The key to making important decisions about your health is reliable information and often when talking about breast cancer it is hard to distinguish between good information and the myths. Today we’d like to debunk some common myths about breast cancer to empower listeners to take charge of their health and to make the best possible choices for treatment.
About Dr. Patel
Dr. Amy K. Patel is a Board-Certified Radiologist who specializes in Breast Imaging. She is a Breast Radiologist, Medical Director of the Women’s Imaging Center at Liberty Hospital and Assistant Professor of Radiology at the University of Missouri-Kansas City School of Medicine. Dr. Patel is a graduate of the combined BA/MD accelerated program at the University of Missouri-Kansas City. She completed her Diagnostic Radiology Residency at the University of Kansas-Wichita where she served as the first female chief resident in an all male program. She completed her Breast Imaging Fellowship at Mallinckrodt Institute of Radiology Washington University in Saint Louis.
Adam: (00:00) The key to making important decisions about your health is reliable information and often when talking about breast cancer it’s hard to distinguish between good information and the myths. Today we’d like to debunk some common myths about breast cancer, to empower listeners to take charge of their health and to make the best possible choices for treatment. My guest on the show today is Dr. Amy Patel. Dr. Patel, welcome to the show.
Dr. Amy Patel: (00:25) Thank you. Thank you for having me.
Adam: (00:27) Well, I’m excited to talk to you. I know there’s a lot of myths out there so we’re going to get to those, but before we do tell us a little bit about you, give us your story and why you chose to specialize in breast radiology.
Dr. Amy Patel: (00:40) Sure, well, I am a breast radiologist and medical director of the Women’s Imaging Center at Liberty Hospital, which is near Kansas city, Missouri area. So essentially my story is I grew up in very, very rural America, in rural Missouri. I thought that I was going to go back home eventually after medical school and residency and do some sort of primary care and emphasis on women’s health because I always had such an interest in women’s health. And then once I hit medical school in my second to last year of medical school, I had a mentor that took me under her wing and she said, “You know, I think you’d be really good at breast imaging and it sort of opened up my world because it had everything I’ve wanted. Patient interaction, I could have all this freedom to do procedures for breast disease and as well as all of the things that we do at the workstation, the diagnostic capabilities and it’s such a transformative field.
(01:41) Every year we’re finding new things in the field of breast imaging, new technologies. Very exciting and so I ended up training in the Midwest and then I actually went out to Boston, Massachusetts to practice, and I was working for Harvard. It was a wonderful experience, but I knew that there was such a need for sub-specialized breast care, particularly in the Midwest and where I grew up. So essentially a really amazing leadership opportunity presented itself to me to come back to the area in which I was raised. Come back to the Kansas city area to provide that care and to lead this breast center and consequently we are now serving the entire Northwestern Missouri in addition to where we are in the North Kansas city area. So I really feel that I’m making an impact that I never saw earlier in clinical practice and I think that’s what we need to do as breast radiologists. We have that sub-specialized skill set. It’s wonderful to be saturated in very big cities, but there’s still so many areas in this country that are desperate and really need us to be there to help them and to save lives.
Adam: (02:47) That’s right, that’s right. I love what you’re doing. It’s really amazing that you’re getting to do that and make such a huge impact. So let’s talk a little bit about the common myths around breast cancer, so what are some of the most common myths that you hear about breast cancer in your practice?
Dr. Amy Patel: (03:04) So there’s just such a plethora of myths and as a breast radiologist, I’ve really taken it upon myself to get out and really implement very, very aggressive community outreach because there’s just so many misconceptions and I think as well, it varies per patient demographic. If you particularly serve populations that education level may not be as high or they just have not been privy to education I think it’s really important for us to get out there so I do a lot of lunch and learns and things like that. Evening events to really educate the public, but the most frequent ones I hear are, deodorant causes breast cancer. So I’ll have a lot of women say, “You know I [invent? 03:49] my own deodorant so I won’t get breast cancer,” but there’s really no scientific evidence that commercial deodorant products cause breast cancer.
(03:58) I mean I use Secret myself. So there was one study that was done almost over a decade ago that shows no links between commercial deodorant products inducing breast cancer, so that’s a complete myth and I try to tell my patients, that’s great if you want to make your own deodorant but it’s not going to hurt you to use any sort of commercial product. Another one that I get a lot is breast pain means I have breast cancer, but very little studies show a correlation between breast pain and cancer typically, and that’s not to say that we don’t see cases of women who have breast cancer and experienced pain, but typically some of those women have a more aggressive type of breast cancer. You’ll see skin changes, things like that so I try to reassure women. I always say regardless, if you feel something is off, please get it examined. I’m not saying disregard it, but if you can come in and also provide that reassurance that we’ve evaluated you, there’s nothing there and then give them these statistics, and usually it really is [inaudible 05:03]fears.
