An accurate and thorough diagnosis is important so that your breast cancer team can develop the best treatment plan for you. At City of Hope, your care team will utilize the most state-of-the art breast imaging technologies and laboratory techniques to guide your personalized treatment.
Listen as Monique White-Dominguez, D.O. discusses the latest advances in breast cancer screening to give women the best chance to catch cancer early when treatment can be most effective.
Latest Advances in Breast Cancer Screening
Featured Speaker:
Dr. White-Dominguez earned her undergraduate degree in biology at the University of California, San Diego (UCSD), then went on to receive her doctorate in osteopathy from the Western University of Health Sciences in Pomona, graduating Sigma Sigma Phi. She continued her postgraduate training with an internship and residency in internal medicine at the University of Southern California.
Board-certified in internal medicine, Dr. White-Dominguez is the recipient of several scholarships and honors, including the Louise Kramer Scholarship Award and the American Osteopathic Association Touch Award. Her peer-reviewed publications have focused on health perceptions in African-American women, and she has previously completed research on obstructive sleep apnea in chronic kidney disease.
Monique White-Dominguez, D.O
Monique White-Dominguez, D.O., is an Assistant Clinical Professor in the Department of Medical Specialists, division of Hospital Medicine. She joins City of Hope from Providence Little Company of Mary in Torrance where she served as a hospitalist.Dr. White-Dominguez earned her undergraduate degree in biology at the University of California, San Diego (UCSD), then went on to receive her doctorate in osteopathy from the Western University of Health Sciences in Pomona, graduating Sigma Sigma Phi. She continued her postgraduate training with an internship and residency in internal medicine at the University of Southern California.
Board-certified in internal medicine, Dr. White-Dominguez is the recipient of several scholarships and honors, including the Louise Kramer Scholarship Award and the American Osteopathic Association Touch Award. Her peer-reviewed publications have focused on health perceptions in African-American women, and she has previously completed research on obstructive sleep apnea in chronic kidney disease.
Transcription:
Latest Advances in Breast Cancer Screening
Melanie Cole (Host): An accurate and thorough diagnosis is important so that your breast cancer team can develop the best treatment plan for you. At City of Hope, your care team will utilize the most state-of-the-art breast imaging technologies and laboratory techniques to guide your personalized treatment. My guest today is Dr. Monique White-Dominguez. She's an assistant clinical professor in the Department of Medical Specialists Division of Hospital Medicine at City of Hope. Welcome to the show, Dr. White-Dominguez. First of all, what is the current screening guidelines for breast cancer? People hear in the media different things coming out from ACOG and different organizations and they don't know what to believe.
Dr. Monique White-Dominguez (Guest): Okay. So, when we talk about women with average risk, which is a large part of the population, risk being like usually less than 15%, generally, we start screening at age 40. So, we decide to start screening average risk women at the age of 40 and it's usually from age 40-49, screening every one to two years and it's again, based on the woman's average risk of breast cancer. So, again, when you have a strong family history or genetic predisposition for breast cancer, screening actually starts earlier than 40 and it's on a per patient basis.
Melanie: So, if somebody has a family history of breast cancer, then they might start earlier, but for the average risk woman, starting at 40 and every one to two years, they get a mammogram. What is involved in the mammogram and also speak about self-exams. What do you want women to know about doing a self-breast exam to maybe find it earlier even than a mammogram?
Dr. White-Dominguez: Exactly. So, what the current recommendations are is when you're between the ages of 30 and 39, you do your clinical breast exam. Well, clinical breast exam is actually every year with your pap smear, but because they've changed the pap smear guidelines, women are not necessarily getting their pap smear annually any more, and so they're not getting their clinical breast exam annually any more. It's usually between one to three years but the clinical breast exams by a licensed professional is supposed to be annually and your self-breast exams are supposed to be done monthly right after the period.
Melanie: So, how do we do the self-breast exam? If a woman asks you for advice on what it is we're supposed…because we all have lumps and bumps, doctor, and sometimes you're not really quite sure what you're supposed to be feeling.
Dr. White-Dominguez: Yes. So, you definitely need to know what your breasts feel like and so it's easier to go in . . . because what I've done, as I'm a doctor and a patient and a woman, right? So, what I've done, when I was in med school, was really worked with my instructor on what normal breast feels like and what an abnormal breast feels like because there's models. Now, not a lot of women are going to be able to know what an abnormal breast feels like, but if they start with lifting their arm up and start in circular motions feeling their breast, there's a pattern in which to do so. So, if you look in Google Self Breast Exams, you'll be able to see--and there's, of course, everything's on YouTube--so, you'd be able to see how one does a self-breast exam. So, that's one start on how to actually do the breast exam, but it's really feeling your breasts completely. It's all the quadrants. Going from the nipple all the way out to the axilla, or the armpit. So, it's definitely a technique, it's very easy to do, but it's getting yourself comfortable with feeling your breast to be able to see if you have a lump of if there is anything abnormal.
