Gabby Cinnamon (Host): Welcome back to the Well Within Reach podcast brought to you by Riverside HealthCare. I'm your host, Gabby Cinnamon, and today I'm very excited to be joined by Dr. Niketa Kataria, a Radiologist at Riverside, to talk about the recent updates to the breast cancer screening recommendations.

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Gabby Cinnamon (Host): Thank you for coming on the podcast today, Dr. Kataria.

Niketa Kataria, MD: Yes, of course.

Host: So can you tell us a little about yourself? This is your first episode with us.

Niketa Kataria, MD: Yes. So as Gabby said, my name is Dr. Niketa Kataria. I'm a Breast Radiologist at Riverside Hospital. I went to medical school in Milwaukee at the Medical College of Wisconsin, and then I moved to Seattle for my radiology residency at the University of Washington.

After that, I moved to Chicago to complete my breast imaging fellowship at Northwestern University. So, all in all, I've been training for over a decade.

Host: Wow, so you're just the person we need to be talking to today about these updated screening recommendations. So first off, let's, you know, start with the basics. Who should be screened for breast cancer?

Niketa Kataria, MD: So for the average risk population, the American College of Radiology and the Society of Breast Imaging recommends annual screening with mammography starting at age 40. In breast imaging, we stratify women into average risk, intermediate risk, and high risk. The high risk patients are usually with a greater than lifetime 20 percent risk of breast cancer, and then average risk is less than 15%.

Host: Yeah, there's a lot of different stuff out there and I think with, you know, as new things come out, people sometimes, which I understand, there's so much information, people get confused on when they should start screening, so that definitely clarifies it for us.

Niketa Kataria, MD: Everyone should start at age 40, and if you have certain risk factors, you might need to start screening earlier than that.

Host: Perfect. When would a patient want to consider screening for breast cancer sooner than age 40? You mentioned some additional risk factors. Can you kind of go more into that?

Niketa Kataria, MD: Yeah, so there's many risk factors for which women might consider screening prior to age 40. If a woman starts screening prior to age 40, they are generally considered higher than average risk.

And some of the examples of patients that may fall into that category would be women with genetic mutations such as BRCA1 and BRCA2, which are more well known, but there's lots of other genetic mutations associated with breast cancers. Patients with a history of chest wall radiation, patients with a personal history of breast cancer prior to the age of 40, a history of a prior high risk breast biopsy, women with dense breast tissue, and women with a calculated lifetime risk of breast cancer of greater than 20%, which is based primarily on their family history, and that calculation is actually done via a risk model.

Host: So, kind of going into that, there are some updated supplemental screening guidelines. Can you talk about those?

Niketa Kataria, MD: Yes, of course. So, the American College of Radiology, also known as the ACR, updated their guidelines in 2023, so last year, based on a review of multiple randomized control trials, observational studies, as well as U.S. screening data. According to the updated guidelines now, all women should undergo a breast cancer risk assessment at the age of 25. Such an assessment is particularly important in Black women, women of Ashkenazi Jewish descent, and other minority women, as these populations tend to have higher likelihood of genetic mutations associated with breast cancers.

A risk assessment is performed using a mathematical model like I mentioned, and that model takes into account a multitude of factors such as your current age, the age at which you had your first period. Your breast density, any family history of breast cancer, prior high risk biopsies, just to name a few.

Risk assessment is dynamic. It'll change over time based on new information in a patient's chart, such as breast biopsies or any new additional family history. At Riverside, we use the Tyrer-Cusick-8 model, which is very well studied and validated. There are many, many models out there, and they each have their own benefits and shortcomings.

 If a patient is deemed higher than average risk, which is greater than 20 percent risk of developing breast cancer over their lifetime, then we would recommend that they do annual screening mammography as well as a supplemental screening. And that supplemental screening, we would generally recommend with a breast MRI, and we would recommend that they start at age 30.

