Ep 31: Breast Cancer Screening with Dr. Sasmita Misra

In this episode of Reset Recharge, host Dr. Komal Patil-Sisodia is joined by Dr. Sasmita Misra, a fellowship-trained breast radiologist. Dr. Misra shares insights into the importance of breast cancer screening, common misconceptions, and risk factors that women should be aware of. The episode emphasizes the effectiveness of mammograms, discusses the role of breast density, and provides an overview of various imaging modalities, including mammograms, ultrasounds, MRI, and contrast-enhanced mammograms. The conversation also touches on the significance of lifestyle changes, genetic testing, and the impact of early detection on treatment outcomes. Dr. Misra encourages women to advocate for their health by prioritizing regular screenings and provides practical advice for navigating the screening process.

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Audio Stamps:

00:00 Introduction to Reset Recharge

00:55 Special Guest: Dr. Sasmita Misra

01:44 The Role of a Breast Radiologist

03:00 Common Scenarios in Breast Cancer Diagnosis

04:23 Misconceptions About Breast Cancer

06:20 Risk Factors for Breast Cancer

11:09 Breast Density and Its Implications

15:48 Screening Guidelines and Recommendations

20:11 Advanced Imaging Modalities

23:23 Thermography: Myths and Facts

26:06 What Happens After an Abnormal Mammogram?

29:36 Concluding Thoughts and Recommendations

Thanks for listening. Find more info about Reset Recharge on the website or Instagram.

Transcript

Dr. Komal Patil-Sisodia 0:02

Welcome to Reset Recharge, the podcast where women's health takes center stage. I'm your host, Dr. Komal Patil-Sisodia, a triple board certified endocrinologist and women's health expert. This show is all about empowering you with the knowledge to understand your metabolic health, navigate hormonal changes, and feel confident in the conversations you're having with your healthcare provider. Whether you're managing symptoms, exploring treatment options, or just want to feel more in tune with your body, you're in the right place. As a physician, my goal is to educate on this podcast. The content shared here is for informational purposes only and should not replace personalized medical advice. If something we discuss resonates with you, please talk to your healthcare provider at your next visit. Now let's dive in and help you reset, recharge, and take control of your health. Hi everyone. Welcome back to Reset Recharge. I'm your host, Dr. Komal Patil-Sisodia, and I am so excited for a very special guest today, Dr. Sasmita Misra, who is a fellowship trained breast radiologist. She trained at UCLA for her fellowship. She works at RAD Partners and currently sees patients at University of Chicago in Illinois. This episode is super special for me because Dr. Misra is my bestie from medical school and we ended up. On the first day of school walking into class in the same outfit down to the shoes. And I remember we both kind of sized each other up and we were thinking we are either gonna be best friends or mortal enemies. And here we are, like 25 years later. So this makes me really happy to have you here. Welcome to the show.

Dr. Sasmita Misra 1:42

Thank you. I'm excited to be here.

Dr. Komal Patil-Sisodia 1:44

Thanks. I have always admired the work that you've done with female patients. You are that first point of contact for women as they are getting screened and diagnosed with breast cancer. Tell us why you decided to become a breast radiologist.

Dr. Sasmita Misra 2:00

I just really enjoy the intersection between imaging and dealing with patients and largely, I love empowering women and working with women, and when I did my rotation through breast imaging in residency, it really just was very impactful because we are the first point of contact, like you said, for our patients in the diagnosis of breast cancer, and at that point they're very vulnerable, our patients, and they really need their handheld throughout this process. And it really resonated with me and I realized, we can make a difference if we do the practice.

Dr. Komal Patil-Sisodia 2:33

Well, just knowing you on a personal level, I know that you are like one of the most caring and nurturing people, so your patients are so lucky, happy you, they're advocating for them. I would love to, and I'm sure our listeners would love to hear from you, like what is the most common. Scenario that you see walk into your office when you are diagnosing a or screening a patient, diagnosing a patient with breast cancer, what are you seeing typically?

