The Breast of Everything

What women should want to know about their breast health

February 17, 2021 Comprehensive Breast Care Season 1 Episode 11
The Breast of Everything
What women should want to know about their breast health
Show Notes Transcript

Repeatedly, in our office, we hear the same questions and concerns from women about their breast health. Sugar causes cancer; underwire bras shouldn’t be worn; don’t use deodorant; if there is no family history of breast cancer, I won’t get it; I’m too young to get breast cancer … we hear the same misconceptions over and over. Social media doesn’t help. Friends share fabricated cancer horror stories, and the epidemic of bad information intensifies. 

During The Breast of Everything podcast, Comprehensive Breast Care Surgeons Linsey Gold, DO; along with Ashley Richardson, DO; set the record straight on breast health and what women should want to know about their breasts and breast cancer.

Here are a few highlights from the podcast:

Sugar does not cause cancer, underwire bras do not cause cancer and wearing deodorant does not cause cancer. When women go for a mammogram, they are told not to wear deodorant, antiperspirant or other lotions or powders under their arms or in the chest area because these products may contain metallic substances (usually from aluminum in the product) that resemble calcifications, which show up as bright white specs or dots on the mammogram. Sometimes calcifications in the breast can mean an early cancer is developing. 

Breast cancer risk-reduction products you may see on the shelves of stores will not reduce your risk of breast cancer. 

Many women overestimate their risk for breast cancer, while others underestimate their risk. For example, if your grandmother had breast cancer when she was in her 70s, that does not necessarily mean you are at high risk for getting breast cancer. Don’t overestimate this, but also don’t overlook it. Learn what your risks are, and what risk reduction strategies you can take by talking with your health care provider. 

Some risk reduction strategies include monthly breast self-exams, reducing your body mass index (BMI) and knowing your family history of cancer. Remember to look at your entire family history (not just your mother’s) and all cancers in the family, not just breast cancer.

Talk with your family physician about genetic testing if you are concerned about your family’s cancer history. Today, testing can be conducted for more than 80 different gene mutations and the cost can be as little as $250.

The breast surgeons also find that many women go on auto pilot after breast cancer surgery and treatment, thinking they are cured. They need to continue regular imaging tests, stay active, eat right and follow their physician’s post cancer recommendations.
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The surgeons of Comprehensive Breast Care recently launched “The Breast of Everything” podcast series as a trusted resource for breast health information, support and encouragement.

If you have a subject you would like the surgeons to discuss, please email your ideas to compbreastcare.com. The doctors want to hear from you. 

The views, thoughts and opinions shared in these podcasts are intended for general educational and informational purposes only and should not be substituted for medical advice, treatment or care from your physician or health care provider. Always consult your health care provider first. 

Unknown Speaker  0:01  
Welcome to the breast of everything podcast your trusted resource for breast health information support and encouragement. Your host today are Dr. Lindsay gold. And Dr. Ashley Richardson of comprehensive breast care. Welcome.

Unknown Speaker  0:15  
Hello, everybody. Welcome to the breast of everything podcast. Thank you so much for joining us today. I am one of your hosts, Dr. Lindsay gold, and I am joined by my co host, Dr. Ashley Richardson. Hello, everyone.

Unknown Speaker  0:29  
We're so glad that you are here with us today to talk about risk factors for breast cancer. We could probably talk a three or four podcasts on this. But we're going to start out by dispelling some of the myths that we hear routinely in the office about what people think are risk factors for breast cancer. Probably one of the most common ones. I'm gonna think it and Ashley, you say it and I bet it's the same thing. What's the most common thing you hear about a myth for breast cancer? You know, I

Unknown Speaker  1:07  
always people always ask me if they're deodorant causes breast 100% the deodorant. They always ask me if sugar causes their breast cancer. You know, there's so many of them and people are really religious to what they hear on the social media and also with their friends. And so all they have to hear is that deodorant causes breast cancer and they come to the office smelling horribly because they don't wear any deodorant into the office. Yes. And I immediately tell them please go get that out of my glove box and put the deodorant because I have some in my drawer and in my glove box. Yes,

