Transcription:
How Breast Screenings Save Lives

Amanda Wilde: Breast cancer screening is important for every single woman and breast screening has changed a lot in the past few decades. We'll get the latest updates and a guided the screening process from Dr. Meghan Garstka, breast surgical oncologist at the breast center at Upper Chesapeake Health. Welcome to the Live Greater podcast series, Information for a Healthier You from the University of Maryland Medical System. I'm Amanda Wilde. Dr. Garstka, thank you for being here.

Dr. Meghan Garstka: Thank you. I'm excited to be here.

Amanda Wilde: So many questions beginning with for breast cancer screening. How often should a woman have her breast checked?

Dr. Meghan Garstka: Great question. Typically we tell patients that an annual breast exam, like a clinical exam with a provider is recommended for women who have an average risk of breast cancer annually over age 40. So in women who are younger than that, we recommend a clinical breast exam with a provider every three years. Some women might have elevated lifetime risk of breast cancer based off of various factors such as a family history or things like that. And so for those patients, they might be followed in a high risk breast clinic or in some sort of a clinical setting for clinical breast exams every six months.

With regards to imaging and mammograms in general and annual mammograms are recommended at age 40. There are some exceptions to this rule and a lot of details with it, but in general, we recommend that patients start with age 40 for their first screening mammogram. And these should be continued every year as long as a patient is really willing and able to pursue treat. If anything is found on the mammogram. So there's really no cutoff age for screening. That's been a question in the past.

So with regards to risk for breast cancer the American Society of Breast Surgeons actually recommends that all women have a discussion about breast cancer risk with a provider at some point between the ages of 25 and 30. And this can be updated annually for, say, for example, if a patient finds out more about their family history or about other risk factors. So in general, the best rule is to plan to start mammograms at age 40 and to discuss the clinical breast exam with a provider at that time every year, and then also potentially prior to that, as needed.

Amanda Wilde: Right. Talk to your doctor about your risk factors and when you should start imaging. So it's mainly annually now. We used to hear all the time that we should do monthly self exams, and now I hear that experts do not recommend women do monthly self breast exams anymore. Is that true?

Dr. Meghan Garstka: There's been a lot of questions that we get about this as well. It definitely is a hot topic, so there have been some studies that have shown that there might not necessarily be a meaningful impact. how long women live with breast cancer, there might be too many biopsies. If a woman, feels something on their breast that prompts too much imaging, too many biopsies. But in general many organizations still believe that breast self-examination is a useful and important screening tool, especially when it's used in combination with regular physical exams by a doctor and screening such as mammograms or perhaps ultrasounds or MRIs.

So what I tell a woman about this is it's really a way to get a baseline exam to compare to Where your breasts are at that moment compared to when you present it to your clinical exam with a provider. So, the data on it, from a research perspective, perhaps not very straightforward, but I think in general we would still encourage patients to do breast self exams to become familiar with their baseline exam. And a good time to do this would be to make sure that you learn your breast self exam around the time when you present to a provider for your clinical exam. You've had your mammogram. You know that things are really at your baseline if there are no issues. And so you can always go back for comparison if there are any questions.

Amanda Wilde: So it's just another tool to, for you to get to know your breasts in case you can find any changes, but it doesn't mean you will necessarily find changes if they're there?

Dr. Meghan Garstka: Right. Exactly. So all of these tools are complimentary for sure.

Amanda Wilde: So what are the latest advancements in the of breast screening?

Dr. Meghan Garstka: So there's been a lot of technology that's come about with the way in which images are obtained during mammogram screening exams. these types of techniques really serve to improve identification then normal findings. So a lot of times women might hear about something called 3D mammography. A fancier way to describe this is a word called tomosynthesis. And so what that means is that not only two dimensional images, but actually three dimensional images are obtained. And a radiologist can actually sort of scroll through the images to see things in three dimensions.

In doing this, they can definitely look a little bit more closely to see if something is a mass or if it perhaps is just normal breast tissue. They can look more at the details that are seen in that 3D tomosynthesis view. There have actually been studies that have shown that tomosynthesis screens a little bit more effectively for breast cancer with fewer false positives, meaning fewer studies where women are called back and it ends up being nothing. And higher rates of what we call true negative mammograms.