Melanie: So, then, let's speak about some of the other forms of testing. We've all heard about the standard 2D mammogram and going in and that it's not nearly as painful or laborious as women sometimes make it out to be and, of course, none of us like that waiting to making sure the pictures came out or that letter that may come that they found something, but there are so many other ways now--ultrasound, MRI, 3D tomosynthesis--speak about some of those as tools to help you guys screen us.
Dr. White-Dominguez: So, basically, the mammogram is the number one, it's the mainstay for the screening of breast cancer. That's going to start an average-risk woman at 40. So, that's still the mainstay of breast cancer screening. Again, when you're a woman with high-risk, you know, high-risk for breast cancer, have a lot of breast cancer in your family, have maternal/paternal relatives diagnosed at a young age with breast cancer, then, typically, before the age of 40, we recommend ultrasound. So, ultrasounds, we may have to do a breast MRI, but the mainstay of screening is number one is going to be your mammogram; ultrasound is used as an adjunct, and it's also used in women younger than 40, and then there's also the breast MRI, which is being used, but, again, it's a more expensive test and there are limitations in terms of insurance and coverage.
Melanie: People hear about the 3D mammogram. What is that?
Dr. White-Dominguez: So, the 3D mammogram is just using basically 3D technology with the mammogram, to see if there's any type of area that wouldn't necessarily have been picked up with the regular mammogram, if there's any area of concern. So, it's just a way in which to provide more sensitivity to the mammogram.
Melanie: Is it easier to read or does it take a different type of specialist to read it?
Dr. White-Dominguez: I don't believe it takes an additional specialist to read, but I do believe there's training with radiologists in terms of reading the 3D part and a lot of insurances in this area won't necessarily cover the 3D portion. You'll have a co-pay of what insurance will not pay and if you do want the 3D mammogram, you would have to pay part of your co-pay that is not covered by insurance to be able to undergo the 3D part of the mammogram.
Melanie: So, what do you tell women all the time, doctor, about some women avoid this because they say that they hear about radiation and that that could increase their risk for breast cancer, and what do you tell them when they question some of this because they hear some of it in the media?
Dr. White-Dominguez: Exactly. I would say that the purpose of screening is to find abnormalities when we can diagnose them early and we can address them properly. And, when we fail to do the recommended screenings, we're at risk to find cancer at later stages, at a terminal stage, when we could have found it sooner. Coming from a family in which several, about 10 of my relatives, maternal/paternal, have some form of cancer, it's not really recommended in my case to not adhere to the current screening guidelines. So, even if you are scared about screening and starting at 40 and do I have to do this every year? My doctor says I need to do it every year. I want to do it every two years--you know, that's when you start asking your doctor, your primary care physician, or if you already have an oncologist, you need to sit down with your doctor and see what's right for you. So, when you usually have that discussion with your physician, hopefully, a physician which you've known for some time, it's easier to make those choices of when and how I should do my screening. What is going to be my screening modality? When should I start and how do I continue you know, to screen in the ways in which it would benefit me the most?
Melanie: Where does genetic testing fit in? You mentioned that you have family members with cancer. Women are hearing more and more about prophylactic mastectomies and the BRCA gene and genetic testing and what do you tell women when they ask you about this new, confusing technology and what it means for them?
Dr. White-Dominguez: So, since I've had first-hand knowledge, for the average-risk woman that has no family history, no factors to make her at high-risk, then you would proceed with the regular current screening guidelines. You would start your mammogram at age 40. In terms of the high-risk individual, like myself, you know, I did already did undergo genetic testing. I went to my OB/GYN who I've known for years, who delivered my children, and we know of my risk, so it's a simple blood test. It isn't always covered by insurance. I had to call and make sure that this genetic test that my OB/GYN recommended was covered, and what I was responsible for in terms of that genetic testing. It's a blood test and you get the results in 7-10 business days.
Melanie: Wow. That is such interesting information and so well spoken. So, just wrap it up for us, what you want women to know about the importance of screening and self-exams to prevent and possibly catch early breast cancer.
