Latest / Clearly Hormonal / Ep 31: Breast Cancer Screening with Dr. Sasmita Misra

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Ep 31: Breast Cancer Screening with Dr. Sasmita Misra · Clearly Hormonal

• 0:02
  Dr. Komal Patil-Sisodia: Welcome to Reset Recharge, the podcast where women's health takes center stage.
• 0:07
  Dr. Komal Patil-Sisodia: I'm your host, Dr.
• 0:08
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, a triple board certified endocrinologist and women's health expert.
• 0:13
  Dr. Komal Patil-Sisodia: This show is all about empowering you with the knowledge to understand your metabolic health, navigate hormonal changes, and feel confident in the conversations you're having with your healthcare provider.
• 0:24
  Dr. Komal Patil-Sisodia: Whether you're managing symptoms, exploring treatment options, or just want to feel more in tune with your body, you're in the right place.
• 0:31
  Dr. Komal Patil-Sisodia: As a physician, my goal is to educate on this podcast.
• 0:34
  Dr. Komal Patil-Sisodia: The content shared here is for informational purposes only and should not replace personalized medical advice.
• 0:41
  Dr. Komal Patil-Sisodia: If something we discuss resonates with you, please talk to your healthcare provider at your next visit.
• 0:46
  Dr. Komal Patil-Sisodia: Now let's dive in and help you reset, recharge, and take control of your health.
• 0:55
  Dr. Komal Patil-Sisodia: Hi everyone.
• 0:56
  Dr. Komal Patil-Sisodia: Welcome back to Reset Recharge.
• 0:58
  Dr. Komal Patil-Sisodia: I'm your host, Dr.
• 0:58
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, and I am so excited for a very special guest today, Dr.
• 1:04
  Dr. Komal Patil-Sisodia: Sasmita Misra, who is a fellowship trained breast radiologist.
• 1:08
  Dr. Komal Patil-Sisodia: She trained at UCLA for her fellowship.
• 1:11
  Dr. Komal Patil-Sisodia: She works at RAD Partners and currently sees patients at University of Chicago in Illinois.
• 1:17
  Dr. Komal Patil-Sisodia: This episode is super special for me because Dr.
• 1:20
  Dr. Komal Patil-Sisodia: Misra is my bestie from medical school and we ended up.
• 1:24
  Dr. Komal Patil-Sisodia: On the first day of school walking into class in the same outfit down to the shoes.
• 1:29
  Dr. Komal Patil-Sisodia: And I remember we both kind of sized each other up and we were thinking we are either gonna be best friends or mortal enemies.
• 1:35
  Dr. Komal Patil-Sisodia: And here we are, like 25 years later.
• 1:37
  Dr. Komal Patil-Sisodia: So this makes me really happy to have you here.
• 1:40
  Dr. Komal Patil-Sisodia: Welcome to the show.
• 1:42
  Dr. Sasmita Misra: Thank you.
• 1:43
  Dr. Sasmita Misra: I'm excited to be here.
• 1:44
  Dr. Komal Patil-Sisodia: Thanks.
• 1:44
  Dr. Komal Patil-Sisodia: I have always admired the work that you've done with female patients.
• 1:49
  Dr. Komal Patil-Sisodia: You are that first point of contact for women as they are getting screened and diagnosed with breast cancer.
• 1:55
  Dr. Komal Patil-Sisodia: Tell us why you decided to become a breast radiologist.
• 2:00
  Dr. Sasmita Misra: I just really enjoy the intersection between imaging and dealing with patients and largely, I love empowering women and working with women, and when I did my rotation through breast imaging in residency, it really just was very impactful because we are the first point of contact, like you said, for our patients in the diagnosis of breast cancer, and at that point they're very vulnerable, our patients, and they really need their handheld throughout this process.
• 2:28
  Dr. Sasmita Misra: And it really resonated with me and I realized, we can make a difference if we do the practice.
• 2:33
  Dr. Komal Patil-Sisodia: Well, just knowing you on a personal level, I know that you are like one of the most caring and nurturing people, so your patients are so lucky, happy you, they're advocating for them.
• 2:44
  Dr. Komal Patil-Sisodia: I would love to, and I'm sure our listeners would love to hear from you, like what is the most common.
• 2:51
  Dr. Komal Patil-Sisodia: Scenario that you see walk into your office when you are diagnosing a or screening a patient, diagnosing a patient with breast cancer, what are you seeing typically?
• 3:00
  Dr. Sasmita Misra: I mean, we have patients come into our office from a multitude of reasons.
• 3:04
  Dr. Sasmita Misra: Either they're coming in just for their screening annual mammogram to see if we can find a breast cancer.
• 3:10
  Dr. Sasmita Misra: And then a lot of our patients will be coming with a symptom if it's a palpable abnormality or an area of concern.
• 3:16
  Dr. Sasmita Misra: So we see breast cancers from either.
• 3:20
  Dr. Sasmita Misra: Way majority of the time if we detect a mass or abnormality on the screening mammogram, they'll come back in and at that point of contact is when we do have to tell them that, we are worried about something and we would need to do a biopsy of some sort.
• 3:34
  Dr. Komal Patil-Sisodia: Yeah.
• 3:34
  Dr. Komal Patil-Sisodia: So would you say that a lot of women who are coming into your office are found because they felt a lump at home?
• 3:41
  Dr. Komal Patil-Sisodia: Like how good are self screenings?
• 3:43
  Dr. Komal Patil-Sisodia: Or is this because, it is a finding on mammogram that they had no idea existed?
• 3:49
  Dr. Sasmita Misra: Or screening mammograms detect 85 to 90% of malignancies.
• 3:54
  Dr. Sasmita Misra: And so a majority of our patients will come through the route of an abnormal screening mammogram, and our goal is actually to detect those cancers before they become the palpable area of concern.
• 4:05
  Dr. Sasmita Misra: Because majority of breast cancers, if you do screening mammograms annually, every year, you'll catch'em about two to three.
• 4:13
  Dr. Sasmita Misra: Years prior to the patient actually feeling the lump, and so that is our goal.
• 4:19
  Dr. Komal Patil-Sisodia: Okay, that's screen exam.
• 4:21
  Dr. Komal Patil-Sisodia: That's great.
• 4:22
  Dr. Komal Patil-Sisodia: That's great to know.
