June 14, 2024 • 54 mins
According to the American Cancer Society, breast cancer remains to be the most common cancer, excluding skin cancers, and accounts for the second leading cause of cancer death, following lung cancer, in women across the nation. Yet, despite these staggering statistics, a Current Oncology commentary from Harvard Medical School states that misinformation believed by the general population within the domain of breast health remains at large, especially when it comes to breast cancer screening. In this episode, we seek to tackle these questions that surround breast cancer screening and detection: What is the BRCA gene, and how does it relate to breast cancer? What are the risk factors for breast cancer? At what age should a woman start getting a mammogram? Can men also get breast cancer? What is the BI-RADS score? How does one perform a monthly breast self-examination? What are the next steps for the patient after a breast cancer diagnosis?
We are joined today by Dr. Robyn Roth, a board-certified diagnostic radiologist and breast & abdominal imaging specialist based in Camden, NJ. She received her BS at the University of Florida, MD from Albert Einstein College of Medicine, and Diagnostic Radiology residency and Women's Imaging fellowship at the Hospital of the University of Pennsylvania. For the past decade, Dr. Roth has been an attending Breast Radiologist, Women's Imaging Fellowship Director, and Assistant Professor of Radiology in New Jersey. Dr. Roth is the founder of "The Boobie Docs," a renowned social media platform and podcast where she discusses breast cancer and breast health in an educational and fun way. Dr. Roth has been featured on The TODAY Show, USA Today, AOL.com, Health.com, Katie Couric Media, and Good Day Philadelphia.
Livestream Air Date: August 22, 2023
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Thankful to the season's brand partners: Covry, House of M Beauty, Nguyen Coffee Supply, V Coterie, Skin By Anthos, Halmi, By Dr Mom, LOUPN, Baisun Candle Co., RĒJINS, Twrl Milk Tea, 1587 Sneakers
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Hi friends, happy Friday. Welcome to Friends of Franz Friday. Wow, it feels both weird and bittersweet
(00:11):
that this would be the last time I'll be saying that short intro. Well, at least for
now. Welcome to the 24th and the episode finale of the podcast's third season. Wow, my heart
is so full and my mind is so overwhelmed. I can't believe that the season is finally
over. This season has been my creative project and outlet and passion baby for the past year
(00:34):
and a half. Insane. I started blueprinting this season, figuring out the roster of the
expert guest and finalizing the theme, etc. around December 2022. Then I recorded our
first episode with Dr. Shelly Rockwell back in February 2023, recorded the last episode
in August of 2023, and officially released the season with the first episode on December
(00:57):
1, 2023. It's now June 14, 2024. 28 weeks later since the first episode official released
and we have made it. My heart is so full. Thank you everyone for all of your support.
I cannot believe that almost four years and three seasons later, we have reached over
21,000 all time unique downloads and listeners in over 100 countries and on seven continents.
(01:23):
We reached Antarctica. I don't know how like, do they even have access to Spotify or Apple
or YouTube or the internet? But anyway, one of the penguins has listened for sure maybe
somewhere down the iceberg. But thank you for all of your support. It means so much.
And thank you for being here in the last day of the season. I'm so excited for all of
(01:45):
you to learn about such an important topic, a very crucial one. And I have the best person
joining us today to teach us all about it. Cancer. Definitely a word no one likes hearing.
We had an episode back in season two with Dr. Sanjay Juneja, an oncologist and hematologist.
And he talked to us about a book by an oncologist called The Emperor of All Maladies. And it's
(02:08):
true. Of all diseases, cancer is really the one that horrifies people the most. Unfortunately,
it is something that runs in my family. My father died from malignant lymphoma. My maternal
grandmother passed away from acute leukemia. I have this aunt who passed away from ovarian
cancer. Today, we're talking about specific cancer that is actually ranked as the most
common cancer worldwide. Breast cancer. According to the American Cancer Society, breast cancer
(02:34):
is also the most common cancer in women in the United States, except for skin cancers.
It accounts for about 30% of all new female cancers each year. Overall, the average risk
of a woman in the United States developing breast cancer sometime in her life is about
13%. This means that there is a one in 8% chance she will develop breast cancer. But
(02:54):
definitely, men can also get breast cancer, though rare, with an average lifetime risk
of about one in 726. Breast cancer is also the second leading cause of cancer death in
women secondary to lung cancer. Because of breast cancer, there is so much education
needed because there is so much misinformation we can find online. And today, we have Dr.
(03:14):
Robyn Roth to talk all about it. Dr. Roth is a board-certified diagnostic radiologist
who is fellowship-trained in breast and abdominal imaging, women's imaging fellowship director,
assistant professor of radiology, and the founder of The Boobie Docs, a renowned social
media platform and podcast where she discusses breast cancer and breast health in an educational
and fun way. From the BRCA gene and genetic mutations to monthly breast self-examination,
(03:40):
mammograms in the BIRAD score to the Tyrer-Cuzick risk assessment calculator, the horrifying
official breast cancer diagnosis, and the next steps of chemotherapy and surgery, we
tackle it all. This episode is both science and heart. I hope you not only get to learn
a lot from it, but you will also be encouraged to advocate for your own health, especially
breast health. As Dr. Roth says in the episode, early detection is the breast protection.
(04:07):
Have a great day, everyone.
(04:37):
So, we are so excited for our episode recording. Thank you so much for joining me. It's such
an honor. If you could first please introduce yourself to everyone, our featured listeners.
(04:59):
Sure. Hi, breasties. So, my name is Dr. Robyn Roth. I am a breast radiologist. So, that
means that I am the doctor who would interpret any of your breast imaging studies, so like
mammograms, ultrasounds, or MRIs. I'm also the doctor that you would meet if any of those
were abnormal. And I'm the doctor that in many cases gives a cancer diagnosis. So, it's
(05:25):
a really important job that I love and I feel so honored to be at the head of my career.
Most people know me as The Boobie Docs, which is my popular social media platform and just
my podcast. And essentially my whole personality is at this point and it's something I'm just
so passionate about. And it's the way I've combined my passion for early detection and
(05:48):
breast cancer awareness to a younger generation through social media and doing what I love,
which is breast radiology. Wow. I love it. So beautiful. I mean, you're right. Such an
important field and it's something that we'll continue to talk about as this conversation
goes on. But I wanted to first talk about your whole journey into the field of medicine
in itself, right? Yeah. I mean, I've been working in healthcare for several years now
(06:13):
and medicine is like overflowing of just so many beautiful and just bewildering and crazy
things, right? What was the first inspiration that you in pursuing this field? Is it a family
number, a friend, a personal experience? So it's a great question. And I kind of fell
into medicine, I think by fate, you know, growing up, I never really thought of myself
(06:34):
as a math and science kid. I always loved writing. I really wanted to pursue a career
in journalism. I was editor of my high school newspaper and I even wrote in college and
I really had all intentions of going to college for journalism. And as a child, I had growth
hormones deficiency actually. And I took growth hormone shots. And that's something that I
(06:57):
kind of, when I was in my teen years, that was pretty instrumental getting my self confidence
and just knowing who I am. So I always wanted to do this journalism track. And then I don't
know, I went to university of Florida, I was in a huge auditorium with all these incoming
freshmen and they were like, who here is going to be pre-med? And I don't even know what
(07:18):
came over me, but I raised my hand like everybody else. And my parents looked at me like, what?
I thought you're going to do journalism. And they said, you know what, I love Dr. Nemery,
who was my endocrinologist growing up. And why not? You know, I kind of took it as a
challenge. And it's funny because my dad at this orientation at University of Florida,
he goes, you're going to be on the Today Show one day. I could see you as like a medical
(07:42):
consultant. And honestly, like that's my ultimate dream job of like combining medical journalism
and what I do now. So I kind of fell into it. I didn't get weeded out. And in terms
of, I mean, specifically breast radiology, that is very personal to me, which I don't
know if you want to go into. Yes, please. Yeah. So I went through University of Florida
(08:04):
and I ended up going to Albert Einstein College of Medicine in the Bronx, New York, which
was an amazing experience. It was really the first time I ever left Florida. So that was,
you know, huge for me. And also, I always thought I wanted to be a pediatrician. And
then in the back of my mind, when I was in med school, my cousins were diagnosed with
breast cancer in their 30s. And then they ended up testing positive for the BRCA-T mutation.
(08:29):
I mean, this was like 15 years ago. They're happy to report they're doing amazing. But
in the back of my mind, I always kind of knew I wanted to help women like them. And then
radiology I kind of fell into because, again, when you're going through medicine, and you're
kind of seeing what feels right, I knew I took things home with me. So I kind of wanted
(08:50):
to be one step removed from patients directly, which is ultimately kind of what drove me
into radiology, which is such an amazing field. And I'm so happy I fell into that. And then
breast radiology was a natural transition.
I mean, such a beautiful story into medicine. I think it's just like a confirmation that
(09:11):
sometimes the very difficult things that we go through, right, like kind of leads the
way and paves the way into where we should be or what we should do that we don't think
or we didn't realize that we would do.
Right. I think by listening to what brings you joy and like what really makes you tick
or gets you excited is important because I feel like if I would have followed the path
(09:32):
that I thought I was going to take, like I might have been, you know, writing for a newspaper
and I'm happy or I might have been a pediatrician and really not fulfilled. And just the way
that I kind of ebbed and flowed and kind of took signs from the universe about what my
next step should be. It's pretty amazing and powerful. My husband, the radiologist, too,
actually. And we work together and we grew up in South Florida and we met up here in
(09:56):
residency.
I mean, if that's not fake, then I don't know what it is. Right. I mean, despite how beautiful
the field of medicine is, and I can't imagine the fulfillment, the gravity of reward and
satisfaction that you feel, you know, helping people, the path to where you are now was
definitely not easy, right? Especially in the United States, the medical route is so
(10:20):
long, the education, the training with all the entailed sacrifices and the twists and
turns, you know, the things that you don't expect. Given through all that, do you have
any regrets in pursuing the field and being a breast radiologist now?
