Breast health and the life-saving power of mammograms

0:00 If you have boobs, you need to listen to this episode of Sarah has questions because we're talking about everybody's favorite medical test, the mammogram. Oh, yeah. Why do you need to get a mammogram? How often should you get a mammogram? And most about what happens when you get that scary callback for a follow-up. It's breast cancer awareness month, and we are talking about it right on time. Let's get into it. I'm Sarah King, and I have a lot of questions. What exactly happens when you orgasm physically? Will popping a knuckle or a joint give us arthritis? What can we learn from our poop? The size of your body doesn't necessarily indicate your measure of health. Yes. And what are your thoughts on that? Cleansing. Do we need to do anything special to our nether regions? In this show, I get to ask all these questions to WakeMed doctors who happen to know everything about everything. Sarah has questions is a production of Capital Broadcasting Company and NYX 101.5.

1:00 It's presented by WakeMed. So today, I have 2 professionals with me, Dana Knapp, who is an imaging man manager with WakeMed, and we have Adrienne Jackson. She's got a longer title, certified breast imaging patient navigator, which sounds very important. I won't have you, explain exactly what you do. I wanna jump right in because this is a very pertinent conversation. Let's start with prevention. Mhmm. I'm talking breast cancer. What are the guidelines on mammograms? Because I know they've changed recently. What are the how do they change? Where do they start, and where do they change? First of all, every woman should have a conversation with her medical provider about that. Talk about your breast health at every visit, but we, recommend annual screening mammography for women starting at the age of 40. From that, you go to if you are high risk, so which we'll get into more. Mhmm. But if you are deemed a high risk patient, that's a conversation with your provider, decide what screening program you're gonna follow. It could start at a much earlier age. It could involve MRI. It could involve ultrasound. Mhmm. So Well, you said talk about your breast health.

2:10 What do you mean by that? Because I don't I mean, like, they're they're there. They seem good. They haven't fallen off yet. Right. So believe it or not, your breasts are always changing. They're a living organism. They're always changing. The breast density is gonna change, do you know the composition of your breast? You always wanna if you feel something that doesn't feel right or not being afraid to say to your doctor, hey. I mean, I I feel this lump under here. Okay. You know? It wasn't there a month ago, or I'm having some nipple discharge. They're gonna ask you questions about that, but that's so important because then they're gonna recommend what you do from there. Yeah. I'm sure I'm sure it's scary to people Yeah. To mention, like, especially if I had discharge coming out of my nipple, I'd be like, oh my gosh. It's scary. And you might not wanna mention it, but it's really important that you do. Yeah. Alright. Adrianne, I'm gonna ask you this. 3 I wanna make sure I say your name so people who are listening will can just sort of differentiate you. I was told when I got my first mammogram many moons ago, that I have dense Mhmm. Breasts. So and I was recommended to have a 3 d mammogram. Is that first of all, what does it mean to have a dense breast? And secondly, is that still the case that dense breast people should have a 3 d mammogram? Yes. That's correct. That all dense breasts and nondense breasts Everybody patients should have Everybody should have it. Should have it. It's like the gold standard now. It's it's our standard of care at WakeMed. We only do 3 d. Okay. Great. That's wonderful. In which it means it's like

3:42 you have more fibroglandular tissue than fatty tissue. What does fibroglandual mean? Glandial Just the composition in your breast Okay. Shows in an image, it shows white. I see. Mhmm. That's what we call dense. And then fatty is kind of in the gray tones in a image. I see. So yeah. Yeah. And so that the the importance of the density is that that because it's like that cloudy Yeah. White, it makes it harder for the radiologist maybe to see something, especially a smaller cancer. But that's the great thing about 3 d. The beauty of 3 d is the 3 d technology for people that don't know. For the radiologist, it's almost like they're reading a book. They can flip the page and see each Interesting. In between rather than just looking at the side of a book. Or seeing, you know, if you wanna use an analogy or whatever. So they're able to see through those dense layers with 3 d I see. Much better. So while they developed this 3 d mammogram, did they decide to make mammograms less miserable? Because would be asking too much. I'm like, they run on par with copy machines, which they still break down and are massive. I mean, I feel like I've made sweet love to a machine, but it's not my legal mammogram. Yeah. Yeah. It is. But it's important to do. And, you know Right. You do the compression is a little less. Yes. It's a little less. Okay. Well, that's good. We're making progress. We are. Yep.