• 4:23
  Dr. Komal Patil-Sisodia: And what is the biggest misconception you hear from patients coming in?
• 4:27
  Dr. Komal Patil-Sisodia: I was super nervous when I went in for my first mammogram and then I made the mistake of reading the numbers on the side and I realized that was like the pounds of pressure they were applying to each breast and that did not feel good.
• 4:38
  Dr. Sasmita Misra: Yeah.
• 4:39
  Dr. Komal Patil-Sisodia: But what do you think is the biggest misconception?
• 4:41
  Dr. Sasmita Misra: I think the biggest misconception is that I believe that breast cancer is mainly found in women who have a first degree relative with breast cancer.
• 4:50
  Dr. Sasmita Misra: But in reality, 85% of our cancers are in women without a family history of breast cancer.
• 4:56
  Dr. Sasmita Misra: So while family history is an important factor, it is relatively a small percentage of those newly diagnosed breast cancers.
• 5:04
  Dr. Sasmita Misra: So the danger of that misconception largely is that these women have a false sense of security.
• 5:09
  Dr. Sasmita Misra: That if they don't have a genetic risk, they're not gonna develop breast cancer in their lifetime.
• 5:14
  Dr. Sasmita Misra: And this may delay them getting a screening mammogram.
• 5:17
  Dr. Sasmita Misra: Yeah.
• 5:18
  Dr. Sasmita Misra: And ultimately delay the diagnosis of breast cancer.
• 5:21
  Dr. Sasmita Misra: And I think if we look at the percentages of cancer itself, breast cancer is the most common cancer among women worldwide.
• 5:30
  Dr. Sasmita Misra: In the United States, one in eight women will develop breast cancer in their lifetime.
• 5:35
  Dr. Sasmita Misra: And unfortunately, it's the second leading cause of death in women.
• 5:38
  Dr. Sasmita Misra: Also.
• 5:40
  Dr. Komal Patil-Sisodia: Scary.
• 5:42
  Dr. Sasmita Misra: So ultimately, what we need to teach our patients is that a breast cancer screening is for everyone, and that every patient needs it because it is our first line of defense in catching cancers early.
• 5:56
  Dr. Komal Patil-Sisodia: I don't think I realized that 85 to 90% were just caught on the screening Mammos.
• 6:00
  Dr. Komal Patil-Sisodia: That's a yes.
• 6:01
  Dr. Sasmita Misra: Yeah, that's
• 6:02
  Dr. Komal Patil-Sisodia: a number that I wasn't really aware of.
• 6:04
  Dr. Komal Patil-Sisodia: What do, so if family history is not the biggest risk factor that you see, which is I think what commonly is thought across all areas of medicine, me not being a breast radiologist, I kind of assumed that would.
• 6:17
  Dr. Komal Patil-Sisodia: That was the case.
• 6:18
  Dr. Komal Patil-Sisodia: Yeah.
• 6:18
  Dr. Komal Patil-Sisodia: But what do you see as risk factors?
• 6:20
  Dr. Komal Patil-Sisodia: What are the biggest risk factors that you see?
• 6:22
  Dr. Sasmita Misra: It's a combination of multiple things.
• 6:24
  Dr. Sasmita Misra: We have environmental risk factors, we have hormonal and we have lifestyle risk across the board.
• 6:29
  Dr. Sasmita Misra: Some of the lifestyle risk factors that we see are alcohol and across the board in any cancer, you'll see an increased risk of cancer in anyone who has a higher intake of alcohol.
• 6:38
  Dr. Sasmita Misra: And the reason why is alcohol actually increases your estrogen.
• 6:42
  Dr. Sasmita Misra: And so that makes sense.
• 6:44
  Dr. Sasmita Misra: Unopposed estrogen will increase your risk for hormonally driven breast cancers.
• 6:48
  Dr. Sasmita Misra: Then also when you think about lifestyle risk, women, for example, if you're a postmenopausal female and you're have obesity, those, the estrogen that you get that's largely produced in a postmenopausal females from the fat cells.
• 7:00
  Dr. Sasmita Misra: And so the postmenopausal obesity will also increase your risk of developing breast cancer as well.
• 7:07
  Dr. Sasmita Misra: And they do say, but there are modifiable risk factors.
• 7:11
  Dr. Sasmita Misra: You make lifestyle modifications such as walking two to three times a week, you can decrease that risk by 20 to 30%.
• 7:18
  Dr. Komal Patil-Sisodia: Wow.
• 7:19
  Dr. Sasmita Misra: Yeah.
• 7:19
  Dr. Sasmita Misra: So that's why exercise is really helpful in women.
• 7:23
  Dr. Sasmita Misra: So I
• 7:24
  Dr. Komal Patil-Sisodia: think that's fascinating because there's so much data about how exercising is like walking just 11 minutes a day reduces your cardiac risk by 33%.
• 7:33
  Dr. Komal Patil-Sisodia: I didn't realize that extended, that.
• 7:36
  Dr. Komal Patil-Sisodia: Smaller amount of exercise extended to decreasing breast cancer risk as well, right?
• 7:41
  Dr. Komal Patil-Sisodia: Yes.
• 7:42
  Dr. Komal Patil-Sisodia: It's very interesting.
• 7:43
  Dr. Komal Patil-Sisodia: Lifestyle changes go a long way.
• 7:45
  Dr. Sasmita Misra: Yeah, a hundred percent.
• 7:46
  Dr. Sasmita Misra: Yeah.
• 7:46
  Dr. Komal Patil-Sisodia: The drink cutoff I've read is that any drink, any nu number of drinks over two drinks per day is considered higher risk, right?
• 7:55
  Dr. Komal Patil-Sisodia: Or you're increasing your risk, or is that a misconception?
• 7:58
  Dr. Sasmita Misra: I think that's a misconception now too.
• 8:00
  Dr. Sasmita Misra: I just read a study actually that's saying any amount of alcohol can increase your risk of.
• 8:04
  Dr. Sasmita Misra: Breast cancer or cancer in general.
• 8:06
  Dr. Sasmita Misra: So it's really something, but largely it's dose dependent.
• 8:10
  Dr. Sasmita Misra: So you know, if say if you are drinking two drinks a day, obviously try to cut back.
• 8:15
  Dr. Sasmita Misra: It's just something that we have to mitigate, along with other lifestyle modifications as well.
