Michelle Rupp: Hello and welcome to this week’s edition of AFMC TV. We’re so glad you’re joining us. You know, we’re in the middle of October. October is Breast Cancer Awareness Month, and so today’s show is dedicated to all things breast cancer. Joining us this morning is Dr. Stacy Smith-Foley. One of our friends out at CARTI. Dr. Smith-Foley, thank you so much for joining us today.

Dr. Stacy Smith-Foley: Thank you so much, Michelle, for inviting me. I’m happy to be here.

MR: So, let’s first start by talking about just breast cancer in general. I mean, it’s something that, is it one in five or one in eight women are faced with?

SS: It’s down to one in six. So, it’s a common issue, and breast cancer doesn’t discriminate. It doesn’t care how much money you make. It doesn’t care. It doesn’t care about your skin color or how tall you are. It can happen to almost any woman. About 75% of the women we diagnosed with breast cancer have no family history. So not having any family history is not as protective as most women assume.

MR: Yes. I remember hearing years ago that it was so important to know your history, and while it is important to know your history, the history could start with you.

SS: Exactly. It is essential to know your history as well, though, because women who have a strong family history of breast, ovarian, and some other cancers may have a genetic predisposition for developing breast cancer. By knowing their family history and by advocating for themselves, they can undergo hereditary genetic testing. A mutation can be identified before they ever develop cancer. So, with the advances that we have in genetic testing in early screening and detection, some women carry one of these genetic mutations with a very high lifetime risk of developing breast cancer. By monitoring them very closely, they may never develop breast cancer. We’ve created a whole new classification of patients that we’re now calling previvors. They will never be survivors because they can make decisions and be monitored in advance, and never develop breast cancer.

MR: That’s astonishing. Just incredible. Well, let’s talk about some of the basics. Remind me of the age when young women should have that first mammogram.

SS: Women who are at average risk with no family history should start screening at age 40. We strongly recommend that women screen each year. There’s a lot of misinformation out there about starting later than that. We are not having a mammogram as frequently. There’s also some misinformation that some older patients think they can stop screening at a certain age. There’s no expiration date. If a woman continues to live a relatively independent life, she should continue to get yearly screening mammograms.

MR: What about self-exams? Are they still important, or is that outdated?

SS: It’s not outdated. I think that it is important. I don’t think that women should drive themselves crazy, checking their breasts and getting worried about every single lump that they feel. I recommend that women learn their lumps because most of us have lumpy tissue, right? But you need to be aware of your body. If you notice any changes in the appearance of how the breast feels, any discharge from the nipple, or even dimpling on the skin, those would be concerning findings. You should talk to your doctor about those and be evaluated.

MR: What about men? We associate breast cancer with women but are men at all at risk?

SS: Some men are at significant risk. Those men that have a family history of breast, ovarian, or a history of prostate cancer at a young age may carry one of those genetic mutations. These genetic mutations that we identify with hereditary genetic testing have a 50% chance of occurring in men and women. There are equal numbers of men that carry these mutations. Some new studies say that performing mammograms on men with genetic mutations may allow us to diagnose cancer in them at a younger age and an earlier stage of development. That is new data. I’m not sure how insurance companies are dealing with that yet. But in general, average-risk men don’t need to get mammograms or don’t need to have breast cancer screening. But I would circle back to and say that men should also be aware of their bodies. If a man feels a lump in his breast, that could be a very concerning thing. Most of the time, it ends up being a benign condition called gynecomastia. But on those rare occasions where it represents breast cancer when men are diagnosed, it’s typically more advanced and has spread into the lymph nodes, so it can present in a more aggressive stage because we’re not doing screening in men.

MR: How have we as a country watched the evolution of breast cancer? In my mind, it used to be that it wasn’t something that you heard much about. And even the statistic as we started, one in six now will be diagnosed. It is very much a part of our conversations and a part of our lives, whereas it used not to be. How do you think we got there? Or have we always been there? We just didn’t talk about it.

SS: We may talk about it more, that this generation of women is more open to talking about intimate details. Some older women feel ashamed or embarrassed about their bodies, and they’re reluctant to even speak to their doctors about anything they might notice. I think we also have technology that allows us to detect breast cancer in an earlier phase. Because we are screening patients, we’re finding more cancers because our tools have improved. We now have 3-D mammography, also known as digital breast tomosynthesis. We see more cancers with that tool, and we’re talking about it more as well.

