Scott Webb (Host): Screening mammograms are paramount in the early diagnosis of breast cancer in women. I'm joined today by Dr. Amy Lantis Stemerman. She's the Medical Director of the Nancy Ausonio Breast Health Center, Co-Medical Director of Diagnostic Imaging, and Medical Director of Imaging at Salinas Valley Health. And she's here today to tell us all about mammograms and what to expect from your first one.

 This is Ask the Experts, the podcast from Salinas Valley Health. I'm Scott Webb. Doctor, thanks so much for your time today. I know we spoke a few years ago, so it's nice to have you on. And today, we're going to talk about when women should get that first mammogram, what they can expect and, you know, just generally what is a mammogram. So, let's start there. What is a mammogram?

Dr. Amy Lantis Stemerman: I'm really glad to tell you a mammogram is a very low-dose x-ray image of the breast tissue. And we usually take two views of each breast. This test is one of the most widely used and best studied tests in the entire world. And it's been around in widespread use since the 1980s. It's the best way to detect early breast cancer and has already saved millions of women's lives. It's a great test.

Host: Yeah. Millions for sure. And it's definitely the gold standard. In a little bit, we'll talk about 2D versus 3D, but let's talk now about when women should get their first mammogram. I know probably family history and genetics plays a part in that, but what are the recommendations?

Dr. Amy Lantis Stemerman: So, the American College of Radiology, which are the standards that we use, recommends that a woman get her first mammogram at the age of 40, and every year after that, as long as she is in good health. And this is really important because early detection of breast cancer can really save women's lives.

Host: Yeah. Early detection is key, of course. And I'm sure listeners want to know, how do they make an appointment for a mammogram? What's the process?

Dr. Amy Lantis Stemerman: So when it's time for your first mammogram, definitely talk to your provider about your breast health and your family history. Some women may need mammograms earlier than 40, just like you said, because they have a strong family history. And other women, if they have a breast problem, might need a mammogram as well.

But screening mammograms are reserved for women who are asymptomatic. And so, they'll talk to their doctor, they'll get an order from their doctor, and then they can either call our Breast Center to schedule or our schedulers can call them as well. We offer extended hours for our mammograms, 7:00 a.m. to 5:30 p.m. And most Saturdays, we work also 7:00 a.m. to 4:00 p.m. So, please come get your mammogram at our center.

Host: Oh, that's great for working folks to be able to come on Saturdays as well. Is there any preparation needed? You know, I know like for colonoscopies, there's a lot of prep involved, obviously. But is there any real preparation mentally or physically for a mammogram for that first one?

Dr. Amy Lantis Stemerman: Yes. So on the day of your mammogram, we ask you not to wear deodorant, lotions, oils, perfumes, that sort of thing. And if you forget, no problem. We will just ask you to wipe the area clean with a towelette that we'll give you. My other recommendation is to wear a two-piece outfit that day. We'll ask you to undress from the waist up, and so you'll be more comfortable in your gown.

Host: And what can they expect, what can women expect when they arrive at the Nancy Esonio Breast Health Center?

Dr. Amy Lantis Stemerman: Well, just like all of our healthcare providers, we'll ask you for a government ID, driver's license, and your insurance card. We'll check you in at the front desk, and we will also either provide you with a computer tablet or ask you some personal and family history medical questions. We will have staff available to help you if you're needing some more help. Our staff speak English as well as Spanish and we also have interpreters, if you speak a different language, to assist as well. These questions are really important so that we can determine what your lifetime risk of cancer is and provide very specialized recommendations as far as screening or other tests in the future.

Host: Now, let's talk about expectations, setting the expectations. I've spoken with a lot of providers about mammograms over the years. And the number one thing they say that women don't really love about mammograms is the pressure, right? So, tell listeners what they can expect in that first mammogram.

Dr. Amy Lantis Stemerman: So once you enter the mammogram room after you've changed, the technologist will talk to you about any breast problems, whether you have trouble standing or if you're breastfeeding or pregnant, and these are all important to let the technologist know. The tech is also your best person to let them know that this is your first mammogram. They'll talk you through the whole thing.

