The technology we use in the Hendricks Regional Health Women’s Center includes an advanced risk assessment tool. The results provide a woman and her doctor with her risk of developing breast cancer within the next five years and within her lifetime. Each patient with increased risk is meticulously tracked and followed more closely.
Listen in to Monet Bowling, MD as she explains how additional care for high-risk patients was created to reduce risk where possible and find cancer early for improved outcomes.
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Assessing Your Risk of Developing Breast Cancer
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Learn more about Dr. Monet Bowling
Monet Bowling, MD
Dr. Monet Bowling is a board-certified breast surgeon in the Hendricks Regional Health Medical Group. A breast surgeon is a physician that is devoted to the care of patients with breast conditions. Breast surgeons are trained to evaluate and manage those patients experiencing breast pain, benign lumps and cysts and abnormal mammograms, in addition to breast cancer. Dr. Bowling is renowned in her field and a passionate crusader in the cause against breast cancer. Dr. Bowling has earned a perfect, five-star rating from her patients on multiple provider review websites including Healthgrades.com.Learn more about Dr. Monet Bowling
Transcription:
Assessing Your Risk of Developing Breast Cancer
Melanie Cole (Host): Today one in eight women will develop breast cancer at some point in their lifetime. Additional care for high-risk patients was created to reduce risk where possible and find cancer early for improved outcomes. My guest today is Dr. Monet Bowling. She’s a board certified breast surgeon at the Hendricks Regional Health Medical Group. Welcome to the show, Dr. Bowling. Women hear about when we should have our screenings, what age we should have our mammogram. What about someone who might be at higher risk for breast cancer? When would we know that?
Dr. Money Bowling (Guest): There are many things that can tell us how women are at a higher risk for breast cancer. We begin to start to look at people’s family history when we discuss people being at higher risk. Those are easy things to start to determine if people are at higher risk for breast cancer. If there’s someone in their family who has had breast cancer in the past, what age those people developed breast cancer, if the person themselves has had a breast cancer at a young age. we also begin to look at have they had multiple biopsies in the past? What age did they have the onset of their menstrual period? Was it a very early age? Was it a very late age? If they had exposure to hormone replacement therapy for a prolonged period of time, those things are when we start to get very concerned, but looking at all of those factors and deciding if they have a hereditary high risk for breast cancer or just a personal, just general, just high risk for breast cancer.
Melanie: And, there are certain heritages that are more at risk, yes?
Dr. Bowling: There are. When we talk about heritages, though, we begin to look at hereditary risk for breast cancer, and that talks about our family’s risk for breast cancer. Now, only ten percent of the people who are actually diagnosed with breast cancer have a familial, hereditary risk for breast cancer. And that means they actually have a gene that is actually altered that is going to cause them to have an elevated risk for breast cancer. And so, that is kind of a separate category for higher risk and one that can be evaluated very easily with genetic testing.
Melanie: Let’s speak about genetic testing then. Women have heard about the BRCA genes and they’re a little confused. Everybody has the BRCA genes. Yes? It’s the mutation that you’re looking for.
Dr. Bowling: It is the mutation that we begin to look for. The thing that is becoming very personal to most people is that we hear about BRCA1 and we hear about BRCA2 as the mutation in those genes lead to breast cancer but there are other genes that can also be altered that can also show hereditary risk or an increased risk for developing breast cancer. The way that we do our testing, the way that we evaluate people for higher risk now has begun to show us all of the different types of genes that put us at risk for breast and for other hereditary cancers--that being colon cancer, that can also be pancreatic cancer, melanoma, and breast and ovarian cancer.
Melanie: So, do you recommend people that have this higher risk get that genetic test?
Dr. Bowling: Well, there are easy ways to evaluate if you need to have genetic testing done. One of the things is actually if you fill out a survey. It’s a very simple thing to do to evaluate your risk. And, one of the ways of doing that is most offices have a risk factor sheet that you can fill out and it can basically look at all of the factors that put you in high risk. If you come up as someone who is elevated on that survey, they can easily test you with a blood test or a sputum sample to be able to evaluate your risk for breast cancer.
Melanie: And, you have a high risk breast cancer assessment tool at Hendricks Regional Health, yes?
Dr. Bowling: We do. We actually have implemented a high risk and a prevention clinic that is essentially run by our nurse practitioner, Jenny Pierle. What she does is she evaluates the risk of patients immediately when they are having their mammogram performed in the Breast and Bone Health Center. As they get their mammogram, they’re actually given that health assessment at the same time. When they fill out that health assessment, as they’re going back for their mammogram, they are either flagged as someone who could be at risk or not. And, if they are flagged to be at risk for that hereditary syndrome, they can actually be tested here at Hendricks Regional Health on the same day as they get their screening mammogram. It kind of takes the middle man out of it. We can already know that you’ve come up and you’re at an elevated risk. We can evaluate you. We can have you seen at that moment once you’ve finished your mammogram and then have your results back within three to four weeks. And then, have a discussion about your results when you results get back.
