Since 1990, mammograms have helped reduce breast cancer mortality in the US by nearly 40%. The reason is early detection – catching tumors before they have a chance to grow and spread. Yet there is still some controversy about how soon, and how often, a woman should get a mammogram. This is an especially important question for women living in Marin, where breast cancer rates have historically been higher than in the rest of the United States.
Listen as Leah Kelley, MD, an award-winning breast surgeon and Medical Director of the Breast Program at MarinHealth Medical Center, weighs in on the benefits of mammography. Dr. Kelley also discusses MarinHealth Medical Center’s renowned cancer program, new Breast Health Center, and high-risk breast program.
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The Importance of Mammography: What Every Woman Should Know
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Learn more about Dr. Leah Kelley
Leah Kelley, MD
Dr. Leah Kelley is an award winning physician specializing in breast and gynecologic surgery. While a medical student, Dr. Kelley developed a lifelong passion for women's health and went on to complete a fellowship in breast surgical oncology at the University of Southern California, studying under Dr. Melvin Silverstein. Combining state-of-the-art breast surgical care with a holistic approach to breast cancer and gynecologic care, Dr. Kelley strives to bring the best of women's healthcare to each patient.Learn more about Dr. Leah Kelley
Transcription:
The Importance of Mammography: What Every Woman Should Know
Bill Klaproth (Host): Mammograms have helped reduce breast cancer mortality in the US by nearly 40% since 1990, yet there are some women that skip this important check up, and there’s still confusion on when to start and how often you should get a mammogram. Here to clear the confusion, is Dr. Leah Kelley, the Medical Director of the Breast Program and Breast Surgeon at Marin General Hospital. Dr. Kelley, thank you so much for your time today. As I mentioned, there seems to be confusion still on when to get screened for breast cancer, so when is the right time to get the screening?
Dr. Leah Kelley (Guest): Well, there is some real debate in the scientific community about that, so there is not a perfect answer. The data still show us that beginning screening at age 40 and continuing screening for as long as a woman is in good health results in the most lives saves. That remains the recommendation that many professional organizations, including the American College of Radiology, stand behind. When to start includes the fact that women between 40 and 50 have lower rates of breast cancer and higher rates of false positive tests, so some organizations, including the US Preventative Services Task Force, have recommended that average-risk women delay the start of mammography until age 50 to reduce the number of false positives.
Bill: So, it’s kind of in the middle, then? You said earlier age 40, but now the guidelines state age 52, so how should a woman – how does she decide or how do you know what to do?
Dr. Kelley: Sure. A woman should know her own risk, and that includes more than just family history. It includes things like breast density, and reproductive history, weight, and activity level. A woman should discuss the risks and benefits with her own physician and weigh her own tolerance for the possibility of false positives, balanced against the possibility of a missed breast cancer.
Bill: How do you identify breast cancer risk?
Dr. Kelley: Sure. There are some very strong statistical models. Of course, none of these actually predict what’s going to happen to an individual person, but they can place individuals into risk categories. It takes into account all of the known risk factors for breast cancer including, but not exclusive to family history. There are also some personal risk factors that are important. It generates ten-year and lifetime risk numbers – these are percentages – that can help a woman to gauge her personal risk. When you come in for a screening mammogram in Marin County, those numbers are generated automatically, and they are part of the report. Women can find out at the time of their screening mammogram what category of risk they fall into.
Bill: So then, what is considered high risk?
Dr. Kelley: Generally, the cut-off is 20% lifetime risk or greater.
Bill: 20% lifetime risk or greater? And they get that report automatically, then?
Dr. Kelley: Um-hum, it comes out as part of their mammography report, and it’s given to their physician. Women will be informed if they fall into that increased risk category.
Bill: And then family history plays an important role as well?
Dr. Kelley: That’s right. In general, it’s again, the advice of many professional groups that women at least consider screen mammography is starting at age 40 for women at low and average risk. There are trade-offs for delaying it, decreased false positives, but some increase in the chance of missing a breast cancer between age 40 and age 50. Of note, those breast cancers typically are more aggressive, the ones that appear in pre-menopausal women. We still encourage women, even those at average risk, to seriously consider the benefits of screening mammography between age 40 and age 50. All women should begin screening at age 50.
Bill: Okay, great advice, but then there are women who skip it. Why is it so important for a woman to get a mammogram and not skip it?
Dr. Kelley: The main thing is the mortality reduction. Breast cancer, as people know, is a common disease, and despite all of the advances in therapy over the last several decades, we still see women die of this disease. We know that that is directly related to stage at diagnosis and mammography reduces the stage at diagnosis. In doing so, it reduces the risk of disease-related mortality, and it reduces the burden of treatment so women can have the successful long-term cure with less therapy when they are diagnosed at an earlier stage.