• 8:21
  Dr. Komal Patil-Sisodia: You mentioned hormonal risk factors.
• 8:23
  Dr. Komal Patil-Sisodia: Can you explain what that is?
• 8:25
  Dr. Sasmita Misra: Yeah, so one of the things that we ask our patients when they come in is we wanna determine how long that they've been exposed to estrogen.
• 8:33
  Dr. Sasmita Misra: So essentially we ask them for the age of their first menstrual period to the age of onset of menopause, and the longer that gap is, or the longer that they've had.
• 8:43
  Dr. Sasmita Misra: Un opposed estrogen that increases the risk for developing breast cancer.
• 8:47
  Dr. Sasmita Misra: And so that is a question that we tend to take into consideration when look at their risk factors.
• 8:53
  Dr. Komal Patil-Sisodia: So is there an age at which you consider menopause to be late, like 60 and beyond?
• 9:00
  Dr. Sasmita Misra: I think 55, right?
• 9:01
  Dr. Sasmita Misra: Isn't 55 consider late?
• 9:03
  Dr. Sasmita Misra: Yeah.
• 9:03
  Dr. Sasmita Misra: 55.
• 9:03
  Dr. Sasmita Misra: Yeah.
• 9:03
  Dr. Komal Patil-Sisodia: The window generally 45 to 55.
• 9:06
  Dr. Komal Patil-Sisodia: So anything like anybody who goes 55 onwards beyond 55, it is considered longer exposure to estrogen.
• 9:13
  Dr. Komal Patil-Sisodia: And the average age of the onset of like menstrual cycles is probably, at least when we were growing up, I think was between 11 to 13.
• 9:21
  Dr. Komal Patil-Sisodia: The generation prior to us, it was even a little later now, I think less
• 9:25
  Dr. Sasmita Misra: than 12.
• 9:27
  Dr. Sasmita Misra: Less than 12.
• 9:27
  Dr. Sasmita Misra: Okay.
• 9:28
  Dr. Sasmita Misra: Yes.
• 9:28
  Dr. Sasmita Misra: Yeah.
• 9:29
  Dr. Komal Patil-Sisodia: Alright, so that's helpful to know.
• 9:31
  Dr. Sasmita Misra: Yeah,
• 9:32
  Dr. Komal Patil-Sisodia: because I feel like women are getting their periods younger and younger now, so
• 9:36
  Dr. Sasmita Misra: Yeah,
• 9:36
  Dr. Komal Patil-Sisodia: it really kind of makes you wonder.
• 9:38
  Dr. Sasmita Misra: Absolutely.
• 9:39
  Dr. Sasmita Misra: Some other lifestyle changes.
• 9:41
  Dr. Sasmita Misra: They have done some studies in these, I don't know the full details about it, but it's disrupting the circadian rhythm, so women who actually have night jobs and disrupting that circadian rhythm can also increase your risk for breast cancer.
• 9:53
  Dr. Sasmita Misra: I don't know the full correlation between that.
• 9:56
  Dr. Sasmita Misra: It is just some studies that they have talked about as well.
• 9:59
  Dr. Komal Patil-Sisodia: That's interesting.
• 10:00
  Dr. Komal Patil-Sisodia: I know that with like people who are working night shifts and things like that, there's a higher prevalence of obesity.
• 10:05
  Dr. Komal Patil-Sisodia: So maybe it's linked, maybe it's that, or maybe it's also, you're not having your circadian axis reset with proper sleep.
• 10:13
  Dr. Komal Patil-Sisodia: And so whatever repair is happening to our bodies as we sleep overnight and rejuvenate, maybe that's also, or maybe there's increased oxidative stress, who knows?
• 10:21
  Dr. Komal Patil-Sisodia: Yeah.
• 10:21
  Dr. Komal Patil-Sisodia: But it's interesting.
• 10:22
  Dr. Komal Patil-Sisodia: I mean that makes sense to some degree.
• 10:24
  Dr. Komal Patil-Sisodia: Yeah.
• 10:24
  Dr. Sasmita Misra: And then.
• 10:25
  Dr. Sasmita Misra: We do when we talk about breast cancer and we ask these questions actually when a patient first comes to see us, we talk about we, yeah, we'll ask the patient about their age of onset of first menstruation and also the age of menopause, and largely the earlier your.
• 10:42
  Dr. Sasmita Misra: Menstruation.
• 10:43
  Dr. Sasmita Misra: If you have like a longer period of what we call unopposed estrogen, so you got your period earlier and you had a delayed menopause, that longer period of unopposed estrogen also is an increased risk for developing breast cancer.
• 10:57
  Dr. Sasmita Misra: Something that you can't truly modify, but it is something that we take into consideration when we do a risk assessment on patients and know that that does increase can increase your risk for developing breast cancer as well.
• 11:09
  Dr. Komal Patil-Sisodia: You mentioned high density breasts as a risk factor.
• 11:12
  Dr. Komal Patil-Sisodia: Can you talk a little bit more about breast density and what that means?
• 11:15
  Dr. Komal Patil-Sisodia: Sure.
• 11:15
  Dr. Komal Patil-Sisodia: And how you evaluate it.
• 11:17
  Dr. Sasmita Misra: Sure.
• 11:18
  Dr. Sasmita Misra: So when we talk about breast density, we're not talking about how the breast feels, but we're talking about the makeup of the breast tissue that we see on mammogram.
• 11:27
  Dr. Sasmita Misra: So breasts are composed primarily of what we call fatty breast tissue and fibro glandular breast tissue.
• 11:32
  Dr. Sasmita Misra: And the percentage composition of each of them is what determines if your breast is gonna be denser or less denser, what we call fatty radiologist categories.
• 11:42
  Dr. Sasmita Misra: Radiologist categorize breast into four levels, almost entirely fatty, scattered, fibro, glandular, heterogeneously dense, or extremely dense.
• 11:50
  Dr. Sasmita Misra: So breast density matters for two reasons.
• 11:52
  Dr. Sasmita Misra: First.
• 11:53
  Dr. Sasmita Misra: Breast cancers can be masked by the breast density because breast density and tumors have the same appearance of white Wow.
• 12:02
  Dr. Sasmita Misra: On a mammographic image.
• 12:04
  Dr. Sasmita Misra: So sometimes a cancer can hide in women with dense breasts.
