Selected Podcast
What You Need to Know About Breast Health
Rachel F. Brem, MD, FACR, FSBI, discusses the various breast cancer screening options (mammography, ultrasound, MR, molecular breast imaging) and clears up some of the confusion surrounding the current mammography recommendations. Dr. Brem also explains the advances in biopsy procedures, as well as why early detection is crucial in preserving women's lives.
Featured Speaker:
Learn more about Rachel F. Brem, MD
Rachel Brem, MD
Rachel F. Brem, MD is the Chief of Breast Surgery and the Director of Breast Imaging and Intervention at The George Washington University Hospital and is affiliated with The George Washington University Hospital and GW Medical Faculty Associates.Learn more about Rachel F. Brem, MD
Transcription:
Dr. Mike Smith (Host): Welcome to GW Healthcast. I’m Dr. Mike Smith. The topic today, “What you need to know about breast health.” My guest is Dr. Rachel Brem. Dr. Brem is the Director of Breast Imaging and Intervention at the George Washington University Hospital and is affiliated with The George Washington University Hospital and GW Medical Faculty Associates. Dr. Brem, welcome to the show.
Dr. Rachel Brem (Guest): Thank you.
Dr. Smith: There are a lot of different recommendations out there for mammography. Can you summarize for us what those recommendations are? And how does a woman decide which recommendations to follow?
Dr. Brem: That’s a great question, and I really appreciate that you brought it up. There are many recommendations, and it’s very confusing. There have been a lot of changes, whether it’s the American Cancer Society or the USPSTF, or the American College of Family Physicians. What women need to know is the death rate from breast cancer has gone down by 35% in the last two decades, and a large part of that is due to screening mammography. What we know is that all of these organizations who have recommended starting at age 50 or less frequent mammograms also agree that more American women will die of breast cancer. What’s clear is that if a woman wants to optimize her chance of finding an early, curable breast cancer, the answer is to begin screening at the age of 40 and every year after that until their life expectancy is five years or less. Whether it be the American Cancer Society or the USPSTF whose recommendations have changed, they agree that more American women will die of breast cancer. That’s really a travesty, particularly since we’ve made such great headway.
The other thing that’s really concerning to all of us who are passionate about this is that the fear is that women are going to be confused because one recommendation is this and another recommendation is that. They may just throw up their hands and say, “Not doing it,” but that would really be a huge shame because what we will see is more American women dying of breast cancer.
Dr. Smith: Okay, so in general, for a woman who is at normal risk, we begin at age 40, and that’s your recommendation. What about for a woman who maybe is at higher risk? Maybe she's had a mom or a sister with breast cancer.
Dr. Brem: That’s a great question. One of the things that we know is that we don’t have a one-size-fits-all solution anymore. We have risk-based screening. If someone does not have dense breast tissue, no family history, a mammogram is enough. If they do have dense tissue – and there are now over 30 states that have laws that require women be told what their breast density is – we have additional screening like ultrasound that can find cancers that mammograms can. The reason dense breast tissue is so important is because not only does it make mammograms more difficult to see cancers in, but it also substantially increases the risk of a woman developing breast cancer. It’s kind of the perfect storm. We now have additional tools that can help us find these cancers that may not be seen with mammography.
And finally, for women who are at extremely high risk – women who have a very strong family history or who have the breast cancer gene – we have screening tools like MRI and molecular breast imaging that allow us to see even more cancers. We have a risk-based approach to screening for breast cancer.
Dr. Smith: You mentioned the breast cancer genes – gene or genes – is it recommended that women get checked for those genes regardless of risk or is it just simply looked at in only high-risk women?
Dr. Brem: We recommend that women who have breast cancer before the age of 50, or have breast cancer in both breasts, or many family members see a genetic counselor. In that way, they can get the best counseling and approach towards finding which gene might or might not be in their family and in their genomic makeup.
Dr. Smith: When we go back to mammography if something is found, can you walk us through the next steps?
Dr. Brem: Yes, absolutely. The first thing women need to know is if they do find something it doesn’t mean you have breast cancer. More often than not, and in the vast majority of the time, it will just require another mammogram or another evaluation, ultrasound, and then we can clear it. If a woman does need a biopsy, she should know that at the George Washington Breast Center – the Comprehensive Breast Center – 100% of the breast biopsies are done with a needle. Nobody goes to the operating room for a diagnosis anymore, and that’s the way it should be because we get a faster, better, less invasive approach to equally accurate diagnosis.
