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Beek on being BREAST AWARE · Beek on being

• 0:00
  Melissa Shere Beek: Hi, I hope you are well. This podcast is a place for people to share personal and professional perspectives, talk openly and ask questions. From serious to silly to sublime, it's all about communication and connection. Always coming from a place of kindness and curiosity, we talk about shared humanity, discuss ideas, and highlight people creating a better world. We've got to keep learning, keep growing, keep being.
• 0:28
  I'm Melissa Beek, and this is Beek on Being. Today's episode is Beek on Being Breast Aware. As we go through the different stages of our life, our breasts change. It's important to maintain screening and diagnostics exams. It's important to continue self exams to know what is normal for your breasts.
• 0:47
  It's important to know what to do when your norm changes or when you're diagnosed with breast cancer. Education, information and awareness are key for prevention and early detection. Today, we have two exceptional specialists, board certified breast surgical oncologist Doctor. Starr Mautner from the Breast Center at Miami Cancer Institute, part of Baptist Health South Florida, and board certified breast radiologist and assistant professor of clinical radiology breast imaging, Doctor. Katherine Lampen Sachar from the University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center.
• 1:24
  It is truly an honor to have you both here. So I'm just so excited to get this started. Please introduce yourself and tell our listeners a little bit about you both.
• 1:35
  Dr. Starr Mautner: Sure. So I'm Starr Mautner. I'm a breast surgical oncologist, and I've been in practice here in South Florida for over the past ten years. And I primarily see patients who are either at high risk for developing breast cancer or have a family history or have been diagnosed with either a precancerous or a cancerous lesion. And I have a lot of patients that are being diagnosed at a very young age, so I specialize in young breast cancer.
• 2:04
  Melissa Shere Beek: Wow.
• 2:05
  Dr. Starr Mautner: And I'm excited to be here today. And I work hand in hand with our expert breast radiologist, my friend Kate, who is joining us today. And, she'll tell us a lot about, you know, the importance of early detection and screening. I enjoy what I do, and it's extremely rewarding because our patients, for the most part, do very well. Breast cancer is one of the cancers that we can detect at an early stage, and prognosis is excellent.
• 2:29
  We've gotten very good at treating it.
• 2:31
  Melissa Shere Beek: That's awesome. That's amazing.
• 2:34
  Dr. Kate Lampen Sachar: Thank you. I'm Kate Lampen Sachar. I'm a breast radiologist. So what that means is I detect breast cancer, hopefully, as Star said, before a patient even has any symptoms. So our hope is that we detect it off a screening study, we'll get into, usually a mammogram.
• 2:56
  So I help with the detection of breast cancer. I also interpret, ultrasound, breast MRI, and I do all of the image guided procedures which aid in the detection of breast cancer. So I'm actually the person that frequently gives the results to the patient. Wow. And that finds the breast cancer.
• 3:18
  I actually work very closely with breast surgeons, with Starr, and help with patients that are newly diagnosed with breast cancer to help with sort of treatment decisions, figuring out, for example, how big is the cancer? What's gonna be the best surgical approach? Considerations for chemotherapy, that sort of thing. Got it. Another part of my practice is also education.
• 3:41
  And I'm very involved in patient education, and also actually involved in educating the next generation of doctors to become either breast surgeons or hopefully breast radiologists Amazing. As
• 3:55
  Melissa Shere Beek: That's amazing. What inspired both of you to get into your professions?
• 4:00
  Dr. Starr Mautner: I knew I wanted to be a surgeon from a pretty young age. In high school, I decided that that was something that I was interested in doing after having the opportunity to work in a surgical practice and really get a little bit of hands on experience. So that was my goal from a very early age, but I didn't know specifically that I was going to become a breast surgical oncologist until later in my training. During residency, I rotated through all different general surgery divisions. And when I was on the breast surgery service, I found that I really clicked with the surgeons on that service, really enjoyed taking care of women, being able to help so many women achieve a cure with their breast cancer.
• 4:38
  And with the prognosis being so well, our patients do well. There's not a lot of complications. It is very rewarding, and you get to follow your patients for a very long time. You really get to know them, their families, their friends. And so it's not like you meet a patient and operate on them and never see them again.
• 4:55
  You're seeing them every six months to a year for follow-up. Right. And you really get to know them And on a very personal I really enjoyed that. And I love what I do, and I think it was definitely the right decision to go into breast surgery.
• 5:08
  Melissa Shere Beek: Well, we're lucky.
• 5:11
  Dr. Kate Lampen Sachar: Yeah. Radiology is not a standard decision, I would say, for a lot of people approaching medical school. And I found it sort of through backwards channels when I was actually on a pediatrics rotation.
• 5:23
  Melissa Shere Beek: Oh, wow.
• 5:24
  Dr. Kate Lampen Sachar: And we had a lecture on pediatric radiology, and something just clicked. And I found it fascinating. We always say sort of all the interesting things go through the radiology department in a hospital, and it's a 100% true. But sort of in terms of my draw to breast imaging, I've always loved women's health Mhmm. And taking care of women.
• 5:46
  And I really found my niche in breast imaging because I do also develop relationships with my patients. And I do get to see them every single year and follow them, whether it be yearly or throughout their cancer journeys. And frequently, I do get to serve in sort of a supportive role in helping them with some of their decision making. So I got to witness that when my mentors were doing that, and I found that very inspiring.
• 6:14
  Melissa Shere Beek: Oh, it's gotta be. It's incredible. Can you tell us as a radiologist a little bit about the difference between screenings and diagnostic tests and what we need
• 6:26
  Dr. Kate Lampen Sachar: to know about breast cancer screening? Sure. So the vast majority of women should have screening mammograms Mhmm. As opposed to having a diagnostic mammogram. A screening test in general is for people that are asymptomatic, don't have anything that they are feeling, sensing, anything like that.
• 6:46
  Annually, just a Right. The vast majority of people have screening tests. And we do them for women starting at age 40. Okay. Unless they have risk factors
• 6:58
  Melissa Shere Beek: Got it.
• 7:00
  Dr. Kate Lampen Sachar: Every single year. A diagnostic test, we reserve for a certain subset of patients. And there are a few reasons why we might do a diagnostic test.
• 7:10
  Melissa Shere Beek: And what are the diagnostic tests?
• 7:11
  Dr. Kate Lampen Sachar: So it would be a mammogram. It could be an ultrasound or MRI. And we now have some sort of divisions within mammograms. We now offer contrast mammograms. Got it.
• 7:22
  The vast majority of places now offer tomosynthesis, which is the three d technology. Amazing. So I'm just kind of lumping mammograms together in that one box. But really, the main difference that I think about when I think about a diagnostic mammogram, let's say, is that the patient's coming in for a particular reason. Maybe they feel a new lump, what we call a palpable abnormality.
• 7:47
  Maybe they're having some nipple discharge. Maybe they're having very specific focal pain. Or maybe they have a prior history of breast cancer. The other most common reason that I see is I've seen a patient for a screening mammogram and I see a little something that I need to evaluate further, I'll have the patient come back in for a diagnostic study. Oh, is
• 8:12
  Melissa Shere Beek: it because you saw something that changed from their previous Possibly.
• 8:17
  Dr. Kate Lampen Sachar: Possibly it's something that changed or
• 8:21
  Melissa Shere Beek: Something new that's there that was never before. Exactly. Okay. Alright. Got it.
