Traci Manis, BSN, RN (Host): Today, we're talking about why routine mammograms are so life-saving and what a mammogram can find before you can feel it. I'm Traci Manis. And on this episode of Care Empowered, we're talking about something that can quite literally save lives, breast cancer screening. Joining me today are Dr. Carl Van Tassel with Northline Radiology, and Mindy Coates, a supervisor with Radiology Operations Imaging Administration. Thank you both for joining us today.

Carl Van Tasell, MD: You're welcome.

Host: What drew you to this work?

Mindy Coates, RT, RDMS, RVT: So actually, I am a mammo tech, and I'm an ultrasound tech. And when I got out of x-ray school, they taught me mammography, and I've been working in this field for the last, what, 30 years. I'm also, like I said, an ultrasound tech, and I did that for a very long time. And then, as I got older, I was given the opportunity to become a supervisor over the two areas that I've worked in. So, it worked out really well.

Host: To utilize your expertise for other people, that's fantastic.

Mindy Coates, RT, RDMS, RVT: Yes.

Host: How about you? What made you choose mammography?

Carl Van Tasell, MD: Well, I'm a general radiologist. And what drew me to radiology when I was in medical school was the technology. As I got into practice, I realized that reading X-rays in a dark room wasn't all that fulfilling. I enjoy the situations when I get to talk to patients about their studies, whether it's good news or bad. I think, you know, leading them through their options and what's going to happen to them next is really fulfilling.

Host: Why is regular screening so important?

Carl Van Tasell, MD: Well, research has shown us that, you know, if you do it yearly, a breast cancer that arrives throughout the year is, in most cases, not going to have the chance to grow and be catastrophic if you do regular screening.

Host: We often hear that finding cancer early can make a big difference. What does early detection actually mean?

Carl Van Tasell, MD: It means discovering a cancer you don't know about in its early stages while it's still new, and it has not had a chance to grow to a large tumor, spread to lymph nodes, and spread to other organs where, you know, it can be a fatal situation. So, regular screening gives the patient the best chance of finding a cancer in a new stage, and it can be life-saving.

Host: So. What would make someone need to see their doctor between regular checkups if they find something?

Carl Van Tasell, MD: Right. We talk to patients about this all the time when we say goodbye to them. You know, if we have a schedule to see them in six months, I say, "Now, if anything changes, all bets are off," and that means if you feel a new lump, whether it be by accident or by your normal self-exam, any changes to the nipple, like retraction, change in color, discharge from the nipple is a big one, particularly discharge that is bloody, brown-colored, or foul-smelling, or breast pain, particularly localized pain that you can point with one finger.

Host: That's great information to know. Okay, Mindy, there are all kinds of medical imaging. We've got X-rays and CTs and MRIs. Tell me what mammogram is exactly.

Mindy Coates, RT, RDMS, RVT: It's a specialized X-ray that we use to look at breast tissue. And we look for cancers. We look just to make sure there haven't been any changes. Ideally, the breast should be symmetrical from one side to the next, and those are just things that we look for with mammography.

Host: There's been a lot of conversation about 2D mammograms versus 3D mammograms. What is a 3D mammogram, and what does that mean for patients?

Carl Van Tasell, MD: The 3D mammograms, we've been doing—I don't know the exact figures—but I think for about 15 years now. They came around the end of my training. And it's just like it sounds, a three-dimensional view. So, let's start with the old traditional mammograms. They're j- like Mindy said at the beginning, they're just X-rays of the breast, so one image.

With 3D mammography, or also called tomography, it's more like a CAT scan or an MRI of the breast where you scroll through. And it's like looking inside the breast and seeing the internal tissue. And what that helps us do is things that in the old two-dimensional system that may look like a shadow or something where wwe have a question mark, we need to investigate that. Now, in the 3D model, that question mark goes away most of the time, and now we know this is a mass or this is just an area of dense tissue. So, it really provides a much more in-depth look of what's going on inside the breast tissue and allows us to be more confident of what we see on a screening mammogram.

Host: So, is a 2D mammogram obsolete? Do we do them anymore?

Carl Van Tasell, MD: They're still done mostly in rural areas. But yeah, I think the simple answer is that they are obsolete.

Host: So for a woman who has dense breast tissue, they get a mammogram, and then the doctor recommends that they also get an ultrasound. Explain to me why the mammogram is necessary if the ultrasound is also being done.