The other thing that women need to know is that should the biopsy – and the biopsy is like going to the dentist. There’s no IV; people often go right back to their desk after the biopsy – and the other thing that women should know is that early breast cancer is a curable disease. There are over 3 million women in the United States today who are thriving after breast cancer. That is why mammography is so important because 95% of early breast cancer is curable, and therefore, it’s a very hopeful situation when someone is diagnosed with early breast cancer. Women, get your mammograms.
Dr. Smith: Yeah, great advice. And we touched on this a little bit, Dr. Brem, but what do you think is going on that is keeping women away from mammography? Are they hearing stories about the radiation? Is it just they’re confused? What do you think is playing here?
Dr. Brem: I think – women should know that the radiation from a mammogram is regulated by law, and you get more radiation flying to California several times than you do from a mammogram. All of us would opt to go to California for the right situation. [LAUGHTER]. The radiation is really – although, we are very vigilant, and again, it is regulated by law. We’re very careful to make it as low as possible. We get more just be living here on Earth. That’s a very important thing to remember.
I think it’s the confusion. I think people are hearing different things. Their doctors aren’t perhaps focusing on mammography as much, but it’s really critical for women to know that this is really an opportunity for them to be empowered and to be able to save their lives. The other thing that women really need to understand is if you read the statistics about breast cancer – we have really powerful chemotherapeutic agents now, and that’s a wonderful thing -- but a woman who is diagnosed with an early, mammographically detected breast cancer – or imaging detected breast cancer who has surgery and is back at work three or four weeks later is very different than a woman who is diagnosed with node-positive disease and has to go through aggressive chemotherapy to come to the same results of a cure. We have to think about this concept of intensity of care, which is what does the woman have to go through to be cured of breast cancer, which is another compelling and really critical reason that women should go for their mammogram. Given a choice between a mammographically detected, early breast cancer or a curable, later-stage breast cancer with aggressive chemotherapy, I’m confident that people would opt for the former.
It’s also important to remember that people like Robin Roberts who developed a second cancer from that aggressive chemotherapy. What we’re trying to do is maximize the cure and minimize the intensity of care. That’s why it’s so important that women get their screening mammogram.
Dr. Smith: Yeah, early detection is key, right?
Dr. Brem: Early detection is cure.
Dr. Smith: Yeah, very good. Let’s talk a little bit about the GW Mammovan. Why is that important?
Dr. Brem: The GW Mammovan is really important because here in D.C., we have the highest death rate from breast cancer in the country, and not by a little. It’s us, and then there’s a big gap, and then a number of the deep south states like Louisiana, Mississippi, and Alabama. We don’t know exactly why that is, but we do know that GW is committed to breaking down every barrier to offer women life-saving mammograms. The van goes to the communities – we partner with faith-based and community leaders. We offer free mammograms for women who can’t afford their mammograms, and we do it in a culturally sensitive – with bilingual navigators – in a culturally sensitive way so that we really can offer women the opportunity for an early cure.
I also want to talk for a second about the GW Comprehensive Breast Center.
Dr. Smith: Sure.
Dr. Brem: It’s really a very unique place that addresses the entire woman. All of the physicians here are dedicated only to breast cancer. All I do – and we have six physicians – all I do is breast imaging. We have three full-time breast surgeons who do nothing but breast cancer, and they’re all women. And we have three medical oncologists, who also happen to be women, who are dedicated to breast cancer.
The other piece about it is that virtually all of us here at the Breast Center, the physicians have been personally impacted by breast cancer in a very personal way. I had breast cancer myself 21 years ago. This is just not – not only are we committed to it because it’s so important, but we’re all very passionate about it, and we approach women in a holistic way that allows us to look at the whole patient. We happen to do it in a beautiful environment in our beautiful new Breast Center.
We try to address the needs of all women in our community at all socioeconomic levels and try to look at the person in totality and try to offer them everything they need.
Dr. Smith: Right. In summary, Dr. Brem, what would you like people to know about breast health?
