Frankye Myers: From Riverside Health System. This is the Healthy you podcast where we talk about a range of health-related topics focused on improving your physical and mental health. We chat with our providers, team members, patients and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier you.
I'm really excited to have with me in the healthy youth studio today doctor Aaron Chevinsky. Doctor Chevinsky is a surgical oncologist and a service line chief for Riverside Integrated Cancer Care Network. We're going to be talking today about health matters, understanding mammograms and breast density. Welcome, Doctor Chevinsky.
Aaron Chevinsky, M.D.: Thank you, Frankie. And thank you for allowing me to come and share some of this vital information, particularly in October. Since this is Breast Cancer Awareness Month, we want to make sure we get the message out to everybody about the importance of breast care and breast health.
Frankye Myers: Absolutely. It might have been a little strategy behind that, but perhaps, yeah. Glad to have you.
All right, welcome back to the Healthy Youth podcast, and I'm your host, Frankie. And today we're diving into a topic that affects so many women, mammogram screenings and the importance of understanding breast density. And I can relate to that myself because I do have breast density. We also want to tackle some common myths and misconceptions about breast cancer.
So, Doctor Chevinsky, first I want to start out by just asking, how did you end up in this line of medicine?
Aaron Chevinsky, M.D.: Well, I was always interested in cancer care, and I trained in New York, at Stony Brook, and did my medical school and residency there. And while I was doing my residency, I got very much involved in the treatment of patients with cancer. And so I went on to do a fellowship in surgical oncology, which is surgical cancer care at Ohio State. The Ohio state? The Ohio state who are 50, by the way.
Frankye Myers: I wasn't going to mention that.
Aaron Chevinsky, M.D.: And as I then went into practice, I became more and more involved in the care of women with breast diseases and breast cancer. I was initially in New Jersey, got involved with the state in looking at how to outreach to underserved women, particularly women who don't normally have access to care. Through several programs in the state of New Jersey, we were able to bring breast care to them. And breast cancer care and breast care has been a large part of my practice right from the beginning up through now at Riverside, where I'm taking on a more administrative role in taking care of the cancer program.
Frankye Myers: Absolutely. Well, thank you for your compassion and your commitment to this important work.
Let's talk a little bit more about breast density and what that means.
The terminology. Some of our viewers may not understand what breast density means and some of these breast screenings and what are some of those common myths around some of those things that I feel sometimes prevent individuals from following up with those important screenings?
Aaron Chevinsky, M.D.: Well, the breast density really refers to the thickness and the ability of an x ray to penetrate the breast tissue to be able to identify the earliest signs of cancer. And so breast density really affects how your breast pictures come out when you do imaging.
Frankye Myers: It's hereditary, doctor SavinSky, because my mom doesn't have breast density, but I do. So are there some genetic things associated with that?
Aaron Chevinsky, M.D.: No. Breast density is more associated with hormonally active breast tissue. The younger you are, the more breast density you tend to have.
It also affects how your weight. If you're overweight and have a lot of fat in your breasts, your breasts tend to be less dense rather than more dense. If you're pregnant or breastfeeding, your breasts become very dense. So it's really a factor of how hormonally active your breasts are. And it changes during the course of a month in a women's cycle, as different parts of the month, your breasts may be more or less dense.
Frankye Myers: Yeah, because they may become more or less tense as well associated with.
Aaron Chevinsky, M.D.: And that correlates with that.
Frankye Myers: Okay, great information.
Are there any other myths that you can think of that sometimes exist around breast screening breast cancer?
Aaron Chevinsky, M.D.: Well, one of the biggest myths is that women that I meet who feel that they're not at risk for breast cancer because there's no cancer in their family.
And that's a really important one because 80% of all breast cancers occur in women who have either no or little family history.
