Amanda Wilde (Host): This is Community Connect presented by Tampa General Hospital. I'm Amanda Wilde. And joining me are breast medical oncologists, Dr. Victoria Rizk, and Dr. Paula Rosenblatt, both of whom practice at Tampa General Hospital. Dr. Rizk, Dr. Rosenblatt, welcome.

Dr. Victoria Rizk: Thank you for having us.

Dr. Paula Rosenblatt: Happy to be Here today.

Host: Glad you're both here to talk about breast cancer in young women, which is on the rise. Dr. Rosenblatt, what are the primary risk factors for breast cancer in women under 40?

Dr. Paula Rosenblatt: So for women under 40, primarily, breast cancer, the vast majority of it ends up being sporadic. And we do not necessarily have a specific risk factor. However, we do know that genetic mutations, if someone has a high penetrant, something like a BRCA mutation that runs in their family, that increases their risk. Even just increasing numbers on members with breast cancer in the family can increase the risk somewhat.

In addition, we know that dense breast or having previous biopsies even though they're benign, that some of these benign biopsies can also lead to a risk of breast cancer.

Host: So, genetics, and maybe if you don't know your genetics, just if a close family member has had breast cancer, that might affect a young woman's risk of developing the disease.

Dr. Paula Rosenblatt: Exactly. Those are risk factors that we think about. There are other somewhat hormonal risk factors such as having early menarchy or late menopause, not having children, or increasing age at the birth of your first child, that also have small, increased risks of breast cancer. So, those are some other things that we kind of think about, although those may not be really modifiable.

Host: Well, Dr. Rizk, aren't mammograms recommended for an older age? How is breast cancer diagnosed for women at an early age?

Dr. Victoria Rizk: Yeah, I think that's the scariest part about, you know, seeing the increase in the number of women who are being diagnosed at a younger age. We really don't have good screening recommendations for the general population before the age of 40. But what we can offer and what we do recommend is that for all women to have a conversation with their primary care doctor as soon as they turn 25, just to go through this potential risk assessment because some people may not know that they're high risk. And I think that's where we have the opportunity to implement high risk screening at an earlier age for those who need it the most. and so we actually do offer a high risk breast clinic at Tampa General. And that's been a really helpful resource. It's a virtual clinic where patients can just reach out to us and we do their risk assessment. There are a few different models that we use. One that's become the most popular would be the Tyrer-Cuzick Risk Assessment Tool. And for a lot of women, you can just go online and do it. We typically recommend doing it with a physician so you can get the most accurate answer and then know what to do once you get those results. But if somebody is, you know, listed as a higher risk than 20%, then they may be eligible for earlier screening. But a lot of people don't know about it, so I think it is an important thing that we talk about and highlight and make sure that people are just aware that it exists, because there is still a scenario where people could get breast imaging done at an earlier age, and we might be able to catch these earlier for some women.

Host: So, it's important to do risk assessment and there are specific risk assessment models tailored to young women.

Dr. Victoria Rizk: Yes, definitely, definitely. They're not really very widely popular and not really talked about that much. But I think it's a really important tool that all women are educated on and aware of. And they're online. So, it's a free tool that you can, do or you can always reach out to one of us and we'd be happy to see you and chat through that risk assessment to figure out if you're high risk or not.

And like Dr. Rosenblatt mentioned, I mean, there are some risk factors that are modifiable, but you really can't change your family history or your DNA. So, those are the scenarios where we really want people to focus on reaching out, being proactive, getting their risk assessment done so we can determine what your risk status is, and then figure out what the appropriate screening recommendations would be.

Host: Well, Dr. Rosenblatt, we went over some of the risk factors. Are there symptoms that young women should be aware of?

Dr. Paula Rosenblatt: So, I think it's always good to have breast awareness to know what your breasts naturally feel like, and then be aware of any changes. So changes can be things such as feeling a lump or a mass in the breast. Changes could be changes on the skin, seeing redness or thickening or like swelling in the skin. Nipple changes, the nipple can invert or if the skin becomes scaly. These are all changes that could be symptoms of breast cancer and should prompt one to go and see their physician.

Host: And Dr. Rizk, does the treatment approach for younger women with breast cancer differ from that of older women?

Dr. Victoria Rizk: You know, it's an interesting question because I think the actual treatment strategies that we have, they are tailored for pre and postmenopausal women. So for premenopausal women, we're typically more aggressive with their systemic treatment, their options, just because we know that they may end up with a more aggressive type of breast cancer. But each person is different. So, we do tailor every person's treatment plan to their specific type of cancer, their specific stage. There are a lot of factors that go into developing these personalized plans.

But I would say that there are some unique needs for women who are younger than 40 that develop breast cancer because that's a patient population that they're probably dealing with young kids at home. They're in the middle of developing their career. They might have just gotten married and haven't had kids yet, so there may be fertility needs. So, there's a whole host of different priorities that we have to focus on for women who are under the age of 40 who get diagnosed, that's not necessarily things that you need to worry about for women in their 60s, 70s, and 80s who are diagnosed. So, I think it is a really important thing to be aware of their needs and to really focus on personalizing the treatment plan for their specific age, but also their stage subtype and their personal needs at home. That's an area that we really try to focus on.

