Scott Webb (Host): Trinity Health of New England's nationally recognized breast cancer program offers the full range of services, including prevention screenings, the latest surgical techniques, and breast reconstruction. Their whole person approach means their care team treats more than just the cancer, they treat the patient's well-being.

Trinity Health of New England's Breast Care Navigators are with you throughout your care journey, providing information and support. And joining me today is Dr. Christina Metcalf. She's Board Certified in General Surgery and Fellowship Trained in Surgical Oncology, and she's here today to tell us how individuals can reduce their risk of breast cancer, the proper way to perform self-exams, and the importance of regular screening mammograms.

 This is Transforming Your Health, the podcast from Trinity Health of New England. I'm Scott Webb.

Doctor, thanks so much for your time today. Thanks for joining me.

Christina Metcalf, MD: Thanks for having me.

Host: Yeah, it's a pleasure to have you here. We're going to talk about breast health, myths, facts, and everything in between. So let's start here. Can things like physical activity or a healthy diet reduce the risk of breast cancer?

Christina Metcalf, MD: So, actually, research shows that exercise boosts the immune system and helps you to keep your weight in check. With as little as 3 hours of exercise per week, or about 30 minutes a day, a woman can begin to lower her risk of breast cancer. This doesn't require going to a gym either. Power walking is more than sufficient.

Anything that gets your heart rate up is really beneficial. We know that a nutritious, low fat diet of 30 fat grams or fewer with a variety of fruits and vegetables can help reduce the risk of developing breast cancer. Obesity increases the risk because fat triggers production of estrogen, which can sometimes fuel tumor growth.

We know it's important for women to keep active and try to maintain a normal body mass index, especially after menopause, to help reduce their risk of developing breast cancer.

Host: Yeah, and of course we all know that physical activity, healthy diet, good on a variety of fronts, but especially as you're saying here today with breast cancer. So does a family history of breast cancer put someone at higher risk?

Christina Metcalf, MD: So although women who have a family history of breast cancer are in a higher risk group, most women who have breast cancer actually have no family history. Statistically, only 5 to 10 percent of breast cancers are hereditary or passed through the genes, which we know increase risk for development of breast cancer.

But it's still important to know your family history because if you do have breast cancer in your family, it's especially important to get screened regularly with mammograms. It's important also to know the history on your father's side of the family also, since you inherit genes from both parents.

There may also be genes we have not yet developed the ability to test for that may increase your risk. If you have had genetic testing in the past, you may also need to have updated testing because of new genes we now have the ability to test for that we may not have had a few years ago.

Host: Yeah, and Doctor, if someone has or is in a higher risk group, would that make them eligible for earlier screenings?

Christina Metcalf, MD: So we usually say we want to screen women about 5 to 10 years before the earliest diagnosis in the family. So that may mean starting screening mammograms before age 40, which is the typical recommendation.

Host: Yeah, it does seem like recommendations have changed, both for breast cancer screenings, especially if you're at higher risk, colonoscopies, which I'm familiar with, of course. So, let's talk about self-exams. What's the proper way, if you will, for someone to do a breast self-exam.

Christina Metcalf, MD: So ideally, women should do a self-exam about once a month. You want to do this a few weeks before or after your period so the breasts are less sensitive and not changing as much. If you're no longer having periods, an easy way to remember when to do a self-exam is on the day of your birthday every month.

 You want to look for any changes that are in breast tissue, such as changes in size, lumps, dimpling, or puckering, inversion of the nipple, redness or scaliness of the breast skin, redness or scaliness on the nipple or areola, or any discharge from the nipple. If you notice a persistent lump in your breast or any other changes, you'll want to see a physician immediately.

Although o8 out of 10 lumps are benign, all require evaluation to confirm that they are not cancerous. Also, you should have a physical every year, which should include a clinical breast exam and a pelvic exam by your primary care physician or gynecologist.

Host: I love that. Using your birthday every month. That's an easy one, probably for all of us to remember, right?

Christina Metcalf, MD: Yeah, I think it's a nice trick to keep it on the forefront of your mind.

Host: Absolutely. Rather than trying to put it in our phones and our calendars, just remember your birthday, which probably all of us can do, of course. So as we wrap up here today, Doctor, let's talk about mammograms. I don't know a lot about mammograms, perhaps obviously, but are mammograms painful?

Christina Metcalf, MD: So mammograms do have to compress the breast tissue and this can cause some discomfort for a very brief period of time during the exam itself. If you're particularly sensitive, you may want to schedule your mammogram a week after your menstrual cycle so that your breasts are less tender. You may also try taking something like acetaminophen an hour before the mammogram is performed to prevent any discomfort.

That compression, unfortunately, is needed because it helps make that breast tissue as thin as possible so that we can get the clearest image on the mammogram and see all that we need to see. Unfortunately, there's not a good alternative to mammograms since they show us things like calcium that isn't well seen on other types of imaging, and calcium may be a sign of an early breast cancer.

Host: Yeah, it does seem that mammograms especially are the gold standard, as you're saying. So there's just things you can see with a mammogram that you can't see otherwise. Just as we wrap up here, finally Doctor, you know, I preface this by saying we're going to talk about some of the myths and facts, but when we think about myths, if you will, what's the one thing you would like to dispel? That one myth you'd like to dispel, or the one thing you just wish everyone knew about breast health, mammograms, whatever.

Christina Metcalf, MD: I think the biggest thing is really that women need to go and just get their mammograms done and get screened. I think women are always fearful about what that mammogram might show, and worried about potentially getting bad news. But we know if it's something that we can only see on a mammogram, it's going to be much easier to treat than if we wait until a woman has a large mass that they can feel. So, don't be afraid of the mammogram. Go out there and get your screening done.

Host: Yeah, that's perfect. A lot of us, especially maybe during COVID, we kind of, you know, took advantage of kind of hiding our heads in the sand a little bit, but as you say, early screening, early diagnosis, generally leads to better results. So, thank you so much for your time today. You stay well.

Christina Metcalf, MD: Thank you. You too. Thanks for having me.

Host: That's Dr. Christina Metcalf. And for more information, go to trinityhealthofne.org/women. I'm Scott Webb, and if you found this information helpful, please share it with others, especially on your social media. Thanks for listening to the Transforming Your Health podcast from Trinity Health of New England.