Dr. Sasmita Misra 3:00

I mean, we have patients come into our office from a multitude of reasons. Either they're coming in just for their screening annual mammogram to see if we can find a breast cancer. And then a lot of our patients will be coming with a symptom if it's a palpable abnormality or an area of concern. So we see breast cancers from either. Way majority of the time if we detect a mass or abnormality on the screening mammogram, they'll come back in and at that point of contact is when we do have to tell them that, we are worried about something and we would need to do a biopsy of some sort.

Dr. Komal Patil-Sisodia 3:34

Yeah. So would you say that a lot of women who are coming into your office are found because they felt a lump at home? Like how good are self screenings? Or is this because, it is a finding on mammogram that they had no idea existed?

Dr. Sasmita Misra 3:49

Or screening mammograms detect 85 to 90% of malignancies. And so a majority of our patients will come through the route of an abnormal screening mammogram, and our goal is actually to detect those cancers before they become the palpable area of concern. Because majority of breast cancers, if you do screening mammograms annually, every year, you'll catch'em about two to three. Years prior to the patient actually feeling the lump, and so that is our goal.

Dr. Komal Patil-Sisodia 4:19

Okay, that's screen exam. That's great. That's great to know. And what is the biggest misconception you hear from patients coming in? I was super nervous when I went in for my first mammogram and then I made the mistake of reading the numbers on the side and I realized that was like the pounds of pressure they were applying to each breast and that did not feel good.

Dr. Sasmita Misra 4:38

Yeah.

Dr. Komal Patil-Sisodia 4:39

But what do you think is the biggest misconception?

Dr. Sasmita Misra 4:41

I think the biggest misconception is that I believe that breast cancer is mainly found in women who have a first degree relative with breast cancer. But in reality, 85% of our cancers are in women without a family history of breast cancer. So while family history is an important factor, it is relatively a small percentage of those newly diagnosed breast cancers. So the danger of that misconception largely is that these women have a false sense of security. That if they don't have a genetic risk, they're not gonna develop breast cancer in their lifetime. And this may delay them getting a screening mammogram. Yeah. And ultimately delay the diagnosis of breast cancer. And I think if we look at the percentages of cancer itself, breast cancer is the most common cancer among women worldwide. In the United States, one in eight women will develop breast cancer in their lifetime. And unfortunately, it's the second leading cause of death in women. Also.

Dr. Komal Patil-Sisodia 5:40

Scary.

Dr. Sasmita Misra 5:42

So ultimately, what we need to teach our patients is that a breast cancer screening is for everyone, and that every patient needs it because it is our first line of defense in catching cancers early.

Dr. Komal Patil-Sisodia 5:56

I don't think I realized that 85 to 90% were just caught on the screening Mammos. That's a yes.

Dr. Sasmita Misra 6:01

Yeah, that's

Dr. Komal Patil-Sisodia 6:02

a number that I wasn't really aware of. What do, so if family history is not the biggest risk factor that you see, which is I think what commonly is thought across all areas of medicine, me not being a breast radiologist, I kind of assumed that would. That was the case. Yeah. But what do you see as risk factors? What are the biggest risk factors that you see?

Dr. Sasmita Misra 6:22

It's a combination of multiple things. We have environmental risk factors, we have hormonal and we have lifestyle risk across the board. Some of the lifestyle risk factors that we see are alcohol and across the board in any cancer, you'll see an increased risk of cancer in anyone who has a higher intake of alcohol. And the reason why is alcohol actually increases your estrogen. And so that makes sense. Unopposed estrogen will increase your risk for hormonally driven breast cancers. Then also when you think about lifestyle risk, women, for example, if you're a postmenopausal female and you're have obesity, those, the estrogen that you get that's largely produced in a postmenopausal females from the fat cells. And so the postmenopausal obesity will also increase your risk of developing breast cancer as well. And they do say, but there are modifiable risk factors. You make lifestyle modifications such as walking two to three times a week, you can decrease that risk by 20 to 30%.