Absolutely none. Like absolutely none. I wish I could have told my younger self, it's going
to be okay. You're going to find a job, a career that you love. And being able to take
(10:42):
that outside of the reading room has also been important because I think about 10 years
into my career as a radiologist, a few years ago, I was really feeling unfulfilled. Like
I, you know, I think going through medicine, you're always like aiming for the next goal.
Like what is the next step? And like, once you become an attending, there's like no more
steps, right? Like you've actually done it. And you're like, what next? And then you start
(11:07):
thinking about like, who am I? Like, I had three kids during residency and fellowship,
like you kind of lose yourself going through training for what? And like, for me, really
sitting, like I always knew I wanted to write. There was a part of me that always wanted
to create. And even like the way I came up with, you know, the booby dogg was really
(11:27):
just listening to myself and doing some self reflection about like who I am and what makes
you tick and what's getting me excited. Like I knew I wanted to start a social media account,
but I didn't know like what to do. Was I a mom? Was I a doctor? I like, I started my
Instagram account in 2018. It was Dr. Robin Ross. I know really creative. Like my first
(11:50):
picture was like me a selfie in front of a reading, like the workstation. And like, you
know, it was like the beginning of breast cancer awareness month. And I was, you know,
I could even see how unconfident I am back in that post. And I really sat on it for two
years. I did nothing with it. And then like one late night while breastfeeding my child,
like my third kid during the pandemic, I realized I was surrounded by boobs all day. And I was
(12:15):
like, Oh my God, the booby dogg. And actually I say dogg. My name is actually the booby
dogg, plural because for a while, I mean, talk about cosmically connected. My best friend
from day one of med school is a breast radiologist too. We work together. And I know, not by
chance, like she was the one who brought me here first place. And I was like, we're going
(12:40):
to do this together. Like we can talk directly to the audience, like reporting to women.
We're best friends. And we did that together for about a year and a half. And that was
really when it kind of took off and I found my voice. And then she ended up leaving the
social media because her father got sick and ultimately passed from cancer. So she left.
But I really, I keep the S because you know, I took some time off. I really evaluated where
(13:04):
I'm going. And I'm like, no, I love collaborating. I am multi-personality. Like, you know, I
have that multiple sides to me. And it just felt like it made sense. So that's how the
booby dogg and my social media kind of came about and natural evolution.
Yeah. I mean, I love it. I mean, I can just feel the emanating passion that you have,
(13:26):
not just for boobs, but you know, just breast health in general, right? I mean, what is
it about breast science and breast medicine? And I guess we can even deeper and more specifically
in your job, right? Breast imaging, women's imaging, what is it all about? I know you
gave a hint of it earlier. What is it all about? And why is it so special to you that
(13:49):
you know, you even created the breast imaging fellowship in an academic institution?
Yeah. So great question. So breast imaging, you know, as a breast radiologist, we use
a combination of the technology we have right now to figure out what is going on in your
breast. And I'm going to use this to talk about it as a moment about just like what
(14:10):
recommendations are. But you know, typically we start screening the average population,
the average risk population. And that's an important keyword, average risk population
with mammograms starting at age 40. But we know that there is a subset of people that
need breast cancer screening much earlier. So we would want to start about, you know,
10 years before first three relatives, and even as early as starting at age 30. And then also,
(14:36):
if you're high risk, we want to start adding MRI even as early as age 25. But really, for the
typical person, we start with a mammogram. If you have dense breast tissue, we use ultra
sound and MRI so we could see through that. I mean, I think that, you know, mammograms get a lot of
bad press out there because it's an imperfect technology, but it's getting better. And we know
(14:57):
that when we add ultrasound and MRI onto that, then we're able to see much more and be much
more sensitive and we're using much more of a risk stratified approach. So really trying to
identify high risk women earlier. I want to actually point out some important article that
came up within the past week. So recently in JAMA, it came out that just cancer in young people is on
(15:20):
the rise, particularly in the 30 to 39 year old women. And we're seeing a rise in breast cancer,
as well as GI malignancies and endocrine tumors. And this is important for a number of reasons.
We don't exactly know why it is affecting this population much more, but it's like,
(15:42):
it's 19% higher in the 30 to 39 year old group over a 10 year period, which is alarming. We don't
exactly know why that is at this point. Like there's probably a number of factors which we
could talk about, but it really just emphasize the importance of screening, you know, early and
taking women's complaints about their breasts seriously, and also appreciating when women
(16:04):
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(18:22):
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right? Is there's so much misinformation and fear mongering and just like so much debates online
(19:32):
from people who have no expertise in the specific topic, right? And this information can definitely
cost lives, right? And so it was like, why don't we bring in the actual experts to talk about their
fields where they were educated, where they are trained, and one of those is you in this field,
right? And you've said so many amazing information, Doc. And I guess I wanted to
bring it back to the rudimentary talk where even the general public may not know much about, right?
(19:57):
Breast cancer in itself. I mean, we have a breast cancer awareness month, we see pain in one month,
and the symbol in so many places. How pressing of an issue is it in, I guess, nationally and
internationally? And do we know the known causes for breast cancer? No, I mean, breast cancer is
the most common cancer worldwide. So and like we said, there's a young breast cancer epidemic going
(20:20):
on. Actually, in the recent article that I mentioned, even though the numbers were small,
their highest rate of increase was in Asian Pacific Islander and Hispanic women. So it is
an important thing and breast cancer disparities is huge, right? So we don't know, there's probably
not one thing that's causing breast cancer is probably multifactorial. We know that there's
(20:43):
lifestyle factors like obesity, alcohol, smoking, sedentary lifestyle, some of these things that
they pointed out in the article, poor sleep, all those things. And then of course, environmental
things like carcinogens and pollutants in the area in the environment. I mean, we know that there are
clusters of people that either are connected by some geographic location. So obviously, something's
(21:08):
going on. And it's really scary. So I just really encourage anyone listening to, you know, do a
monthly self-rest exam, talk to your doctor about breast cancer risk factors, we should be having
that conversation before the age of 30, ideally by age 25, so that we can identify people that are
high risk. And also be your own breast advocate. Like if you feel something that feels off or
(21:33):
doesn't feel right, you always have to bring it to the attention of your doctor and make sure that
your concerns are being taken seriously. If you feel like they're not being taken seriously, then
it might be time to find another doctor. Yeah, definitely. And I want to point out, you mentioned
several times about being high risk for breast cancer. As a doctor, what do you classify as
high risk? Is it like genetics, like family members? No. And so that's a great conversation piece. So
(21:58):
most people that are diagnosed are actually not at high risk. They have no known family history
or genetic mutation. However, we know that high risk individuals are more likely to develop breast
cancer. So when I say high risk, what I'm saying is greater than 20% lifetime risk of developing
breast cancer. And so this is important. One of the newer recommendations is that everyone
(22:19):
have a breast cancer risk assessment by age 30 with your doctor, ideally starting at age 25.
But obviously that's not realistic. It's also most doctors aren't even aware of this recommendation.
So you could do it yourself. Instead of getting mad at your doctor for not doing this with you,
I encourage people to just do it themselves. You can Google something called the Tyra Krusik
(22:41):
calculator. So T-Y-R-E-R, use the IK calculator. You could basically plug in your age, your weight,
your height. It might ask you some family history if you know what you plug it in and things like
that. When your first period was, how many children you had, if you ever breastfed, things like that.
And it will actually give you your breast cancer risk over your lifetime and in the next five years.
(23:04):
So it's an important number that we're starting to talk about more about. Average risk for
one in eight, about 12 to 13% is average risk. I'm considered intermediate on about 15% when you
plug it in. High risk would be over 20%. And those are the people that we really want to identify
because they're the ones that want to start mammography as early as age 30 and MRI as early as age 25.
(23:28):
Got it. Super helpful. See a genetic counselor. Yeah, see a genetic counselor. We've mentioned
mammogram, right? We're talking about screenings and the top of things. We had Dr. Sal Choi,
a few weeks ago, who's a diagnostic radiology resident. So we touched upon different types
of scans. We talked about CT scans, MRI, PET scans. And in this topic, I really wanted to be
(23:51):
a more specialized talk about mammograms. What exactly is it? How does it differ from a CT scan,
from an MRI? Yeah, it's a great question. So there's a lot of misinformation out there about
mammograms. So let's talk about it. So mammograms are essentially X-rays of your breast. Okay. So
the same way you get a chest X-ray, things are black and white, you know, shade, 50 shades of
(24:13):
black and white. Same thing with a mammogram. And it's very low dose. A mammogram is equivalent
to about living in the world for about seven days that you would get from background radiation.
So I want to dispel any myths that, you know, mammograms are high dose, they cause cancer.
I don't think you could claim that mammograms cause cancer. Right now, they're the bold standard for
(24:34):
breast cancer detection. Mammography is going to get way better through artificial intelligence
and contrast mammography and lots of other things. So CT is much higher dose. It's computed
tomography. I don't really know how to explain down the physics level to your viewers. But so
essentially, so when we do a mammogram of your breast, it's using X-rays, we do 3D mammography,
(24:57):
which is like a 3D mammogram of your breast. So it kind of looks like you're scrolling through
a CT scan when you're going through the breast. So the problem with the black and white is that,
you know, dense breast tissue appears white and cancer, breast cancers often appear white.
So that's what we're talking about dense breast tissue, that it makes it harder to see breast
cancer on mammography. Because think of it like finding a snowflake in a blizzard, right? So the
(25:20):
more white dense tissue you have, the harder it's to find breast cancer using mammography alone.
