Cheryl Martin (Host): ​Finding breast cancer early and getting treatment can save your life. Here to talk about healthy habits for prevention, the best options for detection, and more is Dr. Omazonna Amadi, a family medicine physician, obstetrician and women's care physician.

This is Woodlawn Health Doc talk, a podcast from Woodlawn Hospital. I'm Cheryl Martin, Dr. Amadi, so glad you're with us to discuss this vital topic.

Dr. Omazonna Amadi: Good afternoon. Thank you for having me.

Host: First, what are healthy habits women can develop to help prevent breast cancer?

Dr. Omazonna Amadi: I'm glad you asked that question. There are lots of healthy habits that I try to counsel my patients on just in general and not just necessarily related to your breast cancer, but definitely play a role in preventing or to help to reduce your risk of getting breast cancer.

The first I want to talk about is your alcohol consumption. So, studies have linked alcohol consumption to breast cancer. My general rule of thumb is, if one can avoid alcohol use to reduce their risk of breast cancer, they should. I always encourage that. However, if they can't, the recommendation is to limit their alcohol use to just one standard drink per day.

Also, excess body weight, particularly after menopause. So, you know, a lot of estrogen can be found in fatty tissue. So, trying to control your weight and reduce the amount of weight gain, particularly after menopause, does help decrease your risk of getting breast cancer. And speaking of that, increased insulin levels have been linked to some cancers, including breast cancer.

Not being physically active, again, that goes with just general healthy habits. I always counsel both my Female and male patients to always increase their level of activity. You know, we don't want to train our bodies to not be physically active. You don't have to go run a marathon, just taking walks every day, or as much as you can. Whatever you enjoy doing, playing sports, things to keep your joint moving. Evidence is growing that regular physical activity reduces breast cancer, particularly after menopause, which is where unfortunately a lot of breast cancer is diagnosed, it's typically after menopause.

Avoiding smoking and vaping. I mean, that goes without saying, not just for breast cancer. It's been linked to so many cancers, you know, smoking or exposure to smoking or tobacco use. So, if you are smoking, please, please quit. One of the hardest things to do is to quit smoking. I think people try an average of seven times. I want to say, don't quote me on that, but before you quit, it's pretty difficult to quit. But the single best thing you can do for yourself, quitting smoking or vaping.

And if you are at an increased risk of breast cancer, and we're probably going to get into that more in the topic with some of the things that put you an increased risk of having breast cancer. It's always a good idea to get some genetic counseling and testing, just to see if you have the genes for it, because then you can take steps to try to minimize and reduce your risk of getting breast cancer. Those are some of the few things, I will say, healthy habits you can develop to help prevent breast cancer.

Host: Doctor, how effective is early detection in improving breast cancer survival rates?

Dr. Omazonna Amadi: Early detection and treatment. Two of the most important ways to prevent deaths from breast cancer. Because if found early, when the cancer cells are still small, the cancer tissue is still small and has not spread, it's easier to treat and that you improve your chances of survival. When caught early, the five-year survival rate is about 99%. So, a lot of research and a lot of effort has been put into regular testing and finding out if you have breast cancer as early as possible.

Host: So, at what age should women begin routine mammograms, and how often should they get them?

Dr. Omazonna Amadi: So, general consensus now is from the American Cancer Society, if you are at an average risk of getting breast cancer starting at age 40, getting screened yearly, some say every two years. And then, you know, after menopause go down to like age 55 to 65, I'm screening every other year.

Host: What methods are considered best for screening?

Dr. Omazonna Amadi: So, the best method that we have currently is mammograms, which is an x-ray, a low-dose x-ray. There are 2D and 3D mammograms. With the 3D, you know, they call it tomosynthesis, and 3Ds are typically more sensitive in picking up breast cancers. And thankfully, in the U.S., I think most people have access to the 3D mammograms.

So, mammograms can find breast changes that could be cancer years before even you have like physical symptoms. And with 3D mammograms, they've shown that they have decreased callbacks for follow-ups. They detect more breast cancers that can be helpful in women with dense breasts.

