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Breast Screening Can Save Lives
Dr. Shari Siegel-Goldman discusses the importance of breast cancer screenings.
Featured Speaker:
Shari Siegel-Goldman, MD
Dr. Shari E Siegel-Goldman, a board certified and fellowship trained radiologist, is the Director of Breast Imaging at the Breast Center at Montefiore Nyack Hospital. Certified by the American Board of Radiology, Dr. Goldman received her medical degree from New York University Langone Medical Center and School of Medicine in Manhattan, NY. She completed her residency and fellowship at New York University Medical Center and an internship at Saint Vincent’s Hospital both in Manhattan, NY. Dr. Goldman has extensive experience in breast imaging leading a team of experts who work with high-risk cancer populations. She is passionate about promoting breast screening and has worked with state legislators to educate the public about laws that provide for additional screening opportunities for individuals with dense breasts. Transcription:
Breast Screening Can Save Lives
Deborah Howell (Host): No one really loves going to get a mammogram. But they truly do save lives. Welcome to our Health Talk podcast. I’m Deborah Howell. And we’re here today with Dr. Shari Siegel-Goldman, a Board Certified Radiologist and the Director of Breast Imaging at the Breast Center at Montefiore Nyack Hospital serving Rockland County and the Lower Hudson Valley. Today, we’ll be talking about the importance of breast screenings. Thank you so much for joining us Dr. Seigel-Goldman.
Shari Siegel-Goldman, MD (Guest): Thank you for having me.
Host: Now you lead a team of experts who work with high risk cancer populations. Why is it so important to keep current with getting a mammogram?
Dr. Seigel-Goldman: Well as you mentioned earlier, breast cancer has decreased – mortality has decreased over the years and screening mammography does save lives. Screening mammography has enabled us to find breast cancer at an earlier stage and have a much better outcome.
Host: How often should a woman have a mammogram?
Dr. Seigel-Goldman: The recommendation is once a year in most situations. There was a little controversy several years ago in younger women whether women between age 40 and 50 should go every other year. And that is something that we recommend you speak to your doctor about. However, from my perspective, what I see, I do recommend annual mammography starting at age 40.
Host: Oh starting at age 40. That was my next question. But what if I have a strong family history of breast cancer? Should I go more often and start earlier?
Dr. Seigel-Goldman: No, there are other things you can do if you have a strong family history. If you have a history of premenopausal breast cancer in a first degree relative, so, that’s your mother, your sister and if they were diagnosed premenopausal meaning before the age of 40, then we suggest you go ten years earlier than your mother was diagnosed. If your mother was diagnosed at age 40, we would suggest you start screening at age 30. So, that’s the one scenario. However, if you have a very strong family history, there are other things and we can talk about that later that you can do for supplemental screening.
Host: What about our friends who have dense breast tissue?
Dr. Seigel-Goldman: So, dense breast tissue is when the breast tissue which is composed of fatty tissue and fibrous tissue, if you have more of the fibrous tissue, it makes your mammogram look white and that can make it harder to read. It can mask a subtle abnormality. So, over the past several years, we’ve started doing much more breast ultrasound or breast MRI as a way for high risk or supplemental screening specifically the breast ultrasound is nice to pair with the mammogram when you have dense breast tissue. They are complimentary to one another. Breast MRI is usually reserved for very high risk patients as another way to find subtle abnormalities.
Host: Should women still practice self-examination even if they get a mammogram every year?
Dr. Seigel-Goldman: That’s another topic that has had some controversy. My perspective would say yes. Examine your breasts for most women because you are your best diagnostician and if something changes, women usually know it before anyone else. However, there’s some women that have a lot of cysts. There are women that have very lumpy bumpy breasts because they have fibroadenomas or other things. If you know you have very lumpy breasts, or your breast is changing a lot because you have cysts; then you may want to speak to your doctor about whether it’s better for you to just not to do that. Because some women just get so anxious when they are examining their breasts and they feel like they can’t tell. But for most women, I think a monthly breast exam, it just helps keep a good handle on what’s going on.
Host: Yeah, kind of what’s baseline for you.
Dr. Seigel-Goldman: Correct.
Host: Now what’s a 3-D mammogram and will my insurance company pay for one?
