Latest / Living Midlife In Color / What Your Mammogram Doesn’t Tell You About Risk, Race & Survival
Transcript
- Shar'da: Welcome to Living Midlife and Color, where women's voices don't fade into the background and the coat never switches. I am your host, Sardy. it is October. And October is the not amiss with breast cancer awareness. But you know what? awareness is not always enough. So my midlife confession for this week is I Recently had to get my very first mammogram, and it was the most scariest and sobering experiences that I had to endure. It was that moment where I realized that there was a difference between being a provider and encouraging women to get their very first mammogram so casually versus being the patient and getting those very first results. Okay. So my very first mammogram, I was nervous. I'm not even gonna lie to you. I was nervous because it was 70% of the time when I was reading off. A woman's results, it was good news. I sent a cute little message. Great news, your mammogram is fine. No need to repeat for another year, two years, depending on what guidelines you're following. But then that 30% of the time, I was giving some life-changing, devastating news. So I knew that there was a chance that my results wouldn't come that great. And you know, part of me was okay too because I don't have a family history of breast cancer, but That doesn't mean that that can miss you. So stay tuned. We are definitely gonna talk about that. So I schedule it, everything was fine. And I get to the place, and the woman she gives me a robe, told me to get undressed, leave the gown open in the front. And a little bit about myself, I've always been you would never find me in the dressing room during gym class getting dressed out in the open in front of all of these other girls. Okay. You would find me in the stall getting undressed because I was never comfortable. you know, showing off my body or getting undressed in front of other people. So that was already one thing that was working against me. But nonetheless, it was necessary, so I did it. All right, I put the gown on, I left it open in the front, of course. I knocked on her door, let her know that I was ready. She opens the door, and behold, me stands this big, huge machine with a huge mouth. And I knew those were the plates where I had to put my breasts in between. And it validated because that's what she told me to do. So I stepped up to the machine. I had to step up on the little the stool started with one breast, put it in there, and she's grabbing me and she's like manipulating, pushing, smashing it in, squeezing it in just a little bit, so we were able to get a really good picture. I mean she pushed me by the back, lip made me lean in just a little bit forward so she can not only get the breast, but also the area in the armpit as much as she can grab as well. That's also very important. All right, and you know, women would come in and they would tell me about their mammogram experience, and it would be mixed results. Some would say, Nothing easy peasy, you're in, you're out, you're done. But then some woman would tell me that the pressure, because they have to smash the plates in between your breasts, the pet the pressure was so unbearable that they never want to go back again. They left black and blue. And I have to tell you, my from my perspective, I don't really think it was that bad. I mean, yes, there is a little bit of pressure because they have to smash the breasts down to be able to get that good picture, but I don't think it's something that will, you know, turn me away when the next time that I do I'm do my mammogram. Yeah. And she did told me, she asked me if this was my very first mammogram. I told her yes, of course. And she did warn me that being that this is my first, it is common for a mammogram to maybe pick up on something abnormal. Nine times out of ten, it's fine. It's just my baseline. I let that go in one ear and most definitely out of the other. Because like I said, I was already nervous. I was thinking about the results that I had to share in the past. I was thinking about women's testimony. about their very first mammogram experience. So I said, okay, thanks. And I got up and I left. So you know what? it's one thing to spend years as a healthcare provider telling women to go get their mammograms. It is definitely another when you're the woman standing there with your breast in between those plates. Depending on you know what, as a matter of fact, never mind. All guidelines tell you that for average risk woman, breast cancer screening becomes important around the age of four. And you have to excuse me because I'm gonna put my EMP hat on. For the women who are not aware, I want you to know this real quick, okay? Breast cancer screening start at the age of 40 and they go until the age of 74, about. Depending on which guidelines you follow, some say get them yearly, some say get them every two years. So for my ladies who do not like the idea of getting another mammogram because you thought it was so uncomfortable, you don't have to go every year. Pinning your last one was normal. Okay. Try to go every other year. Just please just get it done. All right. And I want you to know that mammography or mammogram isn't just about finding something you can already feel. The whole point of screening is to potentially find breast cancer before symptoms appear. That's why breast cancer screenings, mammograms, become part of your preventative care and it should be a part of your preventative routine. Okay, your 40th birthday should not just be about somebody putting a big 4-0 balloon behind your chair. For a lot of us, this is also when mammograms start to become Part of the conversation. I want you to know that breast cancer just isn't a conversation to be had as we're turning 40. Yes, breast cancer still occur as women get older and age remains an important risk factor, but diagnoses among young women have been