MR: What are some of the new technologies that you are doing out at CARTI?

SS: We offer high-resolution 3-D mammography. We have artificial intelligence helping us interpret those examinations. So those are the latest and greatest things—the high resolution. Now we’re seeing clinically relevant AI introduced into practice and supplemental screening with ultrasound for patients with dense breast tissue and MRI for those patients at an increased risk.

MR: Okay, so, more technique, more tools in the toolbox.

SS: Right. And I think we take a different approach in this day and age. There’s not a one size fits all solution. We try to customize the solution to fit each patient’s circumstances. You may have a patient who doesn’t have any family history but has a very dense breast. They would benefit from supplemental screening with ultrasound.

On the other hand, you may have a patient that doesn’t have dense breast tissue, which is a very strong family history, and she has more than a 20% lifetime risk of developing breast cancer. Those women need to supplement their mammograms with an MRI. But the mammogram is always the base. We don’t ever give up the mammogram for the other tests or tools. We use the different tools as an addition or a supplement to the mammogram.

MR: So, it is 2021. Is there any way to make those mammograms a little more pleasant of an experience?

SS: Well, I will say that most of our patients would describe their experience as more pleasant. We have a lot of techniques and some new tools that make the examination more comfortable. We have ergonomic paddles. You know the breast is not a flat structure. It’s curved. We have an ergonomically curved paddle that our technologists use on some patients. We also have some comfort devices. We have a certain kind of blanket. It kind of feels like a felt blanket that goes over the mammogram unit, and it prevents getting a tear underneath the breast. For other women, we will use a foam pad to kind of reduce the amount of compression. With the high-resolution 3-D mammography, we don’t have to compress the breast as flat as a pancake, as many women remember from their prior experiences. Our staff works with patients. We have a lot of people who have had a bad experience. And so, if you have a bad experience, you don’t want to do it again. We see so many people that just stop. They had a bad experience, and they said, “I’m not doing that again.” Now, something’s brought them back, and we just work with them through that. You know, we tell patients we are only going to compress you to your tolerance. No one is going to, you know, slap your tissue up there and smash it down and crank it down. If the patient is experiencing some discomfort, we dial it back, and you know, some patients just refuse to have a mammogram period. For those patients, we have alternatives ultrasound or MRI. They’re not ideal. The gold standard is the mammogram, but I would rather have some form of breast imaging than no breast imaging at all.

MR: And we should mention that should you receive a breast cancer diagnosis. It’s not necessarily fatal.

SS: No, it’s not always a life-threatening situation. You know, we find very small breast cancers with the digital breast tomosynthesis, the 3-D mammography technology, we find cancers smaller than a centimeter in size that are very treatable. The vast majority of these women can undergo breast-conserving therapy. They can have a lumpectomy. They don’t have to have their breast removed. Many of them don’t even require chemotherapy. They can have an easier treatment for an earlier form of the disease when diagnosed at an early stage.

MR: And that’s the key right there, early detection and prevention.

SS: Right, correct.

MR: Fantastic. Well, Dr. Smith-Foley, is there anything else that you would like to add?

SS: I would like to add that there seem to be some concerns among women about COVID-19 and the vaccine and how that might impact a woman’s mammogram. We have so many women who delayed or deferred getting a mammogram last year due to the pandemic, and as a result, we see more and more breast cancer diagnoses because those cancers were there. Those women just didn’t come. There should be no concern about having your mammogram and how your COVID vaccine might impact your mammogram. If you haven’t had your vaccine, go ahead and get your vaccine. If it’s time to get your mammogram, get your mammogram. Some women may experience a transient enlargement of their lymph nodes due to the vaccine, but that’s something we’re familiar with. We occasionally have to bring patients back in to do an ultrasound and to do some additional imaging. We may even have to do a follow-up. Rarely do we have to do a biopsy in these ladies, but I would encourage women to get the vaccine. Don’t delay in the vaccine, and don’t delay in getting your mammogram.

MR: Very important advice and something that we all need to take. So, thank you. Thank you so much for joining us today. It’s been a pleasure.

SS: Thank you so much.