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Taylor Leddin-McMaster (Host): Hello, listeners, and welcome back to the Well Within Reach podcast, brought to you by Riverside Healthcare. I'm your host, Taylor Leddin-McMaster. Joining me today is Allison Heil, Supervisor of Breast Imaging at Riverside Healthcare, who's here to talk about mammograms and the different testing options available at Riverside. Thank you for being here.

Allison Heil: Thanks, Taylor.

Host: Before we get into today's episode, we're going to take a quick break for a message about myChart.

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Host: And we're back. So first, Allison, can you briefly introduce yourself and your role in breast healthcare?

Allison Heil: Yeah. Hi, my name's Allison Heil. I have been at Riverside for about 20 years, working in the mammography department; different roles as a technologist and as a navigator, and now the supervisor. So, I do oversee the screening program, the diagnostic program and then if patients need to go on further for any follow-up testing, biopsy, onto surgery.

Host: Talking about mammograms and breast cancer, why is early detection so important in the fight against breast cancer?

Allison Heil: So, a mammogram can detect a breast cancer at a much smaller stage than, say if a patient palpated a lump in their breast themselves. The point of early detection is to find it when it's at its smallest size so that it's most treatable. Oftentimes, when we find it as an early stage cancer or stage 0, something called DCIS, those are just like microscopic calcifications that are only seen on a mammogram. The radiologist uses special tools when they're interpreting the image. So, they'll use a magnifying glass, they'll find these microscopic calcifications, and we can biopsy those. That's the earliest stage of breast cancer.

Now, those calcifications can change and grow year to year. And it can be up to five, ten years before they would turn into a palpable lump. So, when a patient finds it that soon, it's treatable, it can be removed with surgery, it often eliminates the need for certain oncology treatments. The best outcome for the breast surgically. So, it can prevent you from having to have a mastectomy versus a lumpectomy. So again, there's so many factors that go into treating a breast cancer, surgical oncology. But if you find it at its earliest stage, oftentimes you have the minimal treatment, with those end treatment plans.

Host: I knew that obviously it could detect things earlier, but I didn't know, like, the calcification part of it and how all that works. So, that's really interesting.

Allison Heil: Yeah. And lots of women think they don't want a mammogram for fear of the discomfort that it is, or just the anxiety of the test results. Those calcifications, the earliest stage is only seen on a mammogram. You cannot see those on an ultrasound. You cannot see those on an MRI. So, mammography is the best screening tool out there for early stage detection.

Host: Yeah, it sounds like it. So, speaking of, what exactly is a mammogram and how does it work?

Allison Heil: So, a mammogram is about a 15-minute appointment. It's an outpatient appointment. It's done in a private room with a female technologist at Riverside. And it is essentially an x-ray of the breast. We always do both breasts for comparison. The breast tissue should be symmetric. So when the radiologist is interpreting the images, they should see symmetric tissue, you know, your right side versus your left side.

To do the exam itself, the x-ray, we do have to do compression over the breast tissue, just to hold the breast in place. Breast tissue comes in different sizes and shapes. And in order to see the most effectively, to see through the different tissue types, we do have to provide compression on the breast. We always let the patient know that they are in charge. They need to speak up if the exam is uncomfortable. We don't want this to be an exam that they don't want to come back to. So, speak up. If the compression's too uncomfortable, let your technologist know. Maybe they can shift your arm, shift the height of the machine to make it more comfortable. But usually, two to three images of each breast. And then, we let you go on your way.

Host: Gotcha.

Allison Heil: Fifteen minutes.

Host: Yeah. That's not too bad.

Allison Heil: It's not.

Host: There's several methods of mammography. What types does Riverside offer?