• 8:26
  And I read a little bit about molecular breast imaging. Can you tell us a
• 8:31
  Dr. Kate Lampen Sachar: little bit about that? Sure. So it's not very widely being used. It is FDA approved. It's an alternate diagnostic study that can be performed to help with detecting breast cancer.
• 8:44
  When would you use it? In very limited scenarios. I would say the vast majority of practitioners are still very much leaning towards MRI, contrast enhanced mammography for more advanced imaging. Okay. Good.
• 9:05
  And I think the data really does support that. Got it. Okay. So that's the best thing to
• 9:10
  Melissa Shere Beek: do then. Absolutely. Okay. In being proactive with screening and early detection, you when should we start the screening? You said forty.
• 9:19
  But what are the cases where someone should go
• 9:22
  Dr. Kate Lampen Sachar: earlier than forty? Right. So the American College of Radiology actually recommends that women get assessed for their breast cancer risk at age 25. Okay. Which is really young.
• 9:34
  So I said 40. That's the best case scenario when I'll meet a patient for the first time. So that means that a patient's OBGYN or their general practitioner needs to be asking them questions related to their breast cancer risk long before get
• 9:51
  Melissa Shere Beek: to them.
• 9:51
  Dr. Kate Lampen Sachar: Have the potential to see So the reason why we say that is because that will help us determine if there's certain patients that would benefit from screening at an earlier Okay.
• 10:02
  Dr. Starr Mautner: For example, if I see a patient whose mother was diagnosed with breast cancer at the age of 45, then we advise that patient to start screening ten years prior to her mother's diagnosis. So then we would say, actually, instead of starting at 40, we would start you at 35. Got it. And then in patients who know that they have a genetic mutation, let's say in the BRCA one or BRCA two gene Mhmm. We start screening them earlier than the age of 40 as well.
• 10:28
  Melissa Shere Beek: And
• 10:28
  Dr. Starr Mautner: so usually by the age of 25, we will start screening young patients if they know that they're a genetic mutation carrier. Or those that have been exposed to high doses of radiation for lymphoma, let's say, treatment at a young age, they're at higher risk because the chest wall has been radiated in the past. So there are select scenarios that we screen earlier than the age of 40. But for the general population, as Kate said, assuming that there's not extremely high risk factors like a genetic mutation or a very young relative with breast cancer, we're going to start at the age of 40.
• 11:01
  Melissa Shere Beek: Got it. And what are you seeing as far as when you're starting with someone who's younger? Because you said you're seeing a lot of younger people with breast cancer. Is it changes just because of environment? Is it because they have a history that we now know that maybe technology has led us to know earlier that someone's carrying a gene?
• 11:23
  Dr. Starr Mautner: So it's usually not that the technology is so much better that we're detecting it at an earlier age because these women are not necessarily eligible to start their screening mammograms. So a vast majority of these women that are presenting earlier than the age of 40 are coming in because they felt it themselves.
• 11:38
  Melissa Shere Beek: Okay. So from self examination? Exactly.
• 11:41
  Dr. Starr Mautner: And that prompts them to then get imaging in the biopsy. And we know that these women sometimes have delays in diagnosis because of their young age. They may be told, well, yes, there's something there, but it's benign. And so then it takes a while to diagnose those patients sometimes. And oftentimes, those younger patients are coming in with more advanced and more aggressive disease.
• 12:01
  In terms of the reason why we're seeing an uptick in younger breast cancer patients, We don't know an exact reason, but it appears to be multifactorial in that there are delays in childbearing. There's an increase in obesity Mhmm. Lack of exercise, and it may be some environmental factors like processed foods and things like that that we can't exactly pinpoint. Also, increase in alcohol usage too appears to be contributing. But that being said, I have a number of very young healthy patients that are not obese, that do not excessively drink, and do not really have those strong risk factors, and they still are developing breast cancer.
• 12:40
  And so we just cannot identify an exact cause yet. But I think that that's the reason why more research needs to be done on this phenomenon of why we're seeing younger and younger cancers. But it's not only breast, we're seeing it in colorectal as well to the point where they lowered the screening age for colon cancer from the age of 50 to the age of 45. Good. And so it's just in breast cancer that we're seeing younger cancers being diagnosed.
• 13:04
  Melissa Shere Beek: Oh, how frightening. Well, I'm glad you guys are there. What should we expect from these different tests? So a patient comes in, they're just someone who's doing a regular screening, and do you do a combination of tests on them? Or what's the process for someone who's just, say, they're in their twenties and they're now starting their screening?
• 13:24
  Do they get all of these tests? Do they start with one? What's the protocol?
• 13:28
  Dr. Kate Lampen Sachar: Let me just start by sort of start in reverse. What's the ultimate outcome? The vast majority of patients that come in leave with a clean bill of health. Good. So that's kind of the way that we have we interpret studies.
• 13:44
  That's the way the metrics and the data have sort of worked out. The good news is the vast majority of patients that come in and get a screening mammogram, almost ninety percent of them leave with, your breasts look great, we'll see you next year.
• 13:59
  Dr. Starr Mautner: Perfect.
• 14:00
  Dr. Kate Lampen Sachar: Ten percent need to come back for additional imaging. Of those ten for that diagnostic study that we talked about. Mhmm. Of those ten percent, only a very small subset will go on to need an image guided biopsy. Okay.
• 14:17
  And of those, the vast majority of those biopsies come back benign. We're weeding it down now to like a very, very small percentage of patients actually being diagnosed with breast cancer. So when I see a patient, I'm like, listen, the odds are already in your favor. Okay. Like, just to start off.
• 14:36
  Melissa Shere Beek: Well, that's reassuring.
• 14:38
  Dr. Kate Lampen Sachar: So for an average patient,
• 14:40
  Melissa Shere Beek: Mhmm.
• 14:41
  Dr. Kate Lampen Sachar: Let's just say like your friend that is like, hey, I'm turning 40 tomorrow. What study should I get? Mhmm. I generally say schedule yourself for a screening mammogram. When you get the report, you're gonna find out if you have dense breasts or if you don't have dense What are my next questions?
• 14:57
  If you don't have dense breasts, you can say, great, I am done for the year. If you do have dense breasts, we typically recommend that those patients come back in for a breast ultrasound. Women who have dense breasts, it's a little bit harder to detect breast cancer in them from from mammogram. And that sort of is multifactorial. I don't have pictures here to show, but it is.
• 15:23
  It's a little bit harder to see breast cancer. Cancer is white on a mammogram. Dense tissue is white on a mammogram. So it can hide some cancers. But there's also a slightly higher risk of developing breast cancer in women that have dense breast tissue.
• 15:39
  Melissa Shere Beek: Okay.
• 15:39
  Dr. Kate Lampen Sachar: It's nothing pathologic to have dense breast tissue. Half the population does. But it does it is. So we offer breast ultrasound as something additional to add in.
• 15:49
  Melissa Shere Beek: And what about an MRI for someone who has dense breasts?
• 15:52
  Dr. Kate Lampen Sachar: So that is not off label. That is an indication. What I would say is we typically offer that for women. It's indicated for women that are high risk of developing breast cancer. It's much harder to get insurance approval for someone that is dense breast but not totally high risk.
• 16:13
  Dr. Starr Mautner: Got it. And by high risk, that definition is at least twenty percent lifetime risk of developing breast cancer. So you often hear the number one in eight women will develop breast cancer, and that equates to about a thirteen percent risk. And that's average risk women walking around with no family history, no risk factors, one in eight.
