In recent years, breast cancer screening guidelines have changed to reduce the number of times a woman should be screened. Some women are concerned about their own preventive measures as a result of these changes.
Dr. Tina Rizack, medical oncologist and former Women & Infants Hospital physician, discusses the current breast cancer screening and prevention guidelines.
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Breast Cancer Screening and Prevention Guidelines
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Learn more about Dr. Tina Rizack
Tina Rizack, MD, MPH
Dr. Tina Rizack is an oncologist in Wakefield, Rhode Island. She received her medical degree from Emory University School of Medicine and has been in practice between 11-20 years.Learn more about Dr. Tina Rizack
Transcription:
Bill Klaproth: Breast cancer screening guidelines have changed in the last three years for women reducing the number of times a woman should be screened leaving some women concerned about their own preventative measures. Here to talk with us about breast cancer screening and prevention guidelines is Dr. Tina Rizack, a medical oncologist at South County Health. Dr. Rizack, thanks for your time. So, this seems to be a moving target on when to get screened for breast cancer. What are the current breast cancer screening guidelines?
Tina Rizack, MD, MPH: The guidelines actually differ by the organization that recommends them. So, the US Preventive Task Force is the one that has changed the recommendations to screening about every two years. A lot of the other organizations such as the American College of Obstetrics and Gynecology and a lot of the radiology groups and some of the cancer guidelines still recommend annual screenings.
Bill: What age do those screenings start?
Dr. Rizack: Usually we recommend a woman start with a baseline mammogram about 40. Sometimes they do every other year until they reach their 50s or mid-50s, then annual mammogram is recommended. A lot of the organizations still recommend annual mammograms starting at age 40.
Bill: How do risk factors influence screening protocols like when to start? Things such as family history, dense breasts, ethnicity, et cetera. Can you talk about that?
Dr. Rizack: Sure. We know that people that have a high risk for breast cancer are those that have a family history of breast cancer. That really only occurs in 5 to maybe 10% of the population. Women with dense breasts, women that have had radiation to the chest, such as childhood cancers or for other reasons, are at increased risks for breast cancer. For those, we still recommend a baseline at 40 and that is because prior to that the breasts are still very dense. Beginning at 40, they begin—or before 40—to get more fatty tissues. So that screening with mammogram is more efficient.
Bill: So, when should a woman stop getting screened?
Dr. Rizack: There are no age cutoff for when women stop getting mammograms. It’s actually something I try to get across to the patient and the primary care doctors. If a woman is going to live for at least another 10 years, and some say even 5 to 7 years, then you would want to continue mammograms. The women that are most likely to get breast cancer are the ones as they get older. Even though they are less aggressive, it is certainly better to catch breast cancer when it is early and easily cared for then to wait until they begin to have symptoms.
Bill: Can you explain the different types of diagnostics and screening technologies available today?
Dr. Rizack: Sure. Because they have changed in the last couple of years. We used to talk about digital mammography, which is really the standard of care for screening the average population. A lot of centers, used to be the academic centers, but even here at South County we now do tomosynthesis, which is more of a 3D type mammogram, which seems to be more efficient in picking up abnormalities in patients. So, a lot of them are moving to that as a baseline mammogram, or at least in patients who are at slightly higher risk. There is also breast MRI for patients that meet the guidelines for that as well as ultrasounds.
Bill: So, mammograms have helped reduce breast cancer mortality in the U.S by nearly 40% since 1990. Yet, there are some women that skip this important checkup. Why is it so important for a woman to get a mammogram and not skip it?
Dr. Rizack: Mammograms not only pick up precursor lesions—so lesions that are likely to become a breast cancer—but they also pick up breast cancers before you can palpate them yourself. Those patients can get picked up a lot earlier. Instead of having to end up with a huge surgery like a mastectomy or even chemotherapy, they can be picked up with a much smaller tumor and need a lot less treatment. So early detection is very important. We do encourage women to get their mammograms.
