Every year over 200,000 women in the U.S. are diagnosed with breast cancer, When breast cancer is detected early, before it has spread, it is easier to treat and women have a much better chance of survival.
There is no one known cause for breast cancer. Genetics, having a family history, and other lifestyle or environmental factors can play a part.
The nationally-accredited Beth Israel Deaconess - Plymouth Breast Center represents a concerted effort across medical, radiological and surgical disciplines., to provide the highest quality breast health care.
Dr. Lisa Tito, Medical Director of the BID Plymouth Breast Cancer Center, is here to give women great advice on keeping healthy breasts and the latest technologies to help catch breast cancer early when it is most treatable.
Selected Podcast
Breast Health and The Latest Information for Women
Featured Speaker:
Learn more about Elizabeth P. Tito, MD
Elizabeth P. Tito, MD
Elizabeth P. Tito, MD specialty is surgery and breast cancer.Learn more about Elizabeth P. Tito, MD
Transcription:
Breast Health and The Latest Information for Women
Dr. Melanie Cole (Host): Every year over 200,000 women in the U.S. are diagnosed with breast cancer. When breast cancer is detected early, before it has spread, it’s much easier to treat and women have a much better chance of surviving it. My guest today is Dr. Lisa Tito. She’s the medical director for the Breast Cancer Program at BID Plymouth. Welcome to the show, Dr. Tito. So, tell us a little bit about breast health in women and what do you tell women every single day as your most important bits of information?
Dr. List Tito (Guest): Well, one of the first things I tell people is about their risk of developing breast because there is a lot of misinformation out in the community and I want everyone to know that there are three major risk factors for getting breast cancer. They are: Are you a woman? Do you have breasts? And, are you getting older? With those three risk factors, it gives you a 1 in 8 chance of having breast cancer over your lifetime. So, it essentially means all of us. What do we do? The most important thing a woman can do is to get her mammograms. Now, I know there’s a lot of confusion about who should get mammograms and how often because there’s so many different recommendations coming out. I do know it is quite confusing.
Melanie: So, what do you tell women about getting mammograms? When should they get their first one, their baseline? And then, how often after that?
Dr. Tito: Well, there’s a lot of different recommendations. The most recent one to come out is from the American Cancer Society. I think they are very reasonable recommendations. Their recommendations are that women from the ages of 40-44 have the choice to start annual mammograms starting at the age of 40. However, you also have the choice to wait. I think that’s somewhat reasonable although I have to say that I err on the side of recommending mammograms as opposed to waiting but people do have a choice. I’m in full agreement that women age 45-54 definitely need to get their mammograms every year. The reason for this is breast cancers grow differently in women who are younger than women who are older. Younger women tend to have breast cancers that grow quicker and when they grow quicker they tend to get bad quicker. So, if we find them a year or two earlier, we can change the course of the disease. Treatment options are different; surgical options are different and we decrease death from breast cancer from finding it earlier. So, it’s critical for those years to get them every year. We also know that as women age, their breast cancers change as well. When women are older, breast cancers do to tend to grow a little bit slower and they don’t get as aggressive when they get bigger. So, in women who are older, it might be safe to do it every two years because if we wait two years and miss it for a year, it’s still at essentially the same size and treatment options and you’re unlikely to die because of the delay in finding that breast cancer. All of those recommendations are for the “average risk woman”. The, next question is, how do you tell if you’re average risk or not or average risk?
Melanie: So, tell us a little bit about the risk factors and if you have dense breasts, are there different recommendations or is it the same? Do you recommend women with dense breasts get ultrasound? What do we need to know?
Dr. Tito: First of all, the risks, I think that you’re at average risk if you don’t have a very strong family history, you haven’t had biopsies which show abnormal cells in your breasts – things called atypia--and if you’re not having very dense breast tissue. Dense breast tissue essentially means that your breasts are young and healthy. Young and healthy breasts are very white on mammograms. The problem with very white mammograms is, breast cancers show up as white. So, we are trying to find a white breast cancer on a white background which makes it much more difficult. That said, the majority of women from 40-50 are going to have dense breast mammograms because that’s normal. You’re supposed to have a healthy amount of breast tissue on your breasts before going through menopause. After menopause, that dense, healthy breast tissue slowly gets replaced by fat and fat is black on mammograms. So, now it’s much easier to find a white cancer on a black background. The majority of breast cancers do occur after menopause. About 70% of breast cancers happen after you go through menopause. So, as your risk for breast cancer goes up, the ability to find the breast cancer on your mammogram is much easier. That’s a good thing. The question is, what do we do for women with dense breasts in their 40’s? The answer that I’m most comfortable with is that we continue screening with mammograms for the majority of those women if you are at average risk. However, there is a small group of women who have a higher chance of developing breast cancer over their lifetime and those women should be offered additional screening either with MRI or with ultrasound. The way we find those women is at our institution, we have a risk assessment profile that we run on everyone who comes to get a screening mammogram. When you fill out this questionnaire, it generates a percentage or a number that tells you what is your lifetime risk of developing breast cancer. If that lifetime risk is greater than 20%, we then pull you in and then talk about additional screening. This is in women who have dense breasts or even in women who don’t have dense breasts. We talk about the pros and cons about adding different screening modalities.