Bill: And that stage of diagnosis, I would imagine then, early detection is vitally important?
Dr. Kelley: Absolutely.
Bill: What are the realities of risk in Marin? Breast cancer rates used to be higher in Marin, but they aren’t any longer. Is that because the screening process is so good at Marin, now?
Dr. Kelley: Actually, we believe the primary driver of the decreased incidence in this county is the drop-off in the rate of combined hormone-replacement therapy after menopause. There was a very, very high uptake of that therapy in this county in the 80s and 90s, and that seems to have driven some of the increased incidences. As that use has dropped off following data demonstrating that it did increase the risk of invasive breast cancers as well as some other health risks, we have seen the rate of invasive breast cancer decline along with that use.
Bill: Okay. People used to say that living in Marin puts you at risk. It doesn’t sound like that anymore?
Dr. Kelley: No, it’s not a geographic issue, it’s a demographic issue. It’s who lives here and what kinds of risk factors the population has.
Bill: Okay, well thanks for explaining that to us. That’s really important to know. And Dr. Kelley, the procedure itself, can you talk about that a little bit? How quick is it? Is it painful? What about the risk of radiation? What should a woman expect?
Dr. Kelley: Sure, screening mammography is very quick. In the new Breast Center at Drake’s Landing, all of the mammograms are what are called 3D or Tomosynthesis Mammograms. These machines are actually a little gentler, so while compression of the breast is still necessary, these are generally quick and easy to have. Rarely do women find them more than slightly uncomfortable. The associated risk of radiation exposure is extremely low. I always tell women if you get on a plane and fly to New York, you have more radiation exposure than you do from an average mammogram. This is very, very low levels, and compared to other types of medical radiation; it’s really on the low end of the spectrum.
Bill: And it’s a fairly quick procedure, right?
Dr. Kelley: Yeah, just a couple of minutes.
Bill: And then how soon should someone expect to get the results?
Dr. Kelley: We have really shortened the turnaround time, so typically, people can see their results in a few days. Women who come in for diagnostic studies – in other words, they’re there because they have a lump or some other concerning symptom – typically get their results on the day of.
Bill: Okay, and if you could wrap this up for us, what else do we need to know about breast cancer in Marin?
Dr. Kelley: We’ve succeeded in addressing some of the important risk factors in Marin and reducing the risk. We’re very proud of the risk assessment program and of the lovely new Breast Center that we’ve opened at Drake’s Landing. We believe that this is a great venue to both help the population stays healthy by risk assessment and risk reduction interventions, as well as state-of-the-art diagnostic procedures and the kind of care that comes after that for women who do have a diagnosis. We’re just really pleased to be able to serve the women of Marin with these approaches.
Bill: Absolutely, Dr. Kelley, and thank you for your time and talking with us about breast cancer in Marin. For more information, and to learn more about the new Breast Health Center in Marin, visit BreastCenterMarin.org, that’s BreastCenterMarin.org. This is the Healing Podcast brought to you by Marin General Hospital. I’m Bill Klaproth. Thanks for listening.
The Importance of Mammography: What Every Woman Should Know
Bill Klaproth (Host): Mammograms have helped reduce breast cancer mortality in the US by nearly 40% since 1990, yet there are some women that skip this important check up, and there’s still confusion on when to start and how often you should get a mammogram. Here to clear the confusion, is Dr. Leah Kelley, the Medical Director of the Breast Program and Breast Surgeon at Marin General Hospital. Dr. Kelley, thank you so much for your time today. As I mentioned, there seems to be confusion still on when to get screened for breast cancer, so when is the right time to get the screening?
Dr. Leah Kelley (Guest): Well, there is some real debate in the scientific community about that, so there is not a perfect answer. The data still show us that beginning screening at age 40 and continuing screening for as long as a woman is in good health results in the most lives saves. That remains the recommendation that many professional organizations, including the American College of Radiology, stand behind. When to start includes the fact that women between 40 and 50 have lower rates of breast cancer and higher rates of false positive tests, so some organizations, including the US Preventative Services Task Force, have recommended that average-risk women delay the start of mammography until age 50 to reduce the number of false positives.
Bill: So, it’s kind of in the middle, then? You said earlier age 40, but now the guidelines state age 52, so how should a woman – how does she decide or how do you know what to do?
Dr. Kelley: Sure. A woman should know her own risk, and that includes more than just family history. It includes things like breast density, and reproductive history, weight, and activity level. A woman should discuss the risks and benefits with her own physician and weigh her own tolerance for the possibility of false positives, balanced against the possibility of a missed breast cancer.
Bill: How do you identify breast cancer risk?