• 12:08
  Dr. Sasmita Misra: Secondly, and we've discovered this over the years, is that dense breast tissue themselves have a higher risk of developing breast cancer.
• 12:16
  Dr. Komal Patil-Sisodia: And is that because it doesn't originate from the fatty tissue in the breast?
• 12:21
  Dr. Sasmita Misra: Yeah.
• 12:22
  Dr. Komal Patil-Sisodia: Okay.
• 12:22
  Dr. Sasmita Misra: Because it originates from the, what we call the fiber or glandular breast tissue, which is not fully understood, but we think that just increases your giving rise to cancer cells.
• 12:33
  Dr. Sasmita Misra: Yeah.
• 12:34
  Dr. Sasmita Misra: The glandular tissue is the tissue that can give rise to cancer cells.
• 12:37
  Dr. Komal Patil-Sisodia: And that's the tissue that's hormone responsive, right?
• 12:40
  Dr. Sasmita Misra: Yeah.
• 12:40
  Dr. Komal Patil-Sisodia: Okay.
• 12:41
  Dr. Sasmita Misra: So for women with dense breasts, even though the reason why we have to mention that breast density on their mammogram is.
• 12:49
  Dr. Sasmita Misra: We want them to know that there are additional tools that can help them in addition to the mammogram, and so there are some state laws out there.
• 12:56
  Dr. Sasmita Misra: For example, in Illinois, we have to inform a patient that they have dense breasts and that they can get another tool like an breast ultrasound in addition to their mammogram to evaluate the breasts and their breast density.
• 13:08
  Dr. Sasmita Misra: It's really important.
• 13:09
  Dr. Sasmita Misra: Just recently I did a patient with a screening, breast ultrasound after having a negative mammogram, and we found two cancers in their left breast, and it just tells you the importance of the patient knowing that they had dense breasts coming in for their breast ultrasound and diagnosing
• 13:23
  Dr. Komal Patil-Sisodia: Yeah, their
• 13:24
  Dr. Sasmita Misra: cancers.
• 13:25
  Dr. Komal Patil-Sisodia: Okay.
• 13:26
  Dr. Komal Patil-Sisodia: And question for you, I've seen a lot of hype online, especially with Olivia Munn and her use of the Tyrer-Cuzick scale for getting her breast cancer diagnosed that didn't show up on a mammogram.
• 13:39
  Dr. Komal Patil-Sisodia: What are your thoughts on that, and is that something you recommend and yeah, is it helpful?
• 13:44
  Dr. Sasmita Misra: Very helpful.
• 13:45
  Dr. Sasmita Misra: So we have every patient when they come in.
• 13:48
  Dr. Sasmita Misra: Yeah.
• 13:48
  Dr. Sasmita Misra: We ask all the screening questions for the tyro scoring, so that way we can restratify them.
• 13:55
  Dr. Sasmita Misra: Okay.
• 13:55
  Dr. Sasmita Misra: Because one of the breast imaging no longer is a one size fits all.
• 13:59
  Dr. Sasmita Misra: We're not doing screening mammograms for every patient.
• 14:01
  Dr. Sasmita Misra: Beginning at age 40, we actually look into these other risk factors to see what else, what other tools can we give them that we.
• 14:08
  Dr. Sasmita Misra: To help diagnose their breast cancer earlier before it becomes a late later stage.
• 14:13
  Dr. Sasmita Misra: So one of the tools that have been developed is the Tyrer-Cuzick scoring, and what that does is it does ask about, unopposed estrogen, the date of first period, the date of your last menopause, your family history, any abnormal biopsies that you may have had, and all of these questions get placed into a risk calculator, and then it will generate a score and tell you if you're high risk or not.
• 14:36
  Dr. Sasmita Misra: Okay.
• 14:37
  Dr. Sasmita Misra: The average person has about a lifetime risk of developing breast cancer at 12%.
• 14:42
  Dr. Sasmita Misra: So anything in the 15 to 20% category on that score, you're considered intermediate risk.
• 14:47
  Dr. Sasmita Misra: Okay?
• 14:48
  Dr. Sasmita Misra: And anybody who is greater than 20%, they're considered high risk.
• 14:52
  Dr. Sasmita Misra: And so those high risk patients, we will recommend them to not only get a mammogram every year, but we also will ask them to get a MRI every year.
• 15:01
  Dr. Sasmita Misra: But we alternate the mammogram.
• 15:04
  Dr. Sasmita Misra: And the MRI at six month intervals.
• 15:07
  Dr. Sasmita Misra: So they're getting some sort of breast imaging on it every six month basis, but it's alternating with a mammogram and a breast MRI.
• 15:14
  Dr. Sasmita Misra: Okay.
• 15:14
  Dr. Sasmita Misra: And so I think it's very helpful for.
• 15:18
  Dr. Komal Patil-Sisodia: That's great.
• 15:18
  Dr. Komal Patil-Sisodia: It's something that I've started using in my practice recently and it's actually helped me catch some things.
• 15:24
  Dr. Komal Patil-Sisodia: I had a patient who came to see me and had been put on hormones elsewhere, but when I was going through the tire acoustic thing and her family history form, I noticed that her dad had prostate and breast cancer, and I was like, oh my gosh.
• 15:39
  Dr. Komal Patil-Sisodia: Time out.
• 15:40
  Dr. Sasmita Misra: Yeah.
• 15:41
  Dr. Sasmita Misra: Very high risk.
• 15:42
  Dr. Sasmita Misra: Yeah.
• 15:42
  Dr. Komal Patil-Sisodia: Let's shift gears a little bit.
• 15:45
  Dr. Komal Patil-Sisodia: I want people to understand screening, right?
• 15:48
  Dr. Komal Patil-Sisodia: Yeah.
• 15:48
  Dr. Komal Patil-Sisodia: Because I am a physician and sometimes I get confused.
• 15:52
  Dr. Sasmita Misra: Yeah.
• 15:53
  Dr. Komal Patil-Sisodia: If you could break down, let's talk about what is the appropriate screening, what you would recommend to all women and why the guidelines are so different from American College of Radiology to U-S-P-S-T-F.
• 16:05
  Dr. Komal Patil-Sisodia: I'm curious to hear your viewpoint on those things.
• 16:07
  Dr. Sasmita Misra: Yeah, it's a great question.