Dr. White-Dominguez: So, yes. I would say your self-breast exam every month is critical, learning how your breasts feel is going to be important in distinguishing if you have a breast lump or if something feels abnormal to you, or if your skin starts to change around your breast that you haven't noticed. So, you know, the patient--the woman--is going to be the number one proponent for their health. So, doing that is helpful, talking with your physician, doing your clinical breast exams yearly, is also an important aspect of screening, and then if you don't have any family history, if you don't have any of those factors, you know, recommended starting screening for breast cancer at 40 is appropriate. If you want to sit down and have a discussion with your family physician on your OB/GYN on what's best for you, that's very helpful. All you do is when you go to schedule your appointment is say, "Hey, I want to talk about my doctor about my screening, my risk for breast cancer, and what's best for me," and the doctor is usually always grateful to hear that there needs to be an additional discussion and they can tailor the discussion towards your needs. So, I definitely with all my family history of cancer and having to see breast cancer terminal diagnosis at a young age for my family members, I'm passionate about screening. I believe screening is helpful for everyone, low-risk, average-risk, and high-risk, and I urge women to have this discussion with their physician, their licensed health care provider, and have this discussion on what's going to be best for them.
Melanie: Wow, thank you so much for being with us and sharing your story, Dr. White-Dominguez. Great information. You're listening to City of Hope Radio and for more information, you can go to www.cityofhope.org. That's www.cityofhope.org. This is Melanie Cole. Thanks so much for listening.
Latest Advances in Breast Cancer Screening
Melanie Cole (Host): An accurate and thorough diagnosis is important so that your breast cancer team can develop the best treatment plan for you. At City of Hope, your care team will utilize the most state-of-the-art breast imaging technologies and laboratory techniques to guide your personalized treatment. My guest today is Dr. Monique White-Dominguez. She's an assistant clinical professor in the Department of Medical Specialists Division of Hospital Medicine at City of Hope. Welcome to the show, Dr. White-Dominguez. First of all, what is the current screening guidelines for breast cancer? People hear in the media different things coming out from ACOG and different organizations and they don't know what to believe.
Dr. Monique White-Dominguez (Guest): Okay. So, when we talk about women with average risk, which is a large part of the population, risk being like usually less than 15%, generally, we start screening at age 40. So, we decide to start screening average risk women at the age of 40 and it's usually from age 40-49, screening every one to two years and it's again, based on the woman's average risk of breast cancer. So, again, when you have a strong family history or genetic predisposition for breast cancer, screening actually starts earlier than 40 and it's on a per patient basis.
Melanie: So, if somebody has a family history of breast cancer, then they might start earlier, but for the average risk woman, starting at 40 and every one to two years, they get a mammogram. What is involved in the mammogram and also speak about self-exams. What do you want women to know about doing a self-breast exam to maybe find it earlier even than a mammogram?
Dr. White-Dominguez: Exactly. So, what the current recommendations are is when you're between the ages of 30 and 39, you do your clinical breast exam. Well, clinical breast exam is actually every year with your pap smear, but because they've changed the pap smear guidelines, women are not necessarily getting their pap smear annually any more, and so they're not getting their clinical breast exam annually any more. It's usually between one to three years but the clinical breast exams by a licensed professional is supposed to be annually and your self-breast exams are supposed to be done monthly right after the period.
Melanie: So, how do we do the self-breast exam? If a woman asks you for advice on what it is we're supposed…because we all have lumps and bumps, doctor, and sometimes you're not really quite sure what you're supposed to be feeling.
Dr. White-Dominguez: Yes. So, you definitely need to know what your breasts feel like and so it's easier to go in . . . because what I've done, as I'm a doctor and a patient and a woman, right? So, what I've done, when I was in med school, was really worked with my instructor on what normal breast feels like and what an abnormal breast feels like because there's models. Now, not a lot of women are going to be able to know what an abnormal breast feels like, but if they start with lifting their arm up and start in circular motions feeling their breast, there's a pattern in which to do so. So, if you look in Google Self Breast Exams, you'll be able to see--and there's, of course, everything's on YouTube--so, you'd be able to see how one does a self-breast exam. So, that's one start on how to actually do the breast exam, but it's really feeling your breasts completely. It's all the quadrants. Going from the nipple all the way out to the axilla, or the armpit. So, it's definitely a technique, it's very easy to do, but it's getting yourself comfortable with feeling your breast to be able to see if you have a lump of if there is anything abnormal.
Melanie: So, then, let's speak about some of the other forms of testing. We've all heard about the standard 2D mammogram and going in and that it's not nearly as painful or laborious as women sometimes make it out to be and, of course, none of us like that waiting to making sure the pictures came out or that letter that may come that they found something, but there are so many other ways now--ultrasound, MRI, 3D tomosynthesis--speak about some of those as tools to help you guys screen us.
Dr. White-Dominguez: So, basically, the mammogram is the number one, it's the mainstay for the screening of breast cancer. That's going to start an average-risk woman at 40. So, that's still the mainstay of breast cancer screening. Again, when you're a woman with high-risk, you know, high-risk for breast cancer, have a lot of breast cancer in your family, have maternal/paternal relatives diagnosed at a young age with breast cancer, then, typically, before the age of 40, we recommend ultrasound. So, ultrasounds, we may have to do a breast MRI, but the mainstay of screening is number one is going to be your mammogram; ultrasound is used as an adjunct, and it's also used in women younger than 40, and then there's also the breast MRI, which is being used, but, again, it's a more expensive test and there are limitations in terms of insurance and coverage.
