Intro: It's Your Health Radio, a special podcast series presented by Henry Mayo Newhall Hospital. Here's Melanie Cole.

Melanie Cole, MS (Host): In May of 2023, the US Preventative Services Task Force issued new mammogram guidelines. Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. And joining me is Dr. Anjali Date. She's the Medical Director of Henry Mayo Newhall Hospital's Sheila R. Velos Breast Center, and she's here to tell us about the new mammogram guidelines, what we need to know.

Melanie Cole, MS: Dr. Date, it's such a pleasure to have you join us today. So, I'd like you to tell us the importance of early detection as we get into the new guidelines. First, why? Why are we looking at mammograms? Why is it so important?

Anjali Date, MD: Hi, Melanie. Thanks for having me. I always say early detection is the best prevention. So if we want to catch breast cancers early, if we want to give our patients the best fighting chance that they have at treating and curing breast cancer, we want to catch it early. And the only way to do that is to screen and screen appropriately.

Melanie Cole, MS: So, why were the new guidelines developed? I'd like you to speak about that because it seems a little confusing to some of us that these guidelines seem to change quite often, and now these new guidelines, you know, came across. Tell us a little bit why.

Anjali Date, MD: There's always been some conflicting schools of thought. The US Preventative Services Task force was specifically designed to create guidelines for screening and preventative services for the United States. And it comes up with these guidelines based on studies that have been performed in the last 10 to 20 years. So of course, as you can imagine, as new studies come out, as the data is improved and research is improved, the guidelines should change and improve with the new research that comes about. The conflict though is the American College of Radiology has always recommended, and the Society of Breast Imaging, which is in part with the ACR, we've always recommended starting screening mammograms for average risk women, beginning at the age of 40 and continuing screening every year. The US Preventative Services Task Force, however, decided a while ago based on old and outdated data, that the appropriate age to start screening was 50 and to start screening every other year. They determined that between the ages of 40 and 50, that would be a discussion that a patient should have with their doctor.

But now that the new data has come out, more research has shown that there is a demonstrated improvement in mortality by screening at 40. The task force came together again, reviewed the new data, and decided that 40 is in fact the appropriate age. So, the conflict between the ACR and the task force has sort of been resolved in a way. You know, being a radiologist, I've always said, we've always believed in screening at 40. We always believed that earlier detecting the cancer, the better; at a younger age, the better. And so, I'm really glad now that the task force has backed us up and, you know, stood behind that.

Melanie Cole, MS: Well, I love that you explained that it does need to change as we get new data, as we learn more about these diseases and we see younger women coming up with breast cancer, getting that baseline at an early age is such a great idea. I'd like you to speak about the guidelines as far as screening and how often. Because I can tell you, Dr. Date, and I'm a woman who's 59, I'm not stopping getting them every year. Because I have dense breasts, I also get an ABUS, you know, a whole breast ultrasound and I don't want to stop doing that because I'll worry for the year that I don't get it. So, can you speak a little bit about whether it's every year, is it now every other year, who should get screened, when it starts? Give us the whole summary of it.

Anjali Date, MD: Yeah, you make a really good point. So, I'm happy that the task force has come on board with the American College of Radiology and said, you know, we should start screening at 40. But the task force has still recommended that patients do a screening every other year, biannual screening, and that is something that we are still in conflict with. So again, we find that the American College of Radiology radiologists, breast imagers, people who see this day in and day out, we recommend we start at 40 and we screen every year. And it's exactly for the same reason. I couldn't imagine skipping a year, and the anxiety that could cause me or my friends, my family, and then returning, the second consecutive year or whatever, and then perhaps missing something, missing a small cancer that interval year that you didn't get screened and then coming back and it being twice the size because you missed that year of screening. So for that reason, we recommend you start at 40 and you get a mammogram every year.

And then, of course, there's all these additional supplemental exams like you talked about, the ABUS, automated breast ultrasound, and that is for dense breast tissue. So if you find that you have a lot of fibroglandular tissue inside of your breast, then what you want to do is an annual ABUS in addition to your mammogram. If you have an increased risk of breast cancer, family history, genetic predisposition, lots of factors that can contribute to an increased risk, then what you want to do is an annual mammogram in conjunction with an annual MRI. But there's a recurrent theme here, it's annual. We want to see you every year. We want to take a look at that breast tissue in multiple ways every year.

Melanie Cole, MS: I agree with you. And just like you said, the worry, it would just be too much. And then if they did find something, and the fact is, Dr. Date, I love that this is now considered part of preventive wellness, like a colonoscopy. Mammograms don't cost money, right? And yeah, I mean, even my ABUS didn't cost me anything.

Anjali Date, MD: Right. Because it's preventative services, it is free. And even if you don't have health insurance, there are a lot of services especially in California, or even national services such as Every Woman Counts where you could figure out a way to get your mammogram and get it for free. At the Sheila R. Velos Breast Center, we have a subsidized care fund. We do a lot of fundraising in the community, so that we can provide all women regardless of their financial status, we can provide them with the breast health services that they need. It's very, very important.

