Cheryl Martin (Host): Worried about getting your first mammogram or you don't get them regularly? You are not alone. Dr. Gwendolyn Bryant-Smith is here to walk you through the process and share some good news about state-of-the-art technology now providing a great option for you. Dr. Bryant-Smith is a Division Director of Breast Imaging at UAMS and a Professor of Radiology.

This is UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences. I'm Cheryl Martin. Dr. Bryant-Smith, so glad to have you on this episode.

Dr. Gwendolyn Bryant-Smith: I am so happy to be here, Cheryl.

Host: First, why are mammograms so important for early breast cancer detection?

Dr. Gwendolyn Bryant-Smith: So, mammograms are truly the cornerstone of early breast cancer detection. They can find cancers before they can be felt on a physical exam, sometimes up to two years earlier. So, that's the reason why they're so important. And when breast cancer is caught at an earlier stage, treatment is often less aggressive. Outcomes are better and survival rates are significantly higher. Regular screening also provides a baseline for each woman. So, radiologists can detect even subtle changes in breast tissue over time.

Host: Talk about the state-of-the-art mammogram systems at UAMS and the fact that you can now get same-day mammogram results at the UAMS Breast Center.

Dr. Gwendolyn Bryant-Smith: Yes. At UAMS, we use state-of-the-art 3D mammography, also called digital breast tomosynthesis. This advanced technology allows us to capture multiple images of the breast from different angles, which creates a more detailed picture and reduces the chance of something being hidden by overlapping tissue. For women with dense breast tissue, this is especially important.

We are also installing an additional advanced diagnostic tool in the next few weeks, contrast-enhanced mammography. It will help us better evaluate areas of concern and make diagnosis with greater accuracy. These advanced innovations help us provide clear answers faster.

Host: How fast?

Dr. Gwendolyn Bryant-Smith: Very fast. So at the UAMS Breast Center, we offer in-person same-day results, not only for diagnostic evaluation if a patient presents with a breast complaint, but also for that routine screening mammogram, the wellness check. So, any patient that comes to the UAMS Breast Center is offered same-day results where the radiologist comes in person and discusses the results with the patient before they leave the center.

Host: That's great. So upon request, they can get this information same-day.

Dr. Gwendolyn Bryant-Smith: Yes. And it's offered. It doesn't even have to be requested. When the patient comes, the technologist asks the patient, do they have time to wait for the results? If the answer is yes, it's automatic. If the patient says, "Well, I really need to get back to work," we offer a same-day phone call.

Host: Wonderful. Now, explain risk factor identification, what it is and why it's so important.

Dr. Gwendolyn Bryant-Smith: Well, while mammograms are critical, it is also important to understand each person's individual risk. At UAMS, we take time to review family history, genetics, lifestyle, and personal health factors that may increase the person's risk for breast cancer. For example, having a first-degree relative with breast cancer, certain genetic mutations like BRCA1 or BRCA2, a history of radiation to the chest. Those are all strong risk factors. We also look at breast density, hormonal exposure, and lifestyle factors. These factors put into mathematical models allow us to stratify a patient's risk for breast cancer at average risk, intermediate risk, or high risk.

If a patient is deemed high risk, they may need to start screening with mammography and additional screening with MRI earlier. So, it is so important that we understand your level of risk, and all women should have a risk assessment using one of these models by age 25. For a woman at average risk, we say annual mammography at age 40. But for a woman at high risk, they need to start screening mammography at least by age 30 and sometimes sooner, depending on more individual risk.

Host: We, over the last number of years, have heard more about dense breasts and how if you are known for that, the mammography may not be as exact. So for women in that category, is there a next step?

Dr. Gwendolyn Bryant-Smith: Yes. That's why I was so excited initially to introduce the tools that we have in the breast center. So, dense breast tissue is the white tissue that we see on the mammogram. Well, cancers are also white. So, mammography alone is not as sensitive in women that have dense breast tissue as a competition or creating a masked effect for a potential white cancer that might be seen.

So in addition to having the yearly mammogram, which still remains the cornerstone, that patient with dense breast tissue might benefit from additional supplemental screening, a screening ultrasound or the mammogram with contrast dye, which is what we are getting in a few weeks. It's a mammogram where we inject contrast dye, and it's able to see through that dense tissue or if the patient is high risk, 20% or greater, or a gene mutation or radiation to the chest. Not only do they need a mammogram every year, but they need a breast MRI every year. And we have all of those advanced tools in the breast center so we can personalize screening based on the patient's individual factors.

Host: So if something suspicious is found on your mammogram, how soon can you expect to be seen for screening and diagnostic procedures?