Unknown Speaker  1:41  
yet deodorant does not cause breast cancer. Putting cell phones in your bra does not cause breast cancer. Wearing underwire bras does not cause breast cancer. And the list goes on and on. So you know the deodorant thing is funny. Um, my personal feeling is that maybe this got started because when you go to get a mammogram, they tell you not to wear deodorant. And so maybe the leap from that was Oh, it must cause breast cancer. I have no idea where that myth got started. But the reason they tell you not to wear deodorant, when you go to get a mammogram is because all deodorant has aluminum in it. Little aluminum flex, and aluminum is a metal. So it looks like white little flex on the mammogram. And remember, they're looking for calcifications on a mammogram is one of the earliest signs of cancer. So if you wear deodorant, and you have white aluminum flex, they can't tell the difference. radiologists can't tell the difference between if it's, you know, calcifications or your to your aluminum from your deodorant. Anyway, that's the deodorant story. So there are well and I

Unknown Speaker  2:59  
I'm sorry to interrupt, but I also think there's so much out there about healthy products, right? Eating and drinking and ingesting things that are all healthy for you. There's all kinds of beauty companies out there that promote natural products. And deodorant also falls into that. So when ladies are buying natural makeup and natural lotions for their face, the deodorant sitting right next to that, so then it's advertised as, you know, risk reduction for breast cancer. And at the end of the day, there's just nothing from a literature perspective to support that correct. You know, many women overestimate their own risk for breast cancer. But by the same token, a whole host of women also underestimate their risk for breast cancer.

Unknown Speaker  3:43  
So a common scenario that I'll see for overestimation is a young woman in her 20s, who comes in for, let's say, breast pain or cyst or something that cancer and maybe she had a grandmother, her mom's mom had breast cancer, you know, in her mid 70s. And this young woman will frequently feel that she has a significantly elevated risk for breast cancer. And that causes her worry about her breast complaint. And I, you know, we take a very thorough family history, of course, multiple generations. And most of the time, people really don't have more than average risk, but they think because they have one family member or a cousin, that they have a significant increased risk.

Unknown Speaker  4:42  
And I think that brings up a good point that it's always so important to really know your family history. We're now in a generation where people really actually share more with their family members about their diagnosis and things that they may have gone through, even if it's several years back. I know when my grandparents around, they didn't really talk about their medical history. We never really knew what was going on with them. But nowadays, more people are willing to communicate with their family members just say, Hey, I was diagnosed with this, I may or may not have had a genetic mutation, and this is what you should do about that. So it's really important to reach out to family members and ask them, Hey, I heard you, you know, may have had breast cancer 1012 years ago, can you tell me a little bit more about that, because then you can really get a better assessment of what your own risk is, if you truly know your family history. The also is the the young patient that was adopted, you know, they get very concerned when they have breast pain or new onset nipple discharge, and they don't know their family history, and they can't because they're adopted. So those ladies often present in a state of panic, wanting to know what else they can do to decrease their risk for breast cancer.

Unknown Speaker  5:44  
Yes, absolutely. And it is a common misconception that only a mom's family history is important. A lot of people don't understand that a genetic predisposition for breast cancer and abnormal gene can actually be passed through the dad's side of the family. So it's really important when taking family histories or like you just said, actually, when you're, you know, finding out about your own family history, that you go both dad side, and mom's side, right, because either side can give a genetic mutation. So of all the ladies who are diagnosed with breast cancer in any given calendar year 10% or less have breast cancer that we believe is a direct cause of having a genetic mutation. So the corollary to that is that in 90% of people, we don't really know exactly what caused the breast cancer. However, there's a whole host of things that can contribute to risk. Right?