Bill: So, Dr. Rizack, you are a former woman and infant’s hospital physician. Can you briefly talk about that and why you believe community cancer care is important?
Dr. Rizack: So, I worked at women and infants for seven years, which was a wonderful experience. I moved into community medicine about a year and a half ago. About 80% of patients with cancer actually get their care in the community. It’s much more convenient for patients to get care closer to home than to have to drive distances. That can prevent them from participating in other parts of their life. Certainly, if they have children or grandchildren and they need to participate in aspects of their life, it certainly makes it easier for them to get care in the community, which often is the same care that they would get in an academic center. My affiliation with women and infant’s is helpful in that I still have maintained my connections and colleagues there. So, with complicated patients, I can often consult them or talk to them on the phone or participate in some of their tumor boards to discuss more complicated patients.
Bill: I can see how that would be a benefit. That close community care is really important, so people get in and get this necessary preventative diagnostic care done. Having a community center close by is really important.
Dr. Rizack: It is very important because people are living longer and living better. They don’t want to spend a lot of time on their healthcare. So, if they can certainly come in and get their mammogram, or if they actually have cancer, to get their treatment close to home, it has a significant impact on their quality of life.
Bill: Can you also tell us why the South County health cancer center is a great start in facility overall to receive care?
Dr. Rizack: Sure. Well first of all, our imaging is top of the line. We offer tomosynthesis and breast MRI and breast guided biopsies that you could get anywhere else in the state. We can do them right here close to home. We have three board certified hematologists and oncologists. We have our own breast navigator who navigates patients from the minute they have an abnormal mammogram and through follow-up and survivorship so that their care is seamless and coordinated. We feel that we can offer as good of care as they can get in other places. If clinical trials are available or other treatment that we can’t offer here, we are aware of clinical trials and other treatments and we refer patients out when they need to be referred.
Bill: So, it sounds like a complete coordinated team effort.
Dr. Rizack: Yes. We have radiation oncology. We have radiologists. We have surgeons. Of course, the medical oncologist as well as nurse navigators, and our own chemotherapy unit right here in the clinic with us that we can make the care pretty seamless.
Bill: Really important. Well, Dr. Rizack, thank you so much for your time today. For more information, please visit southcountyhealth.org. That’s southcountyhealth.org. This is South County Health Talks from South County Health. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth: Breast cancer screening guidelines have changed in the last three years for women reducing the number of times a woman should be screened leaving some women concerned about their own preventative measures. Here to talk with us about breast cancer screening and prevention guidelines is Dr. Tina Rizack, a medical oncologist at South County Health. Dr. Rizack, thanks for your time. So, this seems to be a moving target on when to get screened for breast cancer. What are the current breast cancer screening guidelines?
Tina Rizack, MD, MPH: The guidelines actually differ by the organization that recommends them. So, the US Preventive Task Force is the one that has changed the recommendations to screening about every two years. A lot of the other organizations such as the American College of Obstetrics and Gynecology and a lot of the radiology groups and some of the cancer guidelines still recommend annual screenings.
Bill: What age do those screenings start?
Dr. Rizack: Usually we recommend a woman start with a baseline mammogram about 40. Sometimes they do every other year until they reach their 50s or mid-50s, then annual mammogram is recommended. A lot of the organizations still recommend annual mammograms starting at age 40.
Bill: How do risk factors influence screening protocols like when to start? Things such as family history, dense breasts, ethnicity, et cetera. Can you talk about that?
Dr. Rizack: Sure. We know that people that have a high risk for breast cancer are those that have a family history of breast cancer. That really only occurs in 5 to maybe 10% of the population. Women with dense breasts, women that have had radiation to the chest, such as childhood cancers or for other reasons, are at increased risks for breast cancer. For those, we still recommend a baseline at 40 and that is because prior to that the breasts are still very dense. Beginning at 40, they begin—or before 40—to get more fatty tissues. So that screening with mammogram is more efficient.
Bill: So, when should a woman stop getting screened?