So really, essentially that there is nothing there. And we can say that with a little bit more certainty once we've seen those three dimensional images or radiologists can say that. So really tomosynthesis is one of the leading ways that we are improving breast screening for women. Additionally, a lot of women ask about breast MRIs. Those are newer techniques as well that again, are very complimentary to the mammogram. We know that mammograms are the best screening technique for all women. MRIs are an additional modality that can look at the enhancement of the soft tissues of the breast to show what areas might also be a little bit more hyper metabolic.

And using more energy, and potentially areas that we would want to look into a little bit further. So again we know mammograms are the best screening technique for all women. MRIs have certain roles and that's a complicated discussion to go into reasons why or why not to obtain an MRI. But that's why we definitely recommend that patients speak with a provider about, whether MRI would also be helpful for, their screening purposes.

Amanda Wilde: Well, how does this newest equipment affect or does it affect the health outcomes of women?

Dr. Meghan Garstka: Also a very good question. As I mentioned, the reason we think mammograms are the best screening tool is that we do find things earlier and things can be treated more effectively when they're found earlier. And so, again, the tomosynthesis that 3D mammogram has really been seen in many studies to increase the detection rates of breast cancer. Some studies say up to about 25% higher rates of detection. Every study's different. It depends on the data, but there certainly has been increased use, and study of this technique since we do think that it can increase your detection rates. And again, it can decrease the number of false positive call backs.

Some people say that that number could be up to 15% decrease, so there's a pretty significant decrease in the amount of women who might have to go back for callback exams because of that tomosynthesis. Women also ask what is the radiation dose difference? For all practical purposes, it's very similar to a 2D mammogram. So the dose is similar and you do have that additional benefit. And then of course, MRIs can also help to identify tumors earlier and earlier detection allows for the improvement in outcome. So all in all, these technologies have helped us to find things earlier, which is really the key.

Amanda Wilde: Are these latest technical advancements like tomosynthesis and the MRI more comfortable for women? Because we always think of mammograms as rather painful. MRIs are rather loud, so that can be scary. Is this a more comfortable place as far as the equipment?

Dr. Meghan Garstka: Good question. That is definitely a question that we get from patients. I will say it depends on the location performing. the studies, and it's always best to talk with the individual site where you're going to have your mammogram performed, But I would say a lot of the newer machines actually do have more comfortable features, such as perhaps a bit of padding on the machine that does not affect the way the image looks, but can help with comfort when the breast is being compressed during a mammogram.

Also, if a woman does have a mammogram that leads to a biopsy, a lot of the time we have ways that radiologists can consider performing that with a patient sitting upright, instead of laying on a table or things like that, where it is a little bit more comfortable to sit in more of a natural sitting position. Same with MRIs. A lot of places who do screening MRIs can potentially talk to patients about using like headphones maybe with the music playing, try to minimize the stress of getting that test.

But in general, with the mammograms since those are the most common tests that we're focusing on for breath screening, every location is different, as I mentioned, but a lot of locations really have tried to make that experience into a better one for patient comfort.

Amanda Wilde: I think too, it might depend on the technologist doing it. I've had mammographers tell me, Yeah, we really have to compress and hurt and it hurts. And others say, It doesn't have to be like that. What do you say to that?

Dr. Meghan Garstka: Right. I think every place is different. I think whatever works the best for getting a patient the best exposure, the best film to make sure we check all the areas. I think, the more frequently that sites, do mammograms and hear feedback from women is also important too. And I know. every imaging site is certainly taking patient feedback into accounts as well to make sure that they try to make this a more comfortable process. So, it's always important to communicate with the site where you're having it done as well.

Amanda Wilde: That's really good to hear. I mean, the goal is to get the best image.

Dr. Meghan Garstka: Right, right.

Amanda Wilde: How do these advancements benefit men? Because there are, of course, men who are at risk for breast cancer as well.

Dr. Meghan Garstka: That's a very good question. what we know about breast cancer and men, it's about one to 2% of all the breast cancers that we see across the country. So it's rare, but it is not impossible that we find it. Typically the only screening mammograms recommended for men, are for men who have a history of a true breast cancer gene in their family. So if you've heard of the BRCA genes, those would be patients who would be recommended to actually have screening mammograms. But if a man does feel something abnormal on a physical exam and does not have a breast cancer gene it's definitely recommended that those patients have diagnostic imaging.