• 16:30
  Melissa Shere Beek: Right.
• 16:31
  Dr. Starr Mautner: But if you have a primary relative who developed breast cancer, like your mother or your sister, that automatically jumps you into the high risk group because it doubles your risk of breast cancer. So you go from one in eight to like a one in four number, and you qualify Does that include for
• 16:44
  Melissa Shere Beek: the population with BRCA or not?
• 16:46
  Dr. Starr Mautner: No. No. We're talking about just women that have a family history or own personal history of a high risk lesion, something like atypia, not cancer.
• 16:54
  Melissa Shere Beek: Got it.
• 16:55
  Dr. Starr Mautner: They're still considered at higher risk for developing breast cancer in the future, so they qualify for MRI. Genetic mutations like BRCA one or BRCA two are extremely high risk. So those patients have a fifty to seventy percent lifetime risk of developing breast cancer. They absolutely qualify for MRI, and we go a step further. We'd only only do an MRI.
• 17:15
  We alternate the MRI with a mammogram and ultrasound every six months. So they're not waiting a full year to get their annual screening, they're doing it semi annually every six months, because you don't want to let an entire year go by. During that interval, they could develop an aggressive cancer very quickly. So we screen them every six months instead of once a year.
• 17:34
  Melissa Shere Beek: What do you advise a young person who comes to you and they have tested positive for BRCA? Because you hear a lot about a previvor, and they do double mastectomies just to ensure that nothing grows, nothing with the possibility grows. Correct. Is that what you advise? Or
• 17:51
  Dr. Starr Mautner: So I see patients in my office all the time that come in with BRCA genetic mutations or other genetic mutations that put them at high risk for breast cancer. And it's a very personal decision of if and when to do a preventative mastectomy because the timing needs to be right. That's a big surgery to undergo. And physically, they need to be prepared for it, but also mentally as well. A lot of these women have young children or they haven't yet had their children.
• 18:14
  And so a lot goes into that discussion of when to do the surgery. I do advise patients, especially young patients that know that they have a BRCA one or two mutation to take that mutation seriously and have the mentality that knowledge is power to do something about it. Oftentimes, these young women will have relatives that died of breast cancer at a young age or were diagnosed with aggressive cancers that required chemotherapy, that were life altering diagnoses. And so many times they come to me because they already have the notion that they wanna do something aggressive to prevent cancer. For me, a BRCA one or BRCA two genetic mutation, to me, it is the right thing to do to consider prophylactic mastectomy.
• 18:52
  Because when you see the flip side of that coin, waiting on it, and then developing something, it's terrible because then it's not surgery alone. It's surgery plus medication and the chance for recurrence in the future. So I tell patients once they feel that they are mentally and physically ready to do the surgery, that we offer those surgeries. I work with the excellent reconstructive plastic surgeon. We can offer ideal cosmetic results.
• 19:15
  Oftentimes, we can do nipple sparing mastectomies and preserve the entire skin envelope including the nipple and offer them a really nice cosmetic result. The upside of doing a surgery like that while it is aggressive and while it does require about at least a month of recovery is that you no longer need to do mammograms or breast MRIs for screening. So you cut that out. Really? Yes.
• 19:36
  The risk of breast cancer is never zero, but we get it down to the low single percentage points to the point where you do not need to do screening with imaging. You just do a physical exam with feeling the skin alone.
• 19:45
  Melissa Shere Beek: So they don't have to go back annually for any sort of exam?
• 19:48
  Dr. Starr Mautner: They come they come in for a clinical breast exam and to the point where they feel comfortable examining themselves. They'll come in, you know, every year to see me often. I didn't
• 19:57
  Dr. Kate Lampen Sachar: know that.
• 19:57
  Dr. Starr Mautner: They go from a risk of fifty to seventy percent to, like, less than five percent. And so it is the right decision for many women to consider doing that surgery, but they just have to be ready for it. They have to have a time in their life that they can take a month off from work and have a hand in the house with kids to make sure that logically they ready.
• 20:16
  Melissa Shere Beek: Are they screened that way too? Do you does do the facilities that you work at offer that kind of help for them?
• 20:23
  Dr. Starr Mautner: Yes. We have psychology and psychiatry support services. And but a patient that's not in the correct head space to have that surgery, I won't recommend doing it yet. Right. You know, I tell them that it's a major decision and if they don't feel mentally ready to do it, that from the the time that I see them to the time that they decide that they're ready, we're going to continue high risk screening.
• 20:43
  Melissa Shere Beek: So when you have someone because you were talking about the percentage of women and things like that. If if someone presents with cancer or BRCA, is it just the female descendants that you start early with screening? The No. Or both genders? Or all genders?
• 21:04
  Dr. Starr Mautner: Or So for men that carry a BRCA genetic mutation, there's an elevated risk of breast cancer compared to men that do not. But still the risk of breast cancer is like one percent. It's very low. Because breast breast cancer in men is extraordinarily rare even with a BRCA mutation. So we don't do mammograms usually.
• 21:20
  Some people will, but usually we just do clinical exam on them. What I thought you were getting at is, is it important to look at male family history when you're looking at someone's history?
• 21:29
  Dr. Kate Lampen Sachar: That too.
• 21:30
  Dr. Starr Mautner: That's important because a lot of people are under the misconception that only their mom's family history matters because it's a disease of women. But that is not true because you get half of your genes from your mother and half of your genes from your father. So let's say there's no breast cancer on your mother's side, but on your father's side, his mother died of breast cancer and paternal first cousin had breast cancer at a young age. That is a concerning family history. Yeah.
• 21:55
  And so you could easily carry a BRCA mutation passed down from your father. Your father never developed breast cancer. Let's say he had prostate cancer.
• 22:02
  Melissa Shere Beek: Right.
• 22:02
  Dr. Starr Mautner: Prostate cancer is one of those that goes along BRCA. Yeah. You So have to look at both sides of the family history when deciding whether or not the patient qualifies for genetic testing and if they're high risk.
• 22:13
  Melissa Shere Beek: Okay. Alright. And is there difficulty when we go back to screenings and things like that? Do you have
• 22:19
  Dr. Kate Lampen Sachar: more difficulty with patients who have implants? So the data actually says that there is no difference in our interpretation of these studies. Mhmm. What we do for mammograms is we get extra views. We get our routine views, and then we actually get some extra views where we push the implant back and pull the breast tissue forward.
• 22:42
  Wow. So it enables us to see more
• 22:44
  Dr. Starr Mautner: of the tissue.
• 22:44
  Melissa Shere Beek: You're able to manipulate it so
• 22:45
  Dr. Kate Lampen Sachar: you can A little bit. See more of the Okay. Yeah. Sometimes easier than others, but we do.
• 22:50
  Dr. Starr Mautner: We do. That being said, it does make some biopsies very difficult for Absolutely. Patients to have big
• 22:56
  Melissa Shere Beek: I can imagine that.
• 22:57
  Dr. Kate Lampen Sachar: Those are the most challenging biopsies, I would say, that I do, are the ones where I'm having to biopsy. Around an implant? A mass that's sitting on top of an implant. It does happen, and we do it. Yeah.
• 23:12
  But frequently, that's where we have to be a little bit creative.
• 23:17
  Melissa Shere Beek: Okay. Creative. I like that word. Outside of all of these tests, when should someone be concerned and come in? Is it because they have a lump, they have redness, they have swelling?
• 23:29
  Like, what are some of the symptomologies that women should say, oh, wait. This is alarming. I need to see my physician.