Melanie Cole, MS: Do they need a referral for a mammogram?

Anjali Date, MD: Nope, because it's preventative. Walk right in and you can get it.

Melanie Cole, MS: Oh, see, that's really cool to know. And tell us a little bit about the mammography technology now. There's 3D tomosynthesis, you and I mentioned ABUS. You know, you mentioned ultrasound and the MRI. So, there's all this different technology, but the one that seems to be really going around the country is the 3D mammography. So, speak about that, would you, Dr. Date?

Anjali Date, MD: Yes. And I think with the invention and integration and implementation of these 3D mammograms, we've increased our early detection and we've increased our accuracy in identifying these abnormalities. So basically, the difference is a 2D image just takes a flat representation of all the breast tissue, superimposes it on one single image. So, we see a lot of overlapping structures, overlapping tissue and fat in the breast tissue, and the mammogram. For a 3D mammogram, however, we take slice by slice images through the breast tissue, so all those superimposed tissues can then be separated and we can identify structures in between the fat, in between the fibroglandular tissue, so we can see if the structure or an abnormality is real, or if it's just the overlapping tissue causing it to look like a mass. So because of this accuracy and efficiency, what we are able to do is identify cancers earlier and identify mammograms that are truly abnormal. So of course, a lot of women come back for abnormal mammograms and extra images, and what we hate to do is cause that anxiety and then just say, "Oh, nevermind. That's okay. You know, the extra images are negative." Honestly, that's my favorite part of the job. I hate telling someone that they have a truly abnormal mammogram, but we want to avoid those false positives. And so, what the 3D mammogram does is it accurately identifies true abnormalities and it really reduces the number of false positives. So if you're getting called back from a screening mammogram, there's a higher chance that there's really something abnormal there.

Melanie Cole, MS: So, the good news about that is the odds are you're not going to get that callback, because that's the scary thing, is waiting for that callback, waiting for that letter, waiting for whatever, and you sit there and then when you don't hear anything or you get that "Your mammogram was totally normal," it really is such a weight off.

Anjali Date, MD: Absolutely.

Melanie Cole, MS: Like now you get another year to not have to worry about that. I'd like you to summarize for us the importance of self-care, of giving our self-breast exams, of seeing our gynecologist every year to make sure that we are keeping all of our lady parts in good working order, getting our mammograms, just really being our own best advocate, Dr. Date, because it would seem to me that that's what all of this really comes down to, is are we willing to listen to what the experts such as yourself are saying and take action to keep ourselves healthy?

Anjali Date, MD: Yeah, I always say that you know your body as a woman, as a patient, you are your own advocate. And so of course, you want to take all of these guidelines and then take your own self into account. Maybe you are a very anxious person and your mental health is going to play a big role in how often you're going to get screened. So, yeah, of course, I'm going to say get screened every year. But if that causes you severe anxiety and you'd rather get screened every other year, then that's your choice. You take all your information and you make the best choice for yourself and your body. But if you really are that person that wants to stay on top of your health, I would advocate for starting at 40 and screening every year and then doing all those extra steps, making sure you're seeing your primary care doctor for your normal screening, normal health, normal labs, making sure you're seeing your OB-GYN for your gynecologic health and your breast health. It's great to have physicians do breast exams as well as you do your own self-breast exam because there have been plenty of cases where a patient will come to me and say, you know, something feels off, something feels wrong. Last year's mammogram, stone cold negative. But this year, she feels something and it turns out to be a real mass.

There's also plenty of cases where the imaging is negative. I don't see anything on mammogram. I don't see anything on ultrasound, but she's persistent, "I really feel something. There's something there. I always trust my patients and I trust that they know their bodies." So then, there's plenty more to do. We can do an MRI, we can send you to a breast surgeon. They can feel that area and do a biopsy, and there's always something that we can do to help you figure out what's going on with yourself. So, you're your best advocate and you know your body better than anyone. So, I encourage all women to be informed, to be educated, to ask questions and, of course, you know, to trust their breast health professionals.

Melanie Cole, MS: Well, you are absolutely a passionate physician, Dr. Date. I love having you as a guest. And I imagine your patients are very lucky to have you as their advocate and their physician. And for ladies listening, the mammogram is a piece of cake. It takes two seconds. It's not painful like you think. Our mother's mammogram is not the same one that we're dealing with now, it's really an easy thing.

And to schedule your next mammogram, please visit sheilavelos.com or you can call 661-200-1099 because that is the way that you are going to be your own best health advocate. You can also visit the free health information library at library.henrymayo.com. And that concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. Please share this show with your friends and family on your social channels. We're learning from the experts at Henry Mayo Newhall Hospital together, and they're giving us the latest information so that we can make those informed decisions. I'm Melanie Cole. Thanks so much for joining us.