While if you have a family history, your risk may be increased. The vast majority of cancers, 80%, occur in women with no family history. So the lack of a family history really is not protective. Other myths are that breast cancer disease of the elderly, and while the older you get, the more likely you are to develop breast cancer. If you're going to develop breast cancer, younger women can get breast cancer and it's a double whammy because when they're younger they don't really think about I'm going to get breast cancer. And so they may not pay as much attention to findings that they see or things that develop in their breast. And since women of average risk, meaning you have no family history, you have no personal history. Start screening at age 40. Women who are at higher risk for any one of a number of reasons, family or personal history, or any kind of genetic mutations often will start screening earlier than that.
Frankye Myers: Okay. Some of the things that I hear as it relates to myths around breast cancer is birth controls. I remember growing up and they say, oh, if you're on birth control pill, it may potentially put you at risk, hormone hormonal replacement. So some women, even myself, are leery of those things. So can you talk a little? Do you feel comfortable speaking on a couple of those things?
Aaron Chevinsky, M.D.: Sure. Well, first of all, one needs to understand what's the baseline risk. Risk of breast cancer in the United States among all women is about one and eight or twelve and a half percent, which, as you can think about, is very high. And so, you know, eight women, one of them may well have had an experience with breast cancer. But when you look at the risk factors for breast cancer, there are some risk factors which are preventable and some risk factors which are not. Some of the risk factors that you have no control over is how early you start your menstrual periods. Women who start periods before age twelve or have periods that last long after age 50 due to the unopposed estrogen, are at increased risk.
Women who have had radiation to their chest, for example, if you've had a Hodgkin's disease or lymphoma or other cancers where you've had radiation, particularly as an adolescent, but your risk of breast cancer goes up several times about 20 years down the road. Other risk factors include delayed first pregnancy beyond age 30 or no pregnancies. And those are things that are somewhat under your control. But if you have a family history of breast cancer, particularly in a first degree relative, mother, sister, daughter, that increases your risk, particularly if you have more than one family member, and particularly if either of those family members had it at an early age, before age 50, or if they've had bilateral cancers. Now, you asked about birth control pills, and birth control pills in general do not increase your risk of breast cancer and in some cases might be somewhat protective.
However, if you take birth control pills beyond age 50, you're really taking it as hormone replacement. That does increase your risk, as does taking estrogen after menopause for more than two years, also increases your risk. And there are other risk factors as well, which we really didn't get to talking about. But the most important thing, the most important message that any of us can bring forward today is get your screenings when appropriate if you see something, say something. If you feel something, say something. Bring it to the attention of your healthcare practitioner, your doctor, your physician assistant or nurse practitioner. If you feel something is different.
Frankye Myers: Right, that's good stuff, doctor Chevinsky, great information.
And mentioning that around having that relationship and checkpoints with your provider, that's another myth, that I'm healthy, so I don't need a, to go have my checkups, I don't need to have a primary care physician. They are so pivotal to keeping all on track with those key checkpoints that you need to have at certain ages.
Aaron Chevinsky, M.D.: Well, certainly seeing your health care provider at regular intervals is critically important. But being body aware, knowing what's normal for you, is equally important because you may see your healthcare practitioner once a year, twice a year, but you're seeing yourself every day. And if you notice a change, you need to bring it to their attention. Maybe nothing. You know, we talk about, well, I had a normal mammogram and therefore I can't have breast cancer.
80% of breast cancers are picked up on mammography, which means 20% are not. And so if you have a lump in your breast, even if you have a normal mammogram, you should bring it to your healthcare practitioners knowledge, make them aware, and often you'll have a biopsy. There are certain types of breast cancer, most typically something called lobular breast cancer, makes up about 15% of breast cancers, which aren't as easily seen on imaging study. And therefore it's a combination of good awareness, good practice, and having your screening studies gives you the best protection.
Frankye Myers: Right, that's good stuff. So, self awareness, doing those self breast exams, you know, I too have to remind myself the importance of doing that. And if you see something, say something. So those are great key takeaways.
All right, let's dig a little bit deeper, Doctor Chevinsky. So talk a little bit about the mammography diagnostic test that's done. You know, some of our viewers may not, may not have had 1, may not understand what happens when you go for that visit. Talk a little bit about a mammography.