• 23:34
  Dr. Starr Mautner: So I tell patients that they should be very familiar with their body. Many women will say, I don't do self breast exams because I don't know how to do it, and everything feels lumpy and bumpy, and I get scared. And I tell the patients, even if you're not sure you're doing it exactly correctly, just know your body so that once a month, and I say feel it on the first if you can't remember when to do it, you do a self check. And you're basically wanting to know if there's an abnormality that's not your normal. You should be looking at your breasts in the mirror, making sure that if you have an asymmetry, let's say one size side is bigger than the other, that's normal as long as it's always been that way.
• 24:08
  But if all of a sudden, your breasts you think is getting smaller and smaller on one side, that is not normal if that's not been that way before. Right. So any change from normal that persists past a couple weeks, I would be concerned about whether it's dimpling of the skin, whether it's new onset spontaneous discharge from one nipple, whether it's a redness of the skin that's not disappearing, so a deviation from normal. It's not always a palpable lump. People will say, you know, if you have pain in the breast, that's not concerning because breast cancer doesn't hurt.
• 24:39
  That's not necessarily true. Pain in the breast is not usually the first sign of a breast cancer, and many women get breast pain. It's super common. Right? Right.
• 24:47
  But you can have breast cancers that hurt, you know, especially if it's an aggressive cancer that's involving the skin or the muscle. But you usually are that's associated usually with a mass, not just pain itself.
• 24:58
  Melissa Shere Beek: Mhmm. Got
• 24:58
  Dr. Starr Mautner: it. So breast cancer can be painful in certain situations, but a vast majority of breast pain is not indicative of cancer.
• 25:06
  Melissa Shere Beek: Got it. And you said the first of the month. Is it better to do it the first of the month or like we used to be told, oh, you had to wait x amount of days after you menstruate because this, that, and the other? It doesn't really matter as long as you're doing it each month.
• 25:18
  Dr. Starr Mautner: As long as you're doing it each month, but I would try to avoid doing it in the week leading up to your period because you know your breasts are more dense, they're more lumpy and bumpy and more engorged, and you're more likely to be a little more tender and feel things. So I say if you can't remember, definitely do it on the first of the But if you can remember, do it the week after your period. But not everyone has, you know, a predictable cycle each month. Some women don't get their period. So in that case, feel it on the first of the month.
• 25:41
  Dr. Kate Lampen Sachar: Got it. I also remind people to pay attention to rashes. Yes. The majority of rashes, skin rashes that people get are dermatologic Right. And don't need to be addressed by a breast radiologist.
• 25:57
  But particularly anything around the nipple Uh-huh. Needs to. And particularly if it's something that does not go away within seven to ten days. Okay. I take very seriously.
• 26:13
  Okay. And I always tell patients I am by no means a dermatologist. That's not what my training is. But I am trained to recognize somewhat atypical appearances Got it. Of breast cancer.
• 26:27
  And when do you refer to a breast oncologist surgeon? So certainly after a biopsy result that comes back with either atypical cells, atypia, or breast cancer. Okay. However, I will, if I see something that is just flat out, I know it is going to be a cancer, or if I see skin changes, I will immediately, even before the biopsy, refer to a surgeon. Because I wanna get the patient set up already, because I know that this is something that we are going to have to move exceedingly quickly.
• 26:59
  Melissa Shere Beek: Okay. So what happens when someone's diagnosed with breast cancer? Can you take us through the
• 27:04
  Dr. Starr Mautner: steps Before of I get into that, though, there's one important thing I wanna say is a vast majority of women that are going in for a mammogram won't necessarily get to speak with the breast radiologist. And that's very important because, I mean, in Kate's practice, she does get to see her patients a lot, but a lot of imaging is read remotely. So that being said, if you go in for an imaging test and you're told it's normal, but you have a persistent problem that's not being described on the imaging, let's say a rash, that they're they're not seeing because the doctor did not see you, but you had a mammogram that was read remotely, be your own advocate. Got Do you think there is something wrong? You know yourself.
• 27:38
  That you have a normal mammogram, but didn't actually see a doctor to evaluate you. You have to still go that extra step and either be referred to a breast surgeon or, you know, go back to your gynecologist and say, listen. I know my mammogram's read as normal, but something is wrong here. Right. When I see a woman that's newly diagnosed with breast cancer, first of I look at all of the imaging myself to make sure I understand the clear picture of what's going on.
• 28:02
  If And there's any discrepancy on the report versus what I'm seeing on the imaging, I'm happy to pick up the phone and, you know, make a phone call because I like to visually see what it is that's being described. Sometimes the description doesn't exactly match, you know, what you're seeing. The image. So I look at all mammograms myself and the MRI as well. And I go over it with the patient and oftentimes will show them too because a lot of times the patient's being told, like, you have these calcifications and you have something that's an early cancer and they're freaking out on the inside.
• 28:29
  But I bring up the mammogram, and I'm like, look, you have like these four little dots, and these are the microcalcifications. And a majority of them were removed with the biopsy, and it's a stage zero breast cancer, and you're going to be okay. And when they see that picture, they they get it. They say, okay, this was super early. I understand.
• 28:46
  I'm going to be okay. So I do think a picture's worth a thousand words. Oh, yeah. You know, seeing that imaging and going over it with the patient is one of the first things that I do. And then we go into the pathology report.
• 28:57
  And the pathology report is really important because that is the tissue that was taken with the biopsy is looked at under the microscope and described. And there'll be some information on that report that really guides treatment, whether the tumor is responsive to the female hormones, estrogen and progesterone. Right. Whether it's a low grade, not very aggressive tumor or a high grade, very aggressive tumor, kind of helps direct which way this is going to go. And it helps give me an idea, is this patient someone that may require chemotherapy?
• 29:27
  Dr. Kate Lampen Sachar: Got it.
• 29:27
  Dr. Starr Mautner: Setting them up mentally for what they're getting into or is this something that's really, you know, not life threatening, super early stage, they're going to be fine. And then we go into the options of whether they should have breast conserving surgery with lumpectomy versus mastectomy. And for some patients, they have both options and they have to make a personal decision of which option is the right one for them. And that takes a lot of guidance. Some patients want me to tell them what to do.
• 29:51
  Right. And that's a hard thing to do if both options are safe for them.
• 29:55
  Melissa Shere Beek: Got it.
• 29:56
  Dr. Starr Mautner: I will try to guide a patient one way versus the other based on what I think is the safest option. Right. Obviously, if I think they're not a good candidate for lumpectomy, I will say you are not a good candidate for lumpectomy and that's not something I am offering for you. Versus I've had patients come in with a super early teeny tiny cancer and they're like, remove both my breasts. And I'm like, listen, you're a diabetic.
• 30:17
  You had a stroke last year. I'm not going to do a high risk procedure on you for something this tiny when you're going to be cured with a lumpectomy.
• 30:24
  Melissa Shere Beek: Got
• 30:24
  Dr. Starr Mautner: it. So it takes a lot of, I think, experience to know when to operate on someone and what operation to do and how to guide them that way. You have to kinda play part breast surgeon, part psychologist.
• 30:36
  Dr. Kate Lampen Sachar: There's who's the same.
• 30:37
  Dr. Starr Mautner: Part plastic surgeon. But luckily, we do have all those counterparts to assist us as well. And I work with excellent plastic surgeons. So when a patient does need or want a mastectomy, they're offered, you know, a good cosmetic result that they're happy with. But with early detection, more and more patients are candidates for breast conserving surgery with lumpectomy, is a relatively easy surgery to recover from.
