Hello. It's time to be well with your help. I'm Nimeet.

And I'm Tina.

Welcome to Adventist Healthcare, a new podcast. Today, we have a special guest host with us. You may recognize her from past episodes. It's great to have you back, Tina.

So happy to be here today, pinch hitting for Shanna.

Yeah.

And during Breast Cancer Awareness Month.

Such an important topic. I know I've got my mammogram scheduled and Shanna did a great public service. She took cameras along with her to have her mammogram done this year. And I know that there's a link where people can view that on YouTube.

Just want to demystify that process. So if it's your first time going in for a mammogram or you're approaching that time and you kind of want to walk through it, you can check out Shanna's video and see exactly what the process entails. But we've got our expert here that's gonna kind of help us with some myths. Right, Nimeet?

Yeah. Absolutely. And my, you know, my mother went to get a mammogram a couple of weeks ago. She had a lot of questions. So I'm very excited about today's talk. We have doctor Nikki Terada, who is a radiologist. She's a director for women's imaging at Adventist Healthcare.

Welcome, Doctor Tirada.

Hi. Thank you for having me.

So why don't we get started, Doctor Tirada? Can you just tell us about what is a mammogram?

So a mammogram is a tool that we use to detect early breast cancer. We can see a cancer on a mammogram way before you can feel it. So, it's just low dose X-ray to take a picture of your breast. The X-ray dose that we get from a mammogram is like a flight to California. So very minimum radiation. And the exam is only take about ten minutes.

The actual image acquisition take less than two minutes but the actual appointment might take a little bit longer. So it's like something you can do between your lunch break even. It's a personal choice but I think it's more important to know and you we can treat it. Breast cancer is very treatable. Like we find it early survival rate for early stage breast cancer such as ductal carcinoma in situ is almost a hundred percent. So very good treatment available.

Right. And I recall from my own mammogram, there's some ground rules, right? So no deodorants, no lotions. These are all good tips. Why is that?

That's a great question. So normally we give a patient a wipe to clear out the deodorant. So in the olden day, deodorant actually some of them have like little Tauk or aluminum or something that we can actually see on a mammogram and can mimic breast cancer because what we're looking for a little calcium deposit. So patient, if it deodorant that you use or a powder or something that have little talc in it, it might show up.

But right now, that is not as much a problem compared to the olden day because we do it in three d. So we actually can tell it's located on their skin. But it's nice not to have that anyway. So we always ask the patient just to clean up before.

I was always curious about that. So glad to hear it from the expert.

That's great. And so when do when should women typically get that first?

As a radiologist, we follow the American College of Radiology recommendation. Also, American Breast Surgery Association also recommend that we start screening mammogram at age forty for women with average risk.

And how often should they do that after that?

So we should do it every year. We believe that if you do a mammogram on a yearly basis, so we can find it earlier, we can treat you sooner.

That's great.

And what if you have a history of breast cancer in your family? How does that impact when you go for your initial mammogram and how you follow-up?

So that's a great question because each patient are different. So if you're having a family history of breast cancer or ovarian cancer, you should talk to your primary care physician. There's a calculator, you can even do it online to calculate your lifetime risk for breast cancer. If your risk is greater than twenty percent, you might need additional study beside a mammogram.

So, you know, when when patients get the result for mammogram, what are the typical means? So if they're negative for the mammogram, does that mean they're all clear? And if they're you know, if the mammogram shows something, does that mean they have cancer? So can you help our listeners understand what do their results mean?

Sure. Definitely. So the when you get a result of your mammogram, if it's for screening exam, it can be just normal or incomplete. So we are not differentiated whether it's cancer or not cancer.

So if it's normal, it can be letter one or letter two. Letter one mean we normally assign a different category from letter zero through number six. So if you get a normal result, negative result, it will come as a level one or two. One, meaning we do not see anything at all in your mammogram, just benign breast tissue.

Number two, mean that we find some finding, but they're benign. Whether they're a little fiber adenoma, a little fibroid, or some benign cyst, which is a fluid filled structure, completely benign, fluctuate with your hormone, or benign course calcium deposit.

For your screening, mammogram can be one or two. If it's number zero, mean that we're not sure. We would like you to come back for additional picture just to get a little bit closer look. We might get additional mammogram or additional exam like an ultrasound, and you'll get that result the same day. A radiologist or her, like, one LT member will come and talk to you and explain you for the result what are the next step. So after you come back for your diagnostic mammogram, will be your second visit with us.

We'll get a result on the same day whether it's number one, number two which is nothing to worry about or number three that we think that is we don't believe it's cancer, but we would like to see you back in six months, like a short term follow-up. For that, like the likelihood of being cancer is so small that we don't feel that we should be aggressive about doing a biopsy or doing additional study. We feel comfortable enough to see you back in six months.

Now, this is your health, so we're going to have this discussion together.

My personal opinion is that we should empower the patient to make her own decision.

If you are a worry, like you really worry about that you have a strong family history, you can talk to us and you know, we can discuss it further.