That's where ultrasound and MRI helps us. So those use different kinds of things. Ultrasound uses
sound waves, and MRI magnetic field, and they create very different images in the breath
and in the body. And they're all used for different things at this point.
(25:41):
Yeah, amazing. I mean, someone comes to you for the first time,
Yeah, like a rod. I finally decided to get my mammogram. Yeah, no, I feel like online,
there's especially Reddit forums and on WhatsApp news, or like Facebook newsfeed. I think there's
really a lot of talks about, oh, it's painful. Oh, it's for that. I obviously can't talk about
(26:05):
that because I will never get my mammogram. But first, a patient comes to you newly, it's like,
doc, I'm ready to get my first mammogram. Right. Can you take us through the process of what we
would expect from beginning to the end of this scan? Sure. That's a great question. So yeah,
I think mammograms need better PR. I'm happy. It's a peer agent.
(26:26):
They obviously are uncomfortable. I can nasty from experience because I've had two of them now that
I'm 41. But they're really, I would say that it's mild to moderate discomfort. There are things that
you could do to minimize your pain level, like taking Advil 30 minutes to an hour before your
exam. Also trying to schedule your mammogram when you are not immediately around your period,
(26:47):
ideally like seven to 10 days after when you're less tender. But even if you pick the worst day
of the month to get it, I think it's still tolerable for most people. And it really depends on the
patient and the technologist also. But yeah, the technologist will take essentially two views of
each breast using an x-ray machine and it's slightly uncomfortable. They press it in a few
(27:09):
different directions. And then usually after they're done, if it's a screening mammogram,
you go home, you get your results in the mail. It's available to your doctor within three days
and you get a report within 30 days. Some places offer same day reads. So they might let you know
if it's normal or abnormal. So about 10% of people get called back from the mammogram.
(27:31):
And the number is higher if it's your first mammogram because we have nothing to compare it to.
And you're more likely to have dense breast tissue. So if you get called back from your
mammogram, especially if it's your first, don't freak out. It does not mean you have cancer.
Of the 10% that get called back, so 10 women out of 100 women get called back. So then they get
something called diagnostic imaging. So where the technologists will be taking additional pictures
(27:55):
of the breasts with a mammogram, they might need to get an ultrasound as well. At the end of that,
you meet with a radiologist or the radiologist will give you results on that day. So that's
considered a diagnostic exam. And basically there's a few different options. So they might tell you
that everything is normal. Okay. So about out of the 10 women that get called back,
(28:17):
six of them will be told that everything is normal. There's nothing to worry about. It's not cancer.
Another two of those women will be told it's probably benign. That means that it's less than
2% chance of that being cancer. And we typically follow that every six months for two years. And
there's specific things that fall into that category. And then the third option about two
(28:37):
of those women will need a biopsy. And even when we recommend the biopsies, that's considered a
BI-REDS four or five. Most of the BI-REDS four. So when I say BI-REDS at the end of your breast
imaging report, you get something called a breast imaging reporting and data system code. So your
BI-REDS code. So if we give you a four or five, that means that you need a biopsy. BI-REDS four
(29:00):
means that it's anywhere between 2% to 95% chance of that being anything to worry about. So most
likely about 80% of those are going to be benign. Okay. But if we tell you it's a category five,
that means it's highly suspicious. I mean, based on our imaging, you know, our imaging, we're very
worried that this is cancer. If it's not cancer, we're probably going to recommend it get taken out
(29:21):
anyways. So, you know, we'll start setting you up maybe with them to meet with the surgeon and
getting the biopsy quicker. So that's like the general thing to understand from getting a
mammogram. But like I said, 90% of women who get their mammograms off the bat will be told it's
normal. And of the 10% women that get called back, you know, the numbers are very small for it to
(29:43):
ultimately be, you know, malignancy. But, you know, it is important to just, you know, talk to the
radiologist, see what they're worried about and why they recommend the biopsy. Thank you so much
for that super filled information. But you know, if we play this out to the general public, right?
Even if we say that, oh, you know, a great part of it may be benign. Yeah. People will stick to that
(30:05):
small percentage of it might be me, right? Can you take me back to, as the physician, as the one who
reads all of this and talks to the patients about, you know, obviously such heartbreaking and horrific
news, take me to that space where you tell the patient, oh, you know, actually, like, these are
the next steps. How does that feel for you as the physician? I feel it's definitely something that
(30:26):
it's a skill that I'm constantly working on. I've been out of practice now for 10 years, and I could
I could like almost remember almost every conversation. And like some of you know, I always
sit down, take a moment to really just sit on that this and the fact that I'm going to give someone
the worst news of their life, and kind of like honor that and just, you know, put myself in their
(30:49):
shoes and make sure, you know, that I'm doing this, taking the time and, you know, answering all our
questions, I often look in their chart to see if anyone's spoken to them, or is this completely,
you know, catching them off guard. Having the conversation that something needs a biopsy,
if I am really suspicious, I'm going to say, you know, I am really concerned about this just based
(31:09):
on how it looks. I think honesty, I think I really try to feel the patient and see where they're at.
Either way, they're going to get the rug pulled out from underneath them, especially if it's, you
know, giving someone a category five highly suspicious for being cancer, you know, I just say
whatever it is, we're going to help you get through this, we're gonna get you the best healthcare team,
and you're gonna get through this, you know, whatever this is. And I just, I feel so fortunate
(31:33):
that I get to help someone through one of, you know, the worst times of their life. I often think
about, you know, many radiologists are not known for their bedside manners. So I feel fortunate
that like I've developed one over time. And, you know, I really tried to empathize with the patient
as much as I can. And like my heart breaks when I get this news too. So, you know, that doesn't get
(31:58):
easy. Yeah, I can't imagine. I mean, just to imagine like someone getting the most horrific news of
their life, right? And many of these probably have families, right? The thoughts of what will happen
to my family or what will happen to me, you know, the next stage itself, maybe a sectomy or chemotherapy,
there's such a lot of things involved in such a journey, right? How have you seen the patients,
(32:26):
now that you talk of how you deal with it, have you seen patients to react to those news?
Well, I always tell patients, like, write down your questions, you're going to have a million,
don't Google everything, because it's really slippery slope. And there's a lot of, like you
said, misinformation out there. And every breast cancer is very different. And your treatment is
(32:50):
very individualized. So what one person might have had as their breast cancer treatment does not mean
that will dictate what your experience will be, you know, even with the medications, the side effects,
everything like that. I really just encourage people to, you know, process the information,
and like I said, write down as many questions as they think of and always, whenever possible,
(33:12):
bring someone to appointments. Because, you know, when you're when you're dealing with something
like cancer, a lot of things I tell you in this moment, you're not going to remember, right? And
you're not going to remember to ask these things. So it's always important when you can, to bring a
companion or someone that you know, can take notes and say, no, the doctor said this, this is the
plan. And just, you know, have an advocate if not you're in addition to yourself, like you have to
(33:36):
be your own best advocate, but also have a friend or family member or someone that can really help
you navigate from these, you know, difficult topics. And, you know, I started, I was the one
giving the news, but I often wondered what happened to my patients and what was next. And that
actually inspired me to start my podcast. So I have a podcast called the Girlfriend's Guide to Breast
(33:59):
Cancer, Breast Health and Beyond. And it actually started like this as an Instagram Live format, and
me and my best friend, Adrian, which would talk to, you know, inspiring people in the breast cancer
community, doctors, advocates, drivers, and ask them like, what the most important questions, how
they got through this, what was their experience like, just because the more we talk about this,
(34:22):
the more, you know, we're getting this information to people who need it. So now through my podcast,
I've been able to, you know, put that in perpetuity. So I'm really happy about that. So
it really is a great resource for anyone who's been newly diagnosed with breast cancer or someone
they love. I always tell people, I hope you never need my podcast, but it's there to do.
Yeah, I love it. I think in those moments, it's so easy to feel alone, right? Like, the whole world
(34:48):
is against me. And it's just, I love that you have your podcast, probably a virtual hug to people,
right? A virtual companion to people like, oh, they've gone through this too, you know, not
everyone's experience, no one's experience ever the same as another's, but just knowing that you
are not alone and that people have gone through it and that we develop maybe the resources or
(35:10):
the mechanisms to be able to go through that, right? Totally. I actually want to speak on that
because the breast cancer community online is incredible. You know, actually, after starting
my Instagram, I started connecting with the breast cancer community and they always say,
and they always say, worst club best members. And I agree with that. And just, I've learned so much
(35:31):
from interacting with organizations like the Breasties. And there's just so many incredible
organizations, incredible advocates out there that have either had breast cancer or providers,
or someone that has a genetic predisposition for a cancer. I never even heard that word until I
joined Instagram and joined the breast cancer community and, you know, thrivers or someone who's
(35:51):
been affected by breast cancer. So just everyone's welcome. It's such an amazing organization,
just an incredible community of breast cancer people. So, you know, when I say don't Google,
I do not mean don't find people on social media because I think that's a real connection they're
made and where people find, you know, I think breast cancer, so many people have been affected
by it. And so it really is important to find people that you connect with that have gone
(36:16):
through similar life situations and got through it and gotten stronger. Yeah, definitely. I feel
like an antithesis to that though is there's a subset to the population and even outside of,
you know, the breast well breast cancer where they're like, oh, I'm not gonna get this test,
I'm not gonna get this mammogram specifically because I don't want to. Yeah, it's better for
(36:37):
me to know. That's a physician, that's a breast doctor. What would be your message to this subset
of people is like, I'd rather not know. Okay, ignorance is not bliss. Early detection is a
breast protection, right? There is really a huge advantage to finding your breast cancer early,
like the earlier stage we can find it, like if we could find it before it's in your lymph nodes
(37:01):
or before it's palpable, then we can possibly avoid chemotherapy, which leads to less time off
of work, which leads to less like, you know, the benefits are endless. So the earlier that we can
get your breast cancer diagnosed and your treatment minimized and get you back to your normal life,
the better. So I really think I encourage people to do their annual mammograms, annual being a
(37:23):
key word, because even that's debatable, which really it's not because, you know, breast cancer,
especially in young women, we know that young women are more likely to get breast cancers in a
interval breast cancers, so in between mammograms. And it's because for a number of reasons. So
that's why annual mammography is really important, especially in young women.
