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Ep. 141 - LiveWell Talk On...Breast Cancer Screening (Therese Michels, R.T.(R)(M)(BD))

episode 141

Ep. 141 - LiveWell Talk On...Breast Cancer Screening

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Host: Dr. Dustin Arnold, chief medical officer, UnityPoint Health - St. Luke's Hospital

Guest: Therese Michels, manager, St. Luke's Breast & Bone Health

Dr. Arnold:
This is LiveWell Talk On...Breast Cancer Screening. I'm Dr. Dustin Arnold, chief medical officer at UnityPoint Health - St. Luke's Hospital. When it comes to breast cancer, early detection is the best prevention. Joining me to talk today about breast cancer screening, current recommendations, newer technology, and the impact of COVID-19 on screening processes, is Therese Michels, manager of St. Luke's Breast and Bone Health. Welcome.

Therese Michels:
Thank you. Nice to be here.

Dr. Arnold:
You know, men obviously—well, 1% of breast cancer is in men, right? I think that's what it is, something like that, less than 1%. But, you know, for the most part men don't understand mammography and the discomfort that it causes and the trepidation that women might have in getting that. So at what age should women start to have mammograms regularly?

Therese Michels:
Well, as a facility here, we go by ACR guidelines and Society of Breast Imaging. And the recommendations for them, is start at 40, unless you have any other relative history to genetics, and then yearly above 40 after that.

Dr. Arnold:
So, start at 40, but yearly following 40.

Therese Michels:
Correct. Yeah, unless you have some first degree relatives with breast cancer. Sometimes your physician will ask you to start before then, like between 30 and 40.

Dr. Arnold:
Okay. All right. And is there an age when you can stop getting mammograms?

Therese Michels:
Not necessarily. With the guidelines that we follow as well, they say to have yearly mammograms through age 74. There's really no limit as to what age you should stop having mammograms. There are some women that do have incidences of other health related problems that may keep them from having surgeries from the breast cancer, if it's found. So in those cases, we ask them to consult their provider as to when and how much they should have a mammogram.

Dr. Arnold:
Sure. Okay, well that makes sense. Kind of like pelvic exams, it's based individually on each patient. You hear this dense breast tissue. Describe what that is. What does that mean, I guess, for a woman if she is told that she has dense breast tissue?

Therese Michels:
That can be confusing to most women. A lot of them take that as the size of their breasts, believe it or not. They think they don't have dense tissue because they don't have full breasts, but it's more about genetics. Your dense tissue is based on mom or your prior history with relatives. What your breast is made of is fatty tissue and basically dense tissue. Dense tissue, it's almost like looking for a polar bear through a foggy day. It's just really thick tissue, that's hard to see things small. So we base off the opinion of the percentage of dense tissue in your breast, compared to the fatty tissue. Some women don't have much dense breast tissue. Some have a lot, where it covers their entire breast, which can make it hard to find small cancers and small little cysts and such in your breasts.

Dr. Arnold:
I think people know what the term three-dimensional means, right? And they know what mammography means, but 3D mammography. What is that? Is that an option for women that have dense breast tissue, or what is the option for that?

Therese Michels:
Absolutely, 3D mammography here at Breast and Bone is standard of care now. So if you're going to walk through our doors, every screening mammogram has 3D mammography with it. It does help—

Dr. Arnold:
It did not know that. I thought it was something else, but that's the standard of care.

Therese Michels:
Standard of care for our department, correct. We made that decision about a year ago because the majority, if not pretty much all insurances, are covering the 3D mammography now. And it has, I think with cancers, it's increased the cancer detection rate by, I believe 40%, when we use 3D mammography. So we have found that just to be the basic standard of care. But with 3D, what it does is, it's like taking multiple slices through your breasts. So instead of just one still shot, like we used to with 2D mammography, you can picture like a loaf of bread and you're cutting slices through it. That's very similar to what 3D mammography is. We're just taking your breasts and looking at it slice by slice. So we can cut through all that dense tissue and cut through everything else through your breast tissue. A lot more detail in those images, so we're able to detect cancer more earlier on.