• 16:08
  Dr. Sasmita Misra: Screening has evolved largely from the seventies to eighties and largely because our equipment and our technology has involved, yeah.
• 16:18
  Dr. Sasmita Misra: And so if you go back to the seventies and eighties and you look at their screening mammography, although it was harder to detect cancers, we still saw a great change in out outcomes and the survivability.
• 16:28
  Dr. Sasmita Misra: And then now you fast forward to today we do digital mammography and majority of facilities do what we call 3D mammography or what we call tomosynthesis, which is just a different closer layered look at looking at the breast through different angles.
• 16:41
  Dr. Sasmita Misra: Okay?
• 16:41
  Dr. Sasmita Misra: We're able to detect breast cancers earlier.
• 16:44
  Dr. Sasmita Misra: And we also have less callback rates.
• 16:46
  Dr. Sasmita Misra: So screening mammography is the only proven method to detect breast cancer early among women.
• 16:54
  Dr. Sasmita Misra: And so there are studies after studies that show this, and it's really important for us to get that information out there.
• 17:01
  Dr. Sasmita Misra: You'll hear a lot of other different types of studies and modalities that are out there, but breast cancer screening is.
• 17:06
  Dr. Sasmita Misra: The one that reduces mortality by 40% in women.
• 17:10
  Dr. Sasmita Misra: Wow.
• 17:10
  Dr. Sasmita Misra: So you'll see these varying organizations, like you mentioned, the us task force, preventative task force.
• 17:16
  Dr. Sasmita Misra: They recommended years ago that screening mammography can happen at age 50 every two years.
• 17:23
  Dr. Sasmita Misra: And largely the way that they look.
• 17:26
  Dr. Sasmita Misra: At the screening mammography was not through the lens of survivability, improved mortality.
• 17:32
  Dr. Sasmita Misra: They're looking at the lens of all patients and more from an anxiety related component.
• 17:39
  Dr. Sasmita Misra: These patients get more anxious because they're being called back for cases and they're also not looking at demographics as much.
• 17:44
  Dr. Sasmita Misra: It was more of a general population.
• 17:48
  Dr. Sasmita Misra: Group of women.
• 17:49
  Dr. Sasmita Misra: What?
• 17:49
  Dr. Sasmita Misra: The the A CR and the American Cancer Society we're aligned and we recommend annual mammograms beginning at age 40.
• 17:57
  Dr. Sasmita Misra: Okay.
• 17:58
  Dr. Sasmita Misra: Every year.
• 17:59
  Dr. Sasmita Misra: And I think that's really important to let everyone know our insurance will pay for it, but there are certain guidelines, if you have a first degree relative, for example, who was diagnosed with breast cancer, say it.
• 18:10
  Dr. Sasmita Misra: 35, we can move up that first screener 10 years prior to the age of the first degree relative developing breast cancer.
• 18:18
  Dr. Sasmita Misra: Okay.
• 18:18
  Dr. Sasmita Misra: So we have a lot of modifiable risk factor.
• 18:20
  Dr. Sasmita Misra: Yeah.
• 18:21
  Dr. Sasmita Misra: Ways of screening now.
• 18:22
  Dr. Komal Patil-Sisodia: And one of the most common questions I get from my patients is what exactly is a first degree relative?
• 18:27
  Dr. Komal Patil-Sisodia: Is that like mother or sister or does that extend to aunts and cousins and things like that?
• 18:33
  Dr. Komal Patil-Sisodia: Yeah.
• 18:33
  Dr. Komal Patil-Sisodia: Because I think, if there's any history of breast cancer at all, right?
• 18:36
  Dr. Komal Patil-Sisodia: People are really worried that could be something for them.
• 18:41
  Dr. Sasmita Misra: First degree relative is your mother, your sister, or your daughter.
• 18:45
  Dr. Sasmita Misra: Okay?
• 18:45
  Dr. Sasmita Misra: Those are what we consider first degree relatives.
• 18:47
  Dr. Sasmita Misra: And your father actually, if you have a father who's diagnosed with breast cancer, we're at a much higher concern that there is genetics at play.
• 18:56
  Dr. Komal Patil-Sisodia: Okay?
• 18:56
  Dr. Komal Patil-Sisodia: Yeah.
• 18:56
  Dr. Komal Patil-Sisodia: And with the genetic testing.
• 18:59
  Dr. Komal Patil-Sisodia: How frequently do you recommend genetic testing?
• 19:03
  Dr. Komal Patil-Sisodia: Or is that something that comes from you or from the oncologist?
• 19:08
  Dr. Sasmita Misra: So what we do when it comes for genetic evaluation is we don't do that in our breast center itself, but we do a risk analysis for every patient that comes in.
• 19:17
  Dr. Sasmita Misra: And in that risk as analysis, we do ask a lot of questions.
• 19:20
  Dr. Sasmita Misra: And if it looks like the patient has a higher risk of duh.
• 19:24
  Dr. Sasmita Misra: Developing breast cancer than the regular population.
• 19:27
  Dr. Sasmita Misra: We will counsel them or suggest for them to go see a genetic counselor for possible evaluation of a genetic component.
• 19:35
  Dr. Sasmita Misra: And so just for risk mitigation, you largely, I think you get genetically tested once, but like I tell a lot of my patients year after year, they're constantly identifying, yeah.
• 19:47
  Dr. Sasmita Misra: New genetic mutations, and so it's important to go back if it's been a couple years, to see if there's a need for another evaluation.
• 19:57
  Dr. Komal Patil-Sisodia: I heard one of the hard cutoff points was like pre 2013, right?
• 20:01
  Dr. Komal Patil-Sisodia: Because the assay really significantly changed for genetic testing after that.
• 20:05
  Dr. Sasmita Misra: Yes.
• 20:06
  Dr. Komal Patil-Sisodia: Would you still.
• 20:07
  Dr. Komal Patil-Sisodia: So definitely for people who'd been tested pre 2013.
• 20:11
  Dr. Komal Patil-Sisodia: Yes.
• 20:11
  Dr. Komal Patil-Sisodia: Let's shift gears now to the different types of imaging modality.
• 20:15
  Dr. Komal Patil-Sisodia: Right.
• 20:16
  Dr. Komal Patil-Sisodia: There's right.
• 20:16
  Dr. Komal Patil-Sisodia: Mammogram ultrasound, MRI and then you talked a little bit about tomo.