Dr. Seigel-Goldman: Sure. So, 3-D mammography or also known as tomosynthesis has been around for the last probably five to seven years already now and when it first came out, it was not being paid for regularly by insurance. But now, insurance companies have come to recognize that tomosynthesis which really is just a mammogram that breaks up the images into tiny little millimeter thick slices and then we slide through them. So, by looking at instead of just a standard image, you’re actually rolling through the images almost like a moving picture and it helps to break up the breast tissue and see subtle abnormalities better. So, the studies have shown that a tomosynthesis will have a lower recall rate meaning there are fewer false positives that need extra workup and it has a better cancer detection rate.
So, because of that, most insurance companies will pay for tomosynthesis.
Host: That’s excellent news. Now what is ultrasound screening?
Dr. Seigel-Goldman: Ultrasound is the other way just like I mentioned, to use with dense breast tissue. Ultrasound uses sound waves and most people know ultrasounds because when they are pregnant, they have a sonogram. Sonogram is the same word as ultrasound. It uses a different technology. There’s no radiation with it to help look at the tissue. And like I mentioned before, it’s very complimentary. So, it helps to get through that dense tissue better, but it has certain things that it doesn’t see. so, that’s why we need to do them together. It will not identify calcifications which can be an early sign of breast cancer. So, we like to pair the mammogram and ultrasound together.
Host: Which brings me to my next question. Do you ever have patients get an MRI in addition to a mammogram and maybe even ultrasound in some cases?
Dr. Seigel-Goldman: Yes. MRI is really, really good for patients who have a high risk for breast cancer. And the most accepted number would be if you have a greater than 20% lifetime risk of breast cancer, and there are certain tools that can help you or your doctor determine your risk of breast cancer; then an MRI will be another test to have. Now it’s a little bit more of a – it’s not invasive but you do have to be in the MRI unit. You have to get intravenous dye for it. Some people get claustrophobic, so it’s a little bit more of an involved study, however, it has a very, very high sensitivity to detect abnormalities. So, it is good for if you have a high risk for breast cancer.
Host: Okay another good tool in our tool chest. Which brings me to my last tool I want to ask you about. What is image-guided biopsy?
Dr. Seigel-Goldman: Image-guided biopsies are what you do once an abnormality is found. So, if we find something on the mammogram, or on the ultrasound or on the MRI, and we don’t know what it is; we need to figure that out. In the olden days, I like to say, patients who all have surgery and they would go to a surgeon and the surgeon would cut out that area. We don’t need to do that anymore, thank God. But when we have findings that are indeterminant, we use the image guidance. It can be either the ultrasound or the mammogram or the MRI and with a special minimal needle, we can do a tiny biopsy where we get a small piece of tissue. And then the nice thing is, that the results come back very quickly, and you know what’s going on. And once we find out what that is, if it’s something benign, we can leave it there and if it’s something that is not benign and needs to be treated, then you can go see your surgeon and have definitive treatment.
Host: And how long has that been around? That particular application.
Dr. Seigel-Goldman: I’m going to sound a little old now, but I’ve been doing them for 25 years, I think. It’s a tried and true way to do biopsy.
Host: Very good. Now Dr. Seigel-Goldman, we know that for some women, getting a mammogram can be kind of stressful. So, tell us about your staff at the Breast Center at Montefiore Nyack.
Dr. Seigel-Goldman: That’s where I think going to a Women’s Center can really change the experience for women. We recognize that women don’t enjoy going for a mammogram and that’s probably saying it mildly. And we have staff that understands that anxiety and nervousness and not liking the compression of the breast tissue is part and parcel of being there. So, our staff is really empathetic. We try to make the whole experience as holistic as possible. We have nice gowns. We now in the COVID era, keep you isolated, so you are not mixing with a lot of other people. And we try to do the mammograms and get you in and out as quickly as possible.
Host: I have to say, the last one I got, was far less traumatic than say ten, twenty years ago.
Dr. Seigel-Goldman: And I think that’s because there’s been a recognition of women’s health and what we can do for women and how we can make the experience more pleasant and also, I think the equipment has gotten better. And the procedures now do go quicker. So, the mammogram compression is still there, and it’s important to have compression, but it will release automatically. So, there are things that kind of help mitigate against the discomfort of the mammogram.
Host: Yeah, perhaps you’re not in that equipment for quite as long.
Dr. Seigel-Goldman: Exactly.