(05:03) Another one that I get all the time is when I give the patient the diagnosis, a lot of times patients are shell shocked. They’ll say, “Well, I don’t have a family history? How could this happen to me?” Well, that’s another misconception, 75% of breast cancers that are diagnosed are actually [sporadic? 05:22] and only 25% are inherited and most patients in the community do not know that statistic so it’s really important that we as breast radiologists let patients know that, and [inaudible 05:35] that really demonstrates how imperative it is to have routine annual mammography screening because of that.
(05:42) And then another myth that I see particularly in my part of the country is thermography. Women go and get their thermogram and then they see something and then somehow they end up with [inaudible 05:53] or one of the other breast [inaudible 05:56] and they think that thermography is just as effective as breast cancer. But we know as a breast cancer community the only screening tool with a proven mortality benefit is mammography, and we know that thermography is not a substitute. The OCA has come out and said this. Thermography does pick up on the heat that’s emanated from the soft tissues of the breast. However, the problem with that is it only detects the superficial heat that’s emanating off a breast.
(06:25) Well, where do most breast cancers arise from, particularly in posterior deeper parts of the breast. So there’s upper outer, lower inner and so it’s not going to detect a lot of those breast cancer, so it’s really not an efficacious thing. Unfortunately, I do think people are profiting off of patients saying thermograms are just as effective, so again, it’s another myth we have to get out there and educate the community about.
Adam: (06:49) That’s right. Wow, that’s a lot of myths and I think you just debunk them all really efficiently so I really appreciate that. That’s great.
Dr. Amy Patel: (06:58) You’re welcome, yeah.
Adam: (06:58) Well, let’s talk just for a minute about diagnostic mammograms. So let’s say someone gets called back to the doctor’s office for a diagnostic mammogram or when they present with a symptom and they go in, they have a diagnostic mammogram at the initial encounter, often their minds go to the worst place. Can you educate us on any statistics or probabilities that are surrounding that?
Dr. Amy Patel: (07:18) Yeah, so I mean really the majority of callbacks are going to end up or call back, meaning that the patients have been for a routine screening mammogram, no symptoms, and then we see something and we call them back. The majority of those end up amounting to nothing. Either their examines have been negative after their full evaluation that day or the patient may go on to biopsy [inaudible 07:43] benign. So I try to put that into perspective for women and then particularly you can really dice it down depending on a finding, so like for example, an asymmetry is a one view finding, whether you see it on one view called a craniocaudal view or one view caudomedial lateral [bleak? 08:03].
(08:04) If you see an asymmetry one view finding your chance of it being anything is about 20%, and then it’s even lower if it’s on that MLO view, the medial-lateral bleak compared to the CC. So I mean there’s so many little statistics with that, but I do tell patients if they do want more education on it, one in eight women will be diagnosed with breast cancer in her lifetime and one in six from ages forty to forty-nine, so it’s important to address any symptom or if you don’t have a symptom coming in for your routine mammogram, but just know that the majority of the time it’s usually going to end up being nothing and it’s particularly nothing, depending on what kind of finding it is that you’re calling the patient back for.
Adam: (08:52) Right, that’s great. So is it true that patients don’t have time to get a second opinion because they must begin treatment as soon as possible?
Dr. Amy Patel: (09:01) That is not true. So typically studies at this time are demonstrating that you don’t really see any sort of transformation, particularly to breast cancer for about sixty to ninety days. Now that doesn’t mean that there aren’t some breast cancers that can biologically progress a lot faster. Obviously, if a woman has triple-negative breast cancer we know that those are more biologically aggressive cancers, then we need to move, but in terms of like, let’s say a woman wants a second opinion and she’s scheduled the following week, I mean a week is not going to make a difference in terms of a formidable treatment plan. So I tell patients that if they do want a second opinion, go ahead, get that second opinion. Don’t be nervous that you’re putting off treatment and then you can make the best-informed decision for yourself so absolutely not. You can most certainly get a second opinion before deciding which treatment plan you want to go with.
Adam: (09:58) Yeah, I love that and I think that’s smart. I appreciate you dispelling that myth, so the next misconception. It’s a common misconception that either everyone diagnosed with breast cancer dies from breast cancer or alternatively that everyone diagnosed with breast cancer survives. Can you touch on that for us and just kind of give us the statistics around that?
Dr. Amy Patel: (10:18) Sure, so bottom line to this question is early detection is so imperative. So we know that if you are diagnosed with breast cancer, and we can find it incredibly early on screening mammography where the tumor, the breast cancer is less than a centimetre, their survival probability is greater than 95% so they’re not going to die of breast cancer. Typically they will die of something else in their life and if that would be considered stage one would be particularly a cancer that’s about less than a centimetre.