5:11 So I've also heard, and especially when I was in college, that caffeine can affect your breasts. Is that true? Like because I was told that you should, that it can cause cysts. I was also told that, when you get a mammogram, it might be a good idea not to have caffeine. Right. Is this all myth or what? I mean, as far as the caffeine goes, I don't think it changes your breast composition. Okay. But if you do, like, an excessive amount of caffeine, it could create cysts or even pain. Right. But not everybody. Hormonal. It can change your hormones a little bit. But I mean, that's if you're, like, excessively drinking caffeine. I mean, one a day is not gonna affect anything. You're it's like drinking a pot. Right? But they do say that. Yeah. They do say they still do say, you know, limit your caffeine intake. You could take a Tylenol before a half hour before you get there. That might help Yeah. If you are very sensitive to the pain. Well and, also, I know that you're being on your period. You know, they they Oh, yeah. If you have pain prior to your cycle, you may wanna refrain from getting Yeah. I've only done that once.

6:13 I didn't know, and I was like, holy cow. This is a totally different body. Yep. They usually wait, like, 3 year 3 to 5. Like, just wait a week after your period to schedule your mammogram. That's gonna be the most comfortable. Yeah. I always feel bad because I have rather big big boobs, and, the women who don't have much. I mean, how do you even get enough skin to get to do a mammogram on a woman with smaller breasts? I just feel so bad for them. Yeah. It is it is a little harder. But but some women won't get their mammogram because they think, oh, I I have small breasts. You know? Is that true? Mhmm. Oh, that's not smart. No. They still need to have their mammogram. Should men because I know men can get breast cancer. Should men be getting mammograms? Only Yeah. If they feel something. Okay. Or pain, lump, or anything like that Mhmm. They should talk to their provider. And then from there, they usually get what they call a diagnostic mammogram. What does that mean? It's more in-depth as far as extra images. The radiologist will look at it that day. They may do ultrasound while they're there. Mhmm. So it's a little more comprehensive. But do they get squished? Yes. They do. We'll be right back because you know I have more questions.

7:27 Okay. So let's talk about, what you see in a mammogram. Mhmm. What what exactly are you looking for? I know you're looking for cancer. What else can you find in a mammogram? I mean, you can see masses. Mhmm. You can see what they call calcifications. It looks like white little specks of, like, salt in there. They look for speculations. What is that? It's like a a webbing, I guess you could say, in an image. Mhmm. It it can start from, like, a mass and it webs out a little bit. They can see what else? Lymph nodes. They can see. Some people have pronounced lymph nodes. Some have lymph nodes that kinda reach further into the breast tissue. Vascular, a lot of vascular Yeah. Vascular. Can you diagnose other things besides cancer by looking at a mammogram? Not so much diagnose, but recommend for further Mhmm. Like what?

8:17 Usually further imaging. I mean, if they see Like in our lymph nodes they're enlarged? Or they see something in a vessel Okay. Because they're calcified? Yep. Yeah. Then they can recommend you to follow-up with your provider and maybe get additional imaging. Okay. I know that in, health class, I was taught how to do a self breast exam. What do you tell your patients about or your clients about self exams? I mean, definitely, it's best doing in the shower. Well, probably prior to that, look in the mirror. Make sure you see your breasts. Make sure you don't see anything out of the ordinary just by looking at them. Okay. If one's starting to get bigger than the other or out of nowhere or an inverted nipple that just like all of a sudden happened or anything like that before you actually do like the manual exam. Okay.

9:01 When you're in the shower, it's easier to kinda glide. That's what they tell you to do in the shower. It's to glide around either in circular motion and then, like, coming from the outer to the inner or through quadrants like like a pie. Yeah. Excess. Uh-huh. Outer inner. You're looking to feel like anything out of the ordinary tea. That's why you should do it every month to make sure, okay, that wasn't there before. Right. It's true. Now there's something there. So that's why it's good to to get to know your breast. Yeah. Well, you should. Yeah. It's like, oh, it's it's your body. You have to take care of it. No one knows it better than you do. What are some of the regular things we should be doing aside from mammograms and self checks? Is there anything? Your provider as well should do a clinical breast exam as well so they can feel But also, like, lifestyle is very important in the prevention of any cancer, not just breast cancer, but any cancer. You know, exercise, what we eat, you know, staying in a healthy weight, the amount of alcohol you consume.

9:57 You like that? Is that not how I that? We say I I enjoy wine. My husband sells wine. So we have a lot There you go. I had, like, a $200 bottle of champagne in my fridge on a Tuesday last night. I am paid for it. Your house. You should. But you should. You know, everything in moderation. Yes. But, you know, exercising, all those all the same things that we would say you should do for for your overall health. Yeah. You wanna do they will affect your cancer risk as well. I see. Your breast cancer risk as well. Okay. Yeah. What about genetics? I know that there is a certain gene that people can have. Talk about genetics in breast cancer. Mhmm. Because I always amass. Do you have does your mom or your sister, which I don't have, but did do they have breast cancer? And my mind has always been no. But what do you tell people?