Host: And as you said, really individualized treatment plans. But Dr. Rosenblatt, in an overall look at this, are there ways to generally decrease a woman's chances of getting breast cancer?

Dr. Paula Rosenblatt: So in decreasing the chance of getting breast cancer, I would say the biggest thing is actually the screening for breast cancer and being able to detect it early. So for those people, as Dr. Rizk was saying, that have a high lifetime risk of developing breast cancer, starting with earlier screening. They can be mammograms. There can be MRIs associated with that. And really getting some early detection in.

For decreasing the total risk of breast cancer, we generally say things on healthy living. In terms of diet and exercise, those can be beneficial. Limiting our alcohol consumption. I jump up and down about the screening portion of it particularly.

Host: So Dr. Rosenblatt, when should a woman plan to get her first screening mammogram? I mean, some of it's dependent on whether they see that they might have genetic factors involved, but let's say that's an unknown.

Dr. Paula Rosenblatt: Yeah. So, this is really where a good conversation with your primary care doctor becomes in play and where it's kind of shared decision-making comes in play based off of your individual risks that's determined. There are many different organizations that kind of weigh in on the age to start screening. So, there's little differences. The National Comprehensive Cancer Network will often say 40, along with the gynecologic group. The American Cancer Society says 45, but consider earlier, depending on your risk. The United States Preventive Task Force, they're in the process of changing their recommendations at this point, but it was a bit higher.

So, I think it's really coming down to this conversation of looking at your risk. And I think the vast majority of women end up leaning towards the 40 if there is not a significantly increased risk that it was determined.

Host: But Dr. Rosenblatt, if you're uncomfortable for some reason and you're 25 years old, I mean, can anyone request a mammogram if that would make them put their mind at ease?

Dr. Paula Rosenblatt: That's a interesting question. I think that the problem with mammograms in the younger ages is that women have very, very dense breast tissue. And they can be very hard to see something like a mass when somebody's in their 20s or their early 30s. So, the benefit of them is significantly lower. So, it's really knowing if there's any changes in the breast at that time. If somebody's feeling something and that makes them uncomfortable, that's an absolute indication for getting testing. And it's not always just a mammogram. We often use ultrasounds if there's a palpable change, that really gives us another view given the limitations sometimes mammograms can have.

Host: Well, Dr. Rizk, if people want to look into this more, are there resources available for women who want to understand more about early-age breast cancer?

Dr. Victoria Rizk: Absolutely. Yeah, we've got a great high risk breast clinic at Tampa General Hospital. You can self refer, so you can go onto our website and just plug in your information and we'll see you, have a virtual consultation and go through that risk assessment. I think there are certainly a set of women that really do need to come and talk to us instead of maybe just their primary care doctors. So, I would say anybody who has a family history, like their mom was diagnosed or their sister was diagnosed, those are the people that typically might be in that intermediate to high risk category off the bat.

But we also offer genetic testing. We have nutrition counseling, genetic counseling, a lot of different resources that I think are very helpful, especially when you're worried at a young age what can I do to lower my risk. There are some other studies too looking at, you know, using a low-dose drug called tamoxifen to help lower the risk as well. So, that's all part of the consultation, is having that conversation and weighing the pros and cons of earlier screening, what your risk status is, healthy lifestyle, making sure you're exercising, eating whole food ingredients mainly. Those are all important things.

But I think as a community at large, we have to do a better job of increasing awareness, having these conversations. So, we do work pretty hard at being a resource to help women throughout Tampa Bay and across the state of Florida really to help with these resources. So, lots of different things that we can offer, but certainly open to all patients coming to have a conversation with us to have these risk assessments. It's incredibly important. And really, something that we hold dear is what can we do to help lower the risk of young women getting diagnosed? Because the reality is, unfortunately, we are seeing it more commonly these days and we don't have a good answer for why that is. So if we can assess women sooner, I think that's the right thing to do.

Host: Well, I like how those resources also fall into the category of support so people don't have to feel alone.

Dr. Victoria Rizk: Yeah. And I think that's what makes it so scary is the healthcare system at large is such a confusing place to navigate, even for physicians. It's nice to know that you can have a virtual appointment to have this conversation. And really, it's just an educational opportunity to say, "What's my risk? What can I do to lower that risk? Are there things I can do?" And you might find that you're not considered high risk. And that's a breath of fresh air too.

So, I think it's certainly worth a conversation, at least with a healthcare provider to have that reassurance that you may not necessarily need more. Or if you do, that those resources are available. But you're right, it all comes down to support and education. That's what we're here for.

Host: And knowledge is power.

Dr. Victoria Rizk: Absolutely. Yeah.

Amanda Wilde (Host): Thank you, Dr. Rizk. Thank you, Dr. Rosenblatt, for this conversation.

Dr. Victoria Rizk: Absolutely. Thanks for having us.

Dr. Paula Rosenblatt: Yeah, it's been a pleasure.

Host: That was breast medical oncologist, Dr. Victoria Rizk, and breast medical oncologist, Dr. Paula Rosenblatt. For more information, please visit tgh.org/cancer. If you enjoyed this episode, please be sure to like, subscribe, and follow Community Connect, presented by TGH on your favorite podcast platform.

I'm Amanda Wilde. This is Community Connect, presented by TGH. Thanks for listening.