August 13, 2025 • 45 mins
Radiologist Sue Jane Grosso-Rivas, MD joins cardiologist and clinical researcher Michael J. Koren, MD to share her inspiring journey from aspiring secretary to Medical Co-Director of Breast Imaging at Summit Health. The doctoral duo discuss how Dr. Grosso-Rivas’s career was shaped by a school counselor who recognized her potential and encouraged her ambition.
Dr. Grosso-Rivas explains the fundamentals of breast mammography: when patients should begin screening, and how to ensure high-quality care for breast cancer prevention. She then explores what happens if mammography finds an abnormality, including if it is benign, suspicious, or indicative of cancer.
This is part one of a two-part series.
Be a part of advancing science by participating in clinical research.
Have a question for Dr. Koren? Email him at askDrKoren@MedEvidence.com
Listen on Spotify
Listen on Apple Podcasts
Watch on YouTube
Share with a friend. Rate, Review, and Subscribe to the MedEvidence! podcast to be notified when new episodes are released.
Follow us on Social Media:
Facebook
Instagram
X (Formerly Twitter)
LinkedIn
Want to learn more? Checkout our entire library of podcasts, videos, articles and presentations at www.MedEvidence.com
Music: Storyblocks - Corporate Inspired
Thank you for listening!
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Announcer (00:00):
Welcome to MedEvidence, where we help you
navigate the Truth behindmedical research with unbiased,
evidence-proven facts Hosted bycardiologist and top medical
researcher, Dr.
Michael Koren.
Dr. Michael Koren (00:11):
Hello, I'm Dr .
Michael Koren, the executiveeditor of MedEvidence! And I
have a really, really specialguest today who is part of our
Master Series, where we take thebest and the brightest and we
have those people break downtheir area of medical expertise
and share that with ourlisteners and viewers and break
(00:32):
it down from the standpoint of apatient's journey.
And today I'm delighted tointroduce Sue Jane Grosso-R ivas
, who is an expert on breastimaging and her current position
is a breast imaging directorfor Summit Health.
But also lots of otherwonderful things on your resume
in terms of advising the FDA onaccrediting breast imaging
(00:55):
organizations, and I think, if Iremember correctly, you also
have a role as an expert withthe American College of
Radiology.
So you can break that all downfor us, Sue Jane.
But welcome to MedEvidence!Thank you so much for being part
of this podcast.
Dr. Sue Jane Grosso (01:11):
Thanks, Mike.
I'm very happy to be here andhappy to share whatever
information I can to enlighteneveryone about breast imaging.
Absolutely, thank you.
Dr. Michael Koren (01:21):
So Sue Jane and I had a really interesting
interaction actually at ourreunion from Harvard Medical
School and I won't say whatnumber reunion it is, because I
want to protect the innocentfrom identity theft and age
discrimination.
Dr. Sue Jane Grosso (01:35):
Very glad to hear that Most people don't
know my age, Mike.
Dr. Michael Koren (01:41):
Well.
I wouldn't know your age, exceptfor the fact that we went to
medical school together.
Dr. Sue Jane Grosso (01:51):
That's right.
I started very early.
Dr. Michael Koren (01:52):
There we go.
Yeah, that's a good thing totell people.
I love that, but anyhow.
So you shared a superinteresting story about how you
built the confidence to actuallygo into medicine and ultimately
apply to Harvard, and it wasinteresting to me because we
both have the commonality ofhaving grown up in New York City
and having experiences there,and so I'll let you get to that
in a second.
But it was a fascinatingjourney and was part of the
(02:14):
reunion, which is my favoritepart of the reunion, where all
of our classmates just kind ofshare their stories.
And one of the wonderful thingsabout getting older is that you
get very comfortable withyourself.
You use the term, you feel goodin your own skin and you're
less worried about what peoplethink and more worried about
sharing your experiences andmaybe helping other people by
(02:35):
virtue of the sharing of thoseexperiences.