Aaron Chevinsky, M.D.: Well, mammography at its basic level is an x ray picture of your breast. Generally speaking, a screening mammography, meaning somebody who has no symptoms, no findings, and no history of cancer or other breast problems goes in and has two pictures of each breast done, and then that's read by a radiologist who's an x ray specialist.
Most of our mammography’s in Riverside are now being done with something called 3d mammography or tomography, where many more than two pictures are taken of each breast, and it gives a much better and much clearer picture of the breast health.
Frankye Myers: And that's newer technology.
Aaron Chevinsky, M.D.: That's newer technology, and we've integrated that into almost all of our screening sites.
Ultrasound is another technique using sound waves, and that helps to differentiate solid from cystic masses, helps to guide biopsies, and in women with dense breasts, can give a window into how the breasts look beyond what you can see just on a mammography and then MRI. Using magnetic waves is done for women at higher risk or to help differentiate in, particularly in women with denser breasts. If there's something going on that's of concern.
Frankye Myers: Okay.
As it relates to breast density, haven't there been some things related to Virginia law and communication around that? Would you just talk a little bit about that? I've had breast density for a long time, and prior to the 3d ultrasound becoming common practice, it was something that I did early on, before insurances were covering that. So would you talk a little bit about that notification of such.
Aaron Chevinsky, M.D.: Sure. You know, in almost every state in the United States, there are laws relating to how you inform women about the result of their mammogram. This is going back many years, and it's really the only x ray test that is, you're legally responsible to have a report sent to the patient directly in addition to the ordering physician. And in fact, in most states, women can go in and get a mammogram even without having a doctor. They can just go in and get a mammogram because they're concerned. And then, of course, they'll ask if that can be routed to a physician that they're seeing. As far as breast density, the notification of a woman about whether they have dense breasts is becoming commonplace across the country. But Virginia was ahead of the curve and really started based on legislative mandate notifying women as early as 2013 about breast density. And so when you get a letter from the mammographer, it's going to tell you, first of all, what your mammogram showed, whether there's any areas of concern that require a follow up. It'll tell you about your density, and it'll give you information about what density means, what you should do with that information, and are any additional tests necessary to really make sure that we're getting the best possible picture of your breast to keep you protected?
Frankye Myers: That's great information. Great information.
Doctor Chevinsky, talk a little bit about artificial intelligence. There's so much conversation about artificial intelligence in all aspects, whether it's healthcare or other related fields, talk a little bit about it as it relates to mammography and how it may be used currently.
Aaron Chevinsky, M.D.: Well, getting into the realm of science fiction, and we all have seen movies about what robots can do and artificial intelligence can do, but we have to understand that artificial intelligence is a tool and it can be used to aid, in your care, we add two. Add two. And we've adopted some artificial intelligence technology in our breast health arena. And so when you get a mammogram, particularly with a 3d mammogram, when there are many more than just four pictures, your radiologist, your mammographer, your breast radiology specialist is going to look at that very carefully. But in addition, there are computer programs which also look for areas of concern and highlight them for the radiologist so that they can particularly look at those areas and maybe make sure that those haven't been missed. And so this is an adjunct to your breast health. This is something that we've embraced at Riverside, and we understand both the benefits and limitations of using it, but it's really to benefit you, our patients, our families, our communities, to give you just the best, most up to date care so that we can make sure we're not missing anything when you come in for your screening.
Frankye Myers: So just to. Just to elaborate on that a little bit further, AI could potentially detect something that the human eye could miss.
Aaron Chevinsky, M.D.: That's correct.
And the AI is based on an algorithm. An algorithm is a set of computations looking for things that are normal versus abnormal. They're programmed by somebody as to what you should be looking for. And they'll point out to a radiologist, to your mammography doctor, areas that might be of concern.
And they'll go back and look at those, in addition to their usual reading, and make certain that they've identified any and all possible concerns that might be on the imaging.
Frankye Myers: That's fantastic.
That's incredible. And so beneficial for women. We haven't mentioned men because one of the myths is that men can't get breast cancer. And I forgot to mention that. And I do want you to just speak on that a little bit.