Melanie: People hear about the 3D mammogram. What is that?
Dr. White-Dominguez: So, the 3D mammogram is just using basically 3D technology with the mammogram, to see if there's any type of area that wouldn't necessarily have been picked up with the regular mammogram, if there's any area of concern. So, it's just a way in which to provide more sensitivity to the mammogram.
Melanie: Is it easier to read or does it take a different type of specialist to read it?
Dr. White-Dominguez: I don't believe it takes an additional specialist to read, but I do believe there's training with radiologists in terms of reading the 3D part and a lot of insurances in this area won't necessarily cover the 3D portion. You'll have a co-pay of what insurance will not pay and if you do want the 3D mammogram, you would have to pay part of your co-pay that is not covered by insurance to be able to undergo the 3D part of the mammogram.
Melanie: So, what do you tell women all the time, doctor, about some women avoid this because they say that they hear about radiation and that that could increase their risk for breast cancer, and what do you tell them when they question some of this because they hear some of it in the media?
Dr. White-Dominguez: Exactly. I would say that the purpose of screening is to find abnormalities when we can diagnose them early and we can address them properly. And, when we fail to do the recommended screenings, we're at risk to find cancer at later stages, at a terminal stage, when we could have found it sooner. Coming from a family in which several, about 10 of my relatives, maternal/paternal, have some form of cancer, it's not really recommended in my case to not adhere to the current screening guidelines. So, even if you are scared about screening and starting at 40 and do I have to do this every year? My doctor says I need to do it every year. I want to do it every two years--you know, that's when you start asking your doctor, your primary care physician, or if you already have an oncologist, you need to sit down with your doctor and see what's right for you. So, when you usually have that discussion with your physician, hopefully, a physician which you've known for some time, it's easier to make those choices of when and how I should do my screening. What is going to be my screening modality? When should I start and how do I continue you know, to screen in the ways in which it would benefit me the most?
Melanie: Where does genetic testing fit in? You mentioned that you have family members with cancer. Women are hearing more and more about prophylactic mastectomies and the BRCA gene and genetic testing and what do you tell women when they ask you about this new, confusing technology and what it means for them?
Dr. White-Dominguez: So, since I've had first-hand knowledge, for the average-risk woman that has no family history, no factors to make her at high-risk, then you would proceed with the regular current screening guidelines. You would start your mammogram at age 40. In terms of the high-risk individual, like myself, you know, I did already did undergo genetic testing. I went to my OB/GYN who I've known for years, who delivered my children, and we know of my risk, so it's a simple blood test. It isn't always covered by insurance. I had to call and make sure that this genetic test that my OB/GYN recommended was covered, and what I was responsible for in terms of that genetic testing. It's a blood test and you get the results in 7-10 business days.
Melanie: Wow. That is such interesting information and so well spoken. So, just wrap it up for us, what you want women to know about the importance of screening and self-exams to prevent and possibly catch early breast cancer.
Dr. White-Dominguez: So, yes. I would say your self-breast exam every month is critical, learning how your breasts feel is going to be important in distinguishing if you have a breast lump or if something feels abnormal to you, or if your skin starts to change around your breast that you haven't noticed. So, you know, the patient--the woman--is going to be the number one proponent for their health. So, doing that is helpful, talking with your physician, doing your clinical breast exams yearly, is also an important aspect of screening, and then if you don't have any family history, if you don't have any of those factors, you know, recommended starting screening for breast cancer at 40 is appropriate. If you want to sit down and have a discussion with your family physician on your OB/GYN on what's best for you, that's very helpful. All you do is when you go to schedule your appointment is say, "Hey, I want to talk about my doctor about my screening, my risk for breast cancer, and what's best for me," and the doctor is usually always grateful to hear that there needs to be an additional discussion and they can tailor the discussion towards your needs. So, I definitely with all my family history of cancer and having to see breast cancer terminal diagnosis at a young age for my family members, I'm passionate about screening. I believe screening is helpful for everyone, low-risk, average-risk, and high-risk, and I urge women to have this discussion with their physician, their licensed health care provider, and have this discussion on what's going to be best for them.
Melanie: Wow, thank you so much for being with us and sharing your story, Dr. White-Dominguez. Great information. You're listening to City of Hope Radio and for more information, you can go to www.cityofhope.org. That's www.cityofhope.org. This is Melanie Cole. Thanks so much for listening.