Dr. Brem: I would like people to know that breast cancer is a curable disease especially when it’s caught early. There is a great deal of confusion out there, but it’s really critical for women to get screened so we can find early, curable breast cancer that’s treated in the least aggressive way.
Dr. Smith: Dr. Brem, thank you so much for the work that you’re doing, and thank you for coming to the show today. You’re listening to GW Healthcast. Please visit GWDocs.com to get connected with Dr. Brem or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment. Thanks for listening.
Dr. Mike Smith (Host): Welcome to GW Healthcast. I’m Dr. Mike Smith. The topic today, “What you need to know about breast health.” My guest is Dr. Rachel Brem. Dr. Brem is the Director of Breast Imaging and Intervention at the George Washington University Hospital and is affiliated with The George Washington University Hospital and GW Medical Faculty Associates. Dr. Brem, welcome to the show.
Dr. Rachel Brem (Guest): Thank you.
Dr. Smith: There are a lot of different recommendations out there for mammography. Can you summarize for us what those recommendations are? And how does a woman decide which recommendations to follow?
Dr. Brem: That’s a great question, and I really appreciate that you brought it up. There are many recommendations, and it’s very confusing. There have been a lot of changes, whether it’s the American Cancer Society or the USPSTF, or the American College of Family Physicians. What women need to know is the death rate from breast cancer has gone down by 35% in the last two decades, and a large part of that is due to screening mammography. What we know is that all of these organizations who have recommended starting at age 50 or less frequent mammograms also agree that more American women will die of breast cancer. What’s clear is that if a woman wants to optimize her chance of finding an early, curable breast cancer, the answer is to begin screening at the age of 40 and every year after that until their life expectancy is five years or less. Whether it be the American Cancer Society or the USPSTF whose recommendations have changed, they agree that more American women will die of breast cancer. That’s really a travesty, particularly since we’ve made such great headway.
The other thing that’s really concerning to all of us who are passionate about this is that the fear is that women are going to be confused because one recommendation is this and another recommendation is that. They may just throw up their hands and say, “Not doing it,” but that would really be a huge shame because what we will see is more American women dying of breast cancer.
Dr. Smith: Okay, so in general, for a woman who is at normal risk, we begin at age 40, and that’s your recommendation. What about for a woman who maybe is at higher risk? Maybe she's had a mom or a sister with breast cancer.
Dr. Brem: That’s a great question. One of the things that we know is that we don’t have a one-size-fits-all solution anymore. We have risk-based screening. If someone does not have dense breast tissue, no family history, a mammogram is enough. If they do have dense tissue – and there are now over 30 states that have laws that require women be told what their breast density is – we have additional screening like ultrasound that can find cancers that mammograms can. The reason dense breast tissue is so important is because not only does it make mammograms more difficult to see cancers in, but it also substantially increases the risk of a woman developing breast cancer. It’s kind of the perfect storm. We now have additional tools that can help us find these cancers that may not be seen with mammography.
And finally, for women who are at extremely high risk – women who have a very strong family history or who have the breast cancer gene – we have screening tools like MRI and molecular breast imaging that allow us to see even more cancers. We have a risk-based approach to screening for breast cancer.
Dr. Smith: You mentioned the breast cancer genes – gene or genes – is it recommended that women get checked for those genes regardless of risk or is it just simply looked at in only high-risk women?
Dr. Brem: We recommend that women who have breast cancer before the age of 50, or have breast cancer in both breasts, or many family members see a genetic counselor. In that way, they can get the best counseling and approach towards finding which gene might or might not be in their family and in their genomic makeup.
Dr. Smith: When we go back to mammography if something is found, can you walk us through the next steps?
Dr. Brem: Yes, absolutely. The first thing women need to know is if they do find something it doesn’t mean you have breast cancer. More often than not, and in the vast majority of the time, it will just require another mammogram or another evaluation, ultrasound, and then we can clear it. If a woman does need a biopsy, she should know that at the George Washington Breast Center – the Comprehensive Breast Center – 100% of the breast biopsies are done with a needle. Nobody goes to the operating room for a diagnosis anymore, and that’s the way it should be because we get a faster, better, less invasive approach to equally accurate diagnosis.