Melanie: Women go through so many changes and when we are giving ourselves self-exams, we feel different lumps and bumps. What do you tell women, Dr. Tito, about self-exams, being their own best advocate and not to fear everything they feel?
Dr. Tito: It’s very hard to do a self-breast exam because breasts are very lumpy, bumpy and they are supposed to be. It’s hard even for your primary care physician and its hard even for me and I do breast exams every single day of my practice and it’s still hard. We do not expect you to be the expert of finding the breast cancer in your breast. Sometimes it can be overwhelming because there’s so many lumps and bumps. My recommendations to my patients are two things. First of all, if it’s confusing and you really can’t get it and you’re really terrified of doing your breast exams and it’s making your life worse, don’t do them. Go and get your breast exam once a year by your physician. However, if you do want to do breast exams I approach it a little bit differently. What I tell my patients to do is, “Listen, your breasts are lumpy, bumpy and that’s normal. I just did your breast exam and these lumps and bumps that we are feeling right now are part of your normal breast tissue. So, what I want you to do is go home and learn your normal breast exam. These lumps are yours and claim them as yours.” That way, you help your primary care physician when they do a breast exam and say “What’s that lump in this upper, outer quadrant of your breast?” And you can say, “You know what, that’s my lumps. It’s been like that for three years. Nothing has changes. Those are mine. Leave me alone.” Or, she might feel a lump and you say, “You know what, I haven’t noticed that as one of my normal lumps.” That can be very powerful and helpful when evaluating a very difficult breast exam.
Melanie: Now, women are hearing, Dr. Tito, about the new digital 3-D mammography called tomosynthesis. What do you want them to know about that? Are they requesting this from you?
Dr. Tito: Yes. I’m hearing a lot of questions from patients about tomosynthesis, or 3-D mammograms. It is one of those unique new technologies that I do think is somewhat better. For one reason, especially. One of the down things of having mammograms, especially starting in your 40’s, is we see so many normal things in your breast that need to be worked up. If we see something on a mammogram, we’re not 100% sure that it’s not a cancer so we have to go through additional views and sometimes biopsies and sometimes even operations. We don’t like to do that if we don’t have to. One of the advantages of this new technique is it has a better ability to look at something in your breast and say, “It’s fine.” We can leave it alone. It’s a modality that finds more cancers than regular mammograms and has the ability to say, “We can do less biopsies because that looks normal.” So, that combination of increased sensitivity and what we call “increased specificity,” meaning it can tell you its normal without a biopsy, is a wonderful combination. Now, does everyone have to go out and find a place with 3-D tomosynthesis? I don’t think that’s really necessary quite yet but if you have access to it, it is a nice addition. The group of people that probably benefits the most are those that have difficult to read mammograms because it’s a slightly better way to see through that difficult tissue.
Melanie: In just the last few minutes, Dr. Tito, give women your best advice about this confusing world of breast health and breast cancer and why they shouldn’t be afraid and why they should come to Beth Israel Deaconess at Plymouth for their care.
Dr. Tito: Well, breast cancer is scary for women because it is the number one cancer that we all get and everyone knows someone who’s had breast cancer and it does affect people who are younger, so it is a scary disease to think about. What I want people to know is that we are winning. It is amazing the progress that we’ve made with the treatment of breast cancer. Surgical technique has improved phenomenally. The way I do surgery now is completely different than the way I was trained to do surgery in residency. I use these newer oncoplastic techniques and I’ve been doing this for many, many years with these newer techniques and they are better. So, I can take breast cancer out of women’s breasts and make their breasts look even better than when they went in for the surgery. We’ve also got a lot more medications and drugs that are targeted towards specific breast cancer characteristics. We’ve also gotten much smarter at determining which cancers need chemotherapy and which cancers don’t need chemotherapy and we’re doing a much better at individualizing cancer treatment. At Beth Israel Deaconess at Plymouth, we have a very comprehensive, multi-disciplinary team that works very well together to treat each individual’s cancer as each individual patient’s cancer needs to be treated. We’re a very tightknit team. If you come to our place, you’ll get cutting edge technology. We’re up on all the data and you’ll get a very cohesive, family-oriented, wonderful experience.
