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Talk Tuesday - Ep. 5: Breast Cancer Screening

November 4, 2020
Dr.Howard

Speaker 1:

The information presented in this podcast is offered for educational purposes, only presenting it is not intended to and does not create a provider-patient relationship between any presenter and anyone else about the medical topics addressed presenters provide general information only not a diagnosis or recommended treatments or any other information specific to any individual listeners are encouraged to see their own health care professional about all topics address on Talk Tuesdays or for any other medical problem. 

Speaker 1:

Welcome, everyone. Thank you for joining us today. My name is Stephanie and I'm part of the team here at My Virtual Physician. We are a direct to consumer multi-specialty telemedicine provider operating in multiple States. It is Talk Tuesday and we are continuing our weekly educational series to talk with our experts, explore some common healthcare concerns that we see and hopefully answer some questions you may have today. Our physician expert is dr. Coleman. She is a general surgeon, and today we are going to talk about breast cancer screening and breast cancer surgery. So thank you for joining us today. Thanks for having me. Yeah. And welcome 

Speaker 2:

Back October was breast cancer awareness month. So we're going to be doing 

Speaker 1:

Again a blog and an episode or two of Talk Tuesday on breast cancer screening. When would someone go in to get a mammogram or if they feel something or they have any history of breast cancer in their family, what's kind of the age range, 

Speaker 2:

What to look for. Okay. So there's actually three organizations, probably more, but there's at least three organizations that have opinions on breast cancer screening, depending on which organization you listen to, it could be 40 years old, 45 years old or 50 years old, either way. Everyone agrees that by the age of 50, you should be getting a screening mammogram, most people, uh, and I believe most insurance companies go with the age of 40 breast cancer. Under the age of 40 is pretty rare. If, if you have 

Speaker 1:

Breast cancer under the age of 40, usually it's associated 

Speaker 2:

With some sort of genetic predisposition. There's the BRC mutation that predispose people to, to breast cancer at a younger age. But there's some other things that can, can run in families. Some other genetic diseases that predispose you at a younger age and typically cancer at a younger age is more aggressive and more advanced when it's found, because who in their thirties thinks that they're going to have breast cancer. So what we learned in residency was at the age of 40, you started getting your screening mammograms, and that's just, you have no symptoms. You have nothing going on. You're 40 years old. It's time to get a mammogram. Just like when you turn 50, you got to get a colonoscopy. It's just a way of life. Some people will come in. Well, I feel a mass I'm worried. And this also kind of depends on your age. 

Speaker 2:

If you're younger, the chances of you having a mass that's breast cancer is pretty low. You, you may have these little hard nodules called fibroadenomas. They're pretty common in younger people and they grow and shrink in size with your menstrual cycle. And that's something that people usually will point out like, Oh, I noticed this, I know I was on my period last week and now I don't really feel it so much. And so that's, that's pretty common and we can actually do ultrasounds in clinic. I mean, not everyone, but if you're, if the clinic has an ultrasound, we can do an ultrasound because sometimes it's just breast cyst that can feel like a lump and they can hurt. And if it is a cyst, they can drain it in the office and, and hopefully give you some relief. So when you turn 40, get a mammogram, if you feel something that's concerning, you would need to go into your doctor, talk to them about getting an ultrasound or a mammogram. 

Speaker 2:

And again, depending on your age, it may dictate what screening that they do. If you have a family history of breast cancer, then that would be something to coordinate with your doctor to get a screening done earlier. They usually recommend doing screening before 40, uh, it may be an MRI and mammogram alternating every six months starting at the age of 25 30. It just kind of depends on when your family member had breast cancer and what genetic mutation it is that you have. So I've had my screening mammogram and I got called back in for more images, do I have cancer? So not necessarily, this is something we actually deal with quite a lot. It really kind of depends on your age and your breast tissue density. It can be really hard to evaluate the breast tissue on a screening mammogram. If you have really dense breast tissue, there's actually, uh, States that have a requirement when they report on your mammogram, that they disclose to you that there are certain regions, depending on the density of your breasts, that they may not be able to see. 

Speaker 2:

So they have to give you that information because then if you end up having breast cancer, but you've, you've had a screening mammogram, you know, why wasn't it caught well, and it, it can just really depend on the density of your arrests. So sometimes you'll get a call that you need to come back in and it's for a more formal or what we call a diagnostic mammogram. The difference in that is with a screening mammogram, you kind of just, you go into a facility, they do the mammogram and you go home. And in a couple of days, they either call you with the results or you go into your doctor's office and they give you the results, a diagnostic mammogram, you go into a facility, but the radiologist is, is physically there. And when they do the mammogram, they try and focus on that area that was questionable in your screening mammogram. 