Aaron Chevinsky, M.D.: Well, men can get breast cancer. The risk of men getting breast cancer is about 1%, meaning out of every hundred breast cancers, one will be a man. And men have different risk factors. Most men who get breast cancer will have developed a lump and come to their doctor. We don't screen men, but there are certain mutations.
When we look at women and men for genetic risk, we look at something called BRCA genes, BRCA, or breast cancer associated gene. And about 20% of men who develop breast cancer will have a BRCA gene mutation, or BRCA two mutation. If that mutation is found, then we screen the rest of the family. Other risks that men have, including longstanding gynecomastia and other genetic syndromes like Klinefelter syndrome, which is a genetic abnormality, also increase your risk, as do radiation and exogenous prior radiation as well. And so we do see men with breast cancer, they're treated very much the same way that we treat women as far as surgery and the addition of chemotherapy or antiestrogen therapy and radiation as necessary.
Frankye Myers: Absolutely. And it goes for all men and women. See something, say something.
Aaron Chevinsky, M.D.: Absolutely. Absolutely.
Frankye Myers: That is fantastic to hear. Before we wrap up, Doctor Shebinski, do you have any final thoughts for our listeners about mammograms, breast density, and how to take care of themselves as it relates to their breast health?
Aaron Chevinsky, M.D.: Well, I wanted to mention a little bit about ethnicity in breast cancer.
Breast cancer does not equally affect women of all races. And in fact, in the United States, the highest incidence of breast cancer is in white women or Caucasian women. However, African American women have a higher risk of young age breast cancer and a particularly virulent form of breast cancer called triple negative breast cancer. And when we evaluate breast cancers, we use what's called the staging system. And staging means how far has your cancer progressed? And we use something called the TNM staging system. T stands for tumor or tumor size. N is for lymph node spread, and breast cancers when they spread, most commonly spread to the lymph nodes under the arm, on that side. And m stands for metastatic disease or spread outside the breast and the lymph nodes. But we also do several tests on the breast cancer to see how aggressive they are. And our pathologists are very adept at looking at these, but we look at does the tumor express estrogen receptors or progesterone receptors? And we also look at something called her two. Her two is a gene that increases the risk of breast cancer spread. Now, if you don't express any of those, it's called triple negative ER PR and her two negative. And that's more highly concentrated in the African American community, and they tend to be a much more aggressive form of cancer. And so it's really important that every woman gets screened, that we make available to those who have less access to care to be sure that they get screened as well, and that we have, you know, access for women who are in the underserved areas that they also are able to participate in early detection. Because with all cancers and breast cancer in particular, the earlier you find it, the more options you have, the less aggressive the treatment may need to be, surgically and otherwise, and the more likely you are to be alive and with your family 10, 15, 20 years later. What we understand is that breast cancer generally does quite well with treatment. Over 90% of women will live five years, but it is stage dependent.
Frankye Myers: That's great information. And so just hearing that, it's really important to inspect and understand what's going on with your body, especially for african american women, because they're getting it earlier, so they may not be in that screening requirement time frame. So, you know, identifying it early and getting it evaluated is very important.
All right, great information. Anything else before we wrap up?
Aaron Chevinsky, M.D.: Well, I just want to make sure that everybody remembers October is breast cancer awareness month. If you haven't gotten your screening and you're at the appropriate age, please do. Please make sure that you and your family get appropriately looked at, screened. And if there's anything that you feel or see, please let your physicians know or your healthcare practitioner.
Frankye Myers: Thank you so much, Doctor Chevinsky, for taking time out of your busy schedule to come chat with us a little bit today and to our listeners that your health matters and staying informed is so very, very important to controlling your well being.
Thank you.
Aaron Chevinsky, M.D.: And thank you, Frankie, for letting me speak with your audience and let them know some of the important things having to do with breast cancer detection and prevention.
Frankye Myers: You're so welcome. Thanks.
Aaron Chevinsky, M.D.: Okay. All right.
Frankye Myers: Thank you for listening to this episode of Healthy Youth. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideonline.com.