So, the patient is standing for this exam, usually. The technologist will position each breast one at a time between two plastic imaging plates and then gentle compression will be necessary to spread the tissue out. And the reason we do this is it helps the radiologist see the tissue better. It decreases the radiation to the breast tissue itself and can decrease the need for additional imaging. So, the pressure will last for each image about 10 seconds and just know that every woman experiences this pressure differently but if you have any pain or pinching you should speak up to the technologist, it really shouldn't hurt. And the tech can reposition and make things more comfortable for you. She'll be checking in at every step.

Host: Yeah, that's awesome. And we teased earlier about 2D versus 3D. It feels like I've heard that 3D screening mammography is really the gold standard today, especially for women with dense breasts. So, I'll let you take this on as the expert here. What types of mammograms do you do?

Dr. Amy Lantis Stemerman: Absolutely. 3D, or tomosynthesis, is really the gold standard these days for breast imaging. We use this for all of our patients, and what happens is rather than getting one two-dimensional image of the breast, we actually get an entire data set when we take this image, and it gives us very thin slices throughout all of the tissue of each breast. It really allows the radiologist to detect more smaller, earlier breast cancer when it's very treatable. And so, that's all we use.

Host: Yeah, that's great. How quickly do women get results? Is it like right when they walk out or do they then have to meet with their provider again? How's that work?

Dr. Amy Lantis Stemerman: As soon as the radiologist has reviewed the images, our reports are available in myChart, and so that's the first way. And usually, it's within a few days. Sometimes it can be very quickly. You'll also get a letter in the mail with your results in about a week or so. And so, either way is acceptable.

Host: Gotcha. I mentioned there earlier, breast density and what that is and why does it matter. I know that in terms of the mammography and also woman's risk or being at higher risk for breast cancer, maybe you can explain how breast density factors into all of this.

Dr. Amy Lantis Stemerman: So, breast density is what we see on a mammogram. There is glandular tissue, or the breast tissue that makes breast milk, that's part of the breast tissue, as well as normal fatty tissue. And every woman has a mix of these two tissues. If you have a lot of the glandular tissue, that means your breast tissue is dense. And this is actually an independent risk factor causing you to be at slightly higher risk for breast cancer in the future. And so, the reason it's important is, one, the risk factor, and two, breast cancer looks like a white area on a mammogram, just like dense breast tissue, which also looks white. So, it makes it a little more challenging for radiologists to find breast cancer. And so, we do offer other modalities to help additionally supplement for screening. And those may be ultrasound or MRI, depending on your risks.

Host: Yeah. And other than family history and genetics, how would a woman know if they're at higher risk for breast cancer?

Dr. Amy Lantis Stemerman: So, the questions that we ask you when you come into our office at the beginning right before you have your mammogram, these are the questions we're asking you that relate to breast cancer. And we plug this into a computer model and it will give us a number that gives us your relative risk for developing breast cancer in the future. It's an estimation.

Host: Yeah. And I was going to ask you, If a person, if a woman gets called back for more imaging, is there any reason for alarm or is it just, "You know what? You've got dense breasts and we need to do some other things just to make sure that we have all the information?"

Dr. Amy Lantis Stemerman: Exactly. The first thing is don't panic. About 10% of patients are called back for more images and only about 1% of those or 1 in 10 actually have breast cancer. And so oftentimes, we just need an extra picture or other imaging to make sure that there's nothing else there or sometimes we will recommend a follow up exam a little sooner than we would have.

Host: Just want to give you a chance here at the end. Final thoughts, takeaways as people, because not just women, but women in general, as they approach that age for their first mammogram, what would you want them to know?

Dr. Amy Lantis Stemerman: iThis s a really easy test, and it's something you can do to be proactive about your health.

Host: Yeah, that's well said. That's perfect. Thank you so much for your time today.

Dr. Amy Lantis Stemerman: Thanks, Scott.

Host: And to listen to more of our podcasts, please visit salinasvalleyhealth.com/podcasts. And if you found this podcast to be helpful, please be sure to tell a friend, neighbor or family member. And subscribe, rate and review this podcast, and check out the entire podcast library for additional topics of interest. This is Ask the Experts from Salinas Valley Health. I'm Scott Webb. Stay well, and we'll talk again next time.