Dr. Rizack: There are no age cutoff for when women stop getting mammograms. It’s actually something I try to get across to the patient and the primary care doctors. If a woman is going to live for at least another 10 years, and some say even 5 to 7 years, then you would want to continue mammograms. The women that are most likely to get breast cancer are the ones as they get older. Even though they are less aggressive, it is certainly better to catch breast cancer when it is early and easily cared for then to wait until they begin to have symptoms.
Bill: Can you explain the different types of diagnostics and screening technologies available today?
Dr. Rizack: Sure. Because they have changed in the last couple of years. We used to talk about digital mammography, which is really the standard of care for screening the average population. A lot of centers, used to be the academic centers, but even here at South County we now do tomosynthesis, which is more of a 3D type mammogram, which seems to be more efficient in picking up abnormalities in patients. So, a lot of them are moving to that as a baseline mammogram, or at least in patients who are at slightly higher risk. There is also breast MRI for patients that meet the guidelines for that as well as ultrasounds.
Bill: So, mammograms have helped reduce breast cancer mortality in the U.S by nearly 40% since 1990. Yet, there are some women that skip this important checkup. Why is it so important for a woman to get a mammogram and not skip it?
Dr. Rizack: Mammograms not only pick up precursor lesions—so lesions that are likely to become a breast cancer—but they also pick up breast cancers before you can palpate them yourself. Those patients can get picked up a lot earlier. Instead of having to end up with a huge surgery like a mastectomy or even chemotherapy, they can be picked up with a much smaller tumor and need a lot less treatment. So early detection is very important. We do encourage women to get their mammograms.
Bill: So, Dr. Rizack, you are a former woman and infant’s hospital physician. Can you briefly talk about that and why you believe community cancer care is important?
Dr. Rizack: So, I worked at women and infants for seven years, which was a wonderful experience. I moved into community medicine about a year and a half ago. About 80% of patients with cancer actually get their care in the community. It’s much more convenient for patients to get care closer to home than to have to drive distances. That can prevent them from participating in other parts of their life. Certainly, if they have children or grandchildren and they need to participate in aspects of their life, it certainly makes it easier for them to get care in the community, which often is the same care that they would get in an academic center. My affiliation with women and infant’s is helpful in that I still have maintained my connections and colleagues there. So, with complicated patients, I can often consult them or talk to them on the phone or participate in some of their tumor boards to discuss more complicated patients.
Bill: I can see how that would be a benefit. That close community care is really important, so people get in and get this necessary preventative diagnostic care done. Having a community center close by is really important.
Dr. Rizack: It is very important because people are living longer and living better. They don’t want to spend a lot of time on their healthcare. So, if they can certainly come in and get their mammogram, or if they actually have cancer, to get their treatment close to home, it has a significant impact on their quality of life.
Bill: Can you also tell us why the South County health cancer center is a great start in facility overall to receive care?
Dr. Rizack: Sure. Well first of all, our imaging is top of the line. We offer tomosynthesis and breast MRI and breast guided biopsies that you could get anywhere else in the state. We can do them right here close to home. We have three board certified hematologists and oncologists. We have our own breast navigator who navigates patients from the minute they have an abnormal mammogram and through follow-up and survivorship so that their care is seamless and coordinated. We feel that we can offer as good of care as they can get in other places. If clinical trials are available or other treatment that we can’t offer here, we are aware of clinical trials and other treatments and we refer patients out when they need to be referred.
Bill: So, it sounds like a complete coordinated team effort.
Dr. Rizack: Yes. We have radiation oncology. We have radiologists. We have surgeons. Of course, the medical oncologist as well as nurse navigators, and our own chemotherapy unit right here in the clinic with us that we can make the care pretty seamless.
Bill: Really important. Well, Dr. Rizack, thank you so much for your time today. For more information, please visit southcountyhealth.org. That’s southcountyhealth.org. This is South County Health Talks from South County Health. I’m Bill Klaproth. Thanks for listening.