10:45 If you have, like, primary or, like, close relation like, family that has breast cancer, mother, sister, maternal grandmother, then your provider will probably like, okay. Let's get some genetic testing to see if that's what's related or not. And they usually test, like, the most common ones are BRCA 1, BRCA 2. Okay. No need to be. Yes. Okay. Mutations to see if you are positive or negative for that. And if you're positive for it, is it like a guarantee that you're gonna get breast cancer? No. Still no. No. Yeah. Okay. That's good. Yeah. You're considered now high risk but yeah. As far as the I don't know. Increase it. Yeah.

11:26 You're you're at higher risk. Yeah. But it doesn't mean you're going to have breast cancer. Do you know why you're at higher risk when you have that mutated gene? Because it is a mutation that they've shown has is Correlated. Correlated to breast cancer. Mhmm. So that there again, that's then a discussion with the genetic counselor and your provider. Where do I go from here? Should I increase my surveillance? Yeah. Right? Should I have more testing more frequently? Do a risk assessment, which Adrianne performs those, you know, it's a series of questions, tells you what is your risk? Do you fall in a category where you need to start having those conversations and come up with a different strategy, game plan? You can follow the the guidelines for everyone. Right. Yeah. You're gonna have to follow a different set. After a mammogram, I've had and this has happened to me once, and it was terrifying. I got a phone call, and it was just like, we saw something in your mammogram. We need you to come back in. I know it happens, but I want you got you to tell everybody what's the next step when they think they may have seen something. Usually, I would contact the patient to schedule them, but I, they become a diagnostic mammogram at that point, which means you come back, you do additional imaging, extra pictures, and then the radiologist is there. They'll look at it, see if you need to do more pictures while you're there or ultrasound while you're there. They look at all those imaging that they had done that day and then they decide whether let's just follow it. I don't think they're deemed to be needing a

12:58 biopsy yet or, everything looks fine. Just come back in a year. Or I think it needs to be biopsied. Yeah. And then a biopsy means going in, cutting out tissue, and then and then It's just more sampling. Yeah. They sample at this point. Yes. Yeah. Yes. And and and going back to the 3 d and, you know, because it's happened, when you get called back, you get very nervous right away. You think I have breast cancer. Yes. 100%. And so I think something, that women might not know is if they have never had a 3 d and now all of a sudden they were to come to WakeMed or and have a 3 d mammogram, they're gonna see things they haven't seen before in your previous imaging. So they may call you back. That's good to know. Yeah. And so it's probably nothing. Yeah. It's just that a radiologist is always gonna call back anything that isn't seen in the previous imaging. Yeah. I was always being overly cautious Yeah. Which is good. Yeah. I want over cautious. Happen in that switch from 2 d to 3 d. So women should know that. Yeah. For me, it turned out to be just 2 fat cells on top of each other. Right? Isn't it? Don't you love it?

14:05 It's like, you know, when you have a a fat containing tumor. Yeah. It's lovely when you hear that as a woman. I was like, oh. You're like Every I've got fat everywhere. And same with baseline patients as well. Those don't have any priors. This is your first mammogram. We don't know what your breasts look like prior to. So too. More than likely, a lot of them get called back. Right. Yeah. And, with those callbacks, like, you know, the anxiety Oh, it's awful. All of it, that's where somebody like Adrian is great. So, like, any question that you have. Questions. Alleviate the fears. Really explain. And also the nagging phone calls maybe that women get saying we need your previous imaging. We need you to send those from say, you moved from California. Yeah. We really need to get those. We really Yeah.

14:50 That's why it's so important. Yeah. We don't wanna have to call you back. And Yeah. Because you get the phone call. Like, oh god. I'm dying. Yeah. That's what you think. It's the first thing you think of. You see all the Yeah. You know, the pink ribbons and you hear the stories. You see the walks. You're like, I don't wanna be on that train. Exactly. Yeah. Yeah. Alright. Well, let's say you end up having breast cancer. Mhmm. What are the types that you can have? Oh, there are. Well Yeah. I guess what I mean, if there's how many? The not good type. Well, the most the most common that I have seen Uh-huh. Is ductal carcinoma in situ, which is DCIS Okay. Which in terms means is still confined within the duct. Okay. It's usually categorized like stage 0.