Dr. Gwendolyn Bryant-Smith: Same-day. So if you present to the UAMS Breast Center, and an abnormality is detected on your mammogram, we do the additional views and ultrasound same-day. If a patient is not having an abnormality on the mammogram, but they have dense breast tissue and the radiologist realizes that the mammogram has decreased sensitivity for cancer detection, we discuss that with the patient while they're in the breast center and offer the additional screening ultrasound evaluation.

If a patient is high risk and they need a breast MRI, as an addition to the mammogram, we get that scheduled. That has to be scheduled as you have to go through pre-authorization for insurance for that to be performed. But it is scheduled very soon, within a week. And then, the day that the patient has the breast MRI performed, they get a same-day phone call regarding the results of that MRI.

Host: Okay. And if it's clear that, there's a tumor there and that first mammogram shows that, are you then contacting doctors or what do you do there?

Dr. Gwendolyn Bryant-Smith: Yes. So, we have a very strong interdisciplinary team, where we work side by side with our breast surgeons, with our medical-oncologist, our radiation-oncologist, our pathologist, our geneticists, our behavioral sciences. So if a patient needs an order for an exam, for biopsy, we have already communicated and are able to get that information through our physicians at UAMS. We have worked with our primary providers, for patients that are seen at UAMS, to be able to immediately proceed to biopsy that day with orders from those physicians. If a patient has a biopsy in the breast center and a cancer diagnosis comes back, we communicate with our breast surgeons and we immediately get that patient scheduled within the next few days for a consultation appointment with the breast surgeon. So, care through our interdisciplinary approach is seamless for the patient. The patient is not having to navigate the system alone.

Host: And you don't waste any time, it appears.

Dr. Gwendolyn Bryant-Smith: No, ma'am. We don't waste any time. So for those patients that live more than an hour away, if they have an abnormality on their mammogram, they get the additional views that day. If an ultrasound or other additional pictures show an abnormality that needs biopsy, if they live more than an hour away, they are offered same-day biopsy. And within a couple of days, those results are known. And once those results are known, if further action is needed, we get them in with the other interdisciplinary team member that is needed. And it is seamless and it is quick.

Host: That's great. So, what's the procedure for scheduling a mammogram at UAMS?

Dr. Gwendolyn Bryant-Smith: So, scheduling a mammogram at UAMS is very simple. Patients can call our scheduling line directly at 501-526-6100 or schedule through myChart. We make it a priority to offer convenient appointment times, including early mornings, Tuesday evenings and Saturday weekend in the clinics to fit into any busy schedule.

For those patients that live in more rural parts of the state, our mammo van provides mobile mammography services, bringing high quality screening to communities that might otherwise have limited access. So whether it's in Little Rock or across Arkansas, we want every woman to have access to life-saving breast cancer screening.

We have three modes of access of screening. We have the UAMS Breast Center that is on the third floor of the Cancer Institute. We have a mammography 3D unit in our off-campus women's gynecology clinic so that patients that cannot take multiple days off from work to get exams, can combine exams. They can have their gynecology exam and then walk downstairs and have a mammogram and receive a same-day phone call. And then, lastly, we have our mammo van, that travels the state of Arkansas bringing mammography services to meet patients where they are.

Host: That is wonderful. Doctor, anything else you'd like to add to encourage women to take advantage of your services there?

Dr. Gwendolyn Bryant-Smith: Yes. Please schedule your screening mammogram. It's self-care. It's self-care, it's care for your family when you take care of yourself. Having a mammogram and if a cancer is found early, you have the best possible chances for survival and to decrease aggressive treatment. So, take care of yourself.

We do things at our breast center to decrease the anxiety that can be associated with mammography. We all understand the anxiety that can be induced with medical procedures. Our environment in our on-campus location is very serene. We have beautiful artwork that's relaxing. We provide aromatherapy tabs during biopsies for patients that need calming. We have beautiful robes. We do everything to sort of make you forget that you're even in a medical facility. So, just know that we give compassionate, kind, clear care. And we want to help you take care of yourself.

Host: Dr. Gwendolyn Bryant-Smith, thanks for educating women about the importance of getting mammograms and just how easy the process is at UAMS Breast Center. Enlightening information, and it's obvious that the compassion and care are there. Thank you.

Dr. Gwendolyn Bryant-Smith: Thank you.

Host: To make an appointment at the UAMS Winthrop P. Rockefeller Cancer Institute's Breast Center, call 501-526-6100. If you found this podcast helpful, please tell others about it and share it on your social media. You may find other topics of interest to you when you check out our entire podcast library. This is UAMS Health Talk, a podcast from the University of Arkansas for Medical Sciences. Thanks for listening.