Carl Van Tasell, MD: Sure. Well, they each have different strengths. One of the key strengths of mammogram is picking up small calcifications in the breast, which can be the very first sign of a breast cancer that hasn't even formed a small mass yet. It's still on the cellular level, and that's our best chance at detecting it early and finding treatable cancers.

Ultrasound is better for finding soft tissue masses or cysts, you know, things of that nature. So, they work hand-in-hand. An ultrasound without a mammogram is not a complete examination in my opinion. If you were going to do one, I would far prefer the mammogram. But for women that have dense breasts, both are a really complete screening examination.

Host: What about women who have a family history of breast cancer? When should someone start thinking about whether they're at high risk, and when should they start getting annual breast exams?

Carl Van Tasell, MD: We assess a risk score to patients once they've started getting mammograms, and that's based on their family history, the density of their breasts, and other factors. That score is arbitrary. But when you get up into the teens or the 20s, then you're into the high-risk category, which means, you know, you should never miss your annual screening mammogram, which is true for everyone, but you also ought to think about augmenting with the automated breast ultrasound. For some patients who are extremely high risk, we cut the year in half. And at the six-month, they also do breast MRIs, which are highly, highly sensitive studies to detect abnormal going on in the breast. So, there's lots of different options. But the moral of the story is, you know, we need to keep an extra eye on these patients, and often their screening mammograms are supplemented with other studies.

The other question was when should they start getting mammogramwell, at the beginning of my career and in my training, women typically started at 45 or 50. That now has gone to 35 or 40. The reasons are because of the 3D tomography, the mammograms are so good at detecting small cancers that would've been undetectable in the old system. Also, the equipment has gotten much better, and it's a much smaller dose of radiation than it used to be in the past.

Host: That should alleviate some fears for women avoid mamography out of fear for radiation or what the test does to their body as opposed to what it would detect that could save them.

Carl Van Tasell, MD: Absolutely. I think it's by far a net gain.

Host: Wonderful. So, what are some of the more common reasons you hear from patients about why they postpone a regular mammogram?

Mindy Coates, RT, RDMS, RVT: Well, probably the biggest one is they say it's too painful. And I will tell you, over the years, mammography, I feel like, has gotten a lot better. Back in the day, when I very first started doing mammograms, they used to say compress until the patient would wince. Well, some women, that's a lot of compression. That's not the case anymore. Now, they say just compress until the tissue feels taut. So after we compress the breasts, a lot of times the technologist will just kind of poke on the side of the breast just to make sure it feels taut.

Host: Okay.

Mindy Coates, RT, RDMS, RVT: But the biggest thing is, you know, the patients should just talk to their technologist that's doing the exam, because I think communication's the key. We don't want to hurt anybody ever. We don't want them to feel like it's too uncomfortable, but we do need adequate compression to be able to see through the breast tissue.

Host: And it's a very vulnerable position to be in, so that relationship between the technologist and the patient is really important. What are some things that you do to build that trust and to make the patient more comfortable in the room?

Mindy Coates, RT, RDMS, RVT: A lot of our patients come back year after year.

Host: Yeah.

Mindy Coates, RT, RDMS, RVT: So, they really do kind of build a rapport with the technologist. In fact, a lot of them will ask for technologists by name when they come in. And I think that's helpful. I think then they form a trust, and they know, you know, "This person's going to take care of me. I can talk to this person if I'm having an issue." And some of the stories that they'll tell us, you know, it's nice just that you do build a relationship with these people.

Host: Yeah. That's important. That's important. What does NKC Health do to maximize that relationship with patients?

Mindy Coates, RT, RDMS, RVT: We allow time slots where our technologists can take their time, and they can talk to people. I don't feel like that we rush people through. That way, they get a chance to know these people and the patients will confide in them. You know, if they're having issues where they may not feel comfortable just talking to somebody, they feel like they're being rushed.

Host: Well, and for prevention screenings, that's really important, that patient satisfaction, because they will then recommend it to friends or tell friends that it's not as scary as you think it is, and they can help them overcome that fear and perhaps save a friend's life as well.

Mindy Coates, RT, RDMS, RVT: I agree with you 100%, yeah.

Host: Very good. So for the woman who has never had a mammogram before, can you walk us through what she can expect from the moment she walks in the door to the office and when she walks out?