Dr. Sue Jane Grosso (02:37):
Absolutely.
Dr. Michael Koren (02:38):
Yeah.
So tell us a little bit abouthow you grew up and sort of
repeat the story that you sharedwith our classmates.
Dr. Sue Jane Grosso (02:53):
Well, Mike, you know, when I wrote my
report for the reunion, Idecided that I wanted to share
my story and tell what Iconsidered the truth of who I
was.
I feel that a lot of times,people you know don't, just by
looking at me, you can't.
You know, you can't tell right,you can't judge the book by its
cover, you have no idea wherethey've been basically, and I
thought that it would be a storythat maybe would motivate
(03:14):
others or inspire others, and soI did want to tell the story
and I titled my story If youremember, it was called East
Side Story.
Dr. Michael Koren (03:21):
Yeah, I love that.
Dr. Sue Jane Grosso (03:22):
And the reason it was because I my
favorite musical was West SideStory and it was because I felt
that it kind of told my story.
Because my mother was fromPuerto Rico.
She came to United States atabout the age of 18.
And my father was a firstgeneration Italian American.
(03:43):
My grandfather came from Italyand settled in the South Bronx.
So my mother, being the, youknow, the Puerto Rican from,
let's say, West Side Story, andmy father, who was Italian, not
Polish as Tony, was in West SideStory, but you know the fact
that their union was was not acommon one back in the 1950s and
(04:04):
in fact it was a beautiful lovestory, certainly, but my mother
was not accepted by his side ofthe family and so,
unfortunately, it led to thembreaking up.
They were separated and I endedup raised by my mother alone.
So it was a single parenthousehold which then changed a
(04:25):
lot of things for me and it was,you know, living in a lower
income neighborhood, basically,and I was going to a school in
East New York and it was at atime when they started to bus
students.
It was part of thedesegregating program.
I don't know if you rememberfrom that time they were trying
(04:48):
to create equality in educationby taking students from a lower
income neighborhood and bringingthem into another neighborhood.
So I was bused from the eastside of Brooklyn to the west
side of Brooklyn and that wasBensonhurst.
So I ended up in Bensonhurstwhere there was a better
educational opportunity for me.
(05:09):
I ended up in.
It was elementary school.
I started at fifth grade, but Iremained there, even though I
moved.
You know, in Brooklyn my familymoved to several different
parts.
I continued to travel toBensonhurst and I ended up at a
high school, New Utrecht HighSchool.
That was a great public highschool.
They had honor classes.
(05:30):
So there were other studentsthat were interested in learning
, like I was, which is veryimportant to be surrounded by
people that are similar as faras their goals.
But, as you remember, the storywas that what really changed
things for me was when I went tomy high school counselor,
Sylvia June Goldberg, and I'llnever forget her.
(05:50):
I went there and you know, asmany counselors sometimes do,
right, not all of them are great, but this particular counselor
asked me what I wanted to be andI said a secretary.
And she looked at me and shesaid a secretary, and I said,
yeah, a really good secretary.
I'm going to be a bilingualsecretary.
(06:12):
I'm going to be an executivesecretary, I'm going to be the
best secretary there is.
And, by the way, I did taketyping and I was very good at
typing and very fast, and that'sone of the best classes I've
ever taken.
So, anyway, but she looked at meand she gave me the lecture
that would change everything.
She started out telling me thatI could be anything I wanted to
be, and she described thatthere was a ladder that would
(06:35):
reach to the sky and I shouldclimb this ladder to the top and
if, for some reason, I couldn'tget to the top, it was okay to
come down one rung right.
She said I could be anything.
I could be a doctor, I could bea lawyer.
And it just opened up my eyesto something I never really
thought about.
(06:56):
You know, I was very good inscience, I was very smart, there
was no doubt about that.
I was excellent in the sciences,excellent in math, and so I
thought, okay, so I guess Icould be a doctor.
And then I said, well, whatabout a nurse?
I could be a nurse too.