15:33 Okay. But it is a cancer. I see. And then there's invasive ductal carcinoma Okay. That has invaded already outside the duct but there's different stages of that as well. And there's invasive lobular. It's within the lobe of the breast. Gotcha. And then I'm trying to think of the other ones that I've seen. What about metastatic I hear about? Yeah. Well, that's usually if there's some pronounced lymph node, they'll biopsy that as well if there's something seen in the breast and that could be metastatic. What does metastatic mean? It has spread. It has spread now through the lymphatic system. Which is very scary. Can be It can be. Yeah. Yeah.

16:13 You can't say. You're like, these people are listening. And then It that's why it's so important to if you feel that lump, you have any concerns why you address it. The earlier it's detected, the less chance that it will spread to the lymph. Well, and it's it sounds like and correct me if I'm wrong here, but, like, with colon cancer, it's a very treatable cancer. Correct. Yeah. It used to be a death sentence. Exactly. In my lifetime, I can remember when I was young, if a friend of my mom's was diagnosed, you were like, oh, no. She's gonna be gone. Right? Now it's very rare to hear that somebody Mhmm. Passes away, which is wonderful. It is wonderful. There's so many new targeted therapies. Precision medicine has come into play.

16:59 We now have better surgical techniques. There's robotic mastectomies in some places, 3 d imaging, what that's done. So the advances have really made this, like you say, like colon cancer. Yeah. It's it's so treatable, which is so great. And the earlier you catch it, the more treatable it is. That's key. That and that's how colon cancer works. Like, if they see it, they just cut it out, and boom. You're all you're all good to go. Yeah. Okay. Can you explain the different type of treatment options once you have cancer and you have to deal with it? What are your treatment options for the cancer? I'm sure it would vary with the type that you have. Yes. Yeah. There's what? Chemotherapy. Yeah. There's radiation therapy.

17:40 There's surgical as far as you can get a lumpectomy or mastectomy. Mhmm. There's even hormonal based type of therapy depending on if your cancer is hormonal based, if it's estrogen, progesterone positive. If that means that it's feeding off of that hormone. So now there's therapy that kinda blocks those therapies to stop the growth of the cancer. So you cut out your estrogen and it stops feeding it. And you're what else does would a cancer feed on if it's not a hormone? Do you do we know the answer to that yet? There's I I would say that's not our wheelhouse as much, but but I will say once, you know, with treatments, Adrian will navigate a a patient who is diagnosed with cancer to our oncology surgery and oncology services, at WakeMed. And then, like before, like I was saying before, there's so many treatments now. There's so many clinical trials clinical trial? I hear that all the time. I'm really not sure what that means.

18:39 Yeah. Clinical trials are when there is a new treatment or a drug, maybe even an imaging, technique, and yet it hasn't been FDA approved yet, or it could be FDA approved, but it hasn't been put into clinical practice. Mhmm. But they they have seen great results, and it's usually if other things aren't working. I see. Well, that actually segues me perfectly to my next question, which is, what are some latest developments that have happened for breast cancer, like, in treatment? There's so many all the time and, like I said, a lot of clinical trials, but it's more those, you know, breast cancer is very individual. Yeah. It it's you you and I could be diagnosed with the same we could both have invasive ductal carcinoma, but mine can be completely different than yours. That's so crazy. Mhmm. Yeah. So Different stages.

19:33 Yeah. Different stages, different the the hormonality of it, the, who we are as a person, comorbidities, everything. What is Co sorry. Lifestyle. Like lifestyle. Or do you have other other, do you have diabetes? I see. Do you have, you know, anything else going on? So that's gonna dictate what your treatment plan is gonna be or what treatment will work for you. But now there's so much more with the targeted therapies that are, you know, they're they're, created to to you. They're I've been hearing about this. Developed for you individually Yeah. With your oncologist. So amazing. Yeah. Amazing outcomes. I keep hearing from numerous doctors, especially this season. This is the 3rd season of this podcast. Thank you, WakeMed.

20:21 That personalized medicine is getting more and more Mhmm. It's they're just making more advances in that direction because everybody is so different. I think that's and so they're doing that breast cancer. It's awesome. Yeah. It's absolutely awesome. What resources are available to a woman who's diagnosed with breast cancer? Because I'm I mean, I know if I was diagnosed, I would freak out. What resources are available to a woman who's diagnosed with breast cancer? Because I I mean, I know if I was diagnosed, I would freak out. What are the re what what do you do to support a a woman who's going through breast cancer treatment? I mean, I can be one of their support Mhmm. Person. There's Susan G Komen website as well. The American Cancer Society as well. Even their provider, oncologist surgeon, they also have navigators as well that can also help with anything, whether it's I gotta say, when you're a navigator Insurance, transportation, anything like that. Any question, it doesn't matter. You have all you can help them. Yes. I'm like, if I don't have the answer right now, I will find it for you. That is awesome. Because that's especially in America, that is one of the worst things is thinking about navigating insurance and all that stuff. Yeah. And we're trying to, you know, get that away from them and let them focus on just their health and healing and have everything else kind of with the navigators to figure out. So if a woman comes to you like I would freaking out, what are some things that you would tell her?