Speaker 2:

And so the radiologist can actually look at it in real-time and determine, okay, well, we need a different view here, or we need to zoom in here and take a better look at that so that you don't get called back in for even more. This is, I'm a little bit better idea of, of what they're looking at. And if it, if it is something that looks suspicious for cancer or not, some patients may actually end up needing an ultrasound to go with their mammogram or an MRI. It's all pretty personalized. So it all just depends on what your breast tissue looks like and what, what exactly it is, that's going on, what was seen, or if you're having symptoms and things like that. So it could just be that you have dense breast tissue, and it does not look abnormal when they do the more focused imaging, or could be something that, that is concerning for breast cancer. But being called back does not mean that you have cancer. You could, but they just need to get better pictures. Yeah. 

Speaker 1:

Since so, after I got called in my mammogram showed an area concerning for breast cancer and I need a biopsy. Can you explain what that is? 

Speaker 2:

Yeah. So when you need a biopsy, it doesn't necessarily mean that it's cancer again. So, so don't panic, but chances are, they saw something that are concerning and suspicious for cancer, and chances are it is, but I need a tissue sample to say for sure what it is. There's different types of breast cancer, there's DCIS, which maybe you've heard of, or there's invasive cancers by doing the biopsy. It gives you a little sample of tissue to be able to determine what type of cancer it is, what hormone receptors it has if it has any. And, and that helps you tailor your treatment, not only for surgery, but if you need chemo or other things, or even additional surgery, when you meet a bias, it can be done a couple of ways, the most common way, or at least the way that I'm used to it being done from when I was in residency is if you have a mask that can be felt if you came in because you had an that you found and you get a mammogram and they, they say, we need to biopsy. 

Speaker 2:

If they can see it, then you can get a biopsy done with an ultrasound and you don't have to go through a mammogram again. If you can't see it on an ultrasound, then you got to get a mammogram again. So not, not super fun for everybody when they do it with under a mammogram, it's done by a radiologist typically, and it's called a stereotactic biopsy. So essentially you lay down on this table and you lay face down and there's, there's a little opening in the table. And the breast with the concerning area goes through this little hole in the table and kind of hangs blue so that the arm on this machine can get in the right position and orientation to access the delusion that the arm on the mammogram machine has a needle on it. And once the area is targeted, the needle goes in, they take a sample of the breast tissue that comes out, but there's also a clip that gets placed in the area that they biopsied. 

Speaker 2:

So that on later imaging, you can say, okay, well, we already biopsy this area and everything was normal. Or this is where they had a biopsy before we don't see anything different. Or, you know, now there's something there that, that wasn't there before. And we need to re-investigate it. Sometimes you can't do the stereotactic biopsy and that's for reasons, you know, maybe you can't lay flat, maybe it's too uncomfortable, or you can't breathe. There are weight limitations. And depending on your age, I mean, it may just not be something that you're very capable of laying there because it's not, it's not a five-minute procedure. I mean, it's a 20-minute procedure or so. And it depends on where the lesion is. If it's really close to your chest wall, like the muscles underneath your breasts, they don't usually do the stereotactic biopsy. They can still do a biopsy under a mammogram. It's just done a little bit differently. This is all kind of targeted and oriented and one process. Whereas if they have to do it with, without the stereotactic part, it's done a little bit differently. Now there are some stereotactic biopsy machines where you can actually sit up. I don't know how many places have those. Like I don't, I'm not real familiar with how prevalent they are, but they do exist. So that maybe something that they could do.

Speaker 1:

Thank you so much, Dr. Coleman. I know it's a really hard topic to talk about. Cancer is always something that's a pretty scary word. I appreciate you joining us for Talk Tuesdays and telling us what we need to know about breast cancer screening for everyone else. This has been Talk Tuesdays with My Virtual Physician. You can schedule a consultation with one of our doctors by visiting our website: www.myvirtualphysician.com. We look forward to seeing you again, and we hope you have a great week. 

Speaker 1 :

Information presented in this podcast is offered for educational purposes, only presenting it is not intended to and does not create a provider-patient relationship between any presenter and anyone else about the medical topics addressed presenters provide general information only not a diagnosis or recommended treatments or any other information specific to any individual listeners are encouraged to see their own healthcare professional about all topics addressed on Talk Tuesdays or for any other medical things. 

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