And she looked at me and saidwell, let me ask you this
question Do you want to tellpeople what to do, or do you
(07:19):
want them to tell you what to do?
And I thought, oh, I want totell people what to do.
And to think that at that ageI don't know, maybe I was 13, 14
years old, 15, I don't remember, but it was so clear to me.
And I went home that day to, mymother was in the kitchen
cooking some fabulous PuertoRican meal and I looked at her
(07:41):
and I said, mommy, I'm going tobe a doctor.
And she looked at me.
She goes okay, but neverexpected, never expected that I
would reach those heights.
But it was all because ofSylvia June Goldberg.
She really, she really startedme on that path.
Dr. Michael Koren (07:56):
Well, that's fabulous and we take our hat off
to her.
Is she still with us?
Is she still alive?
Dr. Sue Jane Grosso (08:02):
No, unfortunately she is not.
I have looked her up and I feelbadly that I didn't get to
speak to her to thank her.
And I even looked her up to seeif maybe she had children or
there was someone that I couldconnect with, but I have not
been able to find that.
I don't think she had children.
(08:22):
I didn't find that information,so it's unfortunate.
I did try reaching otherteachers that I did.
Dr. Michael Koren (08:27):
I'm glad that you're able to give her a
tribute.
That's fabulous.
I will say that clearly.
She was an inspiration to youand, I'm sure, to many other
students.
But she may not have understoodmedicine exactly, because in my
experience the nurses tell thedoctors what to do.
Dr. Sue Jane Grosso (08:42):
Quite right .
I mean, look, nurses extremelyimportant.
Love all of my nurses for sure.
But ultimately, you know, as aphysician, you do have to end up
making a lot of the decisions.
So you know people, even withwhat I do today, as they say,
the buck stops with me.
It's like they expect me tomake the decision for anything
(09:05):
that's going on with aparticular patient.
Dr. Michael Koren (09:07):
Yeah, absolutely, of course.
So tell us a little about yourjourney from graduating medical
school to your training.
How'd you end up gettinginvolved in breast imaging, what
was, where were theinspirations there and how you
eventually got to where you arenow, which is you which is
leading a big group at SummitHealth, and, along the way, you
can mention that we have anumber of commonalities.
(09:29):
You probably don't know this,but I was actually born in the
Bronx.
I was born at Bronx LebanonHospital and I grew up on Staten
Island, where I know that youspend some time, so maybe share
with us in the audience exactlyhow your path played itself out.
Dr. Sue Jane Grosso (09:47):
Well, you know, as you remember, Mike,
when we were at Harvard MedicalSchool, you know, when you are
in medical school, you get to domany different rotations as
you're trying to figure out whatkind of a doctor you will be.
When we were at Harvard, if youremember, they really pushed
primary care.
Do you remember that Primarycare was something that was
valued very much and I thought Iwould be a primary care
(10:08):
physician, a family physician.
I knew that I loved taking careof people.
I knew that.
I knew that I wanted toprobably be a primary care
doctor.
However, as I went through myrotations one of the rotations
that I went into, and I'll tellyou I really enjoyed all of my
rotations every single specialtythat I went through, I would go
(10:29):
.
I don't know if that happenedto you, but I'd go to psychiatry
, do something in psychiatry.
I think, oh my God, this isgreat, I could be a psychiatrist
, or I, you know, do OB, youknow OB.
And next thing, you know, Iwant to deliver babies.
So everything excited me,including surgery.
When I did it at Mass General,I thought, oh my God, I have to
be a surgeon.
But when I did radiology atMass General Hospital I don't
(10:52):
know where you did your rotation, but it was Dr.
Navaline who was in charge ofthe program.
I did it there as well.
Did you do that one?
Dr. Michael Koren (11:02):
I did radiology and surgery at Mass
General, yeah.
Dr. Sue Jane Grosso (11:04):
Okay, I did both also at Mass General, but
it was so well organized and Idon't know if you remember when
they put us into a room to sitdown and look at cases, right.