21:39 Well, I mean, when I because I'm the one that tells them whether they have cancer or not. I'm the bearer of bad news. Oh my god. I don't know. Of course, the first question they ask me is, okay. What stage am I and this and that and I tell them everybody's different. Everybody has their own type of treatment plan based on their pathology, their imaging and what the surgeon or oncologist feels is deemed as necessary for you. Okay. You hear it all the time, but, you know, advocating for your health, like, your oncologist, your surgeon, depending on what your cancer is, you know, ask the questions. They want you to know everything. They want you to be part of your, you know, our we have fantastic breast surgeons. We have fantastic oncologists, you know, they really want you to be part of every decision about your care and you should be. Yeah. It's your body. Yeah. And and they want you to feel completely confident and and assured and because the more, you know, knowledge is power. Right? The more the less stressful the whole process is gonna be, and stress is key, you know, to healing. And so really encourage people to, you know, talk to Adrianne and anybody in your community. There are community support groups. There are church support groups. There are neighborhood support groups of women who have had breast cancer. Reach out to somebody you know went through that. Yeah. Yeah. Alright. Let's get into our listener questions. I love these. Alright. First one, and I have heard this, does wearing underwire bras

23:12 increase the risk of breast cancer? No. No. There's no scientific evidence that says that. It's probably something that they've heard somewhere and they just assume. Yeah. I mean, it may be uncomfortable. Yeah. Yeah. It may even cause some pain. Yeah. But but They won't cause cancer. It does not cause That's wonderful. No. How about deodorant? No. Well, they say aluminum. Mhmm. But, actually, for us, when we say no deodorant as far as for mammogram is because they can show up in the mammogram. Oh, because it's metal in it. Yeah. Yeah. That makes sense. But as far as the whole cause cancer There's no yeah. There's no evidence. Yeah. Got it. Alright. Next question. I typically think of people finding out they have breast cancer from a mammogram, but are there symptoms other than lumps we should be on the lookout for?

24:01 Yes. Like Adrianne said, if you see a dimple in your skin, you know, your skin can all of a sudden invert or an inverted nipple or nipple discharge pain, like and the pain should be you can have pain in your breast, around your cycle, everything. Right? But this would be pain that's very focal. It's in the same Okay. Place and it's 2 and before. And it usually intensifies, and it's pretty constant. I see. That would be a pain that you would say, I better have this checked out. Okay. Yeah. So there are there are other things besides a lump for sure. Okay. Yeah. Alright. Do people with bigger boobs tend to get breast cancer more often than people with smaller boobs? No. No. It has nothing to do with size. Not at all. No. Okay. You would think that the bigger there would be more chance, but I'm not interested. No. No. You know, like, more real estate. No. Does breastfeeding help prevent breast cancer? So, yes, breastfeeding is good. Again, something that's great overall for everybody, but, there are studies that show that breastfeeding is beneficial for all things of health and Yeah. And just keeping all those hormone hormones doing what they should do. Yeah. Yeah. Okay. That makes sense. Yeah. But I don't I don't know if there's, like, a direct correlation. Yeah. Yeah.

25:19 Alright. Last question. Is there a trend of younger women being diagnosed with breast cancer? It seems like I'm hearing about young women having it more often. Unfortunately, yes. Do you think it's because the detection is better? There's that. I think there's hormones. There's, environmental. A lot that could factor into it. Yeah. Yeah. That's the thing about Yeah. Cancers. Like, we don't really know what's causing it. Yeah. Alright. Yeah. Yeah. Well Sadly. It's this is a case of mostly good news though, and that's Yes. Fantastic. I was a little nervous doing this episode, you know, because it's breast cancer. Right. But, I mean, all these walks and all the all the effort we've put into getting more research really has come up with some great results. Oh, it has. Yeah.

26:05 Alright, guys. Gotta schedule those mammograms. There's nothing to be afraid of. Even if you do get a callback for a follow-up, there's really no reason to panic. This is one of the best cancer screening tests we have. Knowledge is power. My guest today were Dana Knapp and Adrianne Jackson. You can find out about WakeMed's Breast Health Services at wakemed.org. Please share this episode with someone who needs to hear it. Hit that share button on your podcast player and pass it on. See you next time.