increasing. As a matter of fact, between 2012 and 2021, overall breast cancer incidence increased about 1% a year. Among women younger than 50, incidence increased approximately to 1.4% in a year. But then as we turn 50, it went back down to the incidence went back down to about 0.7% of a year. So, no, we're not saying that breast cancer suddenly becomes predominantly a young woman's disease. That's not what I'm saying. but we're also not dismissing breast cancer symptoms because you're too young. Most breast cancers still happen as women get older, but breast cancer incidence has been increasing faster among women under the age of 50. So saying that I'm too young for breast cancer isn't something that I would like for you, for us, to notbe reliant on. Now let's back things up even a little further. What has changed over the last 20 years? And this is where it starts to get interesting, y'all. So, over the last couple of decades, breast cancer incidence has gradually increased. More cancers are being diagnosed, but and you know, here's the I like to rain on the parade sometimes, but I also like to flash that light. Screening and imaging has evolved, and treatments have improved, and most women are surviving breast cancer. Overall, breast cancer mortality has fallen dramatically. Since its peak breast cancer diagnosis in 1989, US breast cancer mortality has declined by more than 40 percent. That is tremendous progress. But here's where Living Midlife in Color enters the conversation. Everybody has benefited equally from all that progress. The American breast cancer story is really two stories happening at once. We're diagnosing more breast cancers, while overall we're getting much better at keeping women alive, but that progress has not reached women equally. So now you know we have to look at breast cancer in color. This is not going to simply be a black versus white conversation, but I do want to understand how women across many different ethnicities and racial backgrounds are affected by breast cancer. Let's look at the larger picture here. recent breast cancer incidence rates per 100,000 women are approximately, and before I get into it, when I say what I mean by this, out of 100,000 women, The number of women who will be diagnosed with breast cancer, okay? Out of that total number, 138 of those women will be white. 131 out of those 100,000 women will be black. 124 women out of 100,000 women will be American Indian or Alaska Native women. 108 will be Asian, and 104 will be Hispanic women. So white women do have a higher incidence, meaning that they get diagnosed with breast cancer at a more frequent alarming rate. Let's go ahead and take a look at mortality. Mortality meaning how many women may unfortunately pass out of 100,000. So approximately out of 100,000 women, breast cancer-related deaths, 27 belong to black women. 21 of those women were American Indian. 19 of those were white women. Fourteen were Hispanic women and twelve were Asian women. That means that although white women may be diagnosed more frequently with breast cancer, black women have a higher chance of dying from it. now you can see why only looking at who gets breast cancer doesn't tell the whole story. Black women don't develop breast cancer dramatically more than white women, yet black women are approximately 38 to 40% more likely to die from breast cancer. That is the statistic that I want us to sit with. How can two groups of women develop a disease at a relatively similar rate, but one group is establishedly more likely to die from it? Y'all know I got the answer for you. Okay. So I had to go ahead and do some research. And like most things, there really isn't more than one answer. Part of the difference belongs to your tumor biology. Black women are more likely to develop triple negative breast cancer. Some breast cancer have biological targets: estrogen receptor, progesterone receptor, or HER2 receptors. Triple negative breast cancer tests negative for all three. Historically, that meant fewer targeted treatment options, unfortunately. that does not mean that treatment has not expanded substantially because it has, but triple negative breast cancer tends to behave more aggressively. And it disproportionately affects more black women than white women or women of all other races, as a matter of fact. Biology belongs in this breast cancer disparity conversation, but biology does not get to be the entire conversation. Stage egg diagnosis does matter. Black women are more likely to be diagnosed beyond stage one. And what that means is A cancer confined to the breast is a very different situation from cancer that has spread regionally to lymph nodes or to distant organs. Okay. Earlier detection generally creates more treatment options and better outcomes. So then we have another question: why might some women be diagnosed later versus sooner? And now let's go ahead and leave the tumor conversation and look at the environment that may be surrounding the woman, that may be perpetuating the fact that they may be diagnosed. Diagnosed later or treat it when your cancer has spread to those lymph nodes and to other regions of the body. I want you to start thinking that access to healthcare is more than just if you have insurance. Healthcare access can mean: is a mammography clinic available near you? Can you get an appointment? Can you leave work to get your mammogram done? Do you have paid time off? Or are you living paycheck to paycheck? Do you have transportation, child care? Can you afford the copay or additional testing? What happens if the mammogram is abnormal? Can you in fact get your test results quickly? How long do you have to wait for the biopsy? How long then do you have to wait until treatment? Getting your mammogram is just one step. What happens after the agnormal mammogram? That matters too. The environment doesn't have to stop at the hospital door. When I say an environment, I'm not saying black women live around