Amanda Wilde (Host): Welcome to LIFE Cast by Infirmary Health. I'm Amanda Wilde. Dr. Bryan Jordan is Breast Imaging Medical Director at Infirmary Health. So as a diagnostic radiologist, how do you see this plethora of updated technology, specifically in breast imaging making a difference. Tell me about the technology that you are using these days, because it's constantly being improved, isn't it?

Bryan Jordan, MD: Absolutely. So, our goal is always to use the best for our patients and our communities. So currently, we're using the best iteration of 3D mammography, which images the breast through one-millimeter slices, so you're getting to see the breast in one millimeter slices through. So if there's a potential cancer hiding amongst the dense breast tissue, this gives you the best chance of visualizing to see it. We also utilize computer-assisted detection. So, it accentuates and pulls out areas for our attention or review. So again, subtle areas of cancer, trying to bring it to the forefront. And our goal is to catch cancers at the earliest interventions because stage 0, I and II breast cancer carries with it near a 100% survival with appropriate treatment. And that is done before these issues are palpable or self felt by the patient. If we can catch them on imaging, then the patient has a better prognosis overall.

Host: So really, it's become that early detection is the closest thing we have to a cure for breast cancer, isn't it?

Bryan Jordan, MD: Absolutely. Especially with the data in the times now showing that we're seeing this instance of breast cancer is increasing along with colon and lung, which is disproportionate to previous years in the past. And this trend will continue in the future. So, finding things, finding these cancers earlier and treating them not only saves people's lives, but makes their surgeries and their interventions less harsh, and so easier to recover from.

Host: This 3D mammogram sounds like a big leap forward. Why is that the best, highest standard of care? You said you can see minuscule sections, so you obviously can see more specifically. But I know at least 10 or 15 years ago, you might get a mammogram. And then if something's suspicious, you might also then get an ultrasound. How does the 3D mammogram make a difference?

Bryan Jordan, MD: So, think of it in terms if you had a picture of an apple and you're looking at an apple and you turn the apple on the side and you took a picture of it and you're looking at that. And so, that was 2D mark for your two-dimensional imaging. Three-dimensional is now, say, you have that same apple and if you were to take a razor-thin knife and you cut that apple into the thinnest sections possible, and then you spread the apple apart, you could see what's in the middle of the apple. You could see what's maybe to the side of the apple. So again, if something's hiding and amongst all that dense tissue, which is the apple in and of itself, you can catch things. And so, that's how I relate it to patients, also relate it to food. So now, you know, I draw that analogy. It works well.

Host: So, what does it mean if you do get a call back from your screening mammogram, and there's something suspicious there? What happens next?

Bryan Jordan, MD: So as I relay this to patient, so if we say just objectively 10 patients, 10 patients get called back in a day. We do several more than this, but just to keep it simple, the math, if 10 patients get called back, of those 10, eight will be normal. They will be just a workup of normal tissue, or it's a cyst or a fibroadenoma or a benign calcifications, and goes back to routine screening. One of those will result in biopsy, and then one of those will result in a six-month followup, and that's how the statistics play out.

Host: So, screening mammograms are really important to catch cancer early, and we have the latest, greatest technology to do that. How often should one get a screening mammogram?

Bryan Jordan, MD: So at 25 years old, every female should undergo a risk assessment intake by their referring provider, and this will speciate out their level of risk based upon their family history and additional factors, at the latest of patients who start screening mammography at 40 years old and then annually. As the data is showing us, that trend may be earlier and earlier, as we are seeing more cancers arise in patients that are younger than 40, especially in African-American females, as their cancers tend to be of higher grade and worse outcomes. So in that patient population specifically, there needs to be a greater focus on that and getting them into screening regimens, most likely at a sooner date.

Host: What imaging services do you use? Let's say you see something suspicious, what imaging services do you use after the 3D mammogram? Do you use imaging services or do you go to biopsy next?

Bryan Jordan, MD: It depends. So if I see on a 3D mammogram an area of spiculation or additional suspicious features or a new mass, I will call back and I will do additional views with mammography and their spot compression views. And so, these kind of focused in magnified views on this area of tissue, then applies pressure to separate out that dense tissue to see further if something's hiding there.