Unknown Speaker  6:59  
Well, and I think the other thing that you mentioned, when you mentioned that 10%, is, people really do not realize that a majority of breast cancer is not due to a genetic mutation, they almost all believe that that number is substantially higher. And the other thing when I'm talking to patients within a new consultation, I always say, let's talk about your family history, and not just breast cancer, I want to know about colon cancer, pancreatic cancer, ovarian cancer, because a lot of our gene mutations also cause other cancers, as well as breast cancer. So I'm not interested in just the breast cancer history, but the whole overall cancer history in the family. And that's another kind of eye opening piece for patients that they don't realize until you sit down and talk with them that, oh, yeah, I've had four family members with colon cancer, and that same gene mutation could have caused their colon cancer and cause my patients breast cancer.

Unknown Speaker  7:47  
Yes, that's absolutely true. I mean, how, how often do you hear somebody diagnosed with an early stage breast cancer? Who says, I'm just shocked? I don't understand. I don't, how did I get this? I have no breast cancer in my family. And then we say what we just said, right? The majority of people don't have a family history and don't have a genetic mutation. But you're right, when you go to take an extensive history, maybe they have only men in their family, and they all had early onset prostate cancer, right? So there's also things like limited family structures, right? If the previous three generations only had one child in each generation, or maybe people died young from, you know, any other cause. They didn't live long enough to manifest the disease. So there's lots of different components that go into a history. And sometimes, of course, you know, we send people to genetic counselors for that reasons. But we do you know, you and I both do a lot of genetic testing in the office, right. We believe that we believe basically in Universal genetic testing, which for the most part today means that any patient diagnosed with breast cancer ever, maybe 10 years ago, treated, you weren't offered genetic testing, you should have genetic testing, if you desire it. And then every new cancer that comes in, I offer genetic testing to regardless of family history. And I think that's pretty important. Yeah,

Unknown Speaker  9:26  
I absolutely do the same. And I think you hit a good point that, you know, when I see a lady, that's just let's say she had cancer 10 years ago, one of the first things I'll say was, did you have genetic testing when you are first diagnosed? And what did they test for? Because 10 years ago, we were only testing for a couple of the genes most significantly, the braca, one and two gene mutation. And nowadays, we test for up to 80 different genes that can cause multiple cancers. So those folks that were even if they were tested 10 years ago, they're eligible to retest, and most likely, it's always covered by insurance. And the other thing that I explained to all the ladies when we talk about universal genetic tests, As the financial cost because obviously there can be a burden there. But I know in both of our offices, that company that we use the most out of pocket cost is about $250, which is a lot of money, but it's substantially decreased over the last several years to make it more affordable and be less of a financial burden. So I think once you explain that to patients and kind of get down to the details of cost, and finding out the information, almost all of the ladies want to know, whether it will affect them or their children or their siblings. Exactly, you know, a mirror, I

Unknown Speaker  10:31  
think, five years ago, the out of pocket cost of genetic testing was, you know, $4,000, or more so, you know, clearly cost prohibitive for, you know, the vast, vast majority of people and it wasn't covered by a lot of insurances. But now, in VA, the company we use, they're wonderful, right? It's actually free for Medicare, and Medicaid, and the out of pocket costs. If your plan doesn't cover it is like you say we say down to $250, which Yes, is a lot of money. But, you know, maybe in the grand scheme of your total health and health care costs, it's more palatable than, you know, four or $5,000. But most of the time, we plan in a new cancer patient for it to be negative, right? Because 90 plus percent of the time, it's going to be negative, right? Of course, there are those ladies who will have a positive diagnosis, right, either. It's a surprise because nobody in their family had been diagnosed, I just had that recently, a young lady who was adapted, and then happened to have had a genetic mutation. Or maybe they do have a strong family history. And you're kind of anticipating that there could be an abnormality, and then it comes. So that requires a whole different discussion, right, from a recommendation perspective of their cancer, and it has meaning for all of their family, all of their blood relatives.