Allison Heil: So, 3D mammography is the standard, and that is what we provide to all of our patients. Once in a while, we'll have a patient who cannot tolerate that. And the reason being is it is a little bit longer of an exposure time. So if a patient is unsteady on their feet, if they are maybe needed to be seated for the exam or have limitations to their shoulders and range of motion, we can do what's called a 2D mammogram. And it is still an excellent exam. It gets good pictures of the breast tissue, but the 3D does take tomographic slices. So, it actually gets anywhere-- it depends on the thickness of the breast-- but it can get up to about maybe 30 slices of tissue for the radiologist to visualize. So, we do offer 2D and 3D, and it really is just dependent on patient tolerance. But I would say 98% of patients can do the 3D.

Host: Okay. Okay. At what age should someone start getting mammograms and how often should they be doing this?

Allison Heil: So, the recommendations that we are accredited by at our facilities are the American College of Radiology, we follow their guidelines, and as well as the American Cancer Society will say an annual mammogram starting at age 40. So, every year, once a year. From your first mammogram, of course, we talked about being a little bit nervous about the exam and the comfort of the exam a little bit ago. I would say that's typical. But once you're in the room, you see how quick it is. We offer you a warm gown. We try to keep the exam comfortable as possible for you. Most of the time, generally when I do a first time patient, they are done, they're getting dressed, and they look at me and they say, "Wow, that was not that bad." And I'm like, "Yep, I'll see you next year." So, you'll be pleasantly surprised of how simple the procedure it is.

Host: Yeah. And it sounds like you're good at your job if you're--

Allison Heil: Well, thanks. We all are. Yeah.

Host: Well, great. Before we continue our conversation, we're going to talk about the importance of primary care.

At Riverside Healthcare, your primary care provider is dedicated to being in your corner. Helping you and your family stay healthy and thrive, find the right primary care provider for you at riversidehealthcare.org/primarycare. From annual screenings to well checks and everything in between, having a primary care provider that you can trust makes all the difference.

And we're back with our conversation on mammography. Allison, how do mammography guidelines differ for individuals with dense breast tissue?

Allison Heil: So, dense breast tissue has kind of come in the media a little bit the last few years. There are now guidelines set by this state, and we are now required to let patients know of their breast density at the time of mammogram. So when a patient gets their mammo results, it will say in the report and then also the lay letter that they get the breast density that they have.

The breast density is categorized in four different categories. It can be letters A, B, C, or D, or it can actually be written out. It can be fatty fibroglandular, heterogeneously dense, moderately dense, or extremely dense. Generally, as we age, our breast density changes. We have babies. Our breasts change through those pregnancies. We go through menopause. Our hormones decrease in our bodies. Maybe we're taking hormones for supplements through menopause. All of those factors affect your breast density.

Dense breast tissue can be a little bit trickier for the radiologist to interpret. Dense means like thick, kind of lumpy. You're naturally lumpy. Those women can get supplemental screenings, if they have that C or D, moderately or extremely dense. When you get your mammo results and you see that you're a C or a D, it is important for you to know-- I think you should be responsible and kind of take ownership to knowing your breast density. Get your annual mammo. Supplemental screenings can include an MRI, a breast screening MRI or an ABUS, A-B-U-S. It stands for automated breast ultrasound. Those are two additional screenings that can be done for women with dense breast tissue. They do not replace the mammogram. Again, mammography is the standard screening of choice. But those two additional tests can help women with dense tissue. It can give the radiologist more information. It can help them see through that dense tissue better. And also, if you're a high risk patient-- I know we're going to talk about that in a minute-- but if you're a high risk patient, those additional screenings can be beneficial as well.

Host: What is the risk assessment tool and how does it relate to screenings for patients?

Allison Heil: So at Riverside, we have a software that, when you have your mammogram, we take a history from the patient. We ask questions like: How old were you when you had your first period? How many pregnancies have you had? Have you had breast surgery? Do you have a family history of breast cancer? Those questions go into this software, and the answers, and then it populates a risk score for us. The guidelines state that anyone over 20% is considered high risk.