So there were these folders.
They were called the AmericanCollege of Radiology folders of
images and I know this may soundcorny and it may not.
(11:25):
It doesn't even sound like it'spossible.
However, I reached into afolder, I pulled out an image
and I put it up onto the viewbox, which is what radiology
does, and I tell you that itclicked for me.
I looked at that image and Ifelt like it was comfortable.
(11:47):
It felt like like this issomething I wanted to do.
Then, looking back, I realizedwell, when I was in high school,
I did take a course inphotography, I was very
interested in art, I lovedanatomy and I think that looking
at an image right was all about.
(12:07):
It was black and white, so thatwas photography, and then you
had to go through a differentialand you had to kind of figure
out what was going on based onthat image.
So for me, I found that veryexciting.
I thought this is and not onlythat, with radiology, it
involved all specialties right.
So it involved orthopedics,gynecology, oncology it was all
(12:34):
there for you in radiology.
However, I will say that once Istarted my radiology residency,
which was at New York University, I didn't realize that
radiologists some of them do nothave much of an interaction
with patients.
If you've heard, radiologistsare people that those are
(12:56):
doctors that don't want to seepatients, they don't want to
interact with patients, and thatwas not me at all.
So when I was doing myradiology rotation at NYU is
when mammography was juststarting to get to to to be
popular.
There was no fellowship inmammography at that time and I
met a professor that was broughtin to NYU to head up the breast
(13:20):
imaging department and that waswhere I found my patient
connection again, because in inbreast imaging we talk to the
patients when they come backwith something abnormal on the
mammogram.
We see the patients, weinteract with the patients and I
also do biopsies.
So it sort of gave me theopportunity.
(13:40):
You know how I wanted to doprocedures when I saw it in
surgery.
So it gave me a little bit ofeverything.
And not only that with um, withbreast imaging.
I was also able to do, uh, somework in the community.
So a lot of public speaking,and I wanted to help women.
I became clear I wanted to helpwomen and so I wanted to go
(14:00):
into breast imaging and I knewthat I could help them not just
individually, but being aradiologist with a specialty in
breast imaging meant that Icould get on that bandwagon
where everyone was talking aboutscreening mammography and how
it was so important.
How do you get that message outto people?
So I did a lot of work out inthe community, whether it was
radio, tv, public speaking, justtrying to bring the word out to
(14:25):
everyone about screeningmammography.
Until this day, I still do that, which is, you know, describing
the latest technology, whateverit is, to go out and educate
the people.
So for me it was a perfect fit.
I felt like I had found exactlywhat maybe I was meant to do.
Dr. Michael Koren (14:41):
Beautiful.
I love that I love that.
It's different for me.
Yes, another, you justtriggered our memory.
I remember during our MassGeneral Radiology Clerkship,
Lucy Squire was the leader whowas a female during a time
period there were a fewphysician leaders who were
female who basically had set upthe entire course and the
(15:02):
training at one point.
I don't know if that was aninspiration at all, but it was
something I remember and to mewas kind of neat to see that.
Dr. Sue Jane Grosso (15:11):
Yeah, no, it's true.
Actually, when I went to NYUthey only allow maybe one woman
per year.
Actually there were eightresidents.
There was one woman myparticular year they happened to
have they did take two women.
But even back then I meanradiology and even the practice
that I joined.
Eventually, I mean, I did go toStaten Island and I guess I
(15:32):
should digress, go back to how Iended up at Staten Island.
But when I eventually ended upin New Jersey, I was part of a
group, a private practice group,and they were predominantly all
men.
I was the second woman to joinin 2001.
So nowadays there are a lotmore women in radiology.
But Staten Island, how did I endup in Staten Island?
(15:53):
Well, when I graduated NYU, Iactually went to California for
a little while.
I was there for about a yearand a half.
I joined a group that hadconnections with University of
UCSF and also Stanford.
