Scott Webb (Host): Most women have heard of mammograms, and today, we're talking with Dr. Jamie Murphy. She's a breast surgeon with Franciscan Physician Network and she's here to answer some important questions about what mammography is, why it's important in the detection of breast cancer, and who should be getting a mammogram.

 This is the Franciscan Health DocPod. I'm Scott Webb. Dr. Murphy, thanks so much for joining me today. We're going to talk about mammograms and what they are and why they're important and all that good stuff for listeners. So just on a basic level, what is a mammogram? I hear words like 3D mammography, and I wonder what does that mean? Also, what's the difference then between the 3D and 2D mammography?

Dr. Jamie Murphy: Yeah. So basically, a mammogram is a special x-ray that looks at your breast tissue and it can detect different things that concern us for various cancers. And it can detect other things that are benign as well, but the main thing we're worried about is cancer. And the difference between a 3D mammogram and a 2D mammogram, you may have also heard the term tomosynthesis, which is basically the same thing. It's synonymous with 3D mammography. And so, 2D mammogram is basically one view of your breast. So, it's like just a plain x-ray, whereas 3D mammogram is, if you will, like a CT scan. So, it's three dimensional. It takes multiple slices of your breast so that you can see different layers of the breast.

And this is important because many women have different densities, and I think we'll go into that later. But basically, a 3D mammogram becomes more sensitive as the breast density increases. And there was actually a German study that looked at this. They looked at basically 100,000 women and they looked at the cancer detection rates between 2D and 3D mammogram. And they found that as breast density increases, the 3D mammogram becomes more sensitive at detecting invasive breast cancers. So, it has now become the standard for the screening mammogram to be a 3D mammogram or tomosynthesis.

Host: Yeah, that's definitely what I've heard. It does seem like the 3D has become the gold standard, if you will. So then, at what age do women need to begin mammograms, and is there an age when they're no longer recommended? And also, what is the recommended frequency for mammograms?

Dr. Jamie Murphy: So, this is very dependent on the individual woman. So if it's average risk women, meaning no family history, no other risk factors, we generally recommend them to start their screening mammograms at age 40. Now, if they are determined to be high risk, which a lot of things go into that calculation, they need to be screened a little bit earlier. So for instance myself, my mom had breast cancer at 45. And so, the recommendation there is for the woman to be screened 10 years prior to the earliest family member was diagnosed. So, I started getting my mammograms at 35.

Host: Okay.

Dr. Jamie Murphy: And then, you also asked about when they're not recommended.

Host: Yeah. Is there an age when you're just like, "Nah, you're good, you don't need them anymore"?

Dr. Jamie Murphy: Yeah. Again, it's very individualized. The main cancer organization, the NCCN, recommends to continue screening mammograms basically until the life expectancy is less than 10 years. So as long as the woman is in good health and she can obtain a mammogram relatively with ease, then it's recommended to continue that. Now, the European guidelines actually spread out the mammogram to every two years or even every three years once the woman gets older. So again, it depends on the woman's comfort level as far as the frequency of the mammogram.

Host: Yeah. As you say, like one size doesn't fit all, depends on family history, genetics, preference, all of that. What are some of the common reasons that you hear from women why they don't want mammograms?

Dr. Jamie Murphy: I think the main one is that it's uncomfortable. You know, you have to put up with a lot of compression when they do the mammogram. They are, specifically the techs when I say they, are trained to put your breast into compression so that we can flatten out all of the tissue so that we can get the best view of all of the breast tissue. So if it's not optimal and we're not able to get enough compression, then we may have to bring you back in for additional views, which again is more uncomfortable, so a lot of women are afraid because of the discomfort. So sometimes, you can take some ibuprofen maybe like an hour beforehand to try to minimize that discomfort. I hear a lot of women say that they're afraid of radiation. And really, the risk for the radiation that you get is very minimal, if at all any. It poses really no risk more than the average amount of radiation you get just from the environment. So, that is really not a risk at all and the benefits completely outweigh any potential risk with that.

Host: Yeah. And I'm sure those that don't have a family history, maybe they would not want mammograms, it seems like a few years ago, there was a big focus for women and self-exams. And I'm sure physicians like yourself still recommend those self-exams, but it seems like mammograms, we were talking earlier about 3D being the gold standard, but mammograms in general for screening seems to be the preferred thing from physicians and medical experts. Why is that?

