The Importance of Mammograms

Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): And welcome to the show. I am Deborah Howell, and today we'll be talking about the importance of mammograms. Our guest today is Dr. Brooke Caldwell, a radiologist for the MemorialCare Breast Center at Saddleback Medical Center. Welcome, Dr. Caldwell.

Brooke Caldwell, MD: Thank you for having me. I'm delighted to be here.

Deborah Howell (Host): Well, we're so glad you're here as well. Let's dive right in. What are the benefits of getting a mammogram?

Brooke Caldwell, MD: Basically, mammograms save lives from breast cancer. It's been shown in study after study that women who have annual mammograms are 50% less likely to die from breast cancer than women who don't.

Deborah Howell (Host): 50%?

Brooke Caldwell, MD: Yes. And that's actually an underestimation.

Deborah Howell (Host): I'd say that's worth your time.

Brooke Caldwell, MD: I think so too.

Deborah Howell (Host): Absolutely. And when should women start getting mammograms, and how often?

Brooke Caldwell, MD: You know, actually, that's very controversial right now. It's not controversial for me, but for a lot of my patients, it's very controversial. Recently, a group called the U.S. Preventive Task Force made a recommendation that women start getting mammograms every other year after 50. And I try to teach my patients that that's one group's recommendation. And that group was made up of government officials and no breast cancer doctors. So a lot of women don't understand that just because they make a recommendation doesn't mean it's the right recommendation. That being said, the American College of Radiology, the American College of OBGYNs, the American College of Breast Surgeons, the American College of Gerontology, all recommend that women get annual mammograms beginning at age 40 and that they stop when they believe they have less than a five-year lifespan.

Deborah Howell (Host): Interesting. Wow, that is brand new information.

Brooke Caldwell, MD: Yes.

Deborah Howell (Host): Okay then. So, I mean, if you're going to go with the people who see the breast cancer as these individuals do, then I would highly recommend taking your advice and start at 40, not 50, and annually instead of bi-annually.

Brooke Caldwell, MD: Absolutely. And there was just an article released talking about how many lives are saved following different recommendations. And it's really astounding, the most lives are saved following annual mammograms every year after 40.

Deborah Howell (Host): What should a woman expect when having a mammogram?

Brooke Caldwell, MD: You know, mammograms are, it's really a little thing. I think people, there's drama related to mammograms for a lot of women, but I think you just kind of make up your mind, you go in and you do it. Basically, it's four views. Each view is taken with breast compression. And that allows us the maximum visualization of breast tissue on that woman. All told, it should take maybe five minutes. And I tell women that if your breasts are tender and you think you may be tender when you have your mammogram, when you hit the parking lot of the facility you're going to, take a couple of Advil. And that will make it a more comfortable experience for you.

Deborah Howell (Host): You know what, that never occurred to me.

Brooke Caldwell, MD: Yeah.

Deborah Howell (Host): That's a great idea.

Brooke Caldwell, MD: Yeah, I mean, it's a little deal for such a big payout.

Deborah Howell (Host): Absolutely. And it, can I just say something? It seems to me that it's less painful now than it was say 20 years ago.

Brooke Caldwell, MD: That's true. Our technology has gotten so much better. We still compress, but now we're very scientific about how much it is. It's not, we don't do it till the maximum that you can possibly stand, we do it to a scientific maximum that's determined by the machine.

Deborah Howell (Host): Right. It used to be the garage door thing and it's just not like that anymore.

Brooke Caldwell, MD: That's true. So...

Deborah Howell (Host): All right, let's go a little further into this. What is tomosynthesis 3D mammography, and what is the difference between 2D and 3D tomosynthesis?

Brooke Caldwell, MD: So 2D means taking a two-dimensional picture of a breast. And you can have something on one side of your breast, something on the other side of your breast that overlaps in the picture and makes the breast look denser. With 3D mammography, basically, it slices through the breast on a number of levels. So we don't have this superimposition of tissue that we have on 2D mammography. So we can actually see through the tissue, and it gives us a much better view of what's going on. And right now, the recommendation is women that have dense breasts undergo 3D mammography. But study after study is starting to show that women of all breast densities benefit from 3D mammography. And I think that will be the way we go in the future.

Deborah Howell (Host): And what is, not problematic, but what is different about women with dense breasts?

Brooke Caldwell, MD: Yeah, I want to clarify something. A lot of my patients tell me they have dense breasts based on what they feel. That is different than mammographic density. So breast tissue is made up of fat and fibroglandular tissue. And fibroglandular tissue is white and fat is gray on a mammogram. Cancers are white. So the more fibroglandular tissue you have, it's like looking for a white rabbit in a snowstorm.

Deborah Howell (Host): Got it.

Brooke Caldwell, MD: And that's what we mean by mammographic density. It's not about how you feel. So a lot of people confuse that. But whenever you get your mammo report, it will give you a determination of how dense your breasts are. And basically, women who have very dense breasts, often we'll recommend adjunctive screening like ultrasound. And I also would like to clarify, I'm seeing a lot of patients who believe that ultrasound is better than mammography for finding cancer. And we have no studies proving that screening with ultrasound saves lives at this point in time.

Deborah Howell (Host): What's the difference between ultrasound and mammography?