And then, we have the breast MRI. Typically, after following discussion with my patients, particularly those have a high risk of getting breast cancer or they have dense breasts, I would recommend getting every six months and alternating between the mammogram and the breast MRI. Because if you're at an increased risk, we really want to be very, very cautious and very diligent in screening, making sure we catch things early.

Host: So, are you saying then if a woman has dense breasts-- then we can go into more detail about that-- you're saying, one, six months, a 3D mammogram. The next six months, a breast MRI.

Dr. Omazonna Amadi: Yes.

Host: And are you finding that most insurance companies will approve that and allow both in one year?

Dr. Omazonna Amadi: Yes. I haven't had any problem getting those approved if it is been shown that you have dense breasts or you have a high risk of getting breast cancer.

Host: Talk about how breast density affects cancer detection and risk?

Dr. Omazonna Amadi: It's just harder to detect, you know, with x-rays, with the mammograms, just because how the tissue is formed. And the whole goal is to try to find things early before you have physical symptoms. So, women with dense breasts, typically, some things could be missed. So, that's why we're more diligent with screening more frequently to catch things early.

Host: Anything else aside from the mammogram once a year, and then six months later, the breast MRI, for those who have dense breasts? Anything else they should do differently?

Dr. Omazonna Amadi: No, I mean, typically, that's all I advise my patients on if you have dense breasts.

Host: So when it comes to examinations, what are the pros and cons of self-examination and medical examination?

Dr. Omazonna Amadi: Well, clinical breast examination, which is medical, research hasn't really shown any clear benefits. I always tell my patients, "Hey, just be familiar with how your breast feels and how they normally look." You don't have to go into details. The reason being, you find a lot of what we call false positives. Things you think are a problem, which are not. And that can cause a lot of anxiety, unnecessary ultrasounds and mammograms and things like that.

So, the pros of clinical self-breast examination is that you get to know what your breast tissue feels like, you know what's your normal, what do they look like. So that if anything appears abnormal, at least you can reach out to your physician, to get more clinical exams or ultrasounds or mammograms. Cons is, like I said, the false positives. But we typically don't try to diagnose or screen for breast cancer with clinical breast examinations.

Host: But I've heard of instances where a woman detected her breast cancer as a result of self-examination.

Dr. Omazonna Amadi: That is true. The thing is with the mammograms and the breast MRIs, we're trying to find small breast cancer tissue before it becomes a problem. So if it's to the point where she's able to feel it, chances are things have progressed.

Host: You still need the screening?

Dr. Omazonna Amadi: You still need the screening, absolutely. The whole goal is to try to find it before it becomes something.

Host: So, how do hormonal factors like birth control pills, hormone replacement therapy, or even early menstruation affect breast cancer risk?

Dr. Omazonna Amadi: Higher estrogen levels are associated with higher breast cancer risk, particularly with hormone receptor-positive diseases. That goes for oral contraceptives or even hormone replacement therapy after menopause. Also like longer menstrual history, for example, when you had your first period earlier on in life compared to the average person, or you go through menopause later on in life. So, you have all these years where you're exposed to a higher level of estrogen, those studies have shown for oral contraceptives, the association disappeared within two to five years after you stop using the oral contraceptives. But there is a high correlation between estrogen levels and breast cancers.

Host: What are some early warning signs of breast cancer that people often overlook or dismiss?

Dr. Omazonna Amadi: If you feel something different when you do your self-breast examination, like a hard mass that feels like it's fixed to the tissue. You know, it's not movable, irregular borders, abnormal nipple discharge, breast skin changes, those are some of the signs that could point to breast cancer. If you have any of that, please call your physician. Sometimes, in your armpit or your axillary region, the lymph node can be enlarged. And that's another sign of maybe this might be related to breast cancer.

I would say though, thankfully in countries with established breast cancer screening programs like the U.S., most patients are diagnosed when they're asymptomatic, which, like I said, is the goal. We try to catch these things early. Because if you're having your regular screening mammograms and doing that on time, we can catch as many people early as we can before it becomes a problem where you can feel things.