The other thing that women need to know is that should the biopsy – and the biopsy is like going to the dentist. There’s no IV; people often go right back to their desk after the biopsy – and the other thing that women should know is that early breast cancer is a curable disease. There are over 3 million women in the United States today who are thriving after breast cancer. That is why mammography is so important because 95% of early breast cancer is curable, and therefore, it’s a very hopeful situation when someone is diagnosed with early breast cancer. Women, get your mammograms.
Dr. Smith: Yeah, great advice. And we touched on this a little bit, Dr. Brem, but what do you think is going on that is keeping women away from mammography? Are they hearing stories about the radiation? Is it just they’re confused? What do you think is playing here?
Dr. Brem: I think – women should know that the radiation from a mammogram is regulated by law, and you get more radiation flying to California several times than you do from a mammogram. All of us would opt to go to California for the right situation. [LAUGHTER]. The radiation is really – although, we are very vigilant, and again, it is regulated by law. We’re very careful to make it as low as possible. We get more just be living here on Earth. That’s a very important thing to remember.
I think it’s the confusion. I think people are hearing different things. Their doctors aren’t perhaps focusing on mammography as much, but it’s really critical for women to know that this is really an opportunity for them to be empowered and to be able to save their lives. The other thing that women really need to understand is if you read the statistics about breast cancer – we have really powerful chemotherapeutic agents now, and that’s a wonderful thing -- but a woman who is diagnosed with an early, mammographically detected breast cancer – or imaging detected breast cancer who has surgery and is back at work three or four weeks later is very different than a woman who is diagnosed with node-positive disease and has to go through aggressive chemotherapy to come to the same results of a cure. We have to think about this concept of intensity of care, which is what does the woman have to go through to be cured of breast cancer, which is another compelling and really critical reason that women should go for their mammogram. Given a choice between a mammographically detected, early breast cancer or a curable, later-stage breast cancer with aggressive chemotherapy, I’m confident that people would opt for the former.
It’s also important to remember that people like Robin Roberts who developed a second cancer from that aggressive chemotherapy. What we’re trying to do is maximize the cure and minimize the intensity of care. That’s why it’s so important that women get their screening mammogram.
Dr. Smith: Yeah, early detection is key, right?
Dr. Brem: Early detection is cure.
Dr. Smith: Yeah, very good. Let’s talk a little bit about the GW Mammovan. Why is that important?
Dr. Brem: The GW Mammovan is really important because here in D.C., we have the highest death rate from breast cancer in the country, and not by a little. It’s us, and then there’s a big gap, and then a number of the deep south states like Louisiana, Mississippi, and Alabama. We don’t know exactly why that is, but we do know that GW is committed to breaking down every barrier to offer women life-saving mammograms. The van goes to the communities – we partner with faith-based and community leaders. We offer free mammograms for women who can’t afford their mammograms, and we do it in a culturally sensitive – with bilingual navigators – in a culturally sensitive way so that we really can offer women the opportunity for an early cure.
I also want to talk for a second about the GW Comprehensive Breast Center.
Dr. Smith: Sure.
Dr. Brem: It’s really a very unique place that addresses the entire woman. All of the physicians here are dedicated only to breast cancer. All I do – and we have six physicians – all I do is breast imaging. We have three full-time breast surgeons who do nothing but breast cancer, and they’re all women. And we have three medical oncologists, who also happen to be women, who are dedicated to breast cancer.
The other piece about it is that virtually all of us here at the Breast Center, the physicians have been personally impacted by breast cancer in a very personal way. I had breast cancer myself 21 years ago. This is just not – not only are we committed to it because it’s so important, but we’re all very passionate about it, and we approach women in a holistic way that allows us to look at the whole patient. We happen to do it in a beautiful environment in our beautiful new Breast Center.
We try to address the needs of all women in our community at all socioeconomic levels and try to look at the person in totality and try to offer them everything they need.
Dr. Smith: Right. In summary, Dr. Brem, what would you like people to know about breast health?
Dr. Brem: I would like people to know that breast cancer is a curable disease especially when it’s caught early. There is a great deal of confusion out there, but it’s really critical for women to get screened so we can find early, curable breast cancer that’s treated in the least aggressive way.
Dr. Smith: Dr. Brem, thank you so much for the work that you’re doing, and thank you for coming to the show today. You’re listening to GW Healthcast. Please visit GWDocs.com to get connected with Dr. Brem or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment. Thanks for listening.