Scott Webb (Host): Though breast cancer is not as common as it may seem, it is understandably on the minds of many women, but most women who limit their risk factors, live a healthy lifestyle, and get screening mammograms can either avoid breast cancer or limit the effects that breast cancer will have on their lives. And joining me today for part one of a two-part series on the importance of screening mammograms and early detection is Dr. Marina Feldman. She's a board-certified radiologist with specialty fellowship training in breast imaging.

This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. Doctor, it's so nice to have you here today. We're going to do two parts, essentially. Part one, this first part, we're going to talk about the prevalence of breast cancer, and ways to limit risk, and the importance of being screened, and all of that. And then, we'll come back in part two and have some more questions for you. For part one today, what's the prevalence of breast cancer and who's at the highest risk?

Dr. Marina Feldman: Hi, thanks for having me. So, about one in eight women in the United States will develop breast cancer in her lifetime. That's the prevalence, one in eight. So, it's really important to have regular screenings because early detection can help save lives. One in eight women, that's 12% of all women we know, screening absolutely saves lives. Cancer deaths rates have declined 40% between 1990 and 2020. And the progress is in large part attributed to early detection, what we know as mammography. However, despite the presence of this, breast cancer is still second leading cause of cancer death. in women in the United States. That's how prevalent it is to your question about prevalence, and that's why it's so important to have screenings.

Host: Yeah, it is so important and that's one of the things we're going to emphasize here in this two-part series we're doing. And when we think about the ways in which a woman can limit her risk of developing breast cancer. You mentioned screening mammography, all of that. So, let's go through that. What is it exactly and why is it so important?

Dr. Marina Feldman: Number one way that you can limit your risk of something that spontaneously can occur in your body is just healthy lifestyle. So, these are all things we know. Eating healthy, being active, limiting alcohol intake, not smoking and, of course, doing regular maintenance the same way you do maintenance on the car, do regular maintenance on yourself, get your physicals, get your screenings, all of that. So, if we break that down a little bit, healthy lifestyle, so eating healthy. Lots of foods with antioxidants. We all know about green and red or leafy vegetables, right? Like red peppers and blueberries have a lot of antioxidants, and antioxidants are essentially molecules that help you fight whatever damaging molecules are entering your body. So, that's good. 

Being active. Whatever your activity of choice is, it's better than no activity. So, exercise regularly, walking, jogging, running, Pilates, yoga, strength training, rowing, whatever it is. There are many options out there, but any one is better than no activity at all. 

I mentioned alcohol. Everyone knows that it's important to limit alcohol intake. There are a lot of studies that link alcohol intake to cancer risk, not necessarily breast cancer, but in general. And so, the latest statement by ASCO, that's the American Society of Clinical Oncologists, says that there's no minimal intake of alcohol that's considered to be safe with respect to cancer. I'm not suggesting everyone should stop drinking. I'm just saying that if people are educated, then they can make choices that are right for them. 

Of course, smoking is another big one. Everyone knows why smoking is bad for you, I think, at this point. So, we also know it's very addicting and very hard to quit. So, I would just recommend seeking either cessation advice from your doctor, if you'd like to cut down and ultimately quit. And, of course, we talked about regular screenings and self-breast exams. That's the other way to keep yourself safe. So, I'm not necessarily giving you tricks to avoid it. It's more things you can do to be vigilant and take care of yourself and your family.

Host: Yeah. And to catch it early, as you say, you know, really in all forms of cancer, really, but especially when it comes to breast cancer, early detection is so important. So, let's talk about that. Let's talk about when women should start screening, how often should they be screened and all that good stuff.

Dr. Marina Feldman: So first of all, why we screen, let's get into that first, and why mammography? Mammography is the gold standard for screening the population at large. And it's really the best method we have to diagnose breast cancer early. So, if a woman were to develop breast cancer, we don't want that. But should it happen, we want to find it when it's still in its infancy stage, so when the cancer cells are the size of chalk dust, before it is allowed to develop into a lump that a woman herself can feel and brings to the attention of the doctor. Early detection could be the difference between a woman moving on with her life and thriving after the diagnosis or possibly losing her life to it.