(37:49):
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(41:23):
In medicine, we have kind of the saying that right like prevention is better than cure,
better than actually treating it. And I think you mentioned being palpable, right? And we also
mentioned about breast self-exams. Can you take us through to what a breast self-exam is? Like
what should one be looking for? Oh, she has a rub. I would love to, Chris. You know, so it's funny
(41:45):
because, you know, when we talk about even just misinformation, even the self-breast exam, the
American Cancer Society does not support, which is ludicrous to me. And it's something I'm really
outspoken about because about 80% of young women who are diagnosed with breast cancer find the
abnormality themselves. Let that sink in for a second. Okay, 80% of young women who are diagnosed
(42:07):
with breast cancer find their breast cancer themselves. So I always encourage everyone,
especially young women, to do a monthly self-breast exam. Ideally, we would do it on days seven to
10 of the menstrual cycle, but who is able to keep up with that? So I like to support Feel It
on the first. It was an incredible movement by a breast cancer thriver who passed away last year.
(42:27):
But basically, you're going to look at, it's as simple as looking at your breasts in the mirror
each month, making sure that there's no changes, skin dimpling, rashes that you never notice.
There's no nipple inversion. So just getting familiar with your breast, and then you're
actually going to touch your breast. Again, ideally, you would do this in the shower,
and using three fingers in a circular motion. But again, just really just getting to your breast,
(42:52):
making sure you don't forget the armpit and the clavicle, making sure to get the nipple area,
squeezing your nipple to make sure there's no discharge, especially bloody nipple discharge
would be concerning. All these things, pain, if it's persistent and just focal, again, all these
things are just signs that something's going on. If you're worried about it all, you always bring
(43:13):
it to the attention of your doctor. But I do think it's reasonable to always ask your doctor,
how do you know it's not breast cancer? Are there any imaging tests that we could order to make sure
it's not breast cancer? Because again, we know medical gaslighting is a thing. A lot of people
are told falsely that they're too young to get breast cancer, which is not true. It's probably
(43:33):
not breast cancer, but again, there's no harm in evaluating it with the appropriate imaging studies.
Because again, knowledge is power. We don't want to dismiss anyone's symptoms without working it up
appropriately. Yes, the medical gaslighting, for sure. I'm very curious, when you're talking about
changes in the breast or discharge, even just the palpable changes, it kind of brings me to very,
(44:03):
my thought is very humble, states like pregnancy and breastfeeding stages. If someone does a
self-breast exam during pregnancy or let's say during breastfeeding period, how would one
differentiate between, oh, it's just because of pregnancy or breastfeeding versus, oh, this
might be breast cancer? Well, I think that's a million dollar question. It's important to
(44:27):
point out that breast cancer is the most common cancer during pregnancy and breastfeeding.
As much as lactational changes are a thing and your breast is undergoing normal hormonal changes,
if something is growing, getting bigger, harder, firmer, just not going away, then we have to
(44:47):
evaluate it. We usually start with an ultrasound in a pregnant patient or breastfeeding patient. Even
though mammogram is safe in a pregnant or breastfeeding patient, we could talk about a
little bit how to optimize that. But often we will start with an ultrasound. But I just think it's
important that if a pregnant or breastfeeding woman feels that change, this is for every person,
(45:08):
actually. They pay attention to it over the next few days and making sure it's not getting larger,
bigger, harder, firmer, things like that. Again, always bring to the attention of your doctor
and let them feel it, see how worried they are based on clinical exam. But I do think it's within
everyone's right to say, how do you know it's just a clogged duct? Is there any imaging tests that we
can do to make sure it's not breast cancer? Because that is what a lot of women are told.
(45:33):
And we don't know that without looking at it. Putting an ultrasound on it is usually very
definitive as to whether it's something to be worried about or not. So listening to our
patients and taking their concerns seriously. Definitely. We talk a lot about woman's imaging
and also this is like pregnancy and lactation. Let's talk about the men. Can men get breast cancer?
(45:58):
I think this is something even when I was younger, I keep wondering, can men also get breast cancer?
Yes, men can get breast cancer. Beyonce's dad had breast cancer. One of the KISS members had breast
cancer. It's about one in 850 men. So it's not common, but it counts for about 1% of breast cancer.
(46:18):
We are seeing in younger men as well. So most commonly in men, when a man presents with a
complaint, it's usually gynecomastia. But again, it's not always. And it's pretty easy to decide
if it's anything to worry about with a mammogram starting at age 25, if they have a lump, and then
maybe doing an ultrasound or starting with an ultrasound under age 25. But yes, men can get
(46:42):
mammograms too. There we go. Everybody. And actually some high-risk men are actually screened
with mammography now. That's one of the newer recommendations. So got it. As with any organ
in the body, cancer is not just the only issue that can arise, right? As someone who sees so many
images of breasts, I guess the whole day, for sure, cancer is not the only thing you see. I wanted to
(47:08):
ask, beyond cancer, what would you like the general public to know about breast health in general?
Yeah. I mean, breast health is something that I think a lot of people don't realize that most
doctors and most healthcare practitioners are not trained in breast cancer. It's not something you
learn in med school. It's not really rotation or a class. So I think people falsely assume that
(47:30):
their OB-GYN is really in charge of their breast health. And I'm going to say that they're probably
not. Most OB-GYNs are not familiar with all the up-to-date breast imaging studies. So that's why
I think it's important that you follow the booby dots and you listen to what... Breast health is
important. I think we really need to talk about just breast health in general, as opposed to
(47:52):
breast cancer awareness month, which comes around once a year. I think breast cancer awareness should
be all year round. And it's something that we need to be talking about openly. I think people are still
uncomfortable with the word boobs, talking about breast. It makes people uncomfortable. So, you
know, just getting comfortable. As long as we're having a conversation, I think that's what's
important. Yeah, definitely. I think the things that are uncomfortable to talk about are the things
(48:17):
that should be talked about, right? Because when things are taboo, that's where misinformation
arises. Because there's fear or discomfort talking about it. It's like the most important information,
the life-saving information, are not disseminated. They're not covered or not talked about, right?
And I think that's what's so amazing with the platform we have created, the booby dots.
(48:38):
Aside from, you know, saving people's lives through early detection, from reading images,
you're actually really like sharing that life-saving material online, the booby dots.
What is your main goal or what is your future goal for this just beautiful platform? Thank you so much.
And I am really so proud of my platform because it really speaks. I know that about 10% of people
(49:02):
get their information on social media. That number is going to grow as more people, you know,
the generations get younger and more people are on social media. And I think my ultimate goal is,
you know, I just want to get this message to as many people as needed. Like there's lots of
breast cancer disparities out there. So always growing my platform, growing my podcast. And I
(49:25):
really want to write a book this year. I know it's like, I know I've written it in my head.
I've written a lot of it and I just need to get it out because I just think that this has a
possibility to really get this information out to people who need it. Yeah, definitely. And I want
to tie that to one of my last questions. I guess more of a scenario. A woman, someone in the world
(49:50):
just got the most horrific and heartbreaking news from their breast radiologist that, oh,
this might be something that's really, really worrisome. What would be your message to that
person who's going through probably one of the darkest days of their life? The only way out is
through. You're going to get through this stronger. I think that you're going to get stronger through
(50:13):
this. You just have to have the right attitude. You know, this is, you know, you can't control
what's happening, but you can control how you react. And so, you know, attitude is everything.
Getting a support network in place is really important and asking people for what you need
specifically. Like, could you pick up my child at daycare? You know, sending meals is important.
(50:36):
You know, trying, like I know a lot of times people in the community will send meal trains.
I think that's really helpful. But I always tell people it's going to be a really hard year,
but you're going to get through this. You're going to get stronger and you're going to look back on
this and know why you went through this and how much you've changed. I think, right, there's a
life before breast cancer and there's a life after breast cancer. And just, I think a lot of people
(51:01):
reevaluate where they are in their lives and where they want to go and, you know, use the opportunity
to find purpose in the meaning. Yeah, I love that. That was so beautiful. You know, we talk a lot
about so much educational information, but we also talk a lot about so many heavy and
heartbreaking topics, right? And we touch upon how your response to this, right, is when you see that
(51:27):
perfect or probably worse imaging and then saying it to the patients. How do you decompress out of
this? I do a terrible job of decompressing. Like, I'm on all the time. What I know I need to be
doing more is exercising and meditation. I have a really busy mind. I actually just got diagnosed
(51:49):
within the past year with ADHD, which I think is interesting. I've learned that a lot of women,
a lot of successful women in their 40s are being diagnosed with ADHD later in life because we were
just overlooked, right? We were able to get through with things until it caught up with us. And now we
have three kids in a career where like, how did we end up here? So trying to stay grounded is
(52:13):
important. And, you know, obviously, my kids are everything. I have three kids. And really trying
to compartmentalize my mom time from my screen time, from my work time. You know, I think that's
a constant challenge, but something I'm working on. Okay. Dr. Roth, it's learned so much. I feel
(52:37):
like my brain is like, and these are information that really are distorted online. I mean,
we just have to say it like that, right? Like, it's just distorted. And most of the information
online are not coming from actual educated and trained experts who see imaging all day,
right? And so it's such an honor to just have you on. Beyond all the education information,
(52:59):
it's just so beautiful to see your heart in just this field. And it's such a, I feel like
it's a world of, it's just a double edged sword, right? There's so much beauty in it, but also so
much brokenness and also fear and, and you encapsulate all of that in such a, so much passion.