Niketa Kataria, MD: For most women, we recommend that the supplemental screening of choice be an MRI. Because it's been shown in many observational and modeling studies, a consistent shift towards earlier stage of disease, as well as fewer interval breast cancers. And then for those women who qualify for an MRI, but cannot go undergo an MRI for any reason, we also offer ultrasound screening.

Host: You have options, And I think, you know, we think 25, oh my gosh, that's so young. But you do hear, I mean, I can think of several people, influencers, even, you know, maybe people that don't know who these young people are getting breast cancer younger, these, you know, random cases here and there. But it can happen, and it's cropping up. So that's good that, you know, taking that, preemptive action to catch it early is good.

Niketa Kataria, MD: I do think, you know, in our current media, we are seeing a lot of young women, coming forward with their journeys with breast cancers and, you know, I think that does increase awareness for people. So it, I think people view breast cancer as something that affects, women in older generations but that's not always necessarily the case.

Host: Yeah, for sure. So you mentioned, I just wanna reiterate this because you guys always, you guys talk about this, which is very important. So you don't just need a supplemental screening like an MRI or, automated breast ultrasound. You also need mammography, correct?

Niketa Kataria, MD: Yes. Mammography is the gold standard in breast imaging and multiple society guidelines that recommend that you get a yearly mammogram.

Supplemental screening is in addition to a mammogram. So a mammogram every year saves lives.

Host: Yes, it does not, the supplemental screen does not replace mammography. We always just want to make that clear, because it's still, yeah, like you said, the gold standard. Now we're going to take a quick break to talk about primary care at Riverside. Riverside knows that health is your greatest asset, and keeping up with regular screenings plays a huge role in overall health and well being. Primary care is your starting point to better health. Don't have a primary care provider? Good news! Riverside has a team of primary care providers who are ready to partner with you on your health journey. Visit riversidehealthcare.org/primarycare to find a primary care provider today. Now back to our episode with Dr. Kataria.

 We are back. What is the risk assessment program that Riverside recently implemented? You touched on that earlier.

Niketa Kataria, MD: So, we recently implemented a program that automatically runs the Tyrer-Cusick 8 model, which is the mathematical model that I was talking about, that is run based on the patient provided data that we have in patient's EPIC charts, so every time a patient comes in for a breast imaging exam, the staff will ask if they have any updates to their history, particularly their personal history or their family history, and a score will be run at every visit.

And then that score might change over time, but that way they have a risk assessment every time.

Host: That's awesome. Why is it important to screen for breast cancer regularly?

Niketa Kataria, MD: So in the United States, one in eight women will develop breast cancer during their lifetime. And breast cancer is the second leading cause of cancer related deaths in women in the United States.

So this is not just a small subset of women. This affects a big population. And in multiple randomized controlled trials, as well as other studies that have been done, early detection via screening mammography decreases breast cancer related mortality, and mortality just means the number of deaths associated with breast cancer.

Host: Before we go, is there anything else you would like to add?

Niketa Kataria, MD: I would say that, know, women should really make their breast health a priority and advocate for their wellbeing. Many women are unaware of their increased risk for breast cancer, and by implementing the new guidelines and the risk assessment model, we really want women to gain a better understanding of their individual risk factors and to really empower them to make informed decisions about their health and if they need to be part of a supplemental screening program.

But, I would say that, you know, starting at age 40, every woman should be getting a screening mammogram every year.

Host: Awesome. Well, thank you so much. You did a great job, you know, talking about these changes. And like we say all the time, there's so much information out there. So, you know, kind of having these guidelines and then implementing this risk assessment tool is makes a huge difference for people. So thank you so much for coming on the podcast today.

Niketa Kataria, MD: Thank you for having me.

Host: And thank you listeners for tuning in to Well Within Reach brought to you by Riverside Healthcare. For more information about breast cancer screening at Riverside, visit riversidehealthcare.org. Also make sure to rate and leave a review for Well Within Reach on Apple, Spotify, or wherever you listen to the podcast.