Dr. Jamie Murphy: I think it's still important for women to be aware of what's normal in their breasts. We used to say everybody should do monthly exams in the shower, things like that. But it hasn't really been shown to increase cancer detection rates. What we really just recommend is that women know what is normal in their breasts. Did I have lumpy bumpy breasts before, or is this new? Do I have a new lump? And just be aware of changes that go on in your breasts. Because the screening mammogram is going to be the way to pick it up.

Obviously, in between that yearly interval, if something develops, then you need to get diagnostic imaging. And the difference between screening is basically you go in for your mammogram, they take the pictures and then you go home. And then if you actually have a complaint like a lump or breast pain or whatever, they do what's called diagnostic imaging, where they're taking specific images of an area of concern in addition to whole breast imaging. They have the radiologist read your films that same day while you're there. And if something comes up that they need to further image, they can do it right then and there.

Host: Yeah. And you mentioned earlier dense breasts. And I've heard that term before, having spoken with gynecologists and OB-GYNs and so forth. What does that mean exactly? And maybe you could talk then more about the screening options that are available for women who have dense breasts.

Dr. Jamie Murphy: Yeah. So, there's basically four different levels of density that we have broken down into, and it goes from basically completely fatty breasts, which are on one end of the spectrum. And on the other end of the spectrum are what we call extremely dense breasts. And basically 10% of the population is on one end and 10% is on the other end, and everybody else is somewhere in the middle.

And when we really are concerned about density is when we see extremely dense breasts, those women in that category, because we've seen women with that density have a little bit of an increased risk for breast cancer. And we don't really know why because it could be twofold. Mainly, is it because of the dense breasts or is it because the radiologists have a harder time looking through the dense tissue to try to find a cancer? Because when you look at the mammogram, dense breasts look white, and so do cancers. And so, the breast dense tissue can basically obscure any type of cancer. And that, again, is where the 3D mammogram is more important because it can take slices and get thinner, basically, views of the breast to kind of see through the density, if there's any calcifications or masses.

And then in terms of extra screening, I generally don't recommend extra screening for women unless they're in that extremely dense category. And there's different modalities that we can use for screening. You can have a breast MRI, you can do breast ultrasound. And really, the interval that we do those in hasn't quite been established. In general for the high-risk BRCA1, BRCA2 mutation carriers, we do six-month interval imaging. So every year, you get a mammogram and then six months in between you get an MRI. So, you're getting something every six months.

Host: Yeah, which just makes sense. As you say, those in the higher risk categories.

Dr. Jamie Murphy: Yeah.

Host: So, let's talk about the worst case scenario if cancer is found on a mammogram. Walk us through the next steps for a woman and their families, whomever, that they would experience in that sort of care journey, if you will.

Dr. Jamie Murphy: So, every individual is different. Every cancer is different. Every woman's risk factors are different. How she's going to respond to the treatment is different. It's all an individualized basically plan for each woman. And in general, there's three different physicians that will care for you. And what me being the surgical oncologist is one. The second one is a medical oncologist, and the third being a radiation oncologist, because most women are going to get some therapy from each of us. Now, depending on the size of the cancer, you may need to get some chemotherapy before surgery. And that can be for two reasons. One, because it's shown to have a better survival. And two, it could be to potentially downstage the tumor to shrink it a little bit so that it can make surgery easier. And also, make it so that we don't have to take as much tissue. And then finally, radiation is going to be usually the last thing that you get, whether it's after a lumpectomy or after a mastectomy, it basically depends on the final pathology.

Host: Yeah, it all makes sense and really great information today. I loved having you here and your expertise and all that. I just want to give you a chance here at the end. Final thoughts, takeaways on this topic anyway about mammograms, breast cancer, and how you can help.

Dr. Jamie Murphy: Yeah. I would just say keep getting your mammograms because we've found cancers earlier on than people can feel. And we can do something about it at that time, as opposed to ignoring it and waiting until it becomes a bigger problem. And then, we're dealing with more advanced cancer. So, keep getting your mammograms, act on them right away. And of course, reach out if you have any concerns with your breasts or any new changes.

Host: Yeah, that's great. Yeah, as you say, the gold standard, screening mammograms, get them when you need them, get them often, reach out to your providers if there's anything going on that's unexpected or new or abnormal, all that good stuff. Doctor, thanks so much for your time today. You stay well.

Dr. Jamie Murphy: Of course. Thank you for having me.

Host: And to schedule a mammogram at a Franciscan Health facility near you, visit franciscanhealth.org/breastcare and fill out the form or call the toll free number. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.