So thank you. I hope, I hope people that follow me, you know, if they don't learn something that
(53:24):
maybe they'll come for a laugh or just feel like they have a friend in their corner. So thank you.
I love that. I can't wait for everyone else to hear this episode. Yeah.
So he was asking really quickly how they knew if their nipple flatness was abnormal,
but like if something's a change for you, that's, you know, when to pay attention to something. So
(53:46):
your nipples can be inverted your whole life, but if it's new for you, that's concerning. So
just wanted to throw that out there. Got it. And please follow the WubiDocs for more of this,
more of the breast information. Thank you so much. Have a great night. Bye.
Hi friends, happy Friday. Welcome to Friends of Franz Friday. Wow, it feels both weird and bittersweet
(00:11):
that this would be the last time I'll be saying that short intro. Well, at least for
now. Welcome to the 24th and the episode finale of the podcast's third season. Wow, my heart
is so full and my mind is so overwhelmed. I can't believe that the season is finally
over. This season has been my creative project and outlet and passion baby for the past year
(00:34):
and a half. Insane. I started blueprinting this season, figuring out the roster of the
expert guest and finalizing the theme, etc. around December 2022. Then I recorded our
first episode with Dr. Shelly Rockwell back in February 2023, recorded the last episode
in August of 2023, and officially released the season with the first episode on December
(00:57):
1, 2023. It's now June 14, 2024. 28 weeks later since the first episode official released
and we have made it. My heart is so full. Thank you everyone for all of your support.
I cannot believe that almost four years and three seasons later, we have reached over
21,000 all time unique downloads and listeners in over 100 countries and on seven continents.
(01:23):
We reached Antarctica. I don't know how like, do they even have access to Spotify or Apple
or YouTube or the internet? But anyway, one of the penguins has listened for sure maybe
somewhere down the iceberg. But thank you for all of your support. It means so much.
And thank you for being here in the last day of the season. I'm so excited for all of
(01:45):
you to learn about such an important topic, a very crucial one. And I have the best person
joining us today to teach us all about it. Cancer. Definitely a word no one likes hearing.
We had an episode back in season two with Dr. Sanjay Juneja, an oncologist and hematologist.
And he talked to us about a book by an oncologist called The Emperor of All Maladies. And it's
(02:08):
true. Of all diseases, cancer is really the one that horrifies people the most. Unfortunately,
it is something that runs in my family. My father died from malignant lymphoma. My maternal
grandmother passed away from acute leukemia. I have this aunt who passed away from ovarian
cancer. Today, we're talking about specific cancer that is actually ranked as the most
common cancer worldwide. Breast cancer. According to the American Cancer Society, breast cancer
(02:34):
is also the most common cancer in women in the United States, except for skin cancers.
It accounts for about 30% of all new female cancers each year. Overall, the average risk
of a woman in the United States developing breast cancer sometime in her life is about
13%. This means that there is a one in 8% chance she will develop breast cancer. But
(02:54):
definitely, men can also get breast cancer, though rare, with an average lifetime risk
of about one in 726. Breast cancer is also the second leading cause of cancer death in
women secondary to lung cancer. Because of breast cancer, there is so much education
needed because there is so much misinformation we can find online. And today, we have Dr.
(03:14):
Robyn Roth to talk all about it. Dr. Roth is a board-certified diagnostic radiologist
who is fellowship-trained in breast and abdominal imaging, women's imaging fellowship director,
assistant professor of radiology, and the founder of The Boobie Docs, a renowned social
media platform and podcast where she discusses breast cancer and breast health in an educational
and fun way. From the BRCA gene and genetic mutations to monthly breast self-examination,
(03:40):
mammograms in the BIRAD score to the Tyrer-Cuzick risk assessment calculator, the horrifying
official breast cancer diagnosis, and the next steps of chemotherapy and surgery, we
tackle it all. This episode is both science and heart. I hope you not only get to learn
a lot from it, but you will also be encouraged to advocate for your own health, especially
breast health. As Dr. Roth says in the episode, early detection is the breast protection.
(04:07):
Have a great day, everyone.
(04:37):
So, we are so excited for our episode recording. Thank you so much for joining me. It's such
an honor. If you could first please introduce yourself to everyone, our featured listeners.
(04:59):
Sure. Hi, breasties. So, my name is Dr. Robyn Roth. I am a breast radiologist. So, that
means that I am the doctor who would interpret any of your breast imaging studies, so like
mammograms, ultrasounds, or MRIs. I'm also the doctor that you would meet if any of those
were abnormal. And I'm the doctor that in many cases gives a cancer diagnosis. So, it's
(05:25):
a really important job that I love and I feel so honored to be at the head of my career.
Most people know me as The Boobie Docs, which is my popular social media platform and just
my podcast. And essentially my whole personality is at this point and it's something I'm just
so passionate about. And it's the way I've combined my passion for early detection and
(05:48):
breast cancer awareness to a younger generation through social media and doing what I love,
which is breast radiology. Wow. I love it. So beautiful. I mean, you're right. Such an
important field and it's something that we'll continue to talk about as this conversation
goes on. But I wanted to first talk about your whole journey into the field of medicine
in itself, right? Yeah. I mean, I've been working in healthcare for several years now
(06:13):
and medicine is like overflowing of just so many beautiful and just bewildering and crazy
things, right? What was the first inspiration that you in pursuing this field? Is it a family
number, a friend, a personal experience? So it's a great question. And I kind of fell
into medicine, I think by fate, you know, growing up, I never really thought of myself
(06:34):
as a math and science kid. I always loved writing. I really wanted to pursue a career
in journalism. I was editor of my high school newspaper and I even wrote in college and
I really had all intentions of going to college for journalism. And as a child, I had growth
hormones deficiency actually. And I took growth hormone shots. And that's something that I
(06:57):
kind of, when I was in my teen years, that was pretty instrumental getting my self confidence
and just knowing who I am. So I always wanted to do this journalism track. And then I don't
know, I went to university of Florida, I was in a huge auditorium with all these incoming
freshmen and they were like, who here is going to be pre-med? And I don't even know what
(07:18):
came over me, but I raised my hand like everybody else. And my parents looked at me like, what?
I thought you're going to do journalism. And they said, you know what, I love Dr. Nemery,
who was my endocrinologist growing up. And why not? You know, I kind of took it as a
challenge. And it's funny because my dad at this orientation at University of Florida,
he goes, you're going to be on the Today Show one day. I could see you as like a medical
(07:42):
consultant. And honestly, like that's my ultimate dream job of like combining medical journalism
and what I do now. So I kind of fell into it. I didn't get weeded out. And in terms
of, I mean, specifically breast radiology, that is very personal to me, which I don't
know if you want to go into. Yes, please. Yeah. So I went through University of Florida
(08:04):
and I ended up going to Albert Einstein College of Medicine in the Bronx, New York, which
was an amazing experience. It was really the first time I ever left Florida. So that was,
you know, huge for me. And also, I always thought I wanted to be a pediatrician. And
then in the back of my mind, when I was in med school, my cousins were diagnosed with
breast cancer in their 30s. And then they ended up testing positive for the BRCA-T mutation.
(08:29):
I mean, this was like 15 years ago. They're happy to report they're doing amazing. But
in the back of my mind, I always kind of knew I wanted to help women like them. And then
radiology I kind of fell into because, again, when you're going through medicine, and you're
kind of seeing what feels right, I knew I took things home with me. So I kind of wanted
(08:50):
to be one step removed from patients directly, which is ultimately kind of what drove me
into radiology, which is such an amazing field. And I'm so happy I fell into that. And then
breast radiology was a natural transition.
I mean, such a beautiful story into medicine. I think it's just like a confirmation that
(09:11):
sometimes the very difficult things that we go through, right, like kind of leads the
way and paves the way into where we should be or what we should do that we don't think
or we didn't realize that we would do.
Right. I think by listening to what brings you joy and like what really makes you tick
or gets you excited is important because I feel like if I would have followed the path
(09:32):
that I thought I was going to take, like I might have been, you know, writing for a newspaper
and I'm happy or I might have been a pediatrician and really not fulfilled. And just the way
that I kind of ebbed and flowed and kind of took signs from the universe about what my
next step should be. It's pretty amazing and powerful. My husband, the radiologist, too,
actually. And we work together and we grew up in South Florida and we met up here in
(09:56):
residency.
I mean, if that's not fake, then I don't know what it is. Right. I mean, despite how beautiful
the field of medicine is, and I can't imagine the fulfillment, the gravity of reward and
satisfaction that you feel, you know, helping people, the path to where you are now was
definitely not easy, right? Especially in the United States, the medical route is so
(10:20):
long, the education, the training with all the entailed sacrifices and the twists and
turns, you know, the things that you don't expect. Given through all that, do you have
any regrets in pursuing the field and being a breast radiologist now?
Absolutely none. Like absolutely none. I wish I could have told my younger self, it's going
to be okay. You're going to find a job, a career that you love. And being able to take
(10:42):
that outside of the reading room has also been important because I think about 10 years
into my career as a radiologist, a few years ago, I was really feeling unfulfilled. Like
I, you know, I think going through medicine, you're always like aiming for the next goal.