Melanie: Thank you so much. It is great information. So, beautifully put, Dr. Tito. Thank you for being with us today. You’re listening to BID Plymouth Wellness Radio. For more information, you can go to BIDplymouth.org. That’s BIDplymouth.org. This is Melanie Cole. Thanks so much for listening.
Breast Health and The Latest Information for Women
Dr. Melanie Cole (Host): Every year over 200,000 women in the U.S. are diagnosed with breast cancer. When breast cancer is detected early, before it has spread, it’s much easier to treat and women have a much better chance of surviving it. My guest today is Dr. Lisa Tito. She’s the medical director for the Breast Cancer Program at BID Plymouth. Welcome to the show, Dr. Tito. So, tell us a little bit about breast health in women and what do you tell women every single day as your most important bits of information?
Dr. List Tito (Guest): Well, one of the first things I tell people is about their risk of developing breast because there is a lot of misinformation out in the community and I want everyone to know that there are three major risk factors for getting breast cancer. They are: Are you a woman? Do you have breasts? And, are you getting older? With those three risk factors, it gives you a 1 in 8 chance of having breast cancer over your lifetime. So, it essentially means all of us. What do we do? The most important thing a woman can do is to get her mammograms. Now, I know there’s a lot of confusion about who should get mammograms and how often because there’s so many different recommendations coming out. I do know it is quite confusing.
Melanie: So, what do you tell women about getting mammograms? When should they get their first one, their baseline? And then, how often after that?
Dr. Tito: Well, there’s a lot of different recommendations. The most recent one to come out is from the American Cancer Society. I think they are very reasonable recommendations. Their recommendations are that women from the ages of 40-44 have the choice to start annual mammograms starting at the age of 40. However, you also have the choice to wait. I think that’s somewhat reasonable although I have to say that I err on the side of recommending mammograms as opposed to waiting but people do have a choice. I’m in full agreement that women age 45-54 definitely need to get their mammograms every year. The reason for this is breast cancers grow differently in women who are younger than women who are older. Younger women tend to have breast cancers that grow quicker and when they grow quicker they tend to get bad quicker. So, if we find them a year or two earlier, we can change the course of the disease. Treatment options are different; surgical options are different and we decrease death from breast cancer from finding it earlier. So, it’s critical for those years to get them every year. We also know that as women age, their breast cancers change as well. When women are older, breast cancers do to tend to grow a little bit slower and they don’t get as aggressive when they get bigger. So, in women who are older, it might be safe to do it every two years because if we wait two years and miss it for a year, it’s still at essentially the same size and treatment options and you’re unlikely to die because of the delay in finding that breast cancer. All of those recommendations are for the “average risk woman”. The, next question is, how do you tell if you’re average risk or not or average risk?
Melanie: So, tell us a little bit about the risk factors and if you have dense breasts, are there different recommendations or is it the same? Do you recommend women with dense breasts get ultrasound? What do we need to know?
Dr. Tito: First of all, the risks, I think that you’re at average risk if you don’t have a very strong family history, you haven’t had biopsies which show abnormal cells in your breasts – things called atypia--and if you’re not having very dense breast tissue. Dense breast tissue essentially means that your breasts are young and healthy. Young and healthy breasts are very white on mammograms. The problem with very white mammograms is, breast cancers show up as white. So, we are trying to find a white breast cancer on a white background which makes it much more difficult. That said, the majority of women from 40-50 are going to have dense breast mammograms because that’s normal. You’re supposed to have a healthy amount of breast tissue on your breasts before going through menopause. After menopause, that dense, healthy breast tissue slowly gets replaced by fat and fat is black on mammograms. So, now it’s much easier to find a white cancer on a black background. The majority of breast cancers do occur after menopause. About 70% of breast cancers happen after you go through menopause. So, as your risk for breast cancer goes up, the ability to find the breast cancer on your mammogram is much easier. That’s a good thing. The question is, what do we do for women with dense breasts in their 40’s? The answer that I’m most comfortable with is that we continue screening with mammograms for the majority of those women if you are at average risk. However, there is a small group of women who have a higher chance of developing breast cancer over their lifetime and those women should be offered additional screening either with MRI or with ultrasound. The way we find those women is at our institution, we have a risk assessment profile that we run on everyone who comes to get a screening mammogram. When you fill out this questionnaire, it generates a percentage or a number that tells you what is your lifetime risk of developing breast cancer. If that lifetime risk is greater than 20%, we then pull you in and then talk about additional screening. This is in women who have dense breasts or even in women who don’t have dense breasts. We talk about the pros and cons about adding different screening modalities.