Dr. Komal Patil-Sisodia 7:18

Wow.

Dr. Sasmita Misra 7:19

Yeah. So that's why exercise is really helpful in women. So I

Dr. Komal Patil-Sisodia 7:24

think that's fascinating because there's so much data about how exercising is like walking just 11 minutes a day reduces your cardiac risk by 33%. I didn't realize that extended, that. Smaller amount of exercise extended to decreasing breast cancer risk as well, right? Yes. It's very interesting. Lifestyle changes go a long way.

Dr. Sasmita Misra 7:45

Yeah, a hundred percent. Yeah.

Dr. Komal Patil-Sisodia 7:46

The drink cutoff I've read is that any drink, any nu number of drinks over two drinks per day is considered higher risk, right? Or you're increasing your risk, or is that a misconception?

Dr. Sasmita Misra 7:58

I think that's a misconception now too. I just read a study actually that's saying any amount of alcohol can increase your risk of. Breast cancer or cancer in general. So it's really something, but largely it's dose dependent. So you know, if say if you are drinking two drinks a day, obviously try to cut back. It's just something that we have to mitigate, along with other lifestyle modifications as well.

Dr. Komal Patil-Sisodia 8:21

You mentioned hormonal risk factors. Can you explain what that is?

Dr. Sasmita Misra 8:25

Yeah, so one of the things that we ask our patients when they come in is we wanna determine how long that they've been exposed to estrogen. So essentially we ask them for the age of their first menstrual period to the age of onset of menopause, and the longer that gap is, or the longer that they've had. Un opposed estrogen that increases the risk for developing breast cancer. And so that is a question that we tend to take into consideration when look at their risk factors.

Dr. Komal Patil-Sisodia 8:53

So is there an age at which you consider menopause to be late, like 60 and beyond?

Dr. Sasmita Misra 9:00

I think 55, right? Isn't 55 consider late? Yeah. 55. Yeah.

Dr. Komal Patil-Sisodia 9:03

The window generally 45 to 55. So anything like anybody who goes 55 onwards beyond 55, it is considered longer exposure to estrogen. And the average age of the onset of like menstrual cycles is probably, at least when we were growing up, I think was between 11 to 13. The generation prior to us, it was even a little later now, I think less

Dr. Sasmita Misra 9:25

than 12. Less than 12. Okay. Yes. Yeah.

Dr. Komal Patil-Sisodia 9:29

Alright, so that's helpful to know.

Dr. Sasmita Misra 9:31

Yeah,

Dr. Komal Patil-Sisodia 9:32

because I feel like women are getting their periods younger and younger now, so

Dr. Sasmita Misra 9:36

Yeah,

Dr. Komal Patil-Sisodia 9:36

it really kind of makes you wonder.

Dr. Sasmita Misra 9:38

Absolutely. Some other lifestyle changes. They have done some studies in these, I don't know the full details about it, but it's disrupting the circadian rhythm, so women who actually have night jobs and disrupting that circadian rhythm can also increase your risk for breast cancer. I don't know the full correlation between that. It is just some studies that they have talked about as well.

Dr. Komal Patil-Sisodia 9:59

That's interesting. I know that with like people who are working night shifts and things like that, there's a higher prevalence of obesity. So maybe it's linked, maybe it's that, or maybe it's also, you're not having your circadian axis reset with proper sleep. And so whatever repair is happening to our bodies as we sleep overnight and rejuvenate, maybe that's also, or maybe there's increased oxidative stress, who knows? Yeah. But it's interesting. I mean that makes sense to some degree. Yeah.