Like what is the next step? And like, once you become an attending, there's like no more
steps, right? Like you've actually done it. And you're like, what next? And then you start
(11:07):
thinking about like, who am I? Like, I had three kids during residency and fellowship,
like you kind of lose yourself going through training for what? And like, for me, really
sitting, like I always knew I wanted to write. There was a part of me that always wanted
to create. And even like the way I came up with, you know, the booby dogg was really
(11:27):
just listening to myself and doing some self reflection about like who I am and what makes
you tick and what's getting me excited. Like I knew I wanted to start a social media account,
but I didn't know like what to do. Was I a mom? Was I a doctor? I like, I started my
Instagram account in 2018. It was Dr. Robin Ross. I know really creative. Like my first
(11:50):
picture was like me a selfie in front of a reading, like the workstation. And like, you
know, it was like the beginning of breast cancer awareness month. And I was, you know,
I could even see how unconfident I am back in that post. And I really sat on it for two
years. I did nothing with it. And then like one late night while breastfeeding my child,
like my third kid during the pandemic, I realized I was surrounded by boobs all day. And I was
(12:15):
like, Oh my God, the booby dogg. And actually I say dogg. My name is actually the booby
dogg, plural because for a while, I mean, talk about cosmically connected. My best friend
from day one of med school is a breast radiologist too. We work together. And I know, not by
chance, like she was the one who brought me here first place. And I was like, we're going
(12:40):
to do this together. Like we can talk directly to the audience, like reporting to women.
We're best friends. And we did that together for about a year and a half. And that was
really when it kind of took off and I found my voice. And then she ended up leaving the
social media because her father got sick and ultimately passed from cancer. So she left.
But I really, I keep the S because you know, I took some time off. I really evaluated where
(13:04):
I'm going. And I'm like, no, I love collaborating. I am multi-personality. Like, you know, I
have that multiple sides to me. And it just felt like it made sense. So that's how the
booby dogg and my social media kind of came about and natural evolution.
Yeah. I mean, I love it. I mean, I can just feel the emanating passion that you have,
(13:26):
not just for boobs, but you know, just breast health in general, right? I mean, what is
it about breast science and breast medicine? And I guess we can even deeper and more specifically
in your job, right? Breast imaging, women's imaging, what is it all about? I know you
gave a hint of it earlier. What is it all about? And why is it so special to you that
(13:49):
you know, you even created the breast imaging fellowship in an academic institution?
Yeah. So great question. So breast imaging, you know, as a breast radiologist, we use
a combination of the technology we have right now to figure out what is going on in your
breast. And I'm going to use this to talk about it as a moment about just like what
(14:10):
recommendations are. But you know, typically we start screening the average population,
the average risk population. And that's an important keyword, average risk population
with mammograms starting at age 40. But we know that there is a subset of people that
need breast cancer screening much earlier. So we would want to start about, you know,
10 years before first three relatives, and even as early as starting at age 30. And then also,
(14:36):
if you're high risk, we want to start adding MRI even as early as age 25. But really, for the
typical person, we start with a mammogram. If you have dense breast tissue, we use ultra
sound and MRI so we could see through that. I mean, I think that, you know, mammograms get a lot of
bad press out there because it's an imperfect technology, but it's getting better. And we know
(14:57):
that when we add ultrasound and MRI onto that, then we're able to see much more and be much
more sensitive and we're using much more of a risk stratified approach. So really trying to
identify high risk women earlier. I want to actually point out some important article that
came up within the past week. So recently in JAMA, it came out that just cancer in young people is on
(15:20):
the rise, particularly in the 30 to 39 year old women. And we're seeing a rise in breast cancer,
as well as GI malignancies and endocrine tumors. And this is important for a number of reasons.
We don't exactly know why it is affecting this population much more, but it's like,
(15:42):
it's 19% higher in the 30 to 39 year old group over a 10 year period, which is alarming. We don't
exactly know why that is at this point. Like there's probably a number of factors which we
could talk about, but it really just emphasize the importance of screening, you know, early and
taking women's complaints about their breasts seriously, and also appreciating when women
(16:04):
are proactive and want to get that mammogram starting at 40 or even earlier if they have
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I remember coming home every day from elementary school and smelling the newly steamed jasmine
rice in the cooker that my grandmother made just in time for dinner. It reminded me of my
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first order at bisoncandleco.com. I mean, this is one of the reasons why I started the podcast,
right? Is there's so much misinformation and fear mongering and just like so much debates online
(19:32):
from people who have no expertise in the specific topic, right? And this information can definitely
cost lives, right? And so it was like, why don't we bring in the actual experts to talk about their
fields where they were educated, where they are trained, and one of those is you in this field,
right? And you've said so many amazing information, Doc. And I guess I wanted to
bring it back to the rudimentary talk where even the general public may not know much about, right?
(19:57):
Breast cancer in itself. I mean, we have a breast cancer awareness month, we see pain in one month,
and the symbol in so many places. How pressing of an issue is it in, I guess, nationally and
internationally? And do we know the known causes for breast cancer? No, I mean, breast cancer is
the most common cancer worldwide. So and like we said, there's a young breast cancer epidemic going
(20:20):
on. Actually, in the recent article that I mentioned, even though the numbers were small,
their highest rate of increase was in Asian Pacific Islander and Hispanic women. So it is
an important thing and breast cancer disparities is huge, right? So we don't know, there's probably
not one thing that's causing breast cancer is probably multifactorial. We know that there's
(20:43):
lifestyle factors like obesity, alcohol, smoking, sedentary lifestyle, some of these things that
they pointed out in the article, poor sleep, all those things. And then of course, environmental
things like carcinogens and pollutants in the area in the environment. I mean, we know that there are
clusters of people that either are connected by some geographic location. So obviously, something's
(21:08):
going on. And it's really scary. So I just really encourage anyone listening to, you know, do a
monthly self-rest exam, talk to your doctor about breast cancer risk factors, we should be having
that conversation before the age of 30, ideally by age 25, so that we can identify people that are
high risk. And also be your own breast advocate. Like if you feel something that feels off or
(21:33):
doesn't feel right, you always have to bring it to the attention of your doctor and make sure that
your concerns are being taken seriously. If you feel like they're not being taken seriously, then
it might be time to find another doctor. Yeah, definitely. And I want to point out, you mentioned
several times about being high risk for breast cancer. As a doctor, what do you classify as
high risk? Is it like genetics, like family members? No. And so that's a great conversation piece. So
(21:58):
most people that are diagnosed are actually not at high risk. They have no known family history
or genetic mutation. However, we know that high risk individuals are more likely to develop breast
cancer. So when I say high risk, what I'm saying is greater than 20% lifetime risk of developing
breast cancer. And so this is important. One of the newer recommendations is that everyone
(22:19):
have a breast cancer risk assessment by age 30 with your doctor, ideally starting at age 25.
But obviously that's not realistic. It's also most doctors aren't even aware of this recommendation.
So you could do it yourself. Instead of getting mad at your doctor for not doing this with you,
I encourage people to just do it themselves. You can Google something called the Tyra Krusik
(22:41):
calculator. So T-Y-R-E-R, use the IK calculator. You could basically plug in your age, your weight,
your height. It might ask you some family history if you know what you plug it in and things like
that. When your first period was, how many children you had, if you ever breastfed, things like that.
And it will actually give you your breast cancer risk over your lifetime and in the next five years.
(23:04):
So it's an important number that we're starting to talk about more about. Average risk for
one in eight, about 12 to 13% is average risk. I'm considered intermediate on about 15% when you
plug it in. High risk would be over 20%. And those are the people that we really want to identify
because they're the ones that want to start mammography as early as age 30 and MRI as early as age 25.
(23:28):
Got it. Super helpful. See a genetic counselor. Yeah, see a genetic counselor. We've mentioned
mammogram, right? We're talking about screenings and the top of things. We had Dr. Sal Choi,
a few weeks ago, who's a diagnostic radiology resident. So we touched upon different types
of scans. We talked about CT scans, MRI, PET scans. And in this topic, I really wanted to be
(23:51):
a more specialized talk about mammograms. What exactly is it? How does it differ from a CT scan,
from an MRI? Yeah, it's a great question. So there's a lot of misinformation out there about
mammograms. So let's talk about it. So mammograms are essentially X-rays of your breast. Okay. So
the same way you get a chest X-ray, things are black and white, you know, shade, 50 shades of
(24:13):
black and white. Same thing with a mammogram. And it's very low dose. A mammogram is equivalent
to about living in the world for about seven days that you would get from background radiation.
So I want to dispel any myths that, you know, mammograms are high dose, they cause cancer.
I don't think you could claim that mammograms cause cancer. Right now, they're the bold standard for
(24:34):
breast cancer detection. Mammography is going to get way better through artificial intelligence
and contrast mammography and lots of other things. So CT is much higher dose. It's computed
tomography. I don't really know how to explain down the physics level to your viewers. But so
essentially, so when we do a mammogram of your breast, it's using X-rays, we do 3D mammography,
(24:57):
which is like a 3D mammogram of your breast. So it kind of looks like you're scrolling through
a CT scan when you're going through the breast. So the problem with the black and white is that,
you know, dense breast tissue appears white and cancer, breast cancers often appear white.
So that's what we're talking about dense breast tissue, that it makes it harder to see breast
cancer on mammography. Because think of it like finding a snowflake in a blizzard, right? So the
(25:20):
more white dense tissue you have, the harder it's to find breast cancer using mammography alone.
That's where ultrasound and MRI helps us. So those use different kinds of things. Ultrasound uses
sound waves, and MRI magnetic field, and they create very different images in the breath
and in the body. And they're all used for different things at this point.
(25:41):
Yeah, amazing. I mean, someone comes to you for the first time,
Yeah, like a rod. I finally decided to get my mammogram. Yeah, no, I feel like online,
there's especially Reddit forums and on WhatsApp news, or like Facebook newsfeed. I think there's
really a lot of talks about, oh, it's painful. Oh, it's for that. I obviously can't talk about
(26:05):
that because I will never get my mammogram. But first, a patient comes to you newly, it's like,
doc, I'm ready to get my first mammogram. Right. Can you take us through the process of what we
would expect from beginning to the end of this scan? Sure. That's a great question. So yeah,
I think mammograms need better PR. I'm happy. It's a peer agent.