Unknown Speaker  12:08  
Well, and I think of you, I think you're bringing up a good point to where before we talked about those new patients that overestimate their risk, and then we often will see some that underestimate their risk, or they'll come in and have a new diagnosis. And we'll start talking about their family tree. And in my head, red flag after red flag after red flag for a possible genetic mutation is going off. And I will say to them, you know, I think there's a strong likelihood that there's a genetic mutation here, especially if they know of an aunt or grandmother that did have a genetic mutation. And unfortunately, a lot of patients will just say, I knew that they had a bracha mutation, I just didn't know what that meant. And a lot of that then becomes for them to empower their family members to say, Hey, now I know I have this and you all need to test and so there are those that under estimate their risk, and also those that overestimate their risk. And like you said, it does change the consultation significantly in the discussion for surgery, because oftentimes, we will counsel ladies, if they have a genetic mutation, about undergoing a bilateral mastectomy, removing the cancer side as well as prophylactically taking off the opposite breast to decrease their risk in the future.

Unknown Speaker  13:16  
Yes, correct. That is an important option for ladies who do have certain genetic mutations. So there are some other factors. Besides genetics, of course, that will contribute to a patient's risk. And a lot of times we don't know who has these various risk factors and they're found incidentally. So for example, ladies are getting their screening mammogram and they have an abnormality, and then they get a biopsy. And the needle biopsy report says you have a typical ductal hyperplasia or a typical lobular hyperplasia or anything atypical. So that means abnormal, right? We know that there are findings on a cellular level that will increase risk for breast cancer. And we can manage those ladies differently if we know that those findings are there.

Unknown Speaker  14:18  
Well, especially when we talk to them about our tibia. What do we do for that? And so oftentimes, I know yourself in the office, as well as I will recommend ladies that will often go to surgery to make sure that there's no other abnormal findings in that area of atypia. And then once we know that there's no malignancy or cancer in the breast, and we talk about how do we manage them going forward, and that's really risk reduction strategies. We know when you have a typical cells that your risk for breast cancer is slightly higher than that of the average population. So we want to follow you differently to try and catch something sooner and be more proactive to decreasing your risk. One of the biggest things I talked to ladies about is something as simple as monthly self breast exams. I know that over For the years, sometimes that's been discounted. But I truly believe in the utility and the value of a monthly self breast exam. And so all counsel ladies on how to do a normal self breast exam, I also counseled them to always turn and look in the mirror, which that is difficult for all of us. But it's the turn and look in the mirror, because oftentimes, you will see things before you feel them. So if all of a sudden your nipples pointing towards the ceiling instead of the floor, well, that's a change, right? And Yep, and that it may indicate an underlying problem. And patients are always amazed. You know, I say, if you lift your arm up to do your hair, and you have a big divot in your breast, that's concerning. So you know, sometimes it behooves us to stand naked in front of the mirror, because you'll see things that you might not feel,

Unknown Speaker  15:42  
yep, look at them and feel them, as it were. So when ladies are identified as high risk for any reason, but let's take the a typical sells, for example. There are risk reducing strategies, right, just like you said, there's not a ton of things that a person can do themselves to actively reduce risk. But there are some, and one of the biggest ones is to maintain normal body mass index. So basically, being overweight, obesity, severe obesity, morbid obesity, any level is a significant increase risk for not only breast cancer, but a multitude of other cancers. And, you know, losing weight is hard. If it was easy, everybody would do it. So it's, you know, by no means Can you just say, Okay, I'm going to lose weight. But if you need to be motivated by something, be motivated by knowing that losing weight, and being, you know, your normal body weight is actually healthy for you and will significantly reduce risk for breast cancer. And that's one thing we can control.

Unknown Speaker  17:04  
Yeah, I think patients are always looking for something they can do, specifically after a diagnosis. So they've gone through surgery, they've gone through radiation, and they're now kind of on autopilot. And they say, Well, what can I do to prevent this? What can I do to prevent a recurrence, and I always counsel them about maintaining a healthy weight, not only does it make you feel better, it makes you look better. And overall, it just increases your health. And so I think I really, really instill patients to get out there, get walking, just get doing something every day, that helps not only decrease your risk factors, but makes you feel better. Also, they also always worried about additional imaging, everybody thinks that after a diagnosis or even a diagnosis of atypia, well, I should be getting a mammogram every six months. So I spent a lot of time talking to them about risk reduction reduction with imaging. And so oftentimes, we'll counsel them about an annual screening mammogram, in addition with a breast MRI. And we'll usually set up ladies on a rotating schedule every six months. So each imaging modalities once a year, but every six months, so like a mammogram in June and an MRI in January. And so absolutely.