something that causes breast cancer. It's much more complicated than that. Your environment can include your social economic conditions, your neighborhood resources, insurance, chronic stress, access to nutritious food and opportunities for physical activity, your environmental exposures, of course, health care availability, and of course, treatment access, like we just said. So sometimes we talk about health disparities. And so the disparity lives inside the patient. Sometimes the disparity is everything that is surrounding the patient and that what isn't surrounding the patient. And then there's the factor of trust. This is where I bring this back to why this podcast exists, why living midlife in color exists. What happens to a woman when she's repeatedly been dismissed by her provider? What happens when she doesn't believe somebody would take her concern seriously? What happens when that, you know, that 21-year-old swears up and down that she feels something different with her breast, but she goes to her doctor and her doctor tells her, you're way too young for breast cancer. Go ahead and take this ibuprofen instead or use warm compressors for the pain. It's probably nothing or or my favorite. Let's just watch. Come back in six months. And in six months if you're still going through the same thing, then we'll finally take it seriously. Appropriate reinsurance is not the same thing as dismissal, though. And every delay isn't caused by clinician bias. But communication, previous health care experience, and trust does matter when it comes to the trust between yourself and between your provider. We keep telling women to seek care, but seeking care and feeling her once you get there are two totally different things that oftentimes are does not parallel. But black women aren't the only story here. One reason why I call this podcast Living Mid Life in Colorado is because different groups of women can experience the same disease differently. Asian women, this is one of the trends I really want people to hear. Historically, Asian women. Had comparatively low breast cancer incidence rates. But incidence among Asian women has been rising, in fact, quite rapidly. Among Asian women younger than the age of 50, in the year 2000, there were 57 breast cancers per every 100,000. But by 2021, 21 years later, it went from 57 to 86. By 2021, that was essentially tied with the rate among white women under the age of fifty. One of the fastest change in breast cancer stories is happening among Asian women and Pacific Islander women. And I don't think we're talking about that nearly enough. I what I think happens here is I think we focus most of the conversation on black women and white women. But what about all the other races? Don't worry, Asian ladies. I got you. Let's go ahead and talk about Hispanic women. Hispanic women have lower overall breast cancer incidence and mortality than black and white women, but lower doesn't mean protected. Breast cancer. Remains an important health concern. Screening assets, stage at diagnosis, social economic conditions, language barriers, insurance, and treatment access can all influence outcomes. Let's go ahead and move on to American Indian or Alaskan Native women. This population deserves to be included too, because we talked about their incidence or mortality rates. While U.S. breast cancer mortality overall has fallen dramatically. This group of women have not expected the same long-term mortality improvement. That matters. Different women are experiencing different pieces of the breast cancer problem. Black women are telling us something through mortality. Younger Asian women are telling us something through rising incidence. And American Indian and Alaskan Native women are telling us something through unequal progress. So then why are more younger women being diagnosed? And here's where I want to be careful. Okay. Because the answer is, hell, we don't know. There probably isn't just one explanation. As a matter of fact, I seriously doubt that there is. But researchers have started to look at change in population patterns involving body weight, alcohol use, physical activity, reproductive patterns, the age at first birth, have it if the number of kids you've had, your home exposure to hormones, environmental exposures to toxins, and other lifestyle and population changes, but none of this means. We look at an individual woman and say, that's why you got breast cancer, because your hormonal exposure. Risk factors help us understand populations that do not give us permission to blame an individual woman for developing breast cancer. I hope we're we're listening in on that. And breast cancer doesn't always show up as a lump. This is one of the most important parts of this episode. So if you've been tuning out, tune back in, give me back your intention, and I want to say again: breast cancer doesn't always show up as a lump. A new breast slump needs attention, yes, but breast cancer can also present as breast or underarm thickening, swelling, a change in breast size or shape, skin dimpling, skin irritation, changes in nipple direction. If you start to see redness reflecing around the nipple or discharge that isn't breast milk, bloody nipple discharge. persistent nipple pain or breast pain lump of course or other new changes from your normal that definitely deserves some attention okay and then another thing I want you to know come come back to me come back to me is Some breast cancers can cause no symptoms at all. As a matter of fact, circling back to that 25 to 30 percent I was telling you about before, a lot of for a lot of women, this was news to them. They felt great, they've been doing those their self-breast exams and never felt a thing. But that's why we have mammography because mammography would pick up on something you can't always feel. please stop thinking that breast cancer hasn't introduced itself with the lump. Because I hope you learned right now that. That