(26:26):
They obviously are uncomfortable. I can nasty from experience because I've had two of them now that
I'm 41. But they're really, I would say that it's mild to moderate discomfort. There are things that
you could do to minimize your pain level, like taking Advil 30 minutes to an hour before your
exam. Also trying to schedule your mammogram when you are not immediately around your period,
(26:47):
ideally like seven to 10 days after when you're less tender. But even if you pick the worst day
of the month to get it, I think it's still tolerable for most people. And it really depends on the
patient and the technologist also. But yeah, the technologist will take essentially two views of
each breast using an x-ray machine and it's slightly uncomfortable. They press it in a few
(27:09):
different directions. And then usually after they're done, if it's a screening mammogram,
you go home, you get your results in the mail. It's available to your doctor within three days
and you get a report within 30 days. Some places offer same day reads. So they might let you know
if it's normal or abnormal. So about 10% of people get called back from the mammogram.
(27:31):
And the number is higher if it's your first mammogram because we have nothing to compare it to.
And you're more likely to have dense breast tissue. So if you get called back from your
mammogram, especially if it's your first, don't freak out. It does not mean you have cancer.
Of the 10% that get called back, so 10 women out of 100 women get called back. So then they get
something called diagnostic imaging. So where the technologists will be taking additional pictures
(27:55):
of the breasts with a mammogram, they might need to get an ultrasound as well. At the end of that,
you meet with a radiologist or the radiologist will give you results on that day. So that's
considered a diagnostic exam. And basically there's a few different options. So they might tell you
that everything is normal. Okay. So about out of the 10 women that get called back,
(28:17):
six of them will be told that everything is normal. There's nothing to worry about. It's not cancer.
Another two of those women will be told it's probably benign. That means that it's less than
2% chance of that being cancer. And we typically follow that every six months for two years. And
there's specific things that fall into that category. And then the third option about two
(28:37):
of those women will need a biopsy. And even when we recommend the biopsies, that's considered a
BI-REDS four or five. Most of the BI-REDS four. So when I say BI-REDS at the end of your breast
imaging report, you get something called a breast imaging reporting and data system code. So your
BI-REDS code. So if we give you a four or five, that means that you need a biopsy. BI-REDS four
(29:00):
means that it's anywhere between 2% to 95% chance of that being anything to worry about. So most
likely about 80% of those are going to be benign. Okay. But if we tell you it's a category five,
that means it's highly suspicious. I mean, based on our imaging, you know, our imaging, we're very
worried that this is cancer. If it's not cancer, we're probably going to recommend it get taken out
(29:21):
anyways. So, you know, we'll start setting you up maybe with them to meet with the surgeon and
getting the biopsy quicker. So that's like the general thing to understand from getting a
mammogram. But like I said, 90% of women who get their mammograms off the bat will be told it's
normal. And of the 10% women that get called back, you know, the numbers are very small for it to
(29:43):
ultimately be, you know, malignancy. But, you know, it is important to just, you know, talk to the
radiologist, see what they're worried about and why they recommend the biopsy. Thank you so much
for that super filled information. But you know, if we play this out to the general public, right?
Even if we say that, oh, you know, a great part of it may be benign. Yeah. People will stick to that
(30:05):
small percentage of it might be me, right? Can you take me back to, as the physician, as the one who
reads all of this and talks to the patients about, you know, obviously such heartbreaking and horrific
news, take me to that space where you tell the patient, oh, you know, actually, like, these are
the next steps. How does that feel for you as the physician? I feel it's definitely something that
(30:26):
it's a skill that I'm constantly working on. I've been out of practice now for 10 years, and I could
I could like almost remember almost every conversation. And like some of you know, I always
sit down, take a moment to really just sit on that this and the fact that I'm going to give someone
the worst news of their life, and kind of like honor that and just, you know, put myself in their
(30:49):
shoes and make sure, you know, that I'm doing this, taking the time and, you know, answering all our
questions, I often look in their chart to see if anyone's spoken to them, or is this completely,
you know, catching them off guard. Having the conversation that something needs a biopsy,
if I am really suspicious, I'm going to say, you know, I am really concerned about this just based
(31:09):
on how it looks. I think honesty, I think I really try to feel the patient and see where they're at.
Either way, they're going to get the rug pulled out from underneath them, especially if it's, you
know, giving someone a category five highly suspicious for being cancer, you know, I just say
whatever it is, we're going to help you get through this, we're gonna get you the best healthcare team,
and you're gonna get through this, you know, whatever this is. And I just, I feel so fortunate
(31:33):
that I get to help someone through one of, you know, the worst times of their life. I often think
about, you know, many radiologists are not known for their bedside manners. So I feel fortunate
that like I've developed one over time. And, you know, I really tried to empathize with the patient
as much as I can. And like my heart breaks when I get this news too. So, you know, that doesn't get
(31:58):
easy. Yeah, I can't imagine. I mean, just to imagine like someone getting the most horrific news of
their life, right? And many of these probably have families, right? The thoughts of what will happen
to my family or what will happen to me, you know, the next stage itself, maybe a sectomy or chemotherapy,
there's such a lot of things involved in such a journey, right? How have you seen the patients,
(32:26):
now that you talk of how you deal with it, have you seen patients to react to those news?
Well, I always tell patients, like, write down your questions, you're going to have a million,
don't Google everything, because it's really slippery slope. And there's a lot of, like you
said, misinformation out there. And every breast cancer is very different. And your treatment is
(32:50):
very individualized. So what one person might have had as their breast cancer treatment does not mean
that will dictate what your experience will be, you know, even with the medications, the side effects,
everything like that. I really just encourage people to, you know, process the information,
and like I said, write down as many questions as they think of and always, whenever possible,
(33:12):
bring someone to appointments. Because, you know, when you're when you're dealing with something
like cancer, a lot of things I tell you in this moment, you're not going to remember, right? And
you're not going to remember to ask these things. So it's always important when you can, to bring a
companion or someone that you know, can take notes and say, no, the doctor said this, this is the
plan. And just, you know, have an advocate if not you're in addition to yourself, like you have to
(33:36):
be your own best advocate, but also have a friend or family member or someone that can really help
you navigate from these, you know, difficult topics. And, you know, I started, I was the one
giving the news, but I often wondered what happened to my patients and what was next. And that
actually inspired me to start my podcast. So I have a podcast called the Girlfriend's Guide to Breast
(33:59):
Cancer, Breast Health and Beyond. And it actually started like this as an Instagram Live format, and
me and my best friend, Adrian, which would talk to, you know, inspiring people in the breast cancer
community, doctors, advocates, drivers, and ask them like, what the most important questions, how
they got through this, what was their experience like, just because the more we talk about this,
(34:22):
the more, you know, we're getting this information to people who need it. So now through my podcast,
I've been able to, you know, put that in perpetuity. So I'm really happy about that. So
it really is a great resource for anyone who's been newly diagnosed with breast cancer or someone
they love. I always tell people, I hope you never need my podcast, but it's there to do.
Yeah, I love it. I think in those moments, it's so easy to feel alone, right? Like, the whole world
(34:48):
is against me. And it's just, I love that you have your podcast, probably a virtual hug to people,
right? A virtual companion to people like, oh, they've gone through this too, you know, not
everyone's experience, no one's experience ever the same as another's, but just knowing that you
are not alone and that people have gone through it and that we develop maybe the resources or
(35:10):
the mechanisms to be able to go through that, right? Totally. I actually want to speak on that
because the breast cancer community online is incredible. You know, actually, after starting
my Instagram, I started connecting with the breast cancer community and they always say,
and they always say, worst club best members. And I agree with that. And just, I've learned so much
(35:31):
from interacting with organizations like the Breasties. And there's just so many incredible
organizations, incredible advocates out there that have either had breast cancer or providers,
or someone that has a genetic predisposition for a cancer. I never even heard that word until I
joined Instagram and joined the breast cancer community and, you know, thrivers or someone who's
(35:51):
been affected by breast cancer. So just everyone's welcome. It's such an amazing organization,
just an incredible community of breast cancer people. So, you know, when I say don't Google,
I do not mean don't find people on social media because I think that's a real connection they're
made and where people find, you know, I think breast cancer, so many people have been affected
by it. And so it really is important to find people that you connect with that have gone
(36:16):
through similar life situations and got through it and gotten stronger. Yeah, definitely. I feel
like an antithesis to that though is there's a subset to the population and even outside of,
you know, the breast well breast cancer where they're like, oh, I'm not gonna get this test,
I'm not gonna get this mammogram specifically because I don't want to. Yeah, it's better for
(36:37):
me to know. That's a physician, that's a breast doctor. What would be your message to this subset
of people is like, I'd rather not know. Okay, ignorance is not bliss. Early detection is a
breast protection, right? There is really a huge advantage to finding your breast cancer early,
like the earlier stage we can find it, like if we could find it before it's in your lymph nodes
(37:01):
or before it's palpable, then we can possibly avoid chemotherapy, which leads to less time off
of work, which leads to less like, you know, the benefits are endless. So the earlier that we can
get your breast cancer diagnosed and your treatment minimized and get you back to your normal life,
the better. So I really think I encourage people to do their annual mammograms, annual being a
(37:23):
key word, because even that's debatable, which really it's not because, you know, breast cancer,
especially in young women, we know that young women are more likely to get breast cancers in a
interval breast cancers, so in between mammograms. And it's because for a number of reasons. So
that's why annual mammography is really important, especially in young women.