Dr. Sasmita Misra 10:24

And then. We do when we talk about breast cancer and we ask these questions actually when a patient first comes to see us, we talk about we, yeah, we'll ask the patient about their age of onset of first menstruation and also the age of menopause, and largely the earlier your. Menstruation. If you have like a longer period of what we call unopposed estrogen, so you got your period earlier and you had a delayed menopause, that longer period of unopposed estrogen also is an increased risk for developing breast cancer. Something that you can't truly modify, but it is something that we take into consideration when we do a risk assessment on patients and know that that does increase can increase your risk for developing breast cancer as well.

Dr. Komal Patil-Sisodia 11:09

You mentioned high density breasts as a risk factor. Can you talk a little bit more about breast density and what that means? Sure. And how you evaluate it.

Dr. Sasmita Misra 11:17

Sure. So when we talk about breast density, we're not talking about how the breast feels, but we're talking about the makeup of the breast tissue that we see on mammogram. So breasts are composed primarily of what we call fatty breast tissue and fibro glandular breast tissue. And the percentage composition of each of them is what determines if your breast is gonna be denser or less denser, what we call fatty radiologist categories. Radiologist categorize breast into four levels, almost entirely fatty, scattered, fibro, glandular, heterogeneously dense, or extremely dense. So breast density matters for two reasons. First. Breast cancers can be masked by the breast density because breast density and tumors have the same appearance of white Wow. On a mammographic image. So sometimes a cancer can hide in women with dense breasts. Secondly, and we've discovered this over the years, is that dense breast tissue themselves have a higher risk of developing breast cancer.

Dr. Komal Patil-Sisodia 12:16

And is that because it doesn't originate from the fatty tissue in the breast?

Dr. Sasmita Misra 12:21

Yeah.

Dr. Komal Patil-Sisodia 12:22

Okay.

Dr. Sasmita Misra 12:22

Because it originates from the, what we call the fiber or glandular breast tissue, which is not fully understood, but we think that just increases your giving rise to cancer cells. Yeah. The glandular tissue is the tissue that can give rise to cancer cells.

Dr. Komal Patil-Sisodia 12:37

And that's the tissue that's hormone responsive, right?

Dr. Sasmita Misra 12:40

Yeah.

Dr. Komal Patil-Sisodia 12:40

Okay.

Dr. Sasmita Misra 12:41

So for women with dense breasts, even though the reason why we have to mention that breast density on their mammogram is. We want them to know that there are additional tools that can help them in addition to the mammogram, and so there are some state laws out there. For example, in Illinois, we have to inform a patient that they have dense breasts and that they can get another tool like an breast ultrasound in addition to their mammogram to evaluate the breasts and their breast density. It's really important. Just recently I did a patient with a screening, breast ultrasound after having a negative mammogram, and we found two cancers in their left breast, and it just tells you the importance of the patient knowing that they had dense breasts coming in for their breast ultrasound and diagnosing

Dr. Komal Patil-Sisodia 13:23

Yeah, their

Dr. Sasmita Misra 13:24

cancers.

Dr. Komal Patil-Sisodia 13:25

Okay. And question for you, I've seen a lot of hype online, especially with Olivia Munn and her use of the Tyrer-Cuzick scale for getting her breast cancer diagnosed that didn't show up on a mammogram. What are your thoughts on that, and is that something you recommend and yeah, is it helpful?

Dr. Sasmita Misra 13:44

Very helpful. So we have every patient when they come in. Yeah. We ask all the screening questions for the tyro scoring, so that way we can restratify them. Okay. Because one of the breast imaging no longer is a one size fits all. We're not doing screening mammograms for every patient. Beginning at age 40, we actually look into these other risk factors to see what else, what other tools can we give them that we. To help diagnose their breast cancer earlier before it becomes a late later stage. So one of the tools that have been developed is the Tyrer-Cuzick scoring, and what that does is it does ask about, unopposed estrogen, the date of first period, the date of your last menopause, your family history, any abnormal biopsies that you may have had, and all of these questions get placed into a risk calculator, and then it will generate a score and tell you if you're high risk or not. Okay. The average person has about a lifetime risk of developing breast cancer at 12%. So anything in the 15 to 20% category on that score, you're considered intermediate risk. Okay? And anybody who is greater than 20%, they're considered high risk. And so those high risk patients, we will recommend them to not only get a mammogram every year, but we also will ask them to get a MRI every year. But we alternate the mammogram. And the MRI at six month intervals. So they're getting some sort of breast imaging on it every six month basis, but it's alternating with a mammogram and a breast MRI. Okay. And so I think it's very helpful for.