Unknown Speaker  18:11  
breast MRI is a very important part, I think of a screening for a high risk woman, it's of course, you know, not offered in every corner of the earth because it is advanced technology. But I would say all major metropolitan areas would have access to breast MRI. If you don't know about it, then you can't ask your provider about it. But it's probably the best technology that we have to diagnose breast cancer. And of course, in a perfect world where no insurance companies exist, then we would all get breast MRIs. Well, we don't live in that world. And we're not going to so of course, we sort of save, if you will, this technology for our highest risk individuals, I mean, in addition to patients diagnosed with cancer, but it is a really, really good tool and yes, at alternating six month intervals. And in addition to sort of stepping up our imaging, we also can offer risk reduction with certain medications. We use the term chemo prevention but of course it has nothing to do with chemotherapy. It's using oral medications, generally, estrogen blockers that will substantially reduce a woman's risk for breast cancer generally by 50 to 60%. Compared to a woman who's at risk that does not take the medications.

Unknown Speaker  19:46  
I think ladies often hear chemo prevention when we talk to them in the office and they immediately get anxiety just hearing the word chemo. And you know, I always circle back and stress to them just like you said it's not actually chemotherapy but more of an estrogen blocker. Then I always have to dispel the myth that they won't grow a beard, they won't turn into a man, because 100% of the time people go there. But really, it drives down your estrogen and decreases that risk. And ladies do very well on the medication. And so I always ask them to just meet with medical oncology to have that discussion. Because at the end of the day, if you can do something that doesn't affect your quality of life, that doesn't change your overall activities of daily living and substantially decreases your risk, then it's worth a shot. So I just tell them to keep an open mind and have that discussion. As you mentioned, some ladies are all for it. A majority of ladies get a little bit too worried about it and concerned but most are open to the discussion.

Unknown Speaker  20:40  
Yeah, it is well tolerated medication, it gets a super bad rap online. You know, if you Google it, anybody who Google's these medications is probably not going to take them?

Unknown Speaker  20:52  
Well, yes.

Unknown Speaker  20:54  
Let me just tell you, my mother in law googled her antibiotic the other day, and she literally thought she was dying, and I told her to shut close the computer and don't look at that. And if she's gonna take Tylenol, she can take the antibiotic. So googling, googling, overall can lead to, you know, a lot of just anxiety, unnecessary anxiety.

Unknown Speaker  21:14  
Absolutely. Absolutely. Well, it's always great talking with you, Ashley, and this topic of risk reduction, we could probably go on for quite some time. And we will have some additional podcasts that go into more detail on some of these topics like genetics and risk reducing surgery and so on and so forth. So you know, we talked tonight a lot about dispel dispelling a lot of common myths about breast cancer, right? Where are your deodorant? Where are your underwire bra? If you want to write we talked about both overestimating and under estimating.

Unknown Speaker  21:57  
Yes, our risks you know, we touched on a lot and you know, I am all for the underwire bra, but in 2020 I think we all know now that you don't really need to wear bras. So on that note, I will leave you with Please refer to our website at Camp rescue comm for any other questions, and we will be joining you shortly with the new podcast.

Unknown Speaker  22:15  
Thanks so much.

Unknown Speaker  22:16  
You've been listening to the best of everything podcast with your hosts and board certified breast surgeons, Dr. Lindsay gold and Dr. Ashley Richardson of comprehensive breast care. If you have a subject you would like the surgeons to discuss, please email your suggestions online at comp breast care.com. That's compbeastcare.com the doctors want to hear from you. The views thoughts and opinions shared in this podcast are intended for general education and informational purposes only and should not be substituted for medical advice, treatment or care from your physician or healthcare provider. Always consult your healthcare provider first.