(10:51) Now conversely though, if you have a tumor that you present with that’s over five centimetres, their survival probability really does plummet and especially if you have [inaudible 11:02], you’re at stage fours. The key to that is that like I said, early detection that’s why as a breast cancer community we just come out so aggressively about it because we know that they could fix and we know if we can catch that breast cancer while [inaudible 11:15] the patient has a much, much greater survival probability.
Adam: (11:20) Hmm, that’s great. I appreciate that. Okay, so more myths. It’s widely thought that breast cancer only affects women over the age of forty, but I even know from hosting this podcast that that’s not true. So can you talk a little bit about that myth as well?
Dr. Amy Patel: (11:35) Absolutely, so in April of 2018 the American College of Radiology and the Society of Breast Imaging came out with new guidelines for above-average risk women and we recommend now in this country that any woman of any color is risk assessed for breast before the age of thirty because we feel that at this time in this country we are underestimating breast cancer risk. And then if you are risk assessed and you are deemed high risk, we are recommending annual screening mammography beginning at age thirty, alternating every six months with supplemental screening in the form of breast MRI or breast ultrasound.
(12:16) So we’re really trying to get aggressive, like I told you that statistic one in six women we diagnosed with breast cancer from ages forty to forty-nine, there’s still so much research to be done, particularly researching women from ages thirty to thirty-nine and consequently what we’re seeing across this country, is there are states that are passing legislation to cover annual mammograms in high-risk women beginning at thirty. I mean recently Colorado passed legislation where a woman from the ages of thirty/thirty-nine has to be covered now for an annual mammogram if she’s deemed high risk.
(12:52) So we recommend that, the American College of Radiology deciding breast imaging, the American Society of Breast Surgeons, [inaudible 13:00] speciality breast groups, we’re recommending that you should receive receiving annual screening mammography if you’re an average-risk woman starting at age forty and continue to do so as long as you’re in good health and that now we’re also recommending that if you are deemed high risk by thirty that you do start receiving regular surveillance starting at age thirty. I will mention as well if you are particularly already deemed high risk by the age of twenty-five, if you are a bracket carrier or something that would be new high risk, check two mutation carriers that sort of thing, then we do recommend annual breast MRI from the ages of twenty-five to twenty-nine as well.
Adam: (13:41) Wow, that’s really good information and I think it’s never harmful to get checked, right. So I think a lot of times people put it off, they don’t think they need to, but it’s certainly not going to hurt to get checked, right?
Dr. Amy Patel: (13:54) Absolutely not. Like I say, regardless of what age you are, please, please get evaluated and particularly younger girls or younger women, we know that typically if they do feel a lump palpable if there is a mass it’s typically going to be a benign mass called a fibroadenoma, but it’s important to get checked because we do unfortunately see breast cancer in young women. I remember when I was a breast imaging fellow at Washington University in St Louis, I had a twenty-one year old African/American female with breast cancer, so best do not neglect your body, get checked out. Majority of the time it will be nothing, but it’s important just to get evaluated and have that additional reassurance.
Adam: (14:37) That’s great. Well, Dr. Patel, I have one final question for you. What words of advice can you offer those that have a breast cancer diagnosis?
Dr. Amy Patel: (14:47) Well, the words of advice that I’d like to offer is that you’re not alone. I think that whenever a woman is diagnosed with breast cancer, they’re just so beside themselves that their mind is just racing. There’s so many things involved and I just try to reassure them that you’re not alone. There is a village of physicians, of patient advocates here to help you and I really try to impress upon particularly my patients really, really utilize our nurse navigator. Breast oncology nurse navigators really are the, in my opinion, they really are the glue of breast program and they just provide incredible support and resources for patients and oftentimes the breast oncology navigator has even a more formidable, stronger relationship with the patient than the breast radiologist, the breast surgeon or the oncologist. It’s pretty incredible to see, so I try to tell patients, you’re not alone. We’re all here to help you to get you through this and we’re going to devise a formidable treatment plan to hopefully kick this.
(15:51) And so particularly if it’s a woman who has early breast cancer or something like that, you just have to provide reassurance that we can get this knocked out. Obviously, if it’s something that’s more advanced we use some sort of language, or at least I use some sort of language like, “You know, we’re going to do the best we can. You’re in the right place.” Just providing that reassurance that they’re not alone and we’re here to guide their breast cancer journey [inaudible 16:19] so, so important.
Adam: (16:18) Yeah, wow, that’s fantastic. Well, Dr. Patel, this has been amazing. I think in a very, very short amount of time you have dispelled a vast number of myths and I am very appreciative for that. Thank you so much for joining me on the show and I’d hope that we can do it again sometime.
Dr. Amy Patel: (16:34) Yeah, absolutely anytime.
Adam: (16:36) Thanks so much.
Intro and outro music is City Sunshine by Kevin MacLeod. Ad music is Blue Skies by Silent Partner. The Real Pink podcast is hosted by Adam Walker, produced by Shannon Evanchec and owned by Susan G. Komen.