Maggie McKay (Host): Welcome to the Health Podcast from Pullman Regional Hospital. I'm your host, Maggie McKay. Joining us today is Dr. Nancy Panko, general surgeon and Medical Director of Pullman Surgery and Gastroenterology, to discuss breast cancer awareness and prevention. Thank you so much for being here today to talk about this very important topic that affects so many people.

Nancy Panko, MD: Yes. Thank you for having me, Maggie.

Host: Of course. Let's just dive right in with who is the most likely to get breast cancer?

Nancy Panko, MD: Sure. So, the most likely population is women, which makes sense. Certainly, we see breast cancer rates increase as women get older. After menopause is typically when that increase can occur. We do see breast cancer in men. So, it's something to be aware of, but it's a very small proportion of men who will have breast cancer.

Host: Are there any external factors that could increase or decrease the risk of getting breast cancer?

Nancy Panko, MD: Yes. So when we talk about breast cancer risk, we think about modifiable and unmodifiable risk factors. And so, some of the things that can increase the risk of breast cancer are alcohol intake, exercise, obesity. These things are things that we can potentially modify that can increase or decrease the risk of breast cancer.

Host: You mentioned menopause, but how does menstrual and reproductive history affect breast cancer risks?

Nancy Panko, MD: Yes. So, many breast cancers are influenced by hormones, by estrogen, progesterone, and the length of time that a woman is menstruating. And what I mean by that is the time that she starts menstruation to the time that regular cycles end, which is what we call menopause, is a period of time where those hormones are at the highest levels. And so, one of the things that we take into account when we're predicting breast cancer risk is when women started having regular menstrual cycles and when they stop. In terms of reproductive history, we know that having pregnancies before the age of 30 also reduces the risk of breast cancer.

Host: Well, is there anything I can do to know if I'm at risk of having breast cancer?

Nancy Panko, MD: Yes. So, there are a lot of predictive models out there that look at breast cancer risk. The one that I most commonly use here in my office is something called the Gail Model. And that's something that women can find online. You can plug in your information. Some of the things that the Gail Model takes into consideration are the age when you started having regular menstrual cycles, if you are menopausal, when you went through menopause. It asks about family history, personal history of breast and ovarian cancer. It also asks about when, if you had any pregnancies, how old you were and if you breastfed. And so, these different models can give us a pretty good idea of how high risk somebody is and can also help us guide when we start screening for breast cancer.

Host: Can anyone go online and take that test or survey?

Nancy Panko, MD: Yes. Yes. They can.

Host: Where do they go again?

Nancy Panko, MD: So if you plug in Gail Model for breast cancer risk, you should be able to find a calculator to predict your risk.

Host: Okay. Is that G-A-L-E?

Nancy Panko, MD: G-A-I-L.

Host: Great. Okay. Oh, that's good to know. I've never heard of that. Dr. Panko, who needs a mammogram? And what other options are there for detecting breast cancer?

Nancy Panko, MD: So, we typically start doing screening mammograms at age 40. There are some different guidelines in terms of how frequently those are needed. The American Cancer Society recommends doing annual mammograms for women over the age of 40, and then typically stopping around the age of 74.

There are other options besides mammogram. Mammogram is generally our best test for screening for breast cancer. There are some women who can have very dense breast tissue, and this is something that the radiologist will comment on when you have your mammogram. If that is a concern based on your imaging, then sometimes MRI can be a better test for screening compared to mammogram. And then, finally, women who are at high risk for breast cancer sometimes have better screening with MRI as opposed to mammogram.

Host: Just yesterday, my friend, she went for her mammogram and she said, "Have you ever heard of a 3D mammogram?" Is that new?

Nancy Panko, MD: The 3D mammogram has been around for some time. It's just another way for us to get better views of the breast. And then, we also use it, for example, when we've diagnosed a breast cancer, to better be able to visualize the tumor.

Host: Well, what surgeries or procedures are needed after a diagnosis?

Nancy Panko, MD: Typically, when a woman is diagnosed with breast cancer, this is usually based on a mammogram, followed by an image-guided biopsy. And then, usually, the first stop is the surgeon depending on the size of the tumor. If this is a small tumor, oftentimes, we do catch them when they're quite small because we do screening mammograms.

Then, the discussion that I have with my patients is the option of what we call breast conservation therapy. This is also called a lumpectomy if you've heard of that. And so, what this entails is going in using radiologic guidance to identify the tumor and excise the tumor.

The other thing that we typically do at the time of that surgery is we also sample the lymph nodes to see if there's been any spread. And the nice thing about breast conservation therapy or lumpectomy is that it's a much smaller surgery than a mastectomy, which is the surgery that we do when we remove the entire breast.

Host: So, let's talk about prevention. What preventative surgeries or procedures are available and are these available here at the hospital?

Nancy Panko, MD: So, the patients that I see most often and asking about preventative surgery are patients that are positive for one of the breast cancer genes. So, the two best studied, best identified breast cancer genes are the BRCA1 and BRCA2 genes, and patients who are positive for those genes-- and we determine that through genetic testing-- are much more likely to develop breast cancer. And those patients are appropriate to consider for bilateral preventative mastectomy.

This is something that we do here at Pullman Regional Hospital. Some patients will want reconstruction after bilateral mastectomy, and this is something that I need to send them to a plastic surgeon for. But in my patients who want a mastectomy and want to be done with it, that's something that we absolutely offer here at the hospital.

Host: In closing, is there anything else that you would like to add that you would like patients to know?

Nancy Panko, MD: So, I'm just happy that we are talking about breast cancer more and more. Here we are in October, Breast Cancer Awareness Month, and I think the more that it is in our minds, the better we will be at catching it early and being able to provide treatment for people. I always tell my patients that I see here in the hospital that breast cancer is very treatable. We have very personalized therapy for it these days, and we're lucky to be in an area where we have good surgeons, we have good oncologists, we have good radiation-oncologists who can help us treat this disease and get people back to their normal lives.

Host: That's so encouraging and good to know. And also, this whole discussion has been very informative. Thank you so much for sharing your expertise and for being here.

Nancy Panko, MD: Absolutely. Thank you again.

Host: Again, that's Dr. Nancy Panko. Schedule your annual mammogram or talk to your primary care provider about your risk factors. Learn more about this subject, providers, and services at Pullman Regional Hospital online at pullmanregional.org. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to The Health Podcast.