Dr. Komal Patil-Sisodia 15:18

That's great. It's something that I've started using in my practice recently and it's actually helped me catch some things. I had a patient who came to see me and had been put on hormones elsewhere, but when I was going through the tire acoustic thing and her family history form, I noticed that her dad had prostate and breast cancer, and I was like, oh my gosh. Time out.

Dr. Sasmita Misra 15:40

Yeah. Very high risk. Yeah.

Dr. Komal Patil-Sisodia 15:42

Let's shift gears a little bit. I want people to understand screening, right? Yeah. Because I am a physician and sometimes I get confused.

Dr. Sasmita Misra 15:52

Yeah.

Dr. Komal Patil-Sisodia 15:53

If you could break down, let's talk about what is the appropriate screening, what you would recommend to all women and why the guidelines are so different from American College of Radiology to U-S-P-S-T-F. I'm curious to hear your viewpoint on those things.

Dr. Sasmita Misra 16:07

Yeah, it's a great question. Screening has evolved largely from the seventies to eighties and largely because our equipment and our technology has involved, yeah. And so if you go back to the seventies and eighties and you look at their screening mammography, although it was harder to detect cancers, we still saw a great change in out outcomes and the survivability. And then now you fast forward to today we do digital mammography and majority of facilities do what we call 3D mammography or what we call tomosynthesis, which is just a different closer layered look at looking at the breast through different angles. Okay? We're able to detect breast cancers earlier. And we also have less callback rates. So screening mammography is the only proven method to detect breast cancer early among women. And so there are studies after studies that show this, and it's really important for us to get that information out there. You'll hear a lot of other different types of studies and modalities that are out there, but breast cancer screening is. The one that reduces mortality by 40% in women. Wow. So you'll see these varying organizations, like you mentioned, the us task force, preventative task force. They recommended years ago that screening mammography can happen at age 50 every two years. And largely the way that they look. At the screening mammography was not through the lens of survivability, improved mortality. They're looking at the lens of all patients and more from an anxiety related component. These patients get more anxious because they're being called back for cases and they're also not looking at demographics as much. It was more of a general population. Group of women. What? The the A CR and the American Cancer Society we're aligned and we recommend annual mammograms beginning at age 40. Okay. Every year. And I think that's really important to let everyone know our insurance will pay for it, but there are certain guidelines, if you have a first degree relative, for example, who was diagnosed with breast cancer, say it. 35, we can move up that first screener 10 years prior to the age of the first degree relative developing breast cancer. Okay. So we have a lot of modifiable risk factor. Yeah. Ways of screening now.

Dr. Komal Patil-Sisodia 18:22

And one of the most common questions I get from my patients is what exactly is a first degree relative? Is that like mother or sister or does that extend to aunts and cousins and things like that? Yeah. Because I think, if there's any history of breast cancer at all, right? People are really worried that could be something for them.

Dr. Sasmita Misra 18:41

First degree relative is your mother, your sister, or your daughter. Okay? Those are what we consider first degree relatives. And your father actually, if you have a father who's diagnosed with breast cancer, we're at a much higher concern that there is genetics at play.

Dr. Komal Patil-Sisodia 18:56

Okay? Yeah. And with the genetic testing. How frequently do you recommend genetic testing? Or is that something that comes from you or from the oncologist?