Carl Van Tasell, MD: Sure. For a woman who's never had a mammogram before, let's first assume it's a screening mammogram. So, they're either 35 or 40 years of age and have decided to get started. It's a quick process. After the appointment's made, they'll get a text message from the hospital allowing them to pre-register and give all their information. If they haven't done that, and that's okay. They'll get an iPad in the waiting room where they can enter their information.

I think the typical wait in the waiting room is five to 10 minutes. Then, a technologist will come get them, introduce themselves, show them to a private dressing room, which is right next door to the mammogram suite, and they'll get undressed. The mammogram is typically four sets of images, two for each breast for a screening mammogram. So, you'll get in that compression that Mindy just talked about four different times. And then, the images will be acquired. The technologist reviews them, makes sure every corner has been captured and all the information needed. And then, they're allowed to get dressed and they go home. So, it's typically, you know, a less than 30-minute endeavor.

Host: Okay. Not so scary.

Carl Van Tasell, MD: No, it shouldn't be.

Host: Yeah.

Mindy Coates, RT, RDMS, RVT: So, it will also go on the patient portal. So as soon as the radiologist reads the exam and it's signed, it takes about seven minutes. It's very quick. It can go to the patient portal and then to the doctor, the referring physician, if they have one, and then we also mail letters to our patients. We have to mail letters within 30 days, but honestly, they usually get mailed out the very next day.

Host: For the woman listening who knows that she is overdue for a mammogram but keeps finding reasons to put it off, what would you say directly to her?

Mindy Coates, RT, RDMS, RVT: You're important. Your health's important. Make yourself a priority and come in and do it. It doesn't take that long, and just put it behind you so you don't have to worry about it anymore.

Host: Yeah. So, do you have tips that you give them when they schedule their mammograms to remember to do it the next year, like every year on the birthday, I've heard, or an anniversary of something?

Mindy Coates, RT, RDMS, RVT: We have some women that come in with buddies.

Host: Oh.

Mindy Coates, RT, RDMS, RVT: You know? Yeah. So, they hold each other accountable, and that way they can't not come in.

Host: That's a great idea.

Mindy Coates, RT, RDMS, RVT: We have a lot of people that do that.

Host: Okay. Yeah. That's a great idea. So now, we are going to do speed round. Are you ready? Mammogram in the morning or the afternoon?

Carl Van Tasell, MD: Morniing is the easy answer. I think we're all at our best in the morning. You're less likely to be delayed or have the office be behind. But another key reason is if you get your mammogram done in the morning or early afternoon, your results will be on the patient portal that very day.

Host: Yeah. So, what's one thing you should never do before a mammogram?

Carl Van Tasell, MD: Put on deodorant. Deodorant looks just like calcifications on a mammogram. So if you wear deodorant, your radiologist may get upset over nothing, and you may find yourself in a situation where you're talking about a biopsy you don't need.

Host: That's interesting. I always thought that you didn't wear deodorant because then it would get on the machine.

Carl Van Tasell, MD: No, it's all about the image.

Host: Okay. Yeah. Okay, that's interesting. One word you'd use to describe your radiology team.

Carl Van Tasell, MD: I don't think it could really be done in one word, but if I had to pick one, it would be professional. And what I mean when I say that is, well, number one, they're the best. They come ready to go with a great attitude and the patient in mind every single day without exception. And they're just a pleasure to work with. But what professional doesn't really cover is how loving and how caring they are to the patients, to each other, to me. It's just a true pleasure to work there.

Host: Sounds like a great culture.

Carl Van Tasell, MD: Absolutely. I love it.

Host: Mindy, what about you? I want to know what makes you smile at work.

Mindy Coates, RT, RDMS, RVT: I enjoy what I do. I feel like we make a difference. I am very passionate about this job. I've done it for many years in one way or another. And it's not just me, it's the whole team. I feel like we all together are very passionate and we want to always do what's best for the patients.

Host: It's satisfying when our work is bigger than ourselves. What you do is really important.

Mindy Coates, RT, RDMS, RVT: Yes.

Host: Thank you both for joining me today and for sharing your expertise with our community. It's so important. You're welcome.

Carl Van Tasell, MD: Thank you.

Host: Thank you. If there's one thing we hope you take away from today's episode, it's that taking care of your health doesn't always mean waiting until something feels wrong. Sometimes it means making the appointment, keeping up with your recommended screenings, and giving yourself the best opportunity to catch a problem early. Thank you for listening to this empowering conversation. I'm Traci Manis. And we'll see you next time.