• 31:01
  And so I'm happy to be able to offer that to patients.
• 31:03
  Melissa Shere Beek: Okay, because you covered most of what I was going ask about the different types of cancers, the different types of treatments. Did we talk on stages? Can you talk a little bit about stages?
• 31:14
  Dr. Starr Mautner: Breast cancer is staged clinically and then pathologically. And the clinical staging is based on when I meet the patient and I examine them, and I look at their imaging. And so I can give them an estimated stage based on what I think the tumor size is and whether or not they have lymph node involvement or any evidence of spread of the cancer. And so if I see a patient with a one centimeter tumor and I don't feel any abnormal lymph nodes on exam and everything points to this as an early, breast cancer, this is likely going to be a stage one breast cancer. Got it.
• 31:46
  Stage zero, stage one has the best prognosis. Right? But then at the time of surgery, when the tumor is removed and we check the lymph nodes with something called sentinel lymph node biopsy, that staging can change. Because once all of that information is gathered and looked at under the microscope, it's possible that the tumor is slightly a different size or maybe there's a lymph node involved. And so that's the pathologic staging.
• 32:10
  The stage is important because it's what dictates prognosis. The earlier the stage, the better the prognosis. And that is why we aim to catch cancer at its earliest stage. Stage zero breast cancer, which is really a pre invasive lesion, has a ninety nine percent survival. Stage one, overall survival is ninety five percent five year So when you're in one of those two categories, you have an excellent prognosis.
• 32:33
  Melissa Shere Beek: Got it. And what are the dare I ask what the percentages are if you're stage four?
• 32:38
  Dr. Starr Mautner: Well, stage four breast cancer is technically not curable breast cancer, but treatable breast cancer. And so that indicates that a cancer has spread from the breast Mhmm. To somewhere else distant Mhmm. In the Either bone, liver, lung, brain, other another organ. And so technically, when a patient has a stage four breast cancer, I do not pay play a huge role in their care because if I remove the cancer from their breast, it doesn't necessarily mean that I've cured them of their cancer because they may have
• 33:06
  Melissa Shere Beek: they have cancer somewhere else. So it's continued treatment.
• 33:09
  Dr. Starr Mautner: Correct. Chronic treatment. And we know many ways for these patients to live a long time. There's so many therapies now, systemic medications, and you can alter medications if one's not working. That being said, there are select times, especially in very young patients, who may present with an isolated metastasis to one other organ with stage four disease.
• 33:29
  Let's say an isolated liver metastasis. And they respond really well to chemotherapy, and that that lesion appears to disappear. We will give some of those patients the benefit of the doubt, telling them that we're not a 100% sure that the surgery is going to help you, but, you know, you're in your twenties or early You're a viable
• 33:46
  Melissa Shere Beek: candidate for
• 33:47
  Dr. Starr Mautner: Exactly. And we we go for cure in those cases. There are some select cases that really, you know, do extraordinarily well despite having stage four disease. So can you talk a little bit about after someone's diagnosed and you've gone through all of that,
• 34:00
  Melissa Shere Beek: is there support not just for the patient but for their support team, their family and friends? So, yes. There are support groups.
• 34:13
  Dr. Starr Mautner: That's an interesting question because I think that caregivers obviously go through a lot when it comes to treatment, especially partners and spouses.
• 34:21
  Melissa Shere Beek: Yeah.
• 34:21
  Dr. Starr Mautner: And I think there's probably a lot of PTSD that, you know, from what they've gone through on their side of seeing it. And there's probably not enough support systems in place for Okay. The caregivers and spouses. I don't know what you've seen, Kate.
• 34:34
  Dr. Kate Lampen Sachar: I I don't I would agree. I don't think there's enough. There are various sort of grassroots support networks that exist in some of the various institutions, but I would agree, it's not enough.
• 34:48
  Melissa Shere Beek: Yeah, I kind of always think that the caretaker or the caregiver goes through more stress because the person who's diagnosed, yes they're stressed, but they're doing everything that they possibly can to get themselves better. They're following doctor's orders, they're doing all the things where the caretaker doesn't really have a grasp or a handle on what they should be doing, and no guidance really sometimes. What percentage of we talked about this, men that develop breast cancer.
• 35:16
  Dr. Starr Mautner: So I used to say that I see one man a year basically with breast cancer, but actually it's become a little bit more frequent in my practice. I'll see like two to three a year, but it's very rare. And anytime you do see a man with breast cancer, usually they're presenting with a small mass behind the nipple because they really have very little breast tissue
• 35:33
  Melissa Shere Beek: on I just this would say.
• 35:34
  Dr. Starr Mautner: Yeah. So it's palpable, sometimes nipple discharge. You always want to do genetic testing testing because there's going to be a higher risk of a genetic mutation in a man with breast cancer. And so men usually will present with a mass, but that needs to be differentiated from something called gynecomastia, which is benign enlargement of the breast gland. Right.
• 35:56
  So what we will do is we work it up actually with a mammogram. Men can get mammograms. And so we'll do a mammogram, and then we'll do an ultrasound of any mass and biopsy it just like we would with a woman. We're looking at the receptor status. They're vastly estrogen receptor positive just like in women.
• 36:13
  Men do require usually a mastectomy for the treatment of their cancer because think about it. They don't have much tissue there. They're not gonna just do a lumpectomy. The nipple usually has to be removed in a case like that.
• 36:23
  Melissa Shere Beek: Got it.
• 36:23
  Dr. Starr Mautner: So men undergo a mastectomy usually with loss of the nipple. Most men don't mind too much that they lose the nipple, but you can actually have reconstruction of a nipple with a three d tattoo. Right. Luckily, most men have a hairy chest. And by the time the hair grows over it
• 36:37
  Melissa Shere Beek: They don't cut you
• 36:38
  Dr. Starr Mautner: don't even the really notice it with their shirt off that they had the mastectomy.
• 36:42
  Melissa Shere Beek: Oh, that's amazing. Okay. And you said you're seeing an uptick in younger people who are being diagnosed. Absolutely. What about post menopause?
• 36:51
  Is there an uptick with that as well? Is it because of hormone changes? No.
• 36:55
  Dr. Kate Lampen Sachar: So there is an expected gradual increase in breast cancer. The data has shown that since the seventies.
• 37:07
  Melissa Shere Beek: Okay.
• 37:08
  Dr. Kate Lampen Sachar: And it persists despite benefits in screening and technology and all of that. The hormone replacement therapy debate has been exceedingly contentious for the last twenty to thirty years. Right. And since the black box warning has been removed, I think we will see a dramatic increase in women each year that are on going to be on hormone replacement therapy. Really?
• 37:42
  And we do see very predictable changes in the breasts in those women who are on hormone replacement therapy. The current data suggests that there is no substantial change in risk associated with hormone replacement therapy for average risk women. People. Okay. Got it.
• 38:02
  So with that caveat, average risk women. Right. But I'm sure it increases by multitudes when you factor in the genetics. Absolutely. What I would say though, and I just had this discussion with a friend of mine who's an OBGYN, is it makes these women's breasts look like they're thirty years younger.
• 38:25
  So I see 70 year old women who look like they have 35 Because year old of the HRT. Okay. So they're having benign cysts. Their breasts are exceedingly dense. I'm seeing a lot of fibrocystic changes.