Not necessarily screening, but diagnostic, which again may be more comfortable for the same reasons noted for women. We do say with regards to physical exam for men, who are concerned about the risk of breast cancer, if they do have a BRCA gene, they should definitely do clinical breast exams every year, starting at age 35, actually in practice breast self exams. And again, if they do have a mutation that, like in the BRCA genes they should definitely start getting a mammogram every year, 10 years before the earliest known breast cancer and a family member, or at age 50 or so, whichever age comes first. So for men, screening's a bit different.

In general, we tell men to make sure that they're aware of any masses or things like that, that they find if they, even if they have a family history, but not a breast cancer gene. But a man doesn't necessarily need to go for a screening mammogram every year. However, we definitely have these techniques available with the same comfort and the tomosynthesis and all of those techniques available for men when they do require time for a mammogram as well.

Amanda Wilde: So, as you said earlier, the first step is really to talk to your provider and then you can assess your risk factors and when you should start imaging. What other questions should men and women ask their providers about breast cancer screenings?

Dr. Meghan Garstka: So most importantly, patients should really ask their providers if they are up to date on the screenings, which is definitely the most important aspect of them. So, one of the concepts of screening is that you can always compare to prior years. So I think really asking a provider if a patient is up to date, just checking that there's nothing else that needs to be done, it can be easy with so many appointments to kind of fall out of the timing. Even if radiology is trying to recommend a certain timeframe, they should definitely, discuss with them the timing just to make sure they're up to date.

I think the other important thing is that patients should ask their providers regarding the cancer risk, you know, are they at higher risk? And what can be done about that risk if it is there. We consider patients with a lifetime breast cancer risk over 20% to be considered high risk for breast cancer. The reason for that being that one in eight patients or at least one in eight women by the time that they're in their eighties, have a risk of developing breast cancer. So that puts it, the risk at about 12% or so versus about 20% would be considered to be elevated by the time a woman is in her eighties.

The way to determine this, there are actually several tools that use breast cancer risk calculators. For example, there's one from the NCI, the National Cancer Institute that providers can easily access online and determine individual breast cancer risk. And if they identify these patients as being higher risk, they can definitely discuss this further with them or refer to a specialist such as a high risk breast clinic to discuss further. So I think really focusing on being up to date and discussing risk at some point with a risk assessment is the most important that a patient can do with their provider.

Amanda Wilde: Okay, so we were talking about the newest technology like tomosynthesis 3D imaging. Is it common enough now that insurance and Medicaid and Medicare cover these newest procedures?

Dr. Meghan Garstka: Very good question. In general, these procedures should be covered, but it's always best to discuss with the team where the imaging will be taking place. I know in certain circumstances if there were to be a question of coverage, sometimes you can discuss what additional costs there might be. But I think as these technologies become more and more commonplace, I think we will see that there should be fewer issues with coverage. So in general, I would say they should be covered, but always check where the imaging will be occurring.

Amanda Wilde: Always, always check. You always have to do that with insurance, unfortunately. Any other key takeaways that you want to add?

Dr. Meghan Garstka: No, I think it's, I know we've said this multiple times, but I think really the key to breast cancer screening is that we are finding things earlier, which definitely does save lives when we find things earlier and we can come up with a good treatment plan that's unique and individualized to each patient. So I think we think about this more and months, look October with breast cancer awareness, but it's important at all times. And I think if there's ever any questions about what screening is best for you or about your individual breast cancer risk, it's always something where you should definitely feel like you can discuss that with your providers to learn more about it.

And I think if they have questions, they can always refer to a specialist as well. So I think the key takeaway here is just to make sure you stay up to date. I think every provider is certainly happy to have a conversation as needed about any other questions or risk factors and that really is the key to saving lives from breast cancer.

Amanda Wilde: Breast cancer screening is vital and does save lives. And Thank you, Dr. Garstka for bringing us up to date on the latest advancements and the changes in breast cancer screening.

Dr. Meghan Garstka: All right. Well thank you. It was great to share it with you.

Amanda Wilde: Great information. Find more shows just like this one at umms.org/podcast. Thank you for listening to Live Greater, a Health and Wellness podcast, brought to you by the University of Maryland Medical System. We look forward to joining us again. Until then, be well.