Brooke Caldwell, MD: You know, ultrasound is based on sound waves and we just kind of run a wand over the breast and use sound waves to look into the breast. And ultrasound is really a good problem-solving tool. There was a lot of clamor about screening with ultrasound probably about seven years ago. It became a law that in many states you have to tell women that they have dense breasts, and if they have dense breasts you have to do something additional to doing the mammogram. But at that point, we didn't really have 3D mammography. So a lot of women got it in their head that they didn't need mammograms, they needed ultrasounds. But it's really not a screening tool. Mammography is the best. Mammography in the hands of a skilled breast radiologist misses about 5% of cancers. But ultrasound will miss about 20% of cancers. So it's not a screening tool, it's a problem-solving tool. It's an adjunctive tool.

Deborah Howell (Host): Understandable. Tell me again what 3D tomosynthesis is, please.

Brooke Caldwell, MD: So 3D tomosynthesis is, instead of taking a two-dimensional picture of a three-dimensional breast, you're taking multiple two-dimensional pictures that add up. So you can actually kind of, I call it snorkeling, you can snorkel through the breast tissue and see it on every level, rather than seeing the summation of the tissue in the two-dimensional image.

Deborah Howell (Host): Would a woman ever have mammography and tomosynthesis?

Brooke Caldwell, MD: It is the same thing. So mammograms come in 2D and 3D. 3D is newer, and we're showing now that all women benefit from 3D mammography. And I believe in the very near future we won't even be doing two-dimensional mammography anymore.

Deborah Howell (Host): Got it. And of course, women are always worried about the radiation factor. What can you do to settle their minds about this?

Brooke Caldwell, MD: Oh, I love this question. So, you get more radiation walking through TSA at the airport than you do from a four-view mammogram.

Deborah Howell (Host): That should say it all right there.

Brooke Caldwell, MD: And we do that with impunity, we don't even think about it.

Deborah Howell (Host): Yeah.

Brooke Caldwell, MD: And yet women argue about the radiation. So, you know, we know that there are detriments to a lot of radiation. And we're extrapolating that from catastrophic events like dropping the atom bomb on Hiroshima and Nagasaki. We know that that amount of radiation caused problems in people. But medical radiation is so minimal and so safe, and especially mammography. So I explain to people the risk of getting lung cancer from smoking a half a cigarette is the same as the risk of getting breast cancer from one four-view mammogram.

Deborah Howell (Host): Wow, that's very visual. So, now that we feel better about all of this, where can women in South Orange County get a mammogram?

Brooke Caldwell, MD: At Saddleback, of course. I mean, there's a lot of places. Actually, Saddleback, we have a center in San Clemente, we have a center in Irvine, and we have a center in Laguna Hills. And we're opening up another one probably in the near future as far as the MemorialCare system goes. But most any hospital system should. And actually, I don't know if a lot of women know this, but mammography is the first medical study in the history of the United States that's price-controlled by Congress.

Deborah Howell (Host): Really?

Brooke Caldwell, MD: Yes. So every woman is entitled to annual mammography. And usually, in their health systems, it's without a copay. That is a screening test that all women are by law entitled to.

Deborah Howell (Host): That is shocking to me, and very delightful, I might add.

Brooke Caldwell, MD: So, take advantage of it. I think it's the bomb, and my friends and I, we try to all go together and then go to lunch, you know. Make a party out of it.

Deborah Howell (Host): Well there you go, make a day out of it. Why not?

Brooke Caldwell, MD: Yeah. I get my mammogram on my birthday every year. That's my present to myself.

Deborah Howell (Host): You know what? That's a great way of looking at it. Just embrace it and then celebrate the good news, hopefully, when you get it.

Brooke Caldwell, MD: Yep.

Deborah Howell (Host): I understand you have a dedicated breast radiologist. Can you tell us a little bit about that?

Brooke Caldwell, MD: Yeah, in our practice, so breast radiology is kind of a new specialty. It really started with the advent, it came along with exceptional technology. And I believe I'm probably one of the older dedicated breast radiologists. I've been doing only breast radiology since 1994, and I don't do general radiology, nor do my partners here. We're all fellowship-trained, purely dedicated breast radiologists. So that means I'm not doing CT scans in the emergency room on Saturday nights. I'm just all breast all the time.

Deborah Howell (Host): I love it. I love it. Well, when you're good at a thing, stick with it.

Brooke Caldwell, MD: Yeah. And studies show that, you know, people who do it exclusively have better expertise.

Deborah Howell (Host): Absolutely. Do it 10,000 times, you know what you're doing.

Brooke Caldwell, MD: Oh, I think I'm up to 10 million at this point.

Deborah Howell (Host): I'm going to give a website for women: memorialcare.org/sbbreast. And I'm going to give that again, because I know people, it's hard to write down the first time: memorialcare.org/sbbreast. There's also a phone number to call: 949-452-7200. Schedule that mammogram, maybe have a pedicure afterwards, or a manicure, and then go to lunch. Make a day out of it. And that's all the information you need on MemorialCare breast centers. Just do it every year after 40, ladies, right?

Brooke Caldwell, MD: Yep.

Deborah Howell (Host): Dr. Caldwell, thank you so much for your time and expertise today. We really appreciate your being on the show. To learn more or to listen to a podcast of this show, please go to memorialcare.org. That's memorialcare.org. I'm Deborah Howell, and that's all for this time. Thanks for listening, and have yourself a terrific day.