Venita Currie (Host): Welcome to Wellness in Reach, a Mount Carmel podcast. I'm your host, Venita Currie, and with me is Priyal Patel from Mount Carmel Health Systems. We are going to talk about the importance of routine screenings for breast cancer and why one of the most important decisions you'll ever make is never missing your screenings for early detection and prevention.

Thank you for joining me today, Dr. Patel.

Priyal Patel, MD: Thank you for having me.

Host: I think that medicine is fascinating. What we learn today will evolve into new discoveries for tomorrow. But unfortunately, breast cancer is not a new topic. So my first question to you is, what are the current guidelines for breast cancer screenings?

Priyal Patel, MD: Yeah, so for women at average risk, we recommend starting their annual screening mammograms at age 40. And the reason we emphasize age 40 is because one in six breast cancers occur in women in their forties. But patients should also know that even if they are not yet old enough to start their screening mammograms, they should still know what their normal breast tissue feels like, and that way they can pay attention to any lumps, bumps, or changes, and then report anything new or unusual to their doctor.

Host: As I was preparing for the show, I learned that there are different types of breast cancer screening tests. Can you walk us through what they are?

Priyal Patel, MD: Yes, definitely. So the foundation of breast cancer screening is the mammogram. A mammogram is a low dose x-ray that lets us look for small changes in the breast tissue. Now the traditional version is called 2D mammography, which takes two pictures in each breast. But in the past decade or so, 3D mammography or tomosynthesis has become much more common.

So this technology takes thin images through each breast. And this way the radiologist can look at each of those slices to see if there's anything suspicious hiding within the breast tissue. This has really improved our cancer detection rate, and it's really decreased the number of women who have had to be called back for additional pictures.

 Now for certain women, we do recommend some supplemental screening tests in addition to mammography. So we have screening breast ultrasound, which is often used when patients have dense breast tissue, since it can see through those denser areas better than mammography alone. And then breast MRI is the most sensitive test that we have.

 So, this is again, recommended for patients who have dense breast tissue, but also for patients who are at elevated risk of breast cancer. So breast MRI gives a very detailed view of the breast tissue, and radiologists can look at it to find those tiny cancers that aren't always visible on mammograms.

It is just important to know, though, that these additional screening tools are not intended to replace mammography. They are just effective supplements for detecting breast cancer in certain patients.

Host: So it sounds like the process for women who have dense breasts might be a little different and unique for them?

Priyal Patel, MD: Yeah, so breast density is a really important topic because about 40 to 50% of women fall into that dense breast category. Now what this means is that when your radiologist is looking at your mammogram, the dense tissue appears white, and unfortunately, the cancers also appear white. So cancers can sometimes be hidden by that dense tissue.

 But this doesn't mean that mammograms don't work. They're still life saving. But it just means that they can be less sensitive in women who have dense breast tissue. That's why these women benefit from those additional screening tests that I mentioned, like the ultrasound or MRI. Some states, including Ohio, are now requiring that women are told their breast density after their mammograms, and we just provide this information so that women can have an informed discussion with their doctors to figure out if that additional testing would make sense for them or not.

Host: I wonder if the screening process is also different for women with a family history or predisposition for breast cancer?

Priyal Patel, MD: Yeah. So, we encourage patients, all patients, to start the conversation early with their primary care doctors, ideally by age 25 to check their risk of developing breast cancer. So that way any patients who are high risk can be screened earlier, and we can just keep a closer eye to catch any of those problems as soon as possible.

 Now, what are some of the things that put women into that high risk category? So, family history of breast cancer, known genetic mutations like BRCA1 or BRCA2, and a history of chest radiation in their youth. So for these women, we recommend starting annual MRIs at age 25, and then we tailor when they should start their annual screening mammograms.

So I'll give a couple of examples. If a patient is high risk because of a first degree relative who had breast cancer, so a mother, daughter, or a sister we recommend, again, starting that MRI at 25, and then you should get your mammograms 10 years earlier than the age at which the relative was diagnosed. For example, if the mother was diagnosed at age 45, that patient should start their screening mammograms at 35. Another example, if a woman is high risk because of a known genetic mutation like BRCA, again, we recommend starting that MRI at 25, and then we recommend starting annual mammograms at age 30 with the caveat that if you've been getting that annual MRI, you could potentially push your mammogram to age 40. So I know it's a lot of information and a lot of different ages, but the bottom line is that talk to your doctor early about your risk assessment. If you are high risk, then start getting your MRIs at age 25 and then your doctor can help you figure out when you should start getting your screening mammograms.

Host: It seems like having a good conversation with your doctor, because every woman is different, would really go a long way to understanding what the process looks like for them. My next question to you is it does seem that every ailment has some type of misconception associated with it. So I'm wondering what are some common misconceptions you've heard from your patients about breast cancer?

Priyal Patel, MD: So one common misconception is if I don't feel a lump, I don't need a mammogram. But the reality is that mammograms are designed to find those cancers before you can feel them, when they're much smaller and they're much easier to treat. Another one I hear about is regarding radiation exposure. So people worry that mammograms expose them to a harmful radiation dose, but the dose is actually very low.

It's well below the FDA safety limits. So mammograms are very safe. And then another misconception is that patients think I don't need a mammogram. No one in my family has ever had breast cancer. In fact, about 75% of women who are diagnosed with breast cancer have had no family history at all. So family history is very important for us to know, but it is not the only factor.

Host: I'm sure that I'm not the first person to say that some people don't enjoy going to the doctor. In fact, they probably put off going to see the doctor because they find the experience really stressful. What advice do you give to people who find themselves in that place?

Priyal Patel, MD: I'll start off by saying that it is completely normal to feel nervous about getting a mammogram. A lot of patients worry about the discomfort or what the results might show, but we have these screening tools to find those cancers early when the treatment is most effective and often less aggressive.

 If your anxiety is still overwhelming, there are some things that can help. So you can always bring a friend or a family member to your appointment for support. You can schedule your exam at a familiar facility. You can let the technologist know that you're feeling nervous, and they're very good.

They're very skilled at what they do, so they can help you through this process. And then finally, just remind yourself that this is a quick test. It only takes a few minutes. It's once a year, and it can truly make a lifelong difference.

Host: That is excellent advice. Thank you so much, Dr. Patel.

Priyal Patel, MD: Thank you.

Host: Well, again, that's Dr. Priyal Patel. As we have been discussing early detection and prevention are key to fighting breast cancer before symptoms appear, to reduce your risk of advanced stages, so push past your fear and procrastination and schedule your mammogram today@mountcarmelhealth.com/mammogram.

I'm Venita Currie. Thanks so much for joining us.