Host: Well we want to thank you so very much Dr. Seigel-Goldman for being with us today and making us all so much smarter about taking good care of our health. For more information or to schedule a screening appointment, please call 845-348-8551. The Breast Center at Montefiore Nyack Hospital is located at 160 North Midland Avenue in Nyack, New York. Thanks again, Doctor.
Dr. Seigel-Goldman: My pleasure. Nice to talk to you.
Host: I’m Deborah Howell. Thank you for listening to this episode of our Health Talk Podcast. Have yourself a terrific day.
Breast Screening Can Save Lives
Deborah Howell (Host): No one really loves going to get a mammogram. But they truly do save lives. Welcome to our Health Talk podcast. I’m Deborah Howell. And we’re here today with Dr. Shari Siegel-Goldman, a Board Certified Radiologist and the Director of Breast Imaging at the Breast Center at Montefiore Nyack Hospital serving Rockland County and the Lower Hudson Valley. Today, we’ll be talking about the importance of breast screenings. Thank you so much for joining us Dr. Seigel-Goldman.
Shari Siegel-Goldman, MD (Guest): Thank you for having me.
Host: Now you lead a team of experts who work with high risk cancer populations. Why is it so important to keep current with getting a mammogram?
Dr. Seigel-Goldman: Well as you mentioned earlier, breast cancer has decreased – mortality has decreased over the years and screening mammography does save lives. Screening mammography has enabled us to find breast cancer at an earlier stage and have a much better outcome.
Host: How often should a woman have a mammogram?
Dr. Seigel-Goldman: The recommendation is once a year in most situations. There was a little controversy several years ago in younger women whether women between age 40 and 50 should go every other year. And that is something that we recommend you speak to your doctor about. However, from my perspective, what I see, I do recommend annual mammography starting at age 40.
Host: Oh starting at age 40. That was my next question. But what if I have a strong family history of breast cancer? Should I go more often and start earlier?
Dr. Seigel-Goldman: No, there are other things you can do if you have a strong family history. If you have a history of premenopausal breast cancer in a first degree relative, so, that’s your mother, your sister and if they were diagnosed premenopausal meaning before the age of 40, then we suggest you go ten years earlier than your mother was diagnosed. If your mother was diagnosed at age 40, we would suggest you start screening at age 30. So, that’s the one scenario. However, if you have a very strong family history, there are other things and we can talk about that later that you can do for supplemental screening.
Host: What about our friends who have dense breast tissue?
Dr. Seigel-Goldman: So, dense breast tissue is when the breast tissue which is composed of fatty tissue and fibrous tissue, if you have more of the fibrous tissue, it makes your mammogram look white and that can make it harder to read. It can mask a subtle abnormality. So, over the past several years, we’ve started doing much more breast ultrasound or breast MRI as a way for high risk or supplemental screening specifically the breast ultrasound is nice to pair with the mammogram when you have dense breast tissue. They are complimentary to one another. Breast MRI is usually reserved for very high risk patients as another way to find subtle abnormalities.
Host: Should women still practice self-examination even if they get a mammogram every year?
Dr. Seigel-Goldman: That’s another topic that has had some controversy. My perspective would say yes. Examine your breasts for most women because you are your best diagnostician and if something changes, women usually know it before anyone else. However, there’s some women that have a lot of cysts. There are women that have very lumpy bumpy breasts because they have fibroadenomas or other things. If you know you have very lumpy breasts, or your breast is changing a lot because you have cysts; then you may want to speak to your doctor about whether it’s better for you to just not to do that. Because some women just get so anxious when they are examining their breasts and they feel like they can’t tell. But for most women, I think a monthly breast exam, it just helps keep a good handle on what’s going on.
Host: Yeah, kind of what’s baseline for you.
Dr. Seigel-Goldman: Correct.
Host: Now what’s a 3-D mammogram and will my insurance company pay for one?
Dr. Seigel-Goldman: Sure. So, 3-D mammography or also known as tomosynthesis has been around for the last probably five to seven years already now and when it first came out, it was not being paid for regularly by insurance. But now, insurance companies have come to recognize that tomosynthesis which really is just a mammogram that breaks up the images into tiny little millimeter thick slices and then we slide through them. So, by looking at instead of just a standard image, you’re actually rolling through the images almost like a moving picture and it helps to break up the breast tissue and see subtle abnormalities better. So, the studies have shown that a tomosynthesis will have a lower recall rate meaning there are fewer false positives that need extra workup and it has a better cancer detection rate.