Melanie: What do women ask you if they are determined to be a high risk patient?
Dr. Bowling: I think that those questions span the gamut of lots of different spectrums. Some women are very concerned or what I’d call the “worried well”. They’re at risk but they don’t have the gene so, what types of mammograms to I need? Do I need to have an MRI? How do I need to be followed? How do I need to be evaluated? Are there other things that I can do for preventative measures? Some people come back at elevated risk for breast cancer or for ovarian cancer but oftentimes what we’re finding is that there are people who come back at elevated risk for colon cancer or they at least need to be evaluated in another way. So, do I need to have a screening colonoscopy and what’s the interval? How often do I need to have mammograms? Does my breast density affect how I need to be evaluated? And, in looking at all of those questions I think that now that we’re able to look at more than just the BRCA1 and the BRCA2 gene mutation, we’re able to kind of give the patient a more comprehensive view of what’s going on in their gene line.
Melanie: And, what do women ask you about? They hear in the media about prophylactic mastectomies for people that are found to be at high risk or have that BRCA1, BRCA2 gene mutation. What do you tell them when they ask you about that?
Dr. Bowling: I think that this is a very hot-button topic. We have a lot of famous people who have now had prophylactic mastectomies because they were gene carriers or they were just concerned about being at a high risk for breast cancer. I think every person has to individually look at their risk. You need to be able to evaluate, are you a gene carrier or not? The society as a whole, and that’s the American Society of Breast Surgeons, does not necessarily advocate for taking people’s breasts off if they are not gene carriers. There are problems, issues, complications, or side effects that can happen just from removing someone’s breasts and things that could happen. So, I think that we carefully evaluate if people are carriers of the gene. If they are gene carriers, evaluating them to have their breasts removed prophylactically is one way to go. There are also medications that people can be placed on to help reduce their risk and if they don’t want to opt for either of those options, there is increased screening and the addition of MRI to evaluate someone’s breasts, especially if they are a younger patient when they’re identified to be at familial risk, to be able to watch them and make sure that nothing develops. And, if something does develop, that we catch it at a very early time.
Melanie: And, that would seem to be the least invasive but is it true that if a woman has a mastectomy prophylactically, they still could get breast cancer?
Dr. Bowling: There is always a possibly and as great of a job as all of the breast surgeons around the country and around the world think we are, with removing breast tissue, there is always a one percent chance of development of breast cancer even on a prophylactic site. We are great at taking away the breast tissue but, inevitably, a little bit of breast tissue is always left behind or even cells are left in there. I think it does reduce your risk significantly if you are a hereditary breast and mutation carrier, to have your breast removed prophylactically but we cannot tell anyone that they are one hundred percent never, ever going to have breast cancer again.
Melanie: So, wrap it up for us and tell the women what you really want them to know about breast cancer and their risk and possible prevention.
Dr. Bowling: I think about breast cancer, one of the very many things that people need to realize is to be aware of their own bodies. Be aware of your family history and although there’s much controversy out there about when to start mammograms and if you should or should not do your self-breast exam, you know your own body. Advocate for yourself. Do your self-breast exam. If you see something that’s abnormal, if it’s painful, if it hurts, if it pops up during a pregnancy and you think that it’s not supposed to be there, have it evaluated. Don’t let someone tell you that this doesn’t need to be seen or evaluated. In terms of your risk, know your risk. How many biopsies have you had in your lifetime? When was the first age that someone developed breast cancer? Do we have ovarian cancer in our family? Do we have prostate cancer in our family? You need to know your history. Knowing your history arms you with a lot of power to be able to evaluate, not only breast cancer, ovarian cancer, but other cancers that can follow on the BRCA1, the BRCA2 gene, or colon cancer. You need to take care of your body. I don’t think that people realize that there are very small measures that you can do to lower your risk for breast cancer. One of those is very simple: exercise. Twenty minutes of exercise, three times a week, reduces your risk of breast cancer by almost eighteen percent. Getting rid of fat cells that carry estrogen decreases your chance of developing breast cancer. How simple would it be to go out and just exercise? Just slightly change your body habits, just slightly, to reduce your risk. If it were that simple we would all just do it I’m sure but just thinking about that, of ways to reduce your risk, having your mammogram, being on a schedule, being evaluated, all of those are very important things to be done. With all the controversy that’s out there about when to get your mammogram, not forgetting that it’s important that we get it. It is the best way that we have to evaluate the breast. So, getting your mammogram is still very important and having it done and evaluated and seen so that you know exactly where you are on an annual basis is still the best method.