Dr. Sasmita Misra 19:08

So what we do when it comes for genetic evaluation is we don't do that in our breast center itself, but we do a risk analysis for every patient that comes in. And in that risk as analysis, we do ask a lot of questions. And if it looks like the patient has a higher risk of duh. Developing breast cancer than the regular population. We will counsel them or suggest for them to go see a genetic counselor for possible evaluation of a genetic component. And so just for risk mitigation, you largely, I think you get genetically tested once, but like I tell a lot of my patients year after year, they're constantly identifying, yeah. New genetic mutations, and so it's important to go back if it's been a couple years, to see if there's a need for another evaluation.

Dr. Komal Patil-Sisodia 19:57

I heard one of the hard cutoff points was like pre 2013, right? Because the assay really significantly changed for genetic testing after that.

Dr. Sasmita Misra 20:05

Yes.

Dr. Komal Patil-Sisodia 20:06

Would you still. So definitely for people who'd been tested pre 2013. Yes. Let's shift gears now to the different types of imaging modality. Right. There's right. Mammogram ultrasound, MRI and then you talked a little bit about tomo. I've seen stuff about contrast enhanced mammo and AI is a hot topic. There's lots of stuff on the horizon.

Dr. Sasmita Misra 20:27

Yeah. We have a lot of imaging tools in our toolbox to evaluate the breast, but the mammography remains the gold standard for the detection of breast cancer. And like I mentioned before, it can detect about 85 to 90% of breast cancers. And now with 3D mammography or the tomosynthesis we're detecting even. More breast cancers. It is the only screening method that through decades of large population studies that reduce our breast cancer mortality by 40%. And our goal in screening mammography is to catch cancers when they're small before symptoms develop, so that way our treatments are more effective and less invasive. And so the technology behind mammography is absolutely amazing, and that's why we recommend it for all of our patients across the board. But there are other tools that we can use to help us dig through the mammogram a little bit more. So there are some limitations. For example, we talked about breast density, the denser the breast. Sometimes it is harder to look at a mammogram and we can use an ultrasound to help us evaluate that more. Also, an ultrasound will be a problem solving. If we see a mass in the breast, we can use the ultrasound to detect if the mass is solid or cystic. And ultrasound has no radiation. It's the use of sound waves. So it's really good for a lot of our patients and. We also have breast MRI, which is another great way to look at the breast. So MRI has a high sensitivity in develop detecting breast cancer, so you can detect more breast cancers, but also you can also detect other things that are not related to breast cancer. It can lead to more tests. So that's why it is not the screening tool that we give for every patient. And then we have contrast enhanced mammography, which we actually do at our facility as well.

Dr. Komal Patil-Sisodia 22:14

Very nice. It's a

Dr. Sasmita Misra 22:15

great tool and what it is is you get your mammogram, but we give dye to the patient and we look at areas of higher blood flow and breast cancers tend to have higher blood flow, and so that's why we use that tool as well. And this is great for patients with what we call intermediate risk factors or are unable to lay down in an MRI unit for whatever reason it may be. And it has proven to be a very good problem solving technique for our patients.

Dr. Komal Patil-Sisodia 22:42

Oh, that's very cool. So it is just like the regular die like you would give for a CT scan radio? Exactly. Trust. Okay.

Dr. Sasmita Misra 22:49

Yeah. Alright.

Dr. Komal Patil-Sisodia 22:50

Yeah. And what are your thoughts on like all these AI tools that are coming out? I feel like it's gonna miss stuff, but that's just my paranoia.

Dr. Sasmita Misra 22:57

I mean, people ask me that all the time and I still say I have job security. So that's good because I think it's an ever evolving technology. Right now, nothing is perfect. We use AI in other aspects of radiology. I think it can help aid us, but will not, and maybe as time goes on, be a better. Tool for detecting breast cancer. But right now, that's

Dr. Komal Patil-Sisodia 23:18

not the way to go.

Dr. Sasmita Misra 23:20

Yeah. Not foolproof.