Host: Now, are there preventive medications or treatments available for women who are at high risk for breast cancer? And if so, what are their pros and cons?

Dr. Omazonna Amadi: So, there are two classes of medications that are available to help prevent or reduce your risk of breast cancer. The first class are called selective estrogen receptor modulators or SERMs. In this class, the two medications available are called tamoxifen and raloxifene. These medications work by blocking estrogen in the breast tissue. That's how they help reduce your risk of breast cancer.

One good thing about the medications is that they're both dosed once a day. Also, tamoxifen comes in a liquid form. Raloxifene on the other hand can be used to treat osteoporosis, that means very weak bones in postmenopausal females. So, that's one pro to that one as well. Tamoxifen is also an option for premenopausal women. Also, postmenopausal women can use that as well. So, women who still have a period, want to reduce their risk of breast cancer, tamoxifen is an option available for them.

Cons, I think about their risk of blood clots. So if you have a higher risk of serious blood clots, for example, obesity, you know, you're a smoker, you have a stroke history or history of a heart attack, typically, we try to avoid these medications. Also, you avoid tamoxifen in patients who have been diagnosed with uterine cancer or precancer.

So, the second class of medications that are available as an option to help prevent or reduce your risk of breast cancer, they're called aromatase inhibitors. The caveat with these medications currently is that they are not FDA approved to reduce the risk of breast cancer in the U.S. Most of the time, they're actually used to treat breast cancer. However, it's an option to consider if, for whatever reason, you are unable to take the raloxifene or tamoxifen, those medications I talked about earlier. For example, if you have blood clots or you have blood clots while taking these medications and you're trying to avoid that, the aromatase inhibitors are options that you can use. Cons, they can cause bone thinning, osteoporosis, just because of the way they work. They could also raise a cholesterol. So, you might have to rethink if you have preexisting heart disease. One other con is that they can cause muscle and joint pain. And, lastly, the most common side effects are they can cause symptoms of menopause, like hot flashes and night sweats, things like that.

So, those are the options you have available. And also, there's prophylactic mastectomy in patients who want to go the surgical route.

Host: So, can men get breast cancer too? And if so, what signs should they look out for and how common is it?

Dr. Omazonna Amadi: Men absolutely can get breast cancer, because men do have breast tissue. It's very rare though. In the U.S., about 0.5-1% of all breast cancers diagnosed each year would be males. Typically, when they're diagnosed, they're diagnosed at more advanced stages. Because a lot of times, men would unsurprisingly ignore signs and symptoms of breast cancer.

I mean for signs and symptoms, same for women. If you feel like a hard mass in your breast tissue that's not very mobile, feels like it's fixed to the tissue. Nothing special or different, you know, in terms of signs and symptoms from men compared to women. I would say this though, if you're a male, you have a strong family history of breast cancer or a genetic predisposition, particularly with a BRCA2 gene, you should definitely be more vigilant of that as well.

Host: Anything else you want to add to encourage women to be vigilant about detecting breast cancer?

Dr. Omazonna Amadi: I wouldn't say add, I just want to reiterate, please get your mammograms yearly. And be encouraged to just adopt those healthy habits to try to reduce your risk. I do want to clarify, so in terms of how often you should screen between the ages of 40 to 44 years old, you have the option to screen once a year. And between 45 to 54 years, same once a year. But after 55 years old and older, you can switch to every other year or you can continue with yearly mammogram. It's, you know, whatever you decide with your physician. And you continue to screen as long as you're in good health, or you're expected to live at least 10 more years. Even beyond for example, 75 years old, you can still keep screening if you are otherwise in really good health.

Host: Dr. Omazonna Amadi, thank you so much for educating us on breast cancer. Great practical information. Thank you.

Dr. Omazonna Amadi: I appreciate that. Thank you for having me.

Host: To schedule your mammogram, just call 574-224-1151. To schedule an appointment with Dr. Amadi, call 574-223-2020. If you found this podcast helpful, please share it on your social media. And thanks for listening to Woodlawn Health Doc talk, a podcast from Woodlawn Hospital.