Melanie: Women go through so many changes and when we are giving ourselves self-exams, we feel different lumps and bumps. What do you tell women, Dr. Tito, about self-exams, being their own best advocate and not to fear everything they feel?
Dr. Tito: It’s very hard to do a self-breast exam because breasts are very lumpy, bumpy and they are supposed to be. It’s hard even for your primary care physician and its hard even for me and I do breast exams every single day of my practice and it’s still hard. We do not expect you to be the expert of finding the breast cancer in your breast. Sometimes it can be overwhelming because there’s so many lumps and bumps. My recommendations to my patients are two things. First of all, if it’s confusing and you really can’t get it and you’re really terrified of doing your breast exams and it’s making your life worse, don’t do them. Go and get your breast exam once a year by your physician. However, if you do want to do breast exams I approach it a little bit differently. What I tell my patients to do is, “Listen, your breasts are lumpy, bumpy and that’s normal. I just did your breast exam and these lumps and bumps that we are feeling right now are part of your normal breast tissue. So, what I want you to do is go home and learn your normal breast exam. These lumps are yours and claim them as yours.” That way, you help your primary care physician when they do a breast exam and say “What’s that lump in this upper, outer quadrant of your breast?” And you can say, “You know what, that’s my lumps. It’s been like that for three years. Nothing has changes. Those are mine. Leave me alone.” Or, she might feel a lump and you say, “You know what, I haven’t noticed that as one of my normal lumps.” That can be very powerful and helpful when evaluating a very difficult breast exam.
Melanie: Now, women are hearing, Dr. Tito, about the new digital 3-D mammography called tomosynthesis. What do you want them to know about that? Are they requesting this from you?
Dr. Tito: Yes. I’m hearing a lot of questions from patients about tomosynthesis, or 3-D mammograms. It is one of those unique new technologies that I do think is somewhat better. For one reason, especially. One of the down things of having mammograms, especially starting in your 40’s, is we see so many normal things in your breast that need to be worked up. If we see something on a mammogram, we’re not 100% sure that it’s not a cancer so we have to go through additional views and sometimes biopsies and sometimes even operations. We don’t like to do that if we don’t have to. One of the advantages of this new technique is it has a better ability to look at something in your breast and say, “It’s fine.” We can leave it alone. It’s a modality that finds more cancers than regular mammograms and has the ability to say, “We can do less biopsies because that looks normal.” So, that combination of increased sensitivity and what we call “increased specificity,” meaning it can tell you its normal without a biopsy, is a wonderful combination. Now, does everyone have to go out and find a place with 3-D tomosynthesis? I don’t think that’s really necessary quite yet but if you have access to it, it is a nice addition. The group of people that probably benefits the most are those that have difficult to read mammograms because it’s a slightly better way to see through that difficult tissue.
Melanie: In just the last few minutes, Dr. Tito, give women your best advice about this confusing world of breast health and breast cancer and why they shouldn’t be afraid and why they should come to Beth Israel Deaconess at Plymouth for their care.
Dr. Tito: Well, breast cancer is scary for women because it is the number one cancer that we all get and everyone knows someone who’s had breast cancer and it does affect people who are younger, so it is a scary disease to think about. What I want people to know is that we are winning. It is amazing the progress that we’ve made with the treatment of breast cancer. Surgical technique has improved phenomenally. The way I do surgery now is completely different than the way I was trained to do surgery in residency. I use these newer oncoplastic techniques and I’ve been doing this for many, many years with these newer techniques and they are better. So, I can take breast cancer out of women’s breasts and make their breasts look even better than when they went in for the surgery. We’ve also got a lot more medications and drugs that are targeted towards specific breast cancer characteristics. We’ve also gotten much smarter at determining which cancers need chemotherapy and which cancers don’t need chemotherapy and we’re doing a much better at individualizing cancer treatment. At Beth Israel Deaconess at Plymouth, we have a very comprehensive, multi-disciplinary team that works very well together to treat each individual’s cancer as each individual patient’s cancer needs to be treated. We’re a very tightknit team. If you come to our place, you’ll get cutting edge technology. We’re up on all the data and you’ll get a very cohesive, family-oriented, wonderful experience.
Melanie: Thank you so much. It is great information. So, beautifully put, Dr. Tito. Thank you for being with us today. You’re listening to BID Plymouth Wellness Radio. For more information, you can go to BIDplymouth.org. That’s BIDplymouth.org. This is Melanie Cole. Thanks so much for listening.