Dr. Komal Patil-Sisodia 23:21

So let's talk about a hot topic. I see this all over social media and I've never heard of this in medical school, but what is thermography? Oh my gosh. Okay.

Dr. Sasmita Misra 23:31

I know, I know. I had to ask it. Yes. Get this question a lot, yeah, it is. It's based off of heat imaging. Okay. And so it states that it can detect breast cancer, and it sounds really appealing because it's non-invasive. There's no radiation involved. But the truth is, thermography does not detect breast cancer more accurately than mammography because the thought is breast cancers will emit heat because of increased vascularity or increase blood flow. So if it does, then they'll be able to detect that breast cancer. Yeah. However, early cancers. Small may not detect, emit that heat. And then also breast cancers that are deeper within the breast, they may not be able to catch that. And then there will be

Dr. Komal Patil-Sisodia 24:19

in

Dr. Sasmita Misra 24:19

front of it.

Dr. Komal Patil-Sisodia 24:19

Yeah,

Dr. Sasmita Misra 24:20

exactly. And then there's a lot of reasons why your breast can emit, emit heat that are not cancerous, inflammation of the breast, infections of the breast, so it's a tool that has been LA largely touted because it's not, does not great. Give radiation, but it is not as effective as mammography and it has missed a lot of cancers. And I have seen a lot of patients who will come in and say, well, I had a negative thermogram, but now I have this new lump. And it's really sad to see that. That's heartbreaking.

Dr. Komal Patil-Sisodia 24:48

It's scary because I feel like a lot of times people are doing this because they're fearful of radiation, but you know how much radiation is actually in a mammogram, like I don't think all that much. Right?

Dr. Sasmita Misra 24:58

Yeah. So basically, I hear this all the time, and patients would rather get an MRI or an ultrasound and not get the mammogram. The way I describe the radiation firm that you get from a single mammogram, it's equivalent to seven weeks of the regular background radiation that we all receive. Just sitting around, just living and being near, just living like, yes. Okay. And also it's equivalent to one. Round trip cost crunchy flight Because you get more radiation as your higher up. Yeah. Oh,

Dr. Komal Patil-Sisodia 25:30

okay. So

Dr. Sasmita Misra 25:31

if you think of it that way, they've done studies where say if you get an annual mammogram from 40 to 80, that's equivalent to what we call that radiation amount is so negligible that it does not increase your risk for developing breast cancer

Dr. Komal Patil-Sisodia 25:47

or any other type of cancer, I imagine.

Dr. Sasmita Misra 25:49

No, no. Yeah, exactly.

Dr. Komal Patil-Sisodia 25:50

So that you hear to hear folks. Yeah. Cramps do not incur, increase your risk of other cancers. And it is the best screening tool detects 85 to 90% of cancers and

Dr. Sasmita Misra 26:03

reduces

Dr. Komal Patil-Sisodia 26:03

the risk of mortality by 40%.

Dr. Sasmita Misra 26:05

Mm-hmm.

Dr. Komal Patil-Sisodia 26:06

After somebody gets a call for an abnormal mammo, right? Yeah. Like that's gotta be probably one of the most nerve wracking points Yeah. For a woman when they get that call. So what happens after that? Or what should happen after that?

Dr. Sasmita Misra 26:19

So a patient will come in for their screening mammogram and around, we tend to call back around six to 10% of the patients, okay. From a screening mammogram. And when we're calling them back, it does not mean that they have cancer, it's just that we detected abnormality. We need to take a closer look. Okay? Because there are a lot of benign, non-cancerous reasons to come back from. A screening mammogram. A lot of it could be an overlapping of tissue. We haven't had something to compare it with in the past. So this is the first time that we're seeing this patient. Only one in 10 callbacks will result in a biopsy, and even then, when you get the biopsy, only 30% of those biopsies will be a cancer. So if that just tells you, very small amount of our callbacks are going to end up in a malignancy. And I know it's very anxiety provoking, but what I tell my patients is. Don't go to a diagnosis of cancer when you're called back. We're really just trying to get a closer look of the patient, and majority of the time or 90% of the time, there's nothing going on,