• 20:21
  Dr. Komal Patil-Sisodia: I've seen stuff about contrast enhanced mammo and AI is a hot topic.
• 20:25
  Dr. Komal Patil-Sisodia: There's lots of stuff on the horizon.
• 20:27
  Dr. Sasmita Misra: Yeah.
• 20:27
  Dr. Sasmita Misra: We have a lot of imaging tools in our toolbox to evaluate the breast, but the mammography remains the gold standard for the detection of breast cancer.
• 20:35
  Dr. Sasmita Misra: And like I mentioned before, it can detect about 85 to 90% of breast cancers.
• 20:40
  Dr. Sasmita Misra: And now with 3D mammography or the tomosynthesis we're detecting even.
• 20:45
  Dr. Sasmita Misra: More breast cancers.
• 20:46
  Dr. Sasmita Misra: It is the only screening method that through decades of large population studies that reduce our breast cancer mortality by 40%.
• 20:53
  Dr. Sasmita Misra: And our goal in screening mammography is to catch cancers when they're small before symptoms develop, so that way our treatments are more effective and less invasive.
• 21:04
  Dr. Sasmita Misra: And so the technology behind mammography is absolutely amazing, and that's why we recommend it for all of our patients across the board.
• 21:12
  Dr. Sasmita Misra: But there are other tools that we can use to help us dig through the mammogram a little bit more.
• 21:19
  Dr. Sasmita Misra: So there are some limitations.
• 21:20
  Dr. Sasmita Misra: For example, we talked about breast density, the denser the breast.
• 21:23
  Dr. Sasmita Misra: Sometimes it is harder to look at a mammogram and we can use an ultrasound to help us evaluate that more.
• 21:30
  Dr. Sasmita Misra: Also, an ultrasound will be a problem solving.
• 21:34
  Dr. Sasmita Misra: If we see a mass in the breast, we can use the ultrasound to detect if the mass is solid or cystic.
• 21:40
  Dr. Sasmita Misra: And ultrasound has no radiation.
• 21:42
  Dr. Sasmita Misra: It's the use of sound waves.
• 21:44
  Dr. Sasmita Misra: So it's really good for a lot of our patients and.
• 21:48
  Dr. Sasmita Misra: We also have breast MRI, which is another great way to look at the breast.
• 21:53
  Dr. Sasmita Misra: So MRI has a high sensitivity in develop detecting breast cancer, so you can detect more breast cancers, but also you can also detect other things that are not related to breast cancer.
• 22:04
  Dr. Sasmita Misra: It can lead to more tests.
• 22:05
  Dr. Sasmita Misra: So that's why it is not the screening tool that we give for every patient.
• 22:09
  Dr. Sasmita Misra: And then we have contrast enhanced mammography, which we actually do at our facility as well.
• 22:14
  Dr. Komal Patil-Sisodia: Very nice.
• 22:14
  Dr. Komal Patil-Sisodia: It's a
• 22:15
  Dr. Sasmita Misra: great tool and what it is is you get your mammogram, but we give dye to the patient and we look at areas of higher blood flow and breast cancers tend to have higher blood flow, and so that's why we use that tool as well.
• 22:29
  Dr. Sasmita Misra: And this is great for patients with what we call intermediate risk factors or are unable to lay down in an MRI unit for whatever reason it may be.
• 22:37
  Dr. Sasmita Misra: And it has proven to be a very good problem solving technique for our patients.
• 22:42
  Dr. Komal Patil-Sisodia: Oh, that's very cool.
• 22:43
  Dr. Komal Patil-Sisodia: So it is just like the regular die like you would give for a CT scan radio?
• 22:48
  Dr. Komal Patil-Sisodia: Exactly.
• 22:48
  Dr. Komal Patil-Sisodia: Trust.
• 22:48
  Dr. Komal Patil-Sisodia: Okay.
• 22:49
  Dr. Sasmita Misra: Yeah.
• 22:49
  Dr. Sasmita Misra: Alright.
• 22:50
  Dr. Komal Patil-Sisodia: Yeah.
• 22:50
  Dr. Komal Patil-Sisodia: And what are your thoughts on like all these AI tools that are coming out?
• 22:54
  Dr. Komal Patil-Sisodia: I feel like it's gonna miss stuff, but that's just my paranoia.
• 22:57
  Dr. Sasmita Misra: I mean, people ask me that all the time and I still say I have job security.
• 23:01
  Dr. Sasmita Misra: So that's good because I think it's an ever evolving technology.
• 23:05
  Dr. Sasmita Misra: Right now, nothing is perfect.
• 23:07
  Dr. Sasmita Misra: We use AI in other aspects of radiology.
• 23:10
  Dr. Sasmita Misra: I think it can help aid us, but will not, and maybe as time goes on, be a better.
• 23:15
  Dr. Sasmita Misra: Tool for detecting breast cancer.
• 23:17
  Dr. Sasmita Misra: But right now, that's
• 23:18
  Dr. Komal Patil-Sisodia: not the way to go.
• 23:20
  Dr. Sasmita Misra: Yeah.
• 23:20
  Dr. Sasmita Misra: Not foolproof.
• 23:21
  Dr. Komal Patil-Sisodia: So let's talk about a hot topic.
• 23:23
  Dr. Komal Patil-Sisodia: I see this all over social media and I've never heard of this in medical school, but what is thermography?
• 23:30
  Dr. Komal Patil-Sisodia: Oh my gosh.
• 23:30
  Dr. Komal Patil-Sisodia: Okay.
• 23:31
  Dr. Sasmita Misra: I know, I know.
• 23:32
  Dr. Sasmita Misra: I had to ask it.
• 23:33
  Dr. Sasmita Misra: Yes.
• 23:34
  Dr. Sasmita Misra: Get this question a lot, yeah, it is.
• 23:36
  Dr. Sasmita Misra: It's based off of heat imaging.
• 23:38
  Dr. Sasmita Misra: Okay.
• 23:39
  Dr. Sasmita Misra: And so it states that it can detect breast cancer, and it sounds really appealing because it's non-invasive.
• 23:45
  Dr. Sasmita Misra: There's no radiation involved.
• 23:47
  Dr. Sasmita Misra: But the truth is, thermography does not detect breast cancer more accurately than mammography because the thought is breast cancers will emit heat because of increased vascularity or increase blood flow.