• 38:43
  Not every patient that's on HRT. Right. But when I see a change, it now is very routine for me to walk in and ask, hey, did anything change with you medically in the last year or so? We, you know And Invariably it's usually In the HRT, it's HRT.
• 38:59
  Melissa Shere Beek: Okay. And should a woman, whether they're taking HRT or not, still continue past the age of 80 doing all of these diagnostics and screening?
• 39:13
  Dr. Starr Mautner: It's dependent on their lifespan expectancy. So if you have a really healthy 80 year old woman that's getting up and playing tennis a few times a week and is super active and has very little comorbidities, and we think that woman's gonna live till 100, a 100% she should be doing screening mammograms because if they find something small, we'll do something about it. Right? But if you have that same woman who's wheelchair bound and really in poor health, I would say probably not. Because if they're not a good surgical candidate, what are you looking for on a screening mammogram?
• 39:44
  A little calcification that's not gonna cause a problem Right. For many years to come. Right. And so you have to take it on a case by case basis. Here in South Florida, we see a lot of older women that are in excellent shape.
• 39:55
  Yeah. I've operated on women in their nineties. I operated on two ninety year olds this week. Really? Yes.
• 40:02
  And so there's a couple reasons why you would operate on someone in their nineties. One is if they have something very early, but they're in excellent shape, and you don't want it to progress into a problem over the next few years. And it's an easy little lumpectomy. You can get it done, and they don't have to worry so much about it. Another reason is if they're symptomatic, sometimes a 90 year old hasn't been screening, but they come in with a palpable lump that's very close to the skin.
• 40:25
  And you could tell in the next year or so if you don't do something about this, it's probably gonna break through the skin and become like an oozing open wound. And in a case like that, you want to take care of it, especially if the patient's in good enough health to do a small operation.
• 40:38
  Melissa Shere Beek: Right.
• 40:39
  Dr. Starr Mautner: You remove that lump. Sometimes these patients will go on medication afterward if they can tolerate it. If a patient's not in good health, but they develop a breast cancer, we can sometimes put them on medication to slow the growth of the tumor without doing an operation, and we watch them. And hopefully they respond to that medication. If they don't, you're in a tricky situation of what to do.
• 40:58
  Melissa Shere Beek: Okay. And do you outside of the breast cancer patients that you see, are there others that you follow on a typical basis? Is it someone who has dense tissue? Is it someone who, has implants? What other kind of patients are you seeing outside of those that are diagnosed with breast cancer?
• 41:17
  Or ones that you follow regularly?
• 41:18
  Dr. Starr Mautner: In my try to focus on those that have been diagnosed with breast cancer, either newly diagnosed or those that I've operated on within the past five years that I'm following up, or patients with genetic mutations. That being said, I will have patients that like to come to me for reassurance. They've had a problem in the past. It wasn't necessarily cancer and, you know, we become
• 41:37
  Dr. Kate Lampen Sachar: And they love you.
• 41:38
  Dr. Starr Mautner: They they we become close and I agree to continue to see them once a year to give them peace of mind and look at their imaging and tell them they're okay. Good. But that being said, if I fill my clinic with all of those patients, I won't have room to see the cancer patients. So we do have specialized clinics where I work, where we have benign breast clinic for those who truly have benign breast issues that don't need surgery. A high risk clinic for those that have had a tippy in the past or a family history and just wanna be followed a little bit more Yeah.
• 42:07
  And these are nonsurgical patients that just wanna be seen. Those clinics are typically run by practitioners, but they're backed up by the surgeons in that if my nurse practitioner sees someone and they're concerned, they bring them right over to me and I see them as well.
• 42:20
  Melissa Shere Beek: Got it. What's the biggest misconception with screenings and breast cancer diagnosis? You wanna
• 42:27
  Dr. Starr Mautner: well, I think we should both answer this
• 42:28
  Melissa Shere Beek: from want you both I'm
• 42:30
  Dr. Kate Lampen Sachar: gonna This one's very basic.
• 42:32
  Melissa Shere Beek: Okay.
• 42:32
  Dr. Kate Lampen Sachar: But I feel like we have to say it. Say it. A mammogram doesn't hurt. Yeah. Also, it's finite.
• 42:39
  Yeah. The entire thing it's four views. The entire thing takes a minute total.
• 42:45
  Dr. Starr Mautner: Mhmm.
• 42:45
  Dr. Kate Lampen Sachar: Your breast is compressed, each breast. Five seconds, five seconds, five seconds, five seconds. Like, you're done. There's nothing scary
• 42:52
  Dr. Starr Mautner: about it.
• 42:52
  Dr. Kate Lampen Sachar: There is nothing scary about it. And I hear so many misconceptions related to pain. And I it's just I I really have having experienced it now many Sure. Times myself
• 43:08
  Dr. Starr Mautner: Sure.
• 43:09
  Dr. Kate Lampen Sachar: I it's just I feel like anyone can do anything for one minute. Yeah. And this is really not
• 43:14
  Melissa Shere Beek: Not one of those
• 43:15
  Dr. Kate Lampen Sachar: even a minute long. This is really not one of those, need to think twice about doing. Got it.
• 43:22
  Dr. Starr Mautner: So along the similar lines, I you know, I had a patient today that said, well, what about the risk of getting a mammogram each year? Isn't that a lot of radiation exposure? And, you know, obviously, everything has a risk and a benefit. You go to the dentist once a year and they do x rays as well. And so the amount of radiation that you experience by getting your annual mammogram is an acceptable amount of radiation.
• 43:45
  And when you weigh the risk benefit scenario, the benefit far outweighs the risk. Yeah. I mean, you get radiation exposure by flying on a plane. Was just gonna say And we don't think twice about that. Just living on planet Earth, if you live, let's say, you know, in the mountains, you get a higher level of exposure of radiation than you do living at sea level in Miami.
• 44:03
  So number that's one of the misconceptions that I still am shocked when patients say that to me, that they're worried about the radiation exposure. Oh, yeah. All the time. They say, I don't wanna do a mammogram because of radiation exposure. I mean, think about the radiation exposure you're going to have if you develop extended radiation after.
• 44:22
  And then the other thing I'll hear for patients that don't want to screen is they say, well, I'll just you know, if something happens, I'll deal with it then, you know, if they feel something. But it's such a different scenario when you see a patient that is diagnosed via screening where you cannot feel the cancer versus someone who is coming in because they were not screening and they come in with a palpable mass. The treatment options are so different, and the extent of that treatment Right. Of what they're going to endure is so vastly different. If Kate finds something that you can only see with a microscope and it's a few calcifications and it's stage zero, that makes my day that I can cure this patient of their cancer with a tiny lumpectomy and they're going to be fine.
• 45:02
  Versus I see a patient who hasn't had a mammogram since before the pandemic, and they come in with a four centimeter mass, lymph nodes that are involved, and that patient requires a modified radical mastectomy, removal of the breast, chemotherapy, radiation therapy. I mean, the extent of treatment that and it all could have been prevented. And so just understanding why it matters to catch something early versus waiting until you can feel it. A 100%.
• 45:29
  Dr. Kate Lampen Sachar: I think it's important to go back to what Star said. Knowledge is power Oh. In this case. Absolutely. Absolutely.
• 45:35
  Melissa Shere Beek: Absolutely. Absolutely. Why wouldn't you wanna be informed?