Dr. Komal Patil-Sisodia 27:26

that's really great. Now what happens in the scenario that it does come back as cancer, right? What are the next steps? That you recommend for your patients? Because I imagine again just the callback is nerve wracking. The actual diagnosis I know is devastating. So Yeah,

Dr. Sasmita Misra 27:42

It is. I've been doing this for a long enough time to know that every patient will respond differently to it, but majority of the time, most of our patients are working out of anxiety and fear and what their long-term implications are of having a diagnosis of cancer.'cause the C word is very scary for everyone. What I've learned in having to give bad news to these patients is that sitting with them and asking what they're understanding and telling them that they're not alone, because they are definitely not alone in this process, goes a long way. And when you talk to them in plain language, in language that they can understand, I think it really helps them go from a place of anxiety to a place of calm, and I tell them, and this is the truth, is I've been doing this for a long time and I wouldn't be able to do it without the fact, knowing that most of my patients will be fine. And that's the thing that gets me through, finding these cancers early. And because we really want our patients to do well and there's a large support system. And I think when a patient is diagnosed with breast cancer. There's a whole new world out there for them. There's this huge support group for them. We have nurse navigators that navigate them through the whole process, from the diagnosis to all of the appointments. And there's so much support for them that it's overwhelming, but I think as long as they know that they're being taken care of is the most important thing for them,

Dr. Komal Patil-Sisodia 29:11

that's really encouraging because to your point, I think it feels so isolating and you feel like you're the only one, but

Dr. Sasmita Misra 29:17

Yeah.

Dr. Komal Patil-Sisodia 29:18

But you have this group of people that are rallying around you and I always see the fundraisers for breast cancer. Yeah. I think it's like the Susan Komen breast cancer fundraisers, and then all of the support groups that are out there in the community and so many different. Advocacy arenas to help patients. So that's encouraging. Well thank you so much for your time today. I know it's Breast Cancer Awareness Month and I appreciate you, I'm sure you're super busy with advocating for patients and all of the great work that you do. So I really appreciate you taking the time to come on my podcast and talk to us about all things breast cancer. I really appreciate your perspective on screening tests. So can you recap for us quickly. Your recommendations for age at getting your first screening, what the first screening should be, and then how frequently you think it should happen?

Dr. Sasmita Misra 30:08

So for the general population, we recommend our patients get an annual mammogram beginning at age 40, and they get that every year until they physically. Can't. Yeah. And so there's no real end limit for the screening mammogram. And then, we do urge you to talk to your doctor about other screening tools. If you do have things like family risk factors or a genetic abnormality that could increase your risk for developing breast cancer. And so those tools do not replace the mammogram, but they can supplement the mammogram and we can use them in different ways for our patients. I think what. I really want patients to know is that every woman should get a mammogram and they, it's the way that they can advocate for themselves. Most importantly, it's 20 minutes out of the time once a year, and I know it can be painful, but it's a short-term pain for a long-term gain.

Dr. Komal Patil-Sisodia 30:59

What is your one overarching message to women about their breast health?

Dr. Sasmita Misra 31:04

If there's one message that I want every woman to hear is that your health is worth your time. So women often put themselves last, but mammography saves lives. So regular screening catches cancers early and before symptoms and when it's most treatable. So screening mammograms are really important. Just takes 20 minutes. Make that call, make that appointment, and go get your screening exam.

Dr. Komal Patil-Sisodia 31:30

No, you're not on social media, but where can patients find you practicing? If they want to come see you at your breast center?

Dr. Sasmita Misra 31:37

I work at university of Chicago, Tinley Park. Office in Illinois. Okay. And they can always call and make an appointment.

Dr. Komal Patil-Sisodia 31:45

All right. Fabulous. Well, thank you again and thanks to all of the listeners. We will see you on the next episode. Thank you.