• 24:00
  Dr. Sasmita Misra: So if it does, then they'll be able to detect that breast cancer.
• 24:04
  Dr. Sasmita Misra: Yeah.
• 24:04
  Dr. Sasmita Misra: However, early cancers.
• 24:08
  Dr. Sasmita Misra: Small may not detect, emit that heat.
• 24:12
  Dr. Sasmita Misra: And then also breast cancers that are deeper within the breast, they may not be able to catch that.
• 24:17
  Dr. Sasmita Misra: And then there will be
• 24:19
  Dr. Komal Patil-Sisodia: in
• 24:19
  Dr. Sasmita Misra: front of it.
• 24:19
  Dr. Komal Patil-Sisodia: Yeah,
• 24:20
  Dr. Sasmita Misra: exactly.
• 24:20
  Dr. Sasmita Misra: And then there's a lot of reasons why your breast can emit, emit heat that are not cancerous, inflammation of the breast, infections of the breast, so it's a tool that has been LA largely touted because it's not, does not great.
• 24:34
  Dr. Sasmita Misra: Give radiation, but it is not as effective as mammography and it has missed a lot of cancers.
• 24:39
  Dr. Sasmita Misra: And I have seen a lot of patients who will come in and say, well, I had a negative thermogram, but now I have this new lump.
• 24:45
  Dr. Sasmita Misra: And it's really sad to see that.
• 24:47
  Dr. Sasmita Misra: That's heartbreaking.
• 24:48
  Dr. Komal Patil-Sisodia: It's scary because I feel like a lot of times people are doing this because they're fearful of radiation, but you know how much radiation is actually in a mammogram, like I don't think all that much.
• 24:58
  Dr. Komal Patil-Sisodia: Right?
• 24:58
  Dr. Sasmita Misra: Yeah.
• 24:59
  Dr. Sasmita Misra: So basically, I hear this all the time, and patients would rather get an MRI or an ultrasound and not get the mammogram.
• 25:07
  Dr. Sasmita Misra: The way I describe the radiation firm that you get from a single mammogram, it's equivalent to seven weeks of the regular background radiation that we all receive.
• 25:16
  Dr. Sasmita Misra: Just sitting around, just living and being near, just living like, yes.
• 25:22
  Dr. Sasmita Misra: Okay.
• 25:23
  Dr. Sasmita Misra: And also it's equivalent to one.
• 25:25
  Dr. Sasmita Misra: Round trip cost crunchy flight Because you get more radiation as your higher up.
• 25:29
  Dr. Sasmita Misra: Yeah.
• 25:29
  Dr. Sasmita Misra: Oh,
• 25:30
  Dr. Komal Patil-Sisodia: okay.
• 25:30
  Dr. Komal Patil-Sisodia: So
• 25:31
  Dr. Sasmita Misra: if you think of it that way, they've done studies where say if you get an annual mammogram from 40 to 80, that's equivalent to what we call that radiation amount is so negligible that it does not increase your risk for developing breast cancer
• 25:47
  Dr. Komal Patil-Sisodia: or any other type of cancer, I imagine.
• 25:49
  Dr. Sasmita Misra: No, no.
• 25:49
  Dr. Sasmita Misra: Yeah, exactly.
• 25:50
  Dr. Komal Patil-Sisodia: So that you hear to hear folks.
• 25:53
  Dr. Komal Patil-Sisodia: Yeah.
• 25:53
  Dr. Komal Patil-Sisodia: Cramps do not incur, increase your risk of other cancers.
• 25:57
  Dr. Komal Patil-Sisodia: And it is the best screening tool detects 85 to 90% of cancers and
• 26:03
  Dr. Sasmita Misra: reduces
• 26:03
  Dr. Komal Patil-Sisodia: the risk of mortality by 40%.
• 26:05
  Dr. Sasmita Misra: Mm-hmm.
• 26:06
  Dr. Komal Patil-Sisodia: After somebody gets a call for an abnormal mammo, right?
• 26:10
  Dr. Komal Patil-Sisodia: Yeah.
• 26:10
  Dr. Komal Patil-Sisodia: Like that's gotta be probably one of the most nerve wracking points Yeah.
• 26:14
  Dr. Komal Patil-Sisodia: For a woman when they get that call.
• 26:16
  Dr. Komal Patil-Sisodia: So what happens after that?
• 26:17
  Dr. Komal Patil-Sisodia: Or what should happen after that?
• 26:19
  Dr. Sasmita Misra: So a patient will come in for their screening mammogram and around, we tend to call back around six to 10% of the patients, okay.
• 26:28
  Dr. Sasmita Misra: From a screening mammogram.
• 26:29
  Dr. Sasmita Misra: And when we're calling them back, it does not mean that they have cancer, it's just that we detected abnormality.
• 26:34
  Dr. Sasmita Misra: We need to take a closer look.
• 26:36
  Dr. Sasmita Misra: Okay?
• 26:36
  Dr. Sasmita Misra: Because there are a lot of benign, non-cancerous reasons to come back from.
• 26:41
  Dr. Sasmita Misra: A screening mammogram.
• 26:42
  Dr. Sasmita Misra: A lot of it could be an overlapping of tissue.
• 26:46
  Dr. Sasmita Misra: We haven't had something to compare it with in the past.
• 26:48
  Dr. Sasmita Misra: So this is the first time that we're seeing this patient.
• 26:51
  Dr. Sasmita Misra: Only one in 10 callbacks will result in a biopsy, and even then, when you get the biopsy, only 30% of those biopsies will be a cancer.
• 27:03
  Dr. Sasmita Misra: So if that just tells you, very small amount of our callbacks are going to end up in a malignancy.
• 27:11
  Dr. Sasmita Misra: And I know it's very anxiety provoking, but what I tell my patients is.
• 27:16
  Dr. Sasmita Misra: Don't go to a diagnosis of cancer when you're called back.
• 27:19
  Dr. Sasmita Misra: We're really just trying to get a closer look of the patient, and majority of the time or 90% of the time, there's nothing going on,
• 27:26
  Dr. Komal Patil-Sisodia: that's really great.
• 27:27
  Dr. Komal Patil-Sisodia: Now what happens in the scenario that it does come back as cancer, right?
• 27:31
  Dr. Komal Patil-Sisodia: What are the next steps?