• 45:38
  Dr. Starr Mautner: Right. And I get that, yes, it's scary if they find something and you need a biopsy, but, like, I've gone through this myself. Kate did my biopsies and I remember thinking, oh my god, like I have to do these biopsies. What if it shows something? But then my husband was like, well, what would you tell a patient?
• 45:52
  And I said, I would tell them it's teeny tiny and no matter what it is, it's gonna be fine. And I'm like, okay, It's gonna be fine. And, you know, like, when you think about it, like, yes, it's scary to have to go through that biopsy. But if you know it's so small that no matter what it is, it's going to be It's fine.
• 46:07
  Melissa Shere Beek: Okay. Are insurance companies allowing for greater diagnostic testings?
• 46:12
  Dr. Kate Lampen Sachar: I would say it's mixed. Okay. It's mixed. As radiologists, we're pretty adept with the appropriate language, to assist with that, but I would say it's it's a mixed bag. Okay.
• 46:27
  Patients, I would say, still struggle with high premiums and I bet. The deductibles. And even if it's covered There's still a percentage that isn't. The percentage that isn't.
• 46:45
  Melissa Shere Beek: Okay.
• 46:45
  Dr. Kate Lampen Sachar: And unfortunately, that can be center dependent, insurance dependent. Right.
• 46:53
  Dr. Starr Mautner: Yeah. Seen patients that due to the high deductibles at certain cancer centers, they end up going somewhere else. Somewhere that maybe they've never gone before, but it was cheaper. Maybe they were offering a $100 to get your mammogram and ultrasound and everything. And the problem with that is if it's not high quality imaging and a high quality radiologist reading it.
• 47:11
  Right? Your mammogram's only as good as the radiologist that's Right. Reading they're doing themselves a disservice, a huge disservice. And if they don't have the priors to compare to, every year you went to one place and then this year you just decide to show up somewhere else
• 47:24
  Melissa Shere Beek: Right.
• 47:24
  Dr. Starr Mautner: And they can't compare year by year, then they're not seeing the full picture
• 47:28
  Melissa Shere Beek: of what's going on. Got it. Is there a certain diet that we should or should not be adhering to to help with prevention or, you know, to avoid because it brings on? I mean, I know we have microplastics and all these things, but what what should we be what can we do?
• 47:44
  Dr. Starr Mautner: I think there's a lot of evidence now pointing to ultra processed foods being terrible for you, not only from a breast cancer perspective but other cancers as well. So avoiding ultra processed foods. But then the easy one, I like to say the easy one but patients don't like to hear this, is avoiding alcohol. Because alcohol is a known risk factor for breast cancer and for breast cancer recurrence. So if you have to pick two things, I'd say cut out alcohol and try to avoid ultra processed foods, and then on top of that, exercising.
• 48:12
  Other than that, it's hard to say cut out all sugar out of your diet, cut out all meat, because we don't know for sure that those things will decrease risk. But we do know that ultra processed foods is linked to cancer risk and that alcohol is linked to cancer risk as is obesity and lack of exercise.
• 48:26
  Melissa Shere Beek: Yep. Got it. How do you both handle the stress of your profession?
• 48:31
  Dr. Starr Mautner: We like to go on long walks together in our neighborhood. Certainly. That's amazing. That's great. I think, you know, having friends in the profession and colleagues that you can bounce difficult cases off of.
• 48:44
  We all have those days where we you know, have a really tough case and having someone to commiserate with that on. But for the most part, I would say, like, I love what I do and having a balance of personal life and professional life is really important. Like, you know, after I go home after a long day at work, even if it was tough, like, I have my family, I have my friends. And so that is a major stress relief, just having that balance. But because what I do is so rewarding, a majority of the time, luckily, I don't find it super stressful.
• 49:15
  Dr. Kate Lampen Sachar: Okay. Good. I would agree. Absolutely. And the other thing I would add is so much of being a doctor very frequently, your work life bleeds into your non work life.
• 49:32
  Mhmm. And you know what? That's not always a bad thing. Yeah. That I sometimes come home from work, and I'm thinking about one of my patients.
• 49:43
  Right. And I think about that. I try to compartmentalize. Yeah, but you're invested. But I'm invested.
• 49:50
  And I think about that behavior that I'm modeling for my girls. And I think that it shows that I'm thinking and pondering, did I do the right thing? Did I that I care? Yeah. And that I'm really trying to give the patient the best care that I can.
• 50:09
  So there's a flip side to that.
• 50:11
  Melissa Shere Beek: What else do you wish your patients knew? Because you already said about the eating habits and and things like that and not to be afraid of mammograms. But is there anything else that you Any advice that you could give your patients?
• 50:24
  Dr. Starr Mautner: I usually will tell my patients, especially the ones that are newly diagnosed and are really scared about, like, what lies ahead, is that, like, a year from now, you are going to look back and be like, oh my god, I am so much stronger than I knew that I was. And you're in just this different place in your life. You've reprioritized what's important to you. You automatically become healthier overnight. You know, you cut out certain habits that you were doing that were not good for you.
• 50:48
  Melissa Shere Beek: Your behavior
• 50:49
  Dr. Starr Mautner: is You cut out stress. And you just alter your entire life to a point where so many patients have said, this sounds crazy, but cancer was the best thing that happened to me. Or they say, you know, worst club best members, meaning they made this entire group of friends and support network that they never otherwise would have had. Of course, no one wants to get cancer. But at the same time, sometimes it just becomes this, like, life altering wake up call, and it just alters the way you live your life, and you're just so much more appreciative for every day.
• 51:16
  And we get to experience that from a different lens by just seeing our patients go through it. But it gives me such a different appreciation of life because you know things can change in an instant. Yeah.
• 51:26
  Melissa Shere Beek: A 100%. Do you for those patients who are survivors and a year out, once they're recovered and they're doing well, do they come back and sort of not just tell you how successful you were with them and how successful they are with healing, but as advocates for patients who are just beginning, is there a program that does that for them where they can come back and sort of have a guide?
• 51:51
  Dr. Starr Mautner: I'm so proud of so many of my patients who have started non for profits in the South Florida community to help women go through what they have just gone through, and they really pay it forward. So, one of my patients, Rosemary Carrera, started three zero five Pink Pack, and it's such a great nonprofit helping women that are going through cancer treatment with things like groceries, Uber rides to treatment, child care support, all that ancillary support and social support that they need. I have another patient who started Project Disco Ball to decorate chemo infusion suites in people's homes over the holidays and help fundraise for those patients that can't enjoy the holidays while they're going through treatment. And another patient that started Talk Breasty to Me, and she has her own podcast where she walks patients through what to expect when they're going through surgery. So it really has started this community and network of women, especially in the South Florida community that are paying it forward.
• 52:47
  And a year out, so many of them have done incredible things to help others that are starting their journey.
• 52:52
  Melissa Shere Beek: That is incredible. Oh, I'm so glad to hear that. Oh, that's great. Good to know. Are there anything on the horizon that's coming up for breast cancer awareness?
• 53:00
  New treatments, new therapies, new tests?
• 53:05
  Dr. Kate Lampen Sachar: I mean, there is so much on the horizon. I would say contrast enhanced mammography is becoming more and more mainstream. So we'll see more with that. A lot regarding AI continues to evolve. So a lot of exciting developments there.
• 53:23
  Those are just two things just in the breast imaging world. But really, just always Evolving. Yeah. Always evolving. And that's one thing that I love about breast imaging.
• 53:35
  We're always being creative and evolving. Good.