Number four is that I feel that it is suspicious.

Am not certain and I would like to recommend tissue sampling whether it's a biopsy or additional study like a breast MRI to just to find out more. Number five is that I am ninety five percent sure or like ninety five percent or more certain that I believe it's cancer. It doesn't happen very often, particularly if you're getting your annual mammogram yearly. Hopefully, not gonna see number five ever. Number six is that you have a biopsy proven cancer. We're seeing you as a follow-up as a to evaluate, respond to treatment or to see you right before surgery.

I see. So there's a lot of variants that you can see as radiology team within a mammogram and a lot of lot of things that you're looking for.

Right. And when you get a result letter, we actually sit with you and we try to explain the whole process to you. It's not like, okay, this is your result and we actually will explain to you. We'll help you set up a follow-up appointment or a biopsy appointment on hopefully in a day Two.

Do mammograms always detect breast cancer?

So mammogram is not perfect, but it's much better than physical exam. So mammogram is depend on your breast density. Breast density mean what is the ratio between we call them a glandular tissue, like the tissue with the containing gland that produce milk for women and fat that contain inside the breast. So if you had a lot of glandular tissue, it can hide cancer inside.

So the sensitive will decrease for those women. So it can be ranging from like sixty to ninety nine percent depending on your breast density. So if you have dense breasts, we also gonna recommend that we get supplemental screening exam. We offer automated whole breast ultrasound at Adventist and we can fight additional cancer that way.

And the good thing is if there's this option, so even if, you know, it may not give a hundred percent result, there's other options that you could provide them to better diagnose breast cancer.

That's correct. So yes, and you know, whole breast ultrasound is very straightforward. No radiation at all with ultrasound.

So just to see better what hiding inside that breast.

One of the other things we typically hear is that, you know, there are people answers that it's painful. So are the are mammograms typically painful for patients?

Personally, I have a few mammogram myself. I don't I don't find it painful at all. We do have to compress your breasts. And the reason being that the more you can make the breast thinner, the less radiation we will need to penetrate the normal breast tissue and kind of spread out your overlying tissue. Like, we compress a little bit more tissue is not laying on top of one another but the actual image acquisition like during the compression will last a few seconds. It does not last long, less than a minute. So after we compress, we take a picture, you go out of compression.

So would you say it's more of a discomfort than than Yeah.

A brief brief period. Very short time period.

And the benefit outweighs that temporary moment of discomfort for sure.

Yes, definitely.

One of the things we're trying to do today, Doctor. Terada, is dispel some of the myths about mammograms and present our listeners with facts. And I know one of the things we might hear people say in terms of delaying a scheduling of a mammogram or not going at all is, hey, I don't have a family history, So, you know, I don't need to go at forty or I don't need to go every year. What would you say to that?

So most breast cancer occur in patient who does not have family history. Actually eighty five percent of people with new diagnosis of breast cancer do not have a positive family history.

So I would definitely recommend that that every woman over age forty go in for her annual mammogram.

Another myth that comes up is, you know, I'm doing self exams at home regularly, so maybe I don't need to go in for a mammogram as often. And again, what what's what do you miss there in the self exam that you can find in imaging?

So a lot of breast cancer is not mass. A lot of time when you feel a mass, this means it might be later stage of breast cancer. And a lot of time, the mass you feel can be just dense breast tissue. It's very important to get to know your breast, know, particularly if you're gonna do cell exam to do it regularly.

But also as a radiologist, our goal is to detect cancer at the earliest stage, those that you cannot feel, you know, so give you the best chance of survival and like the least aggressive treatment possible.

That's really what this is about. This is about that early, early detection, seeing things before they turn into something more serious while the cancer is still treatable, for sure. How would a woman know that she had dense breasts prior to coming in for a mammogram? Right? Because that might not be something that anyone's ever Told you.

Actually, that's a great question. You can't know. Actually, you cannot tell at all. Actually, there's no correlation between how firm your breasts feel and actually the breast density, how much you lactate and breast density.

There are lot of myth about it. Actually, only way to find out is to get your mammogram. So determine on a mammogram like how much how is depend on how well we can see the cancer basically. So if I there's a lot of breast like not a lot of breast tissue, mostly fatty tissue, then I can see cancer well.

And I would just assign it, You know, not dense. But if I if I feel like there's a lot of white area that just can hide cancer, then that patient may be dense. So it's determined by a radiologist.

Okay. And this might be sort of in the same line of questioning, but what makes a dense breast dense? So normally it's genetic. A lot of like forty percent of women have dense breasts.

So it's not a small number. Know, it's just what you're born with. The dense breasts mean you just have a lot more glandular tissue like the actual gland and actual fibrous tissue, like whether it's Cooper ligament, something that appear white on a mammogram. And it's just genetic.

This is how you're born and what your body made.

And is there any other than making it a little bit more difficult to see on the mammogram? Is there any additional risk or anything that comes with having dense breasts?