• 27:33
  Dr. Komal Patil-Sisodia: That you recommend for your patients?
• 27:35
  Dr. Komal Patil-Sisodia: Because I imagine again just the callback is nerve wracking.
• 27:38
  Dr. Komal Patil-Sisodia: The actual diagnosis I know is devastating.
• 27:41
  Dr. Komal Patil-Sisodia: So Yeah,
• 27:42
  Dr. Sasmita Misra: It is.
• 27:44
  Dr. Sasmita Misra: I've been doing this for a long enough time to know that every patient will respond differently to it, but majority of the time, most of our patients are working out of anxiety and fear and what their long-term implications are of having a diagnosis of cancer.
• 27:56
  Dr. Sasmita Misra: 'cause the C word is very scary for everyone.
• 27:59
  Dr. Sasmita Misra: What I've learned in having to give bad news to these patients is that sitting with them and asking what they're understanding and telling them that they're not alone, because they are definitely not alone in this process, goes a long way.
• 28:15
  Dr. Sasmita Misra: And when you talk to them in plain language, in language that they can understand, I think it really helps them go from a place of anxiety to a place of calm, and I tell them, and this is the truth, is I've been doing this for a long time and I wouldn't be able to do it without the fact, knowing that most of my patients will be fine.
• 28:37
  Dr. Sasmita Misra: And that's the thing that gets me through, finding these cancers early.
• 28:41
  Dr. Sasmita Misra: And because we really want our patients to do well and there's a large support system.
• 28:46
  Dr. Sasmita Misra: And I think when a patient is diagnosed with breast cancer.
• 28:50
  Dr. Sasmita Misra: There's a whole new world out there for them.
• 28:52
  Dr. Sasmita Misra: There's this huge support group for them.
• 28:54
  Dr. Sasmita Misra: We have nurse navigators that navigate them through the whole process, from the diagnosis to all of the appointments.
• 29:01
  Dr. Sasmita Misra: And there's so much support for them that it's overwhelming, but I think as long as they know that they're being taken care of is the most important thing for them,
• 29:11
  Dr. Komal Patil-Sisodia: that's really encouraging because to your point, I think it feels so isolating and you feel like you're the only one, but
• 29:17
  Dr. Sasmita Misra: Yeah.
• 29:18
  Dr. Komal Patil-Sisodia: But you have this group of people that are rallying around you and I always see the fundraisers for breast cancer.
• 29:23
  Dr. Komal Patil-Sisodia: Yeah.
• 29:24
  Dr. Komal Patil-Sisodia: I think it's like the Susan Komen breast cancer fundraisers, and then all of the support groups that are out there in the community and so many different.
• 29:31
  Dr. Komal Patil-Sisodia: Advocacy arenas to help patients.
• 29:34
  Dr. Komal Patil-Sisodia: So that's encouraging.
• 29:36
  Dr. Komal Patil-Sisodia: Well thank you so much for your time today.
• 29:38
  Dr. Komal Patil-Sisodia: I know it's Breast Cancer Awareness Month and I appreciate you, I'm sure you're super busy with advocating for patients and all of the great work that you do.
• 29:46
  Dr. Komal Patil-Sisodia: So I really appreciate you taking the time to come on my podcast and talk to us about all things breast cancer.
• 29:52
  Dr. Komal Patil-Sisodia: I really appreciate your perspective on screening tests.
• 29:56
  Dr. Komal Patil-Sisodia: So can you recap for us quickly.
• 29:59
  Dr. Komal Patil-Sisodia: Your recommendations for age at getting your first screening, what the first screening should be, and then how frequently you think it should happen?
• 30:08
  Dr. Sasmita Misra: So for the general population, we recommend our patients get an annual mammogram beginning at age 40, and they get that every year until they physically.
• 30:19
  Dr. Sasmita Misra: Can't.
• 30:19
  Dr. Sasmita Misra: Yeah.
• 30:19
  Dr. Sasmita Misra: And so there's no real end limit for the screening mammogram.
• 30:23
  Dr. Sasmita Misra: And then, we do urge you to talk to your doctor about other screening tools.
• 30:28
  Dr. Sasmita Misra: If you do have things like family risk factors or a genetic abnormality that could increase your risk for developing breast cancer.
• 30:35
  Dr. Sasmita Misra: And so those tools do not replace the mammogram, but they can supplement the mammogram and we can use them in different ways for our patients.
• 30:42
  Dr. Sasmita Misra: I think what.
• 30:44
  Dr. Sasmita Misra: I really want patients to know is that every woman should get a mammogram and they, it's the way that they can advocate for themselves.
• 30:51
  Dr. Sasmita Misra: Most importantly, it's 20 minutes out of the time once a year, and I know it can be painful, but it's a short-term pain for a long-term gain.
• 30:59
  Dr. Komal Patil-Sisodia: What is your one overarching message to women about their breast health?
• 31:04
  Dr. Sasmita Misra: If there's one message that I want every woman to hear is that your health is worth your time.
• 31:09
  Dr. Sasmita Misra: So women often put themselves last, but mammography saves lives.
• 31:13
  Dr. Sasmita Misra: So regular screening catches cancers early and before symptoms and when it's most treatable.
• 31:19
  Dr. Sasmita Misra: So screening mammograms are really important.
• 31:24
  Dr. Sasmita Misra: Just takes 20 minutes.
• 31:25
  Dr. Sasmita Misra: Make that call, make that appointment, and go get your screening exam.
• 31:30
  Dr. Komal Patil-Sisodia: No, you're not on social media, but where can patients find you practicing?
• 31:34
  Dr. Komal Patil-Sisodia: If they want to come see you at your breast center?
• 31:37
  Dr. Sasmita Misra: I work at university of Chicago, Tinley Park.
• 31:41
  Dr. Sasmita Misra: Office in Illinois.
• 31:42
  Dr. Sasmita Misra: Okay.
• 31:42
  Dr. Sasmita Misra: And they can always call and make an appointment.
• 31:45
  Dr. Komal Patil-Sisodia: All right.
• 31:45
  Dr. Komal Patil-Sisodia: Fabulous.
• 31:46
  Dr. Komal Patil-Sisodia: Well, thank you again and thanks to all of the listeners.
• 31:49
  Dr. Komal Patil-Sisodia: We will see you on the next episode.
• 31:51
  Dr. Komal Patil-Sisodia: Thank you.