Amanda Wilde (Host): Meaningful Medicine is a Novant Health Podcast bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. Today we're speaking with General Surgeon, Dr. Breanna Durbin, to explore a topic that can actually be a bit scary; what happens after a mammogram. Dr. Durbin, welcome to the podcast.

Dr. Breanna Durbin: Thank you. Thank you for having me.

Host: It's a pleasure. Let's start off with the report the patient sees after the mammogram. For someone who has never had a mammogram, what kind of information would they expect to see in this report?

Dr. Breanna Durbin: Sure. So, radiologists read mammograms and they will typically make a comment on any sort of known clinical history. They will make an assessment about the density of the breast tissue, and then comment on if there are any areas of asymmetry, any calcifications that are seen, masses or any other sort of architectural distortion.

At the end, they'll normally make a final impression, based on a standardized categorization system called the BI-RADS. And that typically will come with some further management guideline down the line.

Host: Now if patients are signed up to MyChart, as so many of us are, they may receive an update as soon as the report is in. So let's say there's a need for further exploration, why may someone need an ultrasound?

Dr. Breanna Durbin: Sure. Not every mammogram from the beginning shows everything that may need to be seen. So sometimes the radiologist just needs a more detailed view of something or a zoomed in view of something or a different area visualized for them be able to make a final impression and guideline.

Host: It can be scary to get a callback after a mammogram that further diagnostics are needed. But not everyone is going to experience the worst case scenario. Right.

Dr. Breanna Durbin: Correct. Yes. So, sometimes just having a zoomed in view with a more detailed mammogram or an ultrasound even can help make the determination that something is less concerning.

Host: Now post ultrasound or mammogram, how do you determine if someone needs a biopsy, which might be the next step?

Dr. Breanna Durbin: Sure. So there are definitely certain findings that are more concerning for cancer that is what we're looking for. Based on that BI-RADS assessment that the radiologist makes, helps us determine whether the findings are suspicious and if a biopsy is needed. Really a biopsy is the only way for us to get tissue diagnosis to prove that it's a cancer or not.

Host: To follow that through, are there national estimates for what percent of breast biopsies are positive for cancer?

Dr. Breanna Durbin: There are. So in patients who have a screening mammogram, only about 25 to 30% of biopsies are positive for cancer. So that really means that the majority, 70 to 75% are not cancer, and can be followed.

Host: If a biopsy is negative, what does that mean for future mammograms? Do you have to monitor that area more closely?

Dr. Breanna Durbin: Typically we do. When we perform the biopsy for tissue, we also leave a little clip marker that's about the size of a grain of rice in that area so that we can find it again if we need to. We typically, will do some short, short term follow up imaging in about six months to image that area again and make sure that there's no significant change.

And then after that, we return to normal screening guidelines.

Host: If the biopsy does confirm breast cancer, when is someone eligible for a lumpectomy? And when do you consider mastectomy?

Dr. Breanna Durbin: When we first diagnose cancer with tissue, we then stage the cancer and that depends on several factors; size, whether there's any involvement in the lymph nodes or any other spread to other parts of the body. In general for smaller sized cancers and lower stages, that's when we start to consider lumpectomy. Also for patients who wish for breast conservation. Mastectomy becomes an option in higher stage tumors, larger tumor to breast ratios and if patients don't necessarily want breast conservation and, would want the reassurance that all of the breast tissue is gone.

Host: This all starts with a mammogram, so they're obviously pretty important. I want to ask, what are the recommendations for who needs a screening mammogram?

Dr. Breanna Durbin: Yes. So this is for average risk patients that don't have any family history of breast cancer or anything like that. But in general, you start having a conversation with your provider at age 40, about annual screening mammograms.

Host: I want to ask a little more about you, but before I do, is there anything we didn't touch on or any common questions you get that you want to address that I didn't ask?

Dr. Breanna Durbin: In general, I would just empower patients to bring their concerns to their provider. If a patient's doing a personal breast exam and find something, you know, concerning, you don't have to wait for your screening mammogram. That's something that can be brought up and definitely should be worked up. If it does come to a point where someone is having, or needs to have a surgery for a diagnosis of breast cancer, it can often feel isolating, but there are a lot of resources for patients. Talk to your provider and I would encourage patients to also talk to family and friends because it's not something that's often talked about, but there are probably more people than you would think that have had someone they know go through this.

Host: Yes. I can vouch for that. Before we close today, I just want to ask how general surgery became a passion of yours? What drew you into that specialty?

Dr. Breanna Durbin: I love what I do with general surgery. I always knew that I wanted to be a doctor, and to help people. But during my training, I really liked the aspect of being able to work with my hands and diagnose and fix a problem. It really is something that you know, you train for, and master the craft every day.

My practice, has a lot of variety to it in general surgery, so no day really looks the same. I do surgery for breast disease, thyroid, colon, gallbladder, anorectal, hernias. So it really is very broad and always interesting.

Host: Yes. And as we know with technology and things, everything's evolving and always changing. So a lot to stay on top of.

Dr. Breanna Durbin: Yes.

Host: Dr. Breanna Durbin, thank you for joining us today.

Dr. Breanna Durbin: Thank you so much for having me.

Host: Dr. Breanna Durbin is a general surgeon at Novant Health. For more information, visit novanthealth.org/services/breasthealth. To find a physician, visit novanthealth.org. For more health and wellness information from our experts, visit healthyheadlines.org. Meaningful Medicine is a Novant Health Podcast.