(37:49):
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(41:23):
In medicine, we have kind of the saying that right like prevention is better than cure,
better than actually treating it. And I think you mentioned being palpable, right? And we also
mentioned about breast self-exams. Can you take us through to what a breast self-exam is? Like
what should one be looking for? Oh, she has a rub. I would love to, Chris. You know, so it's funny
(41:45):
because, you know, when we talk about even just misinformation, even the self-breast exam, the
American Cancer Society does not support, which is ludicrous to me. And it's something I'm really
outspoken about because about 80% of young women who are diagnosed with breast cancer find the
abnormality themselves. Let that sink in for a second. Okay, 80% of young women who are diagnosed
(42:07):
with breast cancer find their breast cancer themselves. So I always encourage everyone,
especially young women, to do a monthly self-breast exam. Ideally, we would do it on days seven to
10 of the menstrual cycle, but who is able to keep up with that? So I like to support Feel It
on the first. It was an incredible movement by a breast cancer thriver who passed away last year.
(42:27):
But basically, you're going to look at, it's as simple as looking at your breasts in the mirror
each month, making sure that there's no changes, skin dimpling, rashes that you never notice.
There's no nipple inversion. So just getting familiar with your breast, and then you're
actually going to touch your breast. Again, ideally, you would do this in the shower,
and using three fingers in a circular motion. But again, just really just getting to your breast,
(42:52):
making sure you don't forget the armpit and the clavicle, making sure to get the nipple area,
squeezing your nipple to make sure there's no discharge, especially bloody nipple discharge
would be concerning. All these things, pain, if it's persistent and just focal, again, all these
things are just signs that something's going on. If you're worried about it all, you always bring
(43:13):
it to the attention of your doctor. But I do think it's reasonable to always ask your doctor,
how do you know it's not breast cancer? Are there any imaging tests that we could order to make sure
it's not breast cancer? Because again, we know medical gaslighting is a thing. A lot of people
are told falsely that they're too young to get breast cancer, which is not true. It's probably
(43:33):
not breast cancer, but again, there's no harm in evaluating it with the appropriate imaging studies.
Because again, knowledge is power. We don't want to dismiss anyone's symptoms without working it up
appropriately. Yes, the medical gaslighting, for sure. I'm very curious, when you're talking about
changes in the breast or discharge, even just the palpable changes, it kind of brings me to very,
(44:03):
my thought is very humble, states like pregnancy and breastfeeding stages. If someone does a
self-breast exam during pregnancy or let's say during breastfeeding period, how would one
differentiate between, oh, it's just because of pregnancy or breastfeeding versus, oh, this
might be breast cancer? Well, I think that's a million dollar question. It's important to
(44:27):
point out that breast cancer is the most common cancer during pregnancy and breastfeeding.
As much as lactational changes are a thing and your breast is undergoing normal hormonal changes,
if something is growing, getting bigger, harder, firmer, just not going away, then we have to
(44:47):
evaluate it. We usually start with an ultrasound in a pregnant patient or breastfeeding patient. Even
though mammogram is safe in a pregnant or breastfeeding patient, we could talk about a
little bit how to optimize that. But often we will start with an ultrasound. But I just think it's
important that if a pregnant or breastfeeding woman feels that change, this is for every person,
(45:08):
actually. They pay attention to it over the next few days and making sure it's not getting larger,
bigger, harder, firmer, things like that. Again, always bring to the attention of your doctor
and let them feel it, see how worried they are based on clinical exam. But I do think it's within
everyone's right to say, how do you know it's just a clogged duct? Is there any imaging tests that we
can do to make sure it's not breast cancer? Because that is what a lot of women are told.
(45:33):
And we don't know that without looking at it. Putting an ultrasound on it is usually very
definitive as to whether it's something to be worried about or not. So listening to our
patients and taking their concerns seriously. Definitely. We talk a lot about woman's imaging
and also this is like pregnancy and lactation. Let's talk about the men. Can men get breast cancer?
(45:58):
I think this is something even when I was younger, I keep wondering, can men also get breast cancer?
Yes, men can get breast cancer. Beyonce's dad had breast cancer. One of the KISS members had breast
cancer. It's about one in 850 men. So it's not common, but it counts for about 1% of breast cancer.
(46:18):
We are seeing in younger men as well. So most commonly in men, when a man presents with a
complaint, it's usually gynecomastia. But again, it's not always. And it's pretty easy to decide
if it's anything to worry about with a mammogram starting at age 25, if they have a lump, and then
maybe doing an ultrasound or starting with an ultrasound under age 25. But yes, men can get
(46:42):
mammograms too. There we go. Everybody. And actually some high-risk men are actually screened
with mammography now. That's one of the newer recommendations. So got it. As with any organ
in the body, cancer is not just the only issue that can arise, right? As someone who sees so many
images of breasts, I guess the whole day, for sure, cancer is not the only thing you see. I wanted to
(47:08):
ask, beyond cancer, what would you like the general public to know about breast health in general?
Yeah. I mean, breast health is something that I think a lot of people don't realize that most
doctors and most healthcare practitioners are not trained in breast cancer. It's not something you
learn in med school. It's not really rotation or a class. So I think people falsely assume that
(47:30):
their OB-GYN is really in charge of their breast health. And I'm going to say that they're probably
not. Most OB-GYNs are not familiar with all the up-to-date breast imaging studies. So that's why
I think it's important that you follow the booby dots and you listen to what... Breast health is
important. I think we really need to talk about just breast health in general, as opposed to
(47:52):
breast cancer awareness month, which comes around once a year. I think breast cancer awareness should
be all year round. And it's something that we need to be talking about openly. I think people are still
uncomfortable with the word boobs, talking about breast. It makes people uncomfortable. So, you
know, just getting comfortable. As long as we're having a conversation, I think that's what's
important. Yeah, definitely. I think the things that are uncomfortable to talk about are the things
(48:17):
that should be talked about, right? Because when things are taboo, that's where misinformation
arises. Because there's fear or discomfort talking about it. It's like the most important information,
the life-saving information, are not disseminated. They're not covered or not talked about, right?
And I think that's what's so amazing with the platform we have created, the booby dots.
(48:38):
Aside from, you know, saving people's lives through early detection, from reading images,
you're actually really like sharing that life-saving material online, the booby dots.
What is your main goal or what is your future goal for this just beautiful platform? Thank you so much.
And I am really so proud of my platform because it really speaks. I know that about 10% of people
(49:02):
get their information on social media. That number is going to grow as more people, you know,
the generations get younger and more people are on social media. And I think my ultimate goal is,
you know, I just want to get this message to as many people as needed. Like there's lots of
breast cancer disparities out there. So always growing my platform, growing my podcast. And I
(49:25):
really want to write a book this year. I know it's like, I know I've written it in my head.
I've written a lot of it and I just need to get it out because I just think that this has a
possibility to really get this information out to people who need it. Yeah, definitely. And I want
to tie that to one of my last questions. I guess more of a scenario. A woman, someone in the world
(49:50):
just got the most horrific and heartbreaking news from their breast radiologist that, oh,
this might be something that's really, really worrisome. What would be your message to that
person who's going through probably one of the darkest days of their life? The only way out is
through. You're going to get through this stronger. I think that you're going to get stronger through
(50:13):
this. You just have to have the right attitude. You know, this is, you know, you can't control
what's happening, but you can control how you react. And so, you know, attitude is everything.
Getting a support network in place is really important and asking people for what you need
specifically. Like, could you pick up my child at daycare? You know, sending meals is important.
(50:36):
You know, trying, like I know a lot of times people in the community will send meal trains.
I think that's really helpful. But I always tell people it's going to be a really hard year,
but you're going to get through this. You're going to get stronger and you're going to look back on
this and know why you went through this and how much you've changed. I think, right, there's a
life before breast cancer and there's a life after breast cancer. And just, I think a lot of people
(51:01):
reevaluate where they are in their lives and where they want to go and, you know, use the opportunity
to find purpose in the meaning. Yeah, I love that. That was so beautiful. You know, we talk a lot
about so much educational information, but we also talk a lot about so many heavy and
heartbreaking topics, right? And we touch upon how your response to this, right, is when you see that
(51:27):
perfect or probably worse imaging and then saying it to the patients. How do you decompress out of
this? I do a terrible job of decompressing. Like, I'm on all the time. What I know I need to be
doing more is exercising and meditation. I have a really busy mind. I actually just got diagnosed
(51:49):
within the past year with ADHD, which I think is interesting. I've learned that a lot of women,
a lot of successful women in their 40s are being diagnosed with ADHD later in life because we were
just overlooked, right? We were able to get through with things until it caught up with us. And now we
have three kids in a career where like, how did we end up here? So trying to stay grounded is
(52:13):
important. And, you know, obviously, my kids are everything. I have three kids. And really trying
to compartmentalize my mom time from my screen time, from my work time. You know, I think that's
a constant challenge, but something I'm working on. Okay. Dr. Roth, it's learned so much. I feel
(52:37):
like my brain is like, and these are information that really are distorted online. I mean,
we just have to say it like that, right? Like, it's just distorted. And most of the information
online are not coming from actual educated and trained experts who see imaging all day,
right? And so it's such an honor to just have you on. Beyond all the education information,
(52:59):
it's just so beautiful to see your heart in just this field. And it's such a, I feel like
it's a world of, it's just a double edged sword, right? There's so much beauty in it, but also so
much brokenness and also fear and, and you encapsulate all of that in such a, so much passion.
So thank you. I hope, I hope people that follow me, you know, if they don't learn something that
(53:24):
maybe they'll come for a laugh or just feel like they have a friend in their corner. So thank you.
I love that. I can't wait for everyone else to hear this episode. Yeah.
So he was asking really quickly how they knew if their nipple flatness was abnormal,
but like if something's a change for you, that's, you know, when to pay attention to something. So
(53:46):
your nipples can be inverted your whole life, but if it's new for you, that's concerning. So
just wanted to throw that out there. Got it. And please follow the WubiDocs for more of this,
more of the breast information. Thank you so much. Have a great night. Bye.
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