Amanda Wilde (Host): Yeah. Are there any other questions we should ask our providers about breast cancer screenings?You've mentioned health, history, family history, lifestyle. Those are things we should tell them. Are there any other questions we might ask of our providers?

Dr Laura Hanson: I think that if, there are any questions, then I think the important thing is that you do ask your provider. I will also say that we have, at least here at First Health, we have, a genetics, counselor program. So we have, one specific genetic counselor, and then we have another one of our advanced practitioners who has a focus in genetic counseling. And so, those are really great resources so that if my patient says to me I have breast cancer, but my sister had breast cancer and my father had prostate cancer.

I'm not sure if I should be screened then that may be somebody that I refer to our genetic counselor, and then they can kind of discuss what the genetic testing entails and some of the advantages and disadvantages of getting genetic testing and then what that can mean in terms of the impact it has on, children and grandchildren and things like that. So I think we're learning a lot about how, cancer can be potentially passed down in, family members. And I think the more that we're learning, unfortunately the more nuanced the guidelines are becoming. But I think that's where having genetic testing, genetic counseling can be very important here.

Amanda Wilde (Host): So all this screening really has to do with early detection because the sooner you can catch an issue, the more you can optimize the outcome. Is that right?

Dr Laura Hanson: Correct. Yeah. I think that, doing the mammogram starting at age 40, having the ability to detect a small lesion, I'll say lesion in the breast because sometimes we detect things and they're not cancer. But being able to detect something early. we know that that leads to better outcomes. So if you detect something when it's small, then it's more easily removed with surgery, sometimes the lesions that we detect on these mammograms when.

You do a biopsy of a lesion to tell you whether it's cancer or not some of these lesions we're detecting are not full blown cancer. They're sort of pre-cancer. And so that is a situation where we're able to, have the patient go see a surgeon, get that pre-cancerous lesion removed, and then they don't necessarily have to worry about it.

Amanda Wilde (Host): Yeah, that sounds like that's happening more and more.

Dr Laura Hanson: Yes it is. And I think if anything, I would say that's where the guidelines have, changed is that it used to be that we would recommend women start getting their mammograms at age 50. And now the guidelines really are suggesting that early mammogram screening at age 40 allows us to identify these women between ages 40 and 50 who have some of these pre-cancer lesions that we can cure them of those lesions if we detect them early.

Amanda Wilde (Host): It's amazing what screening can actually do in terms of prevention to prepare for the screening, is there anything specific we should do? For example, I read that, you can drink coffee before your mammogram, but it might make your breasts more tender, thus making the mammogram a little more painful?

Dr Laura Hanson: I personally don't know that there is anything that is going to make the experience of getting a mammogram any better or worse. I tend to tell my patients that it will be uncomfortable, it may be painful. Certainly taking some Tylenol or Ibuprofen can be helpful beforehand. It's like going to the dentist, right? Sometimes you go to the dentist and they do your teeth cleaning and then it's fine. And sometimes you go and it's painful.

Amanda Wilde (Host): But you also said it's short.

Dr Laura Hanson: Correct, yes. The pain is temporary. Yes. So it's a little bit of pain, for potentially a huge benefit of, early detection.

Amanda Wilde (Host): Which is totally worth the peace of mind.

Dr Laura Hanson: Right, right.

Amanda Wilde (Host): Well, Dr. Hanson, thank you for this insight. I think we know now what the screening guidelines are and how to follow those appropriately for our individual situations, so it's really been helpful to talk with you today.

Dr Laura Hanson: Yeah, of course. Thank you so much for having me.

Amanda Wilde (Host): Okay. Learn more about First Health Cancer Care at nccancercare.org. Thank you for listening to First Health and Wellness Podcast, brought to you by First Health of the Carolinas. We look forward to you joining us again. Until then, be well.