Dr. Kelley: Sure. There are some very strong statistical models. Of course, none of these actually predict what’s going to happen to an individual person, but they can place individuals into risk categories. It takes into account all of the known risk factors for breast cancer including, but not exclusive to family history. There are also some personal risk factors that are important. It generates ten-year and lifetime risk numbers – these are percentages – that can help a woman to gauge her personal risk. When you come in for a screening mammogram in Marin County, those numbers are generated automatically, and they are part of the report. Women can find out at the time of their screening mammogram what category of risk they fall into.
Bill: So then, what is considered high risk?
Dr. Kelley: Generally, the cut-off is 20% lifetime risk or greater.
Bill: 20% lifetime risk or greater? And they get that report automatically, then?
Dr. Kelley: Um-hum, it comes out as part of their mammography report, and it’s given to their physician. Women will be informed if they fall into that increased risk category.
Bill: And then family history plays an important role as well?
Dr. Kelley: That’s right. In general, it’s again, the advice of many professional groups that women at least consider screen mammography is starting at age 40 for women at low and average risk. There are trade-offs for delaying it, decreased false positives, but some increase in the chance of missing a breast cancer between age 40 and age 50. Of note, those breast cancers typically are more aggressive, the ones that appear in pre-menopausal women. We still encourage women, even those at average risk, to seriously consider the benefits of screening mammography between age 40 and age 50. All women should begin screening at age 50.
Bill: Okay, great advice, but then there are women who skip it. Why is it so important for a woman to get a mammogram and not skip it?
Dr. Kelley: The main thing is the mortality reduction. Breast cancer, as people know, is a common disease, and despite all of the advances in therapy over the last several decades, we still see women die of this disease. We know that that is directly related to stage at diagnosis and mammography reduces the stage at diagnosis. In doing so, it reduces the risk of disease-related mortality, and it reduces the burden of treatment so women can have the successful long-term cure with less therapy when they are diagnosed at an earlier stage.
Bill: And that stage of diagnosis, I would imagine then, early detection is vitally important?
Dr. Kelley: Absolutely.
Bill: What are the realities of risk in Marin? Breast cancer rates used to be higher in Marin, but they aren’t any longer. Is that because the screening process is so good at Marin, now?
Dr. Kelley: Actually, we believe the primary driver of the decreased incidence in this county is the drop-off in the rate of combined hormone-replacement therapy after menopause. There was a very, very high uptake of that therapy in this county in the 80s and 90s, and that seems to have driven some of the increased incidences. As that use has dropped off following data demonstrating that it did increase the risk of invasive breast cancers as well as some other health risks, we have seen the rate of invasive breast cancer decline along with that use.
Bill: Okay. People used to say that living in Marin puts you at risk. It doesn’t sound like that anymore?
Dr. Kelley: No, it’s not a geographic issue, it’s a demographic issue. It’s who lives here and what kinds of risk factors the population has.
Bill: Okay, well thanks for explaining that to us. That’s really important to know. And Dr. Kelley, the procedure itself, can you talk about that a little bit? How quick is it? Is it painful? What about the risk of radiation? What should a woman expect?
Dr. Kelley: Sure, screening mammography is very quick. In the new Breast Center at Drake’s Landing, all of the mammograms are what are called 3D or Tomosynthesis Mammograms. These machines are actually a little gentler, so while compression of the breast is still necessary, these are generally quick and easy to have. Rarely do women find them more than slightly uncomfortable. The associated risk of radiation exposure is extremely low. I always tell women if you get on a plane and fly to New York, you have more radiation exposure than you do from an average mammogram. This is very, very low levels, and compared to other types of medical radiation; it’s really on the low end of the spectrum.
Bill: And it’s a fairly quick procedure, right?
Dr. Kelley: Yeah, just a couple of minutes.
Bill: And then how soon should someone expect to get the results?
Dr. Kelley: We have really shortened the turnaround time, so typically, people can see their results in a few days. Women who come in for diagnostic studies – in other words, they’re there because they have a lump or some other concerning symptom – typically get their results on the day of.
Bill: Okay, and if you could wrap this up for us, what else do we need to know about breast cancer in Marin?
Dr. Kelley: We’ve succeeded in addressing some of the important risk factors in Marin and reducing the risk. We’re very proud of the risk assessment program and of the lovely new Breast Center that we’ve opened at Drake’s Landing. We believe that this is a great venue to both help the population stays healthy by risk assessment and risk reduction interventions, as well as state-of-the-art diagnostic procedures and the kind of care that comes after that for women who do have a diagnosis. We’re just really pleased to be able to serve the women of Marin with these approaches.
Bill: Absolutely, Dr. Kelley, and thank you for your time and talking with us about breast cancer in Marin. For more information, and to learn more about the new Breast Health Center in Marin, visit BreastCenterMarin.org, that’s BreastCenterMarin.org. This is the Healing Podcast brought to you by Marin General Hospital. I’m Bill Klaproth. Thanks for listening.