Dr. Arnold:
So, when does MRI play into this? Because sometimes I hear of patients having an MRI on a mammogram. What does that mean?

Therese Michels:
Actually, there's two types of breast MRIs now. There's abbreviated, or fast breast MRI, or a full breast MRI, which is what we've done in the past years prior. Abbreviated, or fast MRI, has just come into play in the last couple of years here in this region. Both are considered more detailed tests. The abbreviated/fast MRI can be used for patients that have dense breast tissue. It's more of a 10-15 minute exam, compared to the full breast MRI. The problem with that, is that it's not covered by insurance, so it is an out-of-pocket expense, but it is a very detailed test. We also have automated breast ultrasound on the side of that with dense breast tissue here in our office too. That's sent through insurance and is usually covered by most insurances. So the full breast MRI is for people that have high genetic risks. You know, if you have first degree relatives and you have dense breast tissue, that's when that's more used for breast MRI.

Dr. Arnold:
Are there women that—So I'm a woman, I had my mammogram at 45 and I had dense breast tissue. Does that ever go away, or does dense tissue stay the whole time?

Therese Michels:
Yeah, it can eventually go down as you age. I mean, with post-menopausal, you know, the dense tissue can relax as you age as well. So from year to year, that can change. So one year you can have dense tissue and the next year the radiologists can label as not dense tissue, so it can fluctuate. But usually, it tends to go down as you age.

Dr. Arnold:
Okay, I did not know that either. There's a lot you're talking about here that I had no clue about.

Therese Michels:
That's good. That's good.

Dr. Arnold:
Yeah. Now, as we've said on another podcasts, you know, disease didn't stop because of the pandemic. And I know we did suspend outpatient radiology studies across the continuum, across the organization. So just kind of walk us through how the pandemic affected, and is affecting, Breast and Bone.

Therese Michels:
Yes. Well that started, I believe, mid-March of 2020. We were, by the ACR guidelines, suggested that we would shut down all screening mammography. We continued with the diagnostic portion of the mammography side of things. I would say, I believe about 97% of facilities did close down their screening operations across the U.S. It did, in the next couple months, decrease the screening mammography, I think by around 90% to 97%. So what happened when we came back on board in June, we were gradual coming back into screening mammography. Patients were afraid. They were afraid to come out, as with anything with COVID and the pandemic, they were afraid to come out of their house. And, you know, we've seen a couple patients actually wait. I mean, I remember one in particular had a lump and she waited, I think, six to eight months to come get that checked and it was a cancer. So just keep in the back of your mind that cancer does not take a break during pandemics. It does not wait for it to be over with. So it's very important to continue any type of screening that your doctor recommends.

Dr. Arnold:
You know, I hear it a lot. Well, we're so busy and it's not all COVID, why are we so busy? Well, you know, we're trying to get—I mean, we really slowed things down for a good six months almost. And so, you're just basically trying to get 18 months’ worth of work done in a year. And it just, it stacks up. And you're right, the cancer didn't go away. The heart disease didn't go away. And I do believe that's contributing to the volumes we're seeing in the hospital at this time.

Therese Michels:
Yeah.

Dr. Arnold:
Now Breast and Bone, I'm assuming, and you can confirm that—I mean, you follow the same precautions we take the hospital: universal masking, stay home if you're sick, socially distance when you can.

Therese Michels:
Right. Yeah, we do.

Dr. Arnold:
Okay, that's great. So Therese, tell me how, now with the electronic health record and MyChart, and we release things right away.

Therese Michels:
Correct.

Dr. Arnold:
When I was in private practice, we never ordered a test on a Friday, unless it was an emergency of course. Because they didn't want the patient to wait all weekend thinking about that test, right? So now with MyChart, you have a scary procedure, a mammogram, it comes back abnormal and it's in MyChart before the doctor can—Do you prep patients to say, look, wait for the final reading—Do you factor that into the encounter with the patient?