So, our radiologists do get a risk score at the time of your mammogram, and they see that score, then they will warrant then additional imaging with the MRI, with the ABUS. Generally, those patients know that they're high risk. Maybe they've had a family member with breast cancer. They are familiar with their breast density. Maybe they've had a previous biopsy in the past that showed like atypical cells in the pathology or something called a papilloma. There's different high risk biopsy results. So, that score is important for patients that are high risk to know and, again, if they need supplemental screening.

Host: Okay. You answered the question I had next about average risk versus high risk and what that risk score looks like. Is there anything else people should be aware of in terms of-- we've talked a bit before the podcast about those genetic concerns. What do you often hear when it comes to that?

Allison Heil: So, I hear women come in all the time and they'll say, "I don't have any family history. My doctor's making me get this. I don't know why I am doing this." Of all breast cancers diagnosed, only 10% are family history-related.

Host: Wow.

Allison Heil: So, the other 90% of women out there who don't have family history, those are the women that are getting diagnosed. It's your neighbor or your coworker who is kind of floored. They got their mammogram and then they have this biopsy and now they're at this little detour in life. So, just because you're not high risk doesn't mean that you shouldn't get screened. Really, it's more important that you are getting screened, because I think the women that know that they're high risk are getting their tests, they're getting their mammogram, they're getting what's necessary.

Now, as far as gene testing, generally those patients that know if they're BRCA positive or if their family member was BRCA positive, that all comes from a cancer diagnosis. So if you were diagnosed with breast cancer or if your sister or a family member was, most likely they're being treated by Oncology and they're getting that genetic testing, the average person does not get genetic testing. But if you do find that you are BRCA positive and still the standard screening is a screening mammogram annually with that high risk MRI or ABUS to be done in addition to the mammogram.

Host: Can you tell us about Riverside's Breast Health program?

Allison Heil: So, we have screening mammography available at four campuses, Watseka, Coal City, Bourbonnais and Kankakee. When a patient needs to come back for additional imaging or follow up, we do bring them back to our Kankakee location. The reason for that is that is where our breast ultrasound department is located. That's where our biopsy equipment's located. And then also, our radiologist is there. So, when a patient does have to return for additional imaging, a radioligist does review the images, and they will give the patient the result the same day. We find that eases a lot of anxiety from the patient. And majority of the time, it's good news. So, we don't want you waiting for a myChart result for an abnormal result. But, yeah, we have four screening locations, and then the Kankakee site is where we'll do all of our biopsy imaging.

Host: Okay, great. Thank you for mentioning those four locations. I think that's important for people to know that it is accessible. Is there anything else on this subject that you would like listeners to know?

Allison Heil: For everyone just to be their own advocate. Know when their test is due, know their breast density. Educate yourself about the supplemental screenings. We've got posters in our department. We've got flyers, handouts in our department. So, you can always ask your technologist, you know, like, "What's my breast density or what's this test I'm hearing about?" I think that patients, women in general, we're moms, we're working, we're wives, we're caregivers, we're busy, and we sometimes put ourselves last on the priority list.

So, definitely, get your screenings. Not just mammography, but you know, all your screenings that are recommended. But again, finding breast cancer at the earliest stage is ultimately what mammography screening's for. And if it can eliminate a more aggressive surgery or a more aggressive oncology treatment plan, that's what you want. So, definitely put yourself as a priority and get your screening test.

Host: Yeah, I couldn't agree more. As we were talking about several days ago, screenings are preventative. Prevention is self-care. So, it's a form of self-care. It's important to stay ahead of that. So, definitely put yourself first and get those screenings.

Allison Heil: Yep.

Host: Well, thank you so much for joining us today. I appreciate it. Appreciate your insight. And thank you listeners for tuning into Well Within Reach. Again, I'm your host, Taylor Leddin-McMaster. Be sure to like and subscribe to Well Within Reach on Apple, Spotify, or wherever you get your podcasts. To learn more about mammography and imaging at Riverside Healthcare, go to myrhc.net/imagingservices.