is not the case. Bottom line: no you're normal. I don't wanna become terrified of every new breast sensation. Breast changes. They will change with menstrual cycles, pregnancy, breastfeeding, medications, weight changes, aging, perimenopause. Most breast changes are not breast cancer, but breast awareness means knowing what is normal for you and noticing something that is new, persistent, and unusual. Breast awareness is not about becoming your own radiologist. Don't always take it to Google, don't always take it to chat. It's about knowing your body well enough to recognize when something has in fact change and when that something needs to be looked at. I want to just briefly introduce inflammatory breast cancer, okay? Because not all breast cancers follow the same classic script where there's a lump, you get, you know, you get a biopsy and some things, okay? Inflammatory breast cancer is uncommon, but it is also very much so aggressive. And it will not, or it may not, I'm gonna say it may not present with that traditional lump. Possible changes include rapid breast swelling, redness or discoloration. Those classic inflammation, the warmth, okay, skin thickening, that that texture that's similar to an orange pill or the appearance of, and of course, nipple changes. This is why breast cancer awareness is to extend beyond filling for a lot. If the only breast cancer symptom you know is a lump, there are breast cancer whose warning size you may not recognize. And that's why I'm doing this podcast, but breast cancer doesn't run in my family. this next segment is going to be for you. Family history matters, but no family history does not mean no breast cancer risk. Know your family history on your mom's side and your dad's side. Okay. Ask about breast cancer. Ask about ovarian cancer, pancreatic cancer, prostate cancer, and the age of diagnosis. You know why you have to do that? Because most of these cancers that I just listed are all hormonal kind of cancers. And then you also need to know whether relatives had genetic testing and if that's available for you. If you learn in your family history that they you do have some family history, either your mom or your dad said with these types of cancers, you should probably seek for genetic counseling. Your father side counts too. Let's talk about dense breasts, okay? Because I'm gonna I'm not gonna spend too much time talking about this, but I think it's important for this conversation because dense breasts are very, very much so common. Nine times out of ten, you may get a result that lets you know you have dense breasts, and breast density describes the relative amounts of that fibroglandular versus fatty tissue seen on your mammogram. And this counts for two main reasons. Number one, dense breasts may make some cancer. Hard to be seen on mammogram. Number two, this breast tissue itself is associated with increased breast cancer risk. Women are now federally required to receive information about breast density in your mammogram reports. That's why we're now seeing more mammogram results. That includes breasts being dense. Dense breasts do not mean you have cancer. Please don't take that from that. And not every woman with dense breasts will automatically need an ultrasound or MRI to follow up with. Additional imaging will depend on your overall risk and, of course, your clinical context. Dense breasts are not a diagnosis. Dense breasts are information, and information should lead to a conversation about your individual risks. I want you to know too that mammograms are right now the gold standard for early detection of breast cancer. But it's a screening test. It's not a guarantee. There can be false positives, false negatives, callbacks, additional imaging, biopsies cancers, mammography can't detect. So for some higher risk women, additional screenings such as MRIs may be appropriate. A mammogram isn't a guarantee that you want to develop breast cancer. It's another opportunity to find cancer earlier and to follow up with my midlife confession, my very first result detected an abnormality. And I had to in fact go back for an a repeat mammogram in an ultrasound just to make sure that what was found on my mammogram was not in fact cancer. Thank goodness that what they thought appeared to be benign, but just to be sure, they want me to go back for a repeat memogram, which I think I have in another month or so. Right? But let's talk about how you can reduce your risk because, like I said, a lot of times I may be classing a cloud over the parade, but I do still like to bring in some sunshine. But I don't want to say if you do these things, you prevent breast cancer because woman can do everything right and could possibly still develop breast cancer. There are factors that we can't, in fact, change, no matter how hard we try. We can't change our age. We can change our genetics, we can't change our family history, we can't change certain reproductive factors, and we can change previous medical exposures, but there are things that we can't influence. Here's that son coming in. Number one, move your body. Regular physical activity is associated with lower breast cancer risk. General adult recommendations include about 150 to 300 minutes of moderate activity each week. Or seventy-five to a hundred minutes of vigorous activity. Those refer to women who go hard. I don't necessarily go hard. you have to get some strength training in too. you can walk with your weight at best, you can get some Pilates in, you can strength train, dance, swimming, bike, whatever you can't sustain is what's good. movement isn't only about making your body smaller. There are reasons I keep telling women to move that have absolutely nothing to do with that scale. Let's go ahead and talk about the alcohol. Okay, if you like to go on the weekends or have heavy alcohol use, you need to know. That alcohol increases breast cancer risk. Risk increases at alcohol exposure increases. we