Melanie: Wow. Thank you, Dr. Bowling, so much for being with us. What an amazing guest you are. Thank you for such important information today. For more information on the special follow-up breast program at Hendricks Regional Health Women’s Center, you can go to Hendricks.org. That’s Hendricks.org. You’re listening to Health Talks with HRH. This is Melanie Cole. Thanks so much for listening.
Assessing Your Risk of Developing Breast Cancer
Melanie Cole (Host): Today one in eight women will develop breast cancer at some point in their lifetime. Additional care for high-risk patients was created to reduce risk where possible and find cancer early for improved outcomes. My guest today is Dr. Monet Bowling. She’s a board certified breast surgeon at the Hendricks Regional Health Medical Group. Welcome to the show, Dr. Bowling. Women hear about when we should have our screenings, what age we should have our mammogram. What about someone who might be at higher risk for breast cancer? When would we know that?
Dr. Money Bowling (Guest): There are many things that can tell us how women are at a higher risk for breast cancer. We begin to start to look at people’s family history when we discuss people being at higher risk. Those are easy things to start to determine if people are at higher risk for breast cancer. If there’s someone in their family who has had breast cancer in the past, what age those people developed breast cancer, if the person themselves has had a breast cancer at a young age. we also begin to look at have they had multiple biopsies in the past? What age did they have the onset of their menstrual period? Was it a very early age? Was it a very late age? If they had exposure to hormone replacement therapy for a prolonged period of time, those things are when we start to get very concerned, but looking at all of those factors and deciding if they have a hereditary high risk for breast cancer or just a personal, just general, just high risk for breast cancer.
Melanie: And, there are certain heritages that are more at risk, yes?
Dr. Bowling: There are. When we talk about heritages, though, we begin to look at hereditary risk for breast cancer, and that talks about our family’s risk for breast cancer. Now, only ten percent of the people who are actually diagnosed with breast cancer have a familial, hereditary risk for breast cancer. And that means they actually have a gene that is actually altered that is going to cause them to have an elevated risk for breast cancer. And so, that is kind of a separate category for higher risk and one that can be evaluated very easily with genetic testing.
Melanie: Let’s speak about genetic testing then. Women have heard about the BRCA genes and they’re a little confused. Everybody has the BRCA genes. Yes? It’s the mutation that you’re looking for.
Dr. Bowling: It is the mutation that we begin to look for. The thing that is becoming very personal to most people is that we hear about BRCA1 and we hear about BRCA2 as the mutation in those genes lead to breast cancer but there are other genes that can also be altered that can also show hereditary risk or an increased risk for developing breast cancer. The way that we do our testing, the way that we evaluate people for higher risk now has begun to show us all of the different types of genes that put us at risk for breast and for other hereditary cancers--that being colon cancer, that can also be pancreatic cancer, melanoma, and breast and ovarian cancer.
Melanie: So, do you recommend people that have this higher risk get that genetic test?
Dr. Bowling: Well, there are easy ways to evaluate if you need to have genetic testing done. One of the things is actually if you fill out a survey. It’s a very simple thing to do to evaluate your risk. And, one of the ways of doing that is most offices have a risk factor sheet that you can fill out and it can basically look at all of the factors that put you in high risk. If you come up as someone who is elevated on that survey, they can easily test you with a blood test or a sputum sample to be able to evaluate your risk for breast cancer.
Melanie: And, you have a high risk breast cancer assessment tool at Hendricks Regional Health, yes?
Dr. Bowling: We do. We actually have implemented a high risk and a prevention clinic that is essentially run by our nurse practitioner, Jenny Pierle. What she does is she evaluates the risk of patients immediately when they are having their mammogram performed in the Breast and Bone Health Center. As they get their mammogram, they’re actually given that health assessment at the same time. When they fill out that health assessment, as they’re going back for their mammogram, they are either flagged as someone who could be at risk or not. And, if they are flagged to be at risk for that hereditary syndrome, they can actually be tested here at Hendricks Regional Health on the same day as they get their screening mammogram. It kind of takes the middle man out of it. We can already know that you’ve come up and you’re at an elevated risk. We can evaluate you. We can have you seen at that moment once you’ve finished your mammogram and then have your results back within three to four weeks. And then, have a discussion about your results when you results get back.
Melanie: What do women ask you if they are determined to be a high risk patient?