So, unfortunately, yes. Because we have more glandular tissue, so you have more place for cancer to occur. So, having dense breast tissue, your lifetime risk for breast cancer increases particularly for those with extremely dense breasts like the very very dense breasts that can increase your risk by about two times.

But I like to stress, this is something that we can't do anything about. So there are modifiable and non modifiable risk factor. We should really be focusing on like things that we can change. So it would be like, and what good for the breast is good for the entire body, like exercise, you know, not smoking, healthy weight, and no alcohol. Those are all the healthy stuff that you can do it, not just for your breast, but for your entire body. And they all the way at risk for breast cancer.

And so that's even more reason to make sure you're coming in for your mammogram, that initial one and all the follow ups is to make sure that you don't fall in that category of having dense or extra dense breasts and staying on top of it for managing that risk.

Yep. Completely.

So how would you say the mammogram technology has improved over the past many years?

Yes. We've come a long way. So initially, mammogram was a film screen. You probably like we actually like when you look at those doctor film and they print out the film and you put against the light.

That's how it started. So we don't do that anymore. So right now mammogram is viewed on a computer screen, you know, and using we also have a three d mammogram where we just don't not taking one picture in a two d dimension. We actually take over like some depend on your breast thickness.

It can range from fifty to almost like two hundred images of just one breast. So we can see through all the different layer of the breast better.

Beside that, automated whole breast ultrasound make breast screening more convenient and much easier. We offer breast MRI in women with elevated lifetimes of breast cancer. Insulin will cover your breast MRI if you have a greater than twenty percent chance, lifetimes of having breast cancer.

Those are great options that I think technology has really kept up with a lot of things that would help detect breast cancer and then help our patients towards the end.

How much of an obstacle is access and insurance and education in terms of getting women in for their mammograms? And what are some of the things that we're doing here at Adventist HealthCare to help with that?

So luckily, I believe that it's a law now that mammogram should be a hundred percent cover by your insurance. You should not have co pay for your mammogram.

Unfortunately, not the same thing for the automated whole breast ultrasound, but we have a discount rate for people with with no insurance at all. We also have a lot of help that we can get through our coordinator. For example, we have a support from the Brem Foundation that can you allow to have us free screening mammogram for women without insurance. And we can help you plug in based on your need.

Our corneas sometimes even help patients apply for what program they're eligible to.

It's great we have that support and those resources and the staff that helps build the bridge there.

Yeah. Think sometimes just being aware of those options, you know, takes away a lot of the obstacles that our patients may be already thinking about.

So if you're one of our listeners, it's they're, they're headed toward forty, they're headed in, they need to schedule their first mammogram. They're a little concerned. What are some sort of words of encouragement that you can give about overcoming the fear of the discomfort or just the fear that something's going to be found and they'll have to deal with what's on the other side of that?

It's okay to be nervous because most people are nervous. I was nervous. I'm a radiologist. So I see it every day, but when it's yourself, it's harder.

So just communicate with your technologist. Tell them you are anxious and they train to make you more comfortable. We're happy to talk to you and we can review the result with you if you requested as well. And remember why you're doing it because you're taking a powerful protective step for your long term health.

This short exam can save your life. And you can treat yourself afterwards, you know, just take it, make it an experience.

Just bring your friend, your mom or your sister to come together. It can be something you can do together.

And it's really powerful, I think. I love that idea too. I love the idea of bringing your sister or a girlfriend and sort of making it into something that's joyful and positive and good for your health and your relationships and kicking something that could be scary or drudgery or whatever into a nice moment. So I love that advice.

Doctor Tirada, if you have one advice for our listeners, what would that be?

I think the most important just to come and just, you know, and it's really a fast exam, easy exam and tell your friends and family, those who you care about just to come for your annual mammogram. It's important and it doesn't take long. It could be lifesaving.

I love that message because we probably have a lot of listeners that are on top of their health, as you know, they're listening to this podcast, And I think it's so important for all of us to be ambassadors for regular screening, for the mechanisms of early detection. And as someone who has used Adventist HealthCare's Breast Center, I can really say the staff there is top notch, super compassionate, and makes it as easy of an experience as it can be. So, so thank you for all you do and all the team there at our imaging sites do to get women and their loved ones through, whether it's a routine screening or there is something that is detected.

I just wanna thank Doctor Tirada for sharing her expertise in today's podcast. For our listeners, remember one in eight women are affected by breast cancer. So if you want to learn your risk for breast cancer and your personalized screening recommendations, take our breast health risk assessment at Adventist HealthCare dot com slash take your girls out.

A bonus, if you complete it in the month of October, you'll be entered to win a prize.

So if you're due to for your annual mammogram, don't wait. Adventist HealthCare Imaging offers convenient locations across Montgomery County. Schedule your mammogram appointment today at your breast health dot com. Remember, early detection is the best protection.

Would also like to hear from you. Let us know if you like the podcast by leaving a review, or you can email us at podcastadventisthealthcare.com. Don't forget to subscribe to the podcast so you can get new episodes. Thank you and be well.