So, because of that, most insurance companies will pay for tomosynthesis.
Host: That’s excellent news. Now what is ultrasound screening?
Dr. Seigel-Goldman: Ultrasound is the other way just like I mentioned, to use with dense breast tissue. Ultrasound uses sound waves and most people know ultrasounds because when they are pregnant, they have a sonogram. Sonogram is the same word as ultrasound. It uses a different technology. There’s no radiation with it to help look at the tissue. And like I mentioned before, it’s very complimentary. So, it helps to get through that dense tissue better, but it has certain things that it doesn’t see. so, that’s why we need to do them together. It will not identify calcifications which can be an early sign of breast cancer. So, we like to pair the mammogram and ultrasound together.
Host: Which brings me to my next question. Do you ever have patients get an MRI in addition to a mammogram and maybe even ultrasound in some cases?
Dr. Seigel-Goldman: Yes. MRI is really, really good for patients who have a high risk for breast cancer. And the most accepted number would be if you have a greater than 20% lifetime risk of breast cancer, and there are certain tools that can help you or your doctor determine your risk of breast cancer; then an MRI will be another test to have. Now it’s a little bit more of a – it’s not invasive but you do have to be in the MRI unit. You have to get intravenous dye for it. Some people get claustrophobic, so it’s a little bit more of an involved study, however, it has a very, very high sensitivity to detect abnormalities. So, it is good for if you have a high risk for breast cancer.
Host: Okay another good tool in our tool chest. Which brings me to my last tool I want to ask you about. What is image-guided biopsy?
Dr. Seigel-Goldman: Image-guided biopsies are what you do once an abnormality is found. So, if we find something on the mammogram, or on the ultrasound or on the MRI, and we don’t know what it is; we need to figure that out. In the olden days, I like to say, patients who all have surgery and they would go to a surgeon and the surgeon would cut out that area. We don’t need to do that anymore, thank God. But when we have findings that are indeterminant, we use the image guidance. It can be either the ultrasound or the mammogram or the MRI and with a special minimal needle, we can do a tiny biopsy where we get a small piece of tissue. And then the nice thing is, that the results come back very quickly, and you know what’s going on. And once we find out what that is, if it’s something benign, we can leave it there and if it’s something that is not benign and needs to be treated, then you can go see your surgeon and have definitive treatment.
Host: And how long has that been around? That particular application.
Dr. Seigel-Goldman: I’m going to sound a little old now, but I’ve been doing them for 25 years, I think. It’s a tried and true way to do biopsy.
Host: Very good. Now Dr. Seigel-Goldman, we know that for some women, getting a mammogram can be kind of stressful. So, tell us about your staff at the Breast Center at Montefiore Nyack.
Dr. Seigel-Goldman: That’s where I think going to a Women’s Center can really change the experience for women. We recognize that women don’t enjoy going for a mammogram and that’s probably saying it mildly. And we have staff that understands that anxiety and nervousness and not liking the compression of the breast tissue is part and parcel of being there. So, our staff is really empathetic. We try to make the whole experience as holistic as possible. We have nice gowns. We now in the COVID era, keep you isolated, so you are not mixing with a lot of other people. And we try to do the mammograms and get you in and out as quickly as possible.
Host: I have to say, the last one I got, was far less traumatic than say ten, twenty years ago.
Dr. Seigel-Goldman: And I think that’s because there’s been a recognition of women’s health and what we can do for women and how we can make the experience more pleasant and also, I think the equipment has gotten better. And the procedures now do go quicker. So, the mammogram compression is still there, and it’s important to have compression, but it will release automatically. So, there are things that kind of help mitigate against the discomfort of the mammogram.
Host: Yeah, perhaps you’re not in that equipment for quite as long.
Dr. Seigel-Goldman: Exactly.
Host: Well we want to thank you so very much Dr. Seigel-Goldman for being with us today and making us all so much smarter about taking good care of our health. For more information or to schedule a screening appointment, please call 845-348-8551. The Breast Center at Montefiore Nyack Hospital is located at 160 North Midland Avenue in Nyack, New York. Thanks again, Doctor.
Dr. Seigel-Goldman: My pleasure. Nice to talk to you.
Host: I’m Deborah Howell. Thank you for listening to this episode of our Health Talk Podcast. Have yourself a terrific day.