Dr. Bowling: I think that those questions span the gamut of lots of different spectrums. Some women are very concerned or what I’d call the “worried well”. They’re at risk but they don’t have the gene so, what types of mammograms to I need? Do I need to have an MRI? How do I need to be followed? How do I need to be evaluated? Are there other things that I can do for preventative measures? Some people come back at elevated risk for breast cancer or for ovarian cancer but oftentimes what we’re finding is that there are people who come back at elevated risk for colon cancer or they at least need to be evaluated in another way. So, do I need to have a screening colonoscopy and what’s the interval? How often do I need to have mammograms? Does my breast density affect how I need to be evaluated? And, in looking at all of those questions I think that now that we’re able to look at more than just the BRCA1 and the BRCA2 gene mutation, we’re able to kind of give the patient a more comprehensive view of what’s going on in their gene line.
Melanie: And, what do women ask you about? They hear in the media about prophylactic mastectomies for people that are found to be at high risk or have that BRCA1, BRCA2 gene mutation. What do you tell them when they ask you about that?
Dr. Bowling: I think that this is a very hot-button topic. We have a lot of famous people who have now had prophylactic mastectomies because they were gene carriers or they were just concerned about being at a high risk for breast cancer. I think every person has to individually look at their risk. You need to be able to evaluate, are you a gene carrier or not? The society as a whole, and that’s the American Society of Breast Surgeons, does not necessarily advocate for taking people’s breasts off if they are not gene carriers. There are problems, issues, complications, or side effects that can happen just from removing someone’s breasts and things that could happen. So, I think that we carefully evaluate if people are carriers of the gene. If they are gene carriers, evaluating them to have their breasts removed prophylactically is one way to go. There are also medications that people can be placed on to help reduce their risk and if they don’t want to opt for either of those options, there is increased screening and the addition of MRI to evaluate someone’s breasts, especially if they are a younger patient when they’re identified to be at familial risk, to be able to watch them and make sure that nothing develops. And, if something does develop, that we catch it at a very early time.
Melanie: And, that would seem to be the least invasive but is it true that if a woman has a mastectomy prophylactically, they still could get breast cancer?
Dr. Bowling: There is always a possibly and as great of a job as all of the breast surgeons around the country and around the world think we are, with removing breast tissue, there is always a one percent chance of development of breast cancer even on a prophylactic site. We are great at taking away the breast tissue but, inevitably, a little bit of breast tissue is always left behind or even cells are left in there. I think it does reduce your risk significantly if you are a hereditary breast and mutation carrier, to have your breast removed prophylactically but we cannot tell anyone that they are one hundred percent never, ever going to have breast cancer again.
Melanie: So, wrap it up for us and tell the women what you really want them to know about breast cancer and their risk and possible prevention.
Dr. Bowling: I think about breast cancer, one of the very many things that people need to realize is to be aware of their own bodies. Be aware of your family history and although there’s much controversy out there about when to start mammograms and if you should or should not do your self-breast exam, you know your own body. Advocate for yourself. Do your self-breast exam. If you see something that’s abnormal, if it’s painful, if it hurts, if it pops up during a pregnancy and you think that it’s not supposed to be there, have it evaluated. Don’t let someone tell you that this doesn’t need to be seen or evaluated. In terms of your risk, know your risk. How many biopsies have you had in your lifetime? When was the first age that someone developed breast cancer? Do we have ovarian cancer in our family? Do we have prostate cancer in our family? You need to know your history. Knowing your history arms you with a lot of power to be able to evaluate, not only breast cancer, ovarian cancer, but other cancers that can follow on the BRCA1, the BRCA2 gene, or colon cancer. You need to take care of your body. I don’t think that people realize that there are very small measures that you can do to lower your risk for breast cancer. One of those is very simple: exercise. Twenty minutes of exercise, three times a week, reduces your risk of breast cancer by almost eighteen percent. Getting rid of fat cells that carry estrogen decreases your chance of developing breast cancer. How simple would it be to go out and just exercise? Just slightly change your body habits, just slightly, to reduce your risk. If it were that simple we would all just do it I’m sure but just thinking about that, of ways to reduce your risk, having your mammogram, being on a schedule, being evaluated, all of those are very important things to be done. With all the controversy that’s out there about when to get your mammogram, not forgetting that it’s important that we get it. It is the best way that we have to evaluate the breast. So, getting your mammogram is still very important and having it done and evaluated and seen so that you know exactly where you are on an annual basis is still the best method.
Melanie: Wow. Thank you, Dr. Bowling, so much for being with us. What an amazing guest you are. Thank you for such important information today. For more information on the special follow-up breast program at Hendricks Regional Health Women’s Center, you can go to Hendricks.org. That’s Hendricks.org. You’re listening to Health Talks with HRH. This is Melanie Cole. Thanks so much for listening.