Therese Michels:
We do. You know, our staff go over that at our monthly meetings. You know, we talk about what we can tell the patient and what we can say. Most normally we'll ask if they're on the MyChart. And we'll just say, you know, if you see on your report that you are getting called back, or there's some wording, always call us and we'll look it up. But for the majority of mammography and results coming over to MyChart, the patient's going to see it before their physician can even see it.

Dr. Arnold:
Yeah, they may. I mean, you get an alert to your phone when it's resulted.

Therese Michels:
Yeah, it could be two hours from the exam. So, we do make the patients aware of that. It's a great thing. But we ask that they reach out to us if, you know, if they have it and they're receiving it and they have questions. They don't have to wait for us to call, but we also make them aware that we will be in contact with them if the need is there to call them back.

Dr. Arnold:
That's an important topic to mention and continues to be important. I mean, it's great. It's outstanding that patients are involved in their healthcare and they can go into MyChart. They can understand what they had done. They can remind their doctor to follow—I mean, as a physician, you love it, but you also hate to have that miscommunication or someone worry when they don't have to.

Therese Michels:
Yes.

Dr. Arnold:
Bone and Breast has been there 10 years. Is that right?

Therese Michels:
As far as, in this facility, it's been about seven to eight years. We were over at the MOP building prior to that. So we've been around for a good 30 some years.

Dr. Arnold:
Yeah, I guess time goes so fast. It seems like it's been over there longer, but yeah.

Therese Michels:
Yeah. We have this clinic. We also have Mammogram Machine at Westdale. We also have one in Marion that also has breast density there as well. So we have expanded a little bit to provide services for patients to make it more convenient for them to, you know, just decide what location is best.

Dr. Arnold:
Yeah. I know, Cedar Rapids is not big, but sometimes it's a challenge for some people to drive across it. I grew up in Cedar Rapids and if it wasn't on the Northeast side, my parents were like, no, that's too far away.

Therese Michels:
Right, yeah.

Dr. Arnold:
You know, we'd go to Bever Park Zoo and we lived in the Northeast side. It was like, you would've thought I asked to go to like Paris, France.

Therese Michels:
Some patients don't like to travel, or don't like to drive downtown, so the Marion and Westdale locations are awesome.

Dr. Arnold:
You stay in your quadrant and everything works fine. So you mentioned the three convenient locations. You mentioned that there are very helpful staff. We've had multiple people on from Bone and Breast through the years, Helen G. Nassif Cancer Center, all great people. You take such pride in your work. You're always fun to be here, because of that pride you take. But, how can someone get a mammogram scheduled? How would that go about? What can a listener hear today that they can get that mammogram scheduled? Perhaps, one they might've put off during the pandemic.

Therese Michels:
Yes. You know, there are a couple of ways. You can go to our website. There is a link to click on to request an appointment there, and somebody would be in contact with you the next couple of days. Or, you can call us directly. Our number is 319-369-7216. And you know, somebody will answer indefinitely and get you scheduled for that. Or, we do have walk-in services for screening mammography. All you will need is an order from your physician. So you can walk into any of our three locations, between the hours of 9:00AM-3:00PM, and we'll get you in for your mammogram.

Dr. Arnold:
Well Therese, this has been great information, as always. Thanks so much for taking your time. Again, this is Therese Michels, manager at St. Luke's Breast and Bone Health. For more information, visit UnityPoint.org.

Therese Michels:
Thank you.

Dr. Arnold:
Thank you for listening LiveWell Talk On. If you enjoyed this episode, don't forget to subscribe. And if you want to spread the word, please give us a five-star review and tell your family, friends, neighbors, strangers about our podcasts. We're available on Apple Podcasts, Spotify, Pandora, or wherever you get your podcasts. Until next time, be well.