• 53:39
  Dr. Starr Mautner: In the breast surgery world, the trend over the past several decades has been less is more. And so we used to do these radical mastectomies that were completely disfiguring, removing the breast tissue, the muscle, the lymph nodes, and then studies showed that that you didn't need to do that in order to cure breast cancer. And so we kept getting smaller and smaller to the point where we said, okay. Not everyone needs their breasts removed. We can conserve the breast.
• 54:00
  And now lumpectomy and breast conserving surgery. And not everyone needs all their lymph nodes removed. We can selectively remove the sentinel nodes or the first draining nodes. And so we keep moving towards a less is more approach. So I think the future of breast surgery will one day to be putting a lot of the breast surgeons out of business.
• 54:18
  We've gotten so good with our systemic medications and therapies that there is a subset of the population that now presents with really advanced ugly tumors and they get chemotherapy, and their tumors are wiped away. I do surgery on them. We find no cancer within the tissue. Incredible. And so there will be a subset of patients that are ultimately probably treated with medication alone at some point in the future during my lifetime, I would think, where we will not be operating on some patients who initially present with aggressive tumors, because the chemotherapy alone could be curative or chemotherapy and radiation together can be curative.
• 54:53
  And so I do think we'll continue to move towards a less is more approach, which is really exciting because it improves outcomes and lessens side effects of our treatment. As we're seeing more and more patients survive breast cancer, we have this whole entire group of survivors, right? And there's a notion of survivorship. We need to get better at managing the side effects of our treatments. Yeah.
• 55:14
  We've gotten so good at curing breast cancer and letting patients live these great lives, you know, for many years. But so many of them are suffering from the side effects of their treatment that it's impacting quality of life. And I think that's the next frontier for managing breast cancer is managing the side effects of the treatment.
• 55:31
  Melissa Shere Beek: I hope so. That would be incredible. That would be incredible. Oh, god. Well, thank you guys so much.
• 55:37
  Is there anything I left out or anything we didn't cover?
• 55:40
  Dr. Starr Mautner: I think we covered it all in an I
• 55:42
  Melissa Shere Beek: think covered a lot. A lot. Yeah. Covered a lot. Okay.
• 55:45
  So one thing I like to do at the end of my podcast with my guest is called Quickie Questions. You ready? Your game?
• 55:51
  Dr. Starr Mautner: Okay.
• 55:51
  Melissa Shere Beek: Okay. Good. What is your greatest strength? Work related? Anything.
• 56:00
  What's your greatest strength? However whatever comes to you.
• 56:04
  Dr. Kate Lampen Sachar: Mother of twins. Oh. Okay. That's a
• 56:07
  Melissa Shere Beek: good one. That's a good one.
• 56:09
  Dr. Starr Mautner: The mother of dragons. I think my greatest strength when it comes to my job and my patients is being able to communicate on a level that can connect and be receptive and understood.
• 56:28
  Melissa Shere Beek: It. I think so too. Who or what inspires you?
• 56:33
  Dr. Starr Mautner: Oh, that's an easy one for me. My patients inspire me every day. I see what they can accomplish and what they do after treatment and during treatment. And I'm like, I I try to put myself in their shoes and I'm like, I don't know if I could do that. And it's unbelievable what we put these people through and how they come out of And it on the other so I'm constantly inspired by my patients.
• 56:52
  Dr. Kate Lampen Sachar: That's cool. I I have to agree, patients. But if I have to come up with something additional, I would say my trainees, The people that I'm working with each day, training them to become radiologists. That's so cool. They're so knowledgeable.
• 57:08
  They have so many more accomplishments that I think that I ever had at that level of training. And I find that I learn from them each day and they push me to be a better doctor each day.
• 57:20
  Melissa Shere Beek: Well said. Well said. Someone said or did that you incorporated and made your own. I'm sorry. I'm making you think at the end of the evening.
• 57:43
  Dr. Kate Lampen Sachar: I don't remember the exact quote, but it was a quote related to grit and resilience.
• 57:47
  Melissa Shere Beek: Okay.
• 57:48
  Dr. Kate Lampen Sachar: I can't think of what it was. It was was another another radiologist Uh-huh. Who made a comment regarding that. And it was in the workplace as well as in personal life. So you incorporated that.
• 58:02
  And I feel like that is something that I took to heart Mhmm. And have tried to infuse into my home life. And I spend a lot of time with my daughters focused on grit building and resilience building activities. And I think that it's also translated into work Yeah. As well, that I may fail at certain things, but I really try to be intentional in picking myself back up and learning from those
• 58:40
  Dr. Starr Mautner: mistakes. Critical. So I think for mine, I've been reading a lot recently about, you know, how screens and social media and all of that negatively affects our kids. And just kind of incorporating that into my own life, trying to be more present at home. Recently, I've been putting my phone in the kitchen at night when I go to sleep, and it helps me sleep better.
• 59:04
  And I think modeling that for our kids, because it's a very different world that they're growing up in than we grew up in. Absolutely. And just trying to be present as much as possible when I'm around my kids and leaving work at work, you know, taking a deep breath in the car before entering the house and just being fun mom when I come inside and like being present with them because they want all of you when you come home. I don't wanna be distracted by my phone and work. Fortunately, in the, you know, the work that we do, while everything is very important, there's very little that's actually, like, a true emergency that needs to be answered at that moment.
• 59:39
  And so a lot of it can wait until an appropriate time to answer it and trying to be just very present for my family and for my kids. Beautiful.
• 59:47
  Melissa Shere Beek: Okay. Last one. What haven't you done yet that you want to?
• 59:52
  Dr. Starr Mautner: Oh, that's probably related to travel. I love to travel. Kate does too, and we actually copy some of their trips around the world. So, you know, traveling to a place that I haven't gone yet would probably be on the top of my list. I definitely wanna hit up places like Vietnam and Greece, or on the top of the list in South Africa.
• 1:00:12
  So more travel, for sure. Good.
• 1:00:15
  Dr. Kate Lampen Sachar: See the gorillas in Rwanda and the penguins in Antarctica. Oh, wow. Okay. So maybe I'll hop on
• 1:00:23
  Melissa Shere Beek: to both of your trips
• 1:00:23
  Dr. Starr Mautner: wherever you're going. And your mom has been a huge inspiration
• 1:00:27
  Melissa Shere Beek: Oh, for yeah. She's a travel goddess.
• 1:00:29
  Dr. Starr Mautner: She loves to travel and she gives me her travel tips, but also, you know, was very encouraging of me taking our young children around the world on crazy trips. And she told me it was the best thing that she ever did. And so I actually if you ask me again what is one thing that stuck with you, it was something that she said as well about traveling with your family. It's we've incorporated that into our life, and it's our best memories and the best thing that we've done for our kids.
• 1:00:54
  Melissa Shere Beek: It's forever, forever, and it sets an example for your children who will do what God willing with their children. And it's just great on every level from connecting with each other and education wise. So if you can afford to do it, go for it. It's the best thing in the entire world. And the memories are there's nothing like it.
• 1:01:13
  There's nothing like it. So thank you, guys.
• 1:01:16
  Dr. Kate Lampen Sachar: Thank you.
• 1:01:16
  Melissa Shere Beek: I thank you so much. I'm so appreciative that you two incredible women were here to discuss it all with us, and specialist on breast health. I'm so grateful that our community has you, how lucky we are. And again, I'm truly appreciative and so honored that you were here and I thank you so much. Thank you.
• 1:01:35
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• 1:01:48
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• 1:02:02
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