So in terms of the age, we recommend yearly screening starting at age 40. A lot of national academic bodies are in that boat. American College of Radiology, Society of Breast Imagers, American Society of Breast Surgeons, American College of OB-GYNs, and NCCN. NCCN is the National Comprehensive Cancer Network. That is the network that issues guidelines for treatment and screening for cancer that all oncologists follow. This is considered to be kind of the gold standard.

Host: Okay.

Dr. Marina Feldman: So, these bodies recommend starting at 40, and it's important that I kind of harp on this because there's some confusion out there. And I tell my patients not to get confused about this. Starting screening mammograms at 40 as opposed to 50 is extremely important. One in six diagnosed breast cancers occur in women in their 40s. So, that's 16% of all diagnosed breast cancers are diagnosed in women in their 40s. And we know that women in their 40s, should they develop breast cancer, tend to have more aggressive disease. That's why 40 is such an important age to start at.

Host: Yeah. And then, how often I imagine that there's some other components here we haven't really brought up yet, but like family history and genetics in terms of maybe someone needing or recommending that they start before 40. But either way, regardless of when they start, what are the recommendations for how often they should be screened?

Dr. Marina Feldman: That's a really important question. Thanks for asking, Scott. For women who have family history of breast cancer, the recommendation is to start screening prior to age 40. So the number 40, yearly, right? How frequently. Starting at 40 and annually is the recommendation for women at average risk of breast cancer. If you have family history of breast cancer, it's important to start earlier than that. But there are a lot of caveats there. It's not a cookie-cutter approach. So, for example, if somebody has a first-degree relative that developed breast cancer, for that individual, the screening recommendation is to start mammograms 10 years prior to the age at which the relative was diagnosed. But you'll notice there are a lot of qualifiers there, right? If first degree, if and then, and then 10 years, if under 40, over 40... 

So, for anyone that has a family history of breast cancer or even other cancers because some of them are genetically linked, and now we know that we encourage them to get a genetic consultation. Consultation is just a conversation. There's no commitment to anything where you get additional information, and a genetic counselor will assess what your overall lifetime risk is, and then they make a recommendation on whether you should start screening before 40 and what kind of screening you should do.

So, for example, if someone is really high risk, in addition to yearly mammograms, we sometimes do adjunct screening or additional screening with ultrasound or with MRI. But it's really very unique to each individual, and it depends on what their overall individual lifetime risk is, what their profile is in terms of genetics. So, that's why the consultation would be important because that would tease all of that out.

Host: Yeah, for sure. And it's so good that we have experts and medical professionals because, as you say, there's just so much swirling around, whether it's from TikTok or friends and family, there's just a lot to consider, a lot of qualifiers, as you said, a lot of ifs, if this, if that, right? I want to ask you about women who are pregnant or breastfeeding and kind of end on that question today. Is it safe for them have screening mammograms?

Dr. Marina Feldman: Absolutely. And the answer is yes. Mammography is absolutely safe during pregnancy and lactation, breastfeeding. Many, many studies at this point document the safety of this. The current recommendation by the American College of Radiology and the Society of Breast Imaging is not to postpone screening during these life stages. 

The reason for this is this. The age profile of an average family has been changing as women postpone child-rearing for careers or for other reasons. About 20% of women will have their first child after the age of 35. And many women, as we all know, are having kids well into their 40s. And we just discussed the importance of regular screening starting at 40, in the 40 plus population. So, really delaying screening mammograms for the duration of pregnancy, and then should she choose to nurse the baby another however long, really, it would be very harmful to their health. So, their recommendation is to not delay, and it is absolutely safe to have screening mammograms while pregnant or breastfeeding.

Host: Right. With breastfeeding, especially, I mean, it could be six months, it could be two years, right? So, if you factor in the time they were pregnant plus a year or two years, perhaps, of breastfeeding, it might be three years past age 40, so definitely don't want to wait, right?

Dr. Marina Feldman: Exactly.

Host: Yeah. Well, this is perfect. As I said in the teaser at the beginning, we're going to do a two-part series here on how to reduce risk, screening mammograms, all of that. I've got a bunch more questions for you. We'll save those for next time. And for today, thanks so much.

Dr. Marina Feldman: Thank you. Till then. 

Host: And if you enjoyed this podcast, please be sure to tell a friend and share on social media. This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. Stay well, and we'll talk again next time.