From there, you proceed on with the ultrasound piece, focusing in on the exact location, so you're really wanting to hone down where you're looking with ultrasound. Ultrasound will show you the tissue and it'll show you the details. From there, if there is something that needs to be biopsied, we will pursue with biopsy if we see it with ultrasound. If we are still suspicious and we only see it with the mammogram, we can biopsy with the mammogram too as guidance.

A couple other things that we have in our toolkit is we have contrast-enhanced mammography, and we also have breast MRI and we have whole breast ultrasound. So, contrast-enhanced mammography is you take a set of images with mammogram, you give the patient contrast, the computer does a subtracted series. And so, what happens is if something enhances, if something lights up like a light bulb in the breast on those post-processed images, that's something that needs to be further evaluated as it lends itself to being suspicious.

The same thing with MRI. MRI, contrast the examination. If something enhances, if it lights up, that's where we need to pay attention to and further investigate. The whole breast ultrasound survey is used in the screening scenario for patients that are higher risk as a secondary screening regimen. So, we have a whole arsenal of tricks in our toolkit to further investigate and track down these things.

Host: Now as a diagnostic radiologist, you're looking at these images in a dark place. You know, I think of it as so removed from the patients. But what I want to ask is how do you see this technology you're using today, specifically breast imaging, making a difference in people's lives?

Bryan Jordan, MD: I think I have a lot of light inside of me. I don't feel like I'm in a dark place at all. I feel like I have a wonderful opportunity to help people on a very personal level, and I get to interact with them. I have the opportunity to give people back their mother, give people back their sister, their wife, their girlfriends, and to prolong the longevity of these individuals for themselves.

And in some instances, you know, 1% of all breast cancers diagnosed every year are male breast cancers. So, we see a whole range of things. And I think, truly, it is something I'm grateful for and appreciative that I get to do what I do.

Host: I think you've given us some great guidelines to go by for screening and what to expect and maybe not jump to conclusions. If you do receive a callback from a screening mammogram, because you said maybe one out of 10 of those calls that you make is going to end up actually being in cancer. Of course, we worry, but that is what early detection is all about. What do you see in the future for your field and for specifically your organization as we move forward in breast cancer detection and care?

Bryan Jordan, MD: So, I see the future as expanding facilities, expanding and making it easier for patients to get in, far more access points so patients can get their screening mammograms, do right by themselves and to give themselves the best opportunity. If, god forbid, something were to happen, to have it easily treated and put behind them and be okay.

And so, the future to me is a lot of outreach, a lot of conversations with people, communities, getting people to show up and just take that time. And I know we're all very busy in our lives, with our families and our jobs and everything. But a 15-minute appointment in and out screening mammogram can truly save your life.

Host: You've changed my perspective too on diagnostic imaging radiologists, because I just think of you being in a dark room looking at images. And you have a lot of interaction with your patients and a lot of interaction with other medical specialties around breast cancer treatment.

Bryan Jordan, MD: No, but you're generally right about diagnostic radiologists because they are typically introverts. And so, those who are attracted to it, they want to be somewhat removed and isolated and focused in their work and not interacting much. And so, the joke is, you know, you go into Diagnostic Radiology, and you think you don't like people.

And then, at the very end, "Oh no, actually I do like people. I want to see people," then you either do Breast Imaging or you do Interventional Radiology. So, you can still see people. But that's just a joke, the diagnostic radiologists see plenty of people when they're doing procedures and do things. But yeah, it's not the first time I've heard that.

Host: Well, I was in a room with my radiologist and looking at my breast screening imagery, and so that's where I got that idea. But I also saw that you have to have very sharp eyes to do what you do, and it truly is an amazing specialty. And I just want to say thank you for the work that you do at Infirmary Health.

Bryan Jordan, MD: I appreciate that. Thank you.

Host: Dr. Bryan Jordan is Breast Imaging Director at Infirmary Health. For more information or to make an appointment, visit infirmaryhealth.org/services/womenshealth/breasthealthwomensimaging. If you found this podcast helpful, please share it on your social media. And thanks for listening to LIFE Cast, a podcast from Infirmary Health.