don't have to turn this into nobody can ever drink again, but informed consent matters here too. If something affects risk, women deserve to know. I'm not here to to tell girl women they can't have a drink here there, but I'm here to make sure you know enough to make that decision with your eyes open. Let's talk about body weight after menopause because this is a little more nuanced. Researchers have found that higher body weight after menopause is associated with increased breast cancer risk, particularly hormone receptor positive breast cancer. After menopause, that fatty tissue becomes an important source of estrogen. But this is not your weight cause you cancer. Weight is one risk factor among many. Health education should give women information, not shame them into believing that their body has caused their disease. Next, smoking. If you don't smoke, don't start. If you do, stopping improves health far beyond breast cancer risks. Breastfeeding. For women who have children and are able to choose to breastfeed, breastfeeding is associated with a modest reduction in breast cancer risk. I gotta make sure I tell my sister that because she just had a baby and she's breastfeeding, so I'm gonna go ahead and let her know but there's a caveat. There's a caveat. A woman who couldn't breastfeed, who chose not to breastfeed, or never had children, did not fail at breast cancer prevention. Okay? This is about information. This is not about judgment. Risk reduction does not replace screening. Exercise doesn't replace mammography. Eating well doesn't replace mammography. Not drinking doesn't replace mammography. Having no family history. That's not replacement. You can do everything right and still develop breast cancer. That's why risk reduction and early detection have to be two different conversations. And please, please, please, you don't have to wait for October to start your screenings. know your normal, know your family history, know your risk. Breast cancer awareness must remind you to pay attention to your breasts. It should not be Only month that you do, Listen, I'm not gonna spend too much more time on this. I don't wanna bore you. I know sometimes these conversations could be a bit daunting, but I did create a course for this that is inside of my Midlife Method community titled Breast Health Durant Midlife. And in this course, I do go much deeper into how breast changes during midlife, breast awareness, warning signs beyond a lump, breast cancer risk screening, breast density, what deserves evaluation, and questions you should be asking. I'm not trying to turn you into a breast specialist. Nor am I trying to convince you that I am one myself, but I do want you to know enough about your own body to participate in the decisions being made about it. Now let's go ahead and pause because I am running out of breath. I am running out of breath, and sometimes I feel like these conversations could be a little bit heavier. So let's go ahead and move into Axhara the MP. And of course, Akshar the MP is when I take your questions and I answer them here. So if you do have a question that you would like for me to answer, it could be a personal question, it could be a medical-related question, go ahead and send me a message, and I would love to take the time to answer it. So let me go ahead. and pull up this question. Ooh, and it's another personal question. You know what? I was waiting for this one. I knew someone was gonna eventually ask me. and the question is, and I don't give the names to the people who asked me, Shar, you obviously have longer hair. Why is it that sometimes I see you in a wig? And you know what? I was waiting for that, and the reason for this is quite simple. During my full time job, I am a community nurse practitioner and I go and I meet people where they are. Oftentimes this is in their homes. And when I'm working, sometimes I'm going into homes that you know people are smoking cigarettes and you know things, and my hair, it really it holds on to cigarettes and smells like nobody's business. So whenever I'm working during the week, I often keep my hair braided and moisturized, and then I put on my little wig so I'm not Out here looking like Seely, and I tried my best, okay? Thank you, thank you for that question. All right, so let's go ahead and move into the final reflection. I was scared. crapless of getting my first mammogram because I didn't know which way the dial was gonna roll. As a matter of fact, a lot of the information that I'm presented here today, I wasn't even aware of at the time. Had I known, I probably would have prolonged my very first mammogram. So for the women who are afraid, for the women who believe that not knowing is good news, that isn't necessarily the case. I have I hope that I have not scared you out of getting your first mammogram or continuing to go to get your mammograms. I hope I have inspired you to make more informed choices. I hope that I have my black woman, my Hispanic woman, my Alaskan woman, Native American woman. I hope we are all listening here and I hope you have a better Understanding of what breast cancer risk and what breast cancer reduction should mean for you. With that being said, breast cancer awareness is not supposed to make us afraid of our bodies. It's supposed to help us to be more informed about them. And when we talk about disparities, I don't want black women, Asian women, Hispanic women, American, Indian women, or any woman walking away thinking, well, That just happens to women like me. No. A statistic describes what happens in a population. It does not determine what has to happen to you. Awareness tells us that breast cancer exists. Education tells you what to do with that information. And if there's one thing I would like for you to remember, know your breasts, know your risk, and know when your body tells you something has changed, listen. All right? Living Midlife in Color, Same Woman, New Chapter, until next week.