So a lot of the radiologistscame from those groups and I was
there and I wanted to do breastimaging as a specialty and also
(16:15):
nuclear medicine, because I didboth of those but they weren't
ready for what I wanted to do.
And in Staten Island, statenIsland University Hospital.
The person that was in charge ofthe radiology program was a
woman and she was at the cuttingedge of where breast imaging
was at that time and she createda little women's imaging center
with all new mammographymachines and at that time nobody
(16:39):
was doing breast biopsies onStaten Island.
I'm talking about the not thebreast biopsies in the operating
room, but the minimallyinvasive breast biopsies that
are image guided.
So she brought me in to createthat program, which meant that I
had to go up against surgeonsright, because surgeons were
used to taking patients to theoperating room for any biopsy,
(17:00):
many of them which were benign.
So I had to start up thatprogram, start up a screening
program, and so that was veryexciting.
That's how I ended up at StatenIsland University Hospital.
I was there for about eightyears until I had an opportunity
, you know, to come and join aprivate practice.
Again joined the privatepractice only because it was an
opportunity to start a programthat they didn't have before.
(17:21):
So I was always looking forleadership positions, something
where I could make a differenceand create a change that was
ultimately helping theindividual woman but also
helping the entire community.
Dr. Michael Koren (17:34):
Yeah, absolutely.
So we definitely both share theStaten Island parts of our
story and the desire to make adifference.
I think that's.
It's a characteristic that somepeople in medicine have and
others don't, and clearly youhave that.
So, one of the reasons I was soimpressed by your little,
speech at the time of ourreunion.
But let's transition a littlebit and talk about the patient
journey.
Obviously when you talk aboutbreast imaging you talk about
lots of people, obviously half,actually over half of the
(18:09):
American population and maybeeven some men you can throw into
that mix as well as I'm surewe'll get to that, but you talk
about something that creates alot of concern, anxiety and,
ultimately, something that isincredibly important in terms of
the early diagnosis of breastcancer and hoping to minimize
the impact of that disease.
So kind of walk us through alittle bit about general
(18:32):
recommendations for women andthen we can talk a little bit
more about people who are athigher risk and how you might
tailor the strategies for thosefolks.
Dr. Sue Jane Grosso (18:41):
Well, you know, I think let's start at the
beginning.
As far as breast health, right,how do we maintain breast
health?
And, at one time, and you mayremember this, the American
Cancer Society, right, which isone of those societies that we
look to to help us figure outwhen to get your mammogram.
You know screening, and do youremember when they would talk
(19:02):
about breast examination,self-examination?
Dr. Michael Koren (19:05):
Self-exams.
Yeah, there was a huge emphasis
Dr. Sue Jane Grosso (19:08):
And it was a big push, for this is how you
do a self-examination, and soforth.
So when they were talking abouthow to find breast cancer, they
would say get your mammogram.
And they would say examine yourbreasts.
Right, this is the way you doit.
Go into the shower, so on andso forth.
I don't know if you know this,but they no longer recommend
(19:28):
that you do breastself-examination.
Dr. Michael Koren (19:30):
Interesting.
Yeah, I haven't heard thatlately and that makes complete
sense, but you're absolutelyright.
It was a huge point of emphasisabout how to do self-exams and
what time of menstrual cycle youdo it and all that sort of
thing.
Dr. Sue Jane Grosso (19:44):
Right, exactly, but they don't
recommend it anymore.
But I'm going to tell you that,as a person in this specialty,
I still think women should dobreast self-examinations.
The reason they stoppedrecommending it is because, when
they looked at the studies, thestudies didn't show that it
made a difference.
(20:05):
Right, but I can tell you storyafter story of the woman that
has come to me and has found herown breast cancer.
Okay, so, yes, we're going totalk about how you should get
your mammogram right, but Ireally want to emphasize how
women have been their ownadvocate and they have saved
(20:27):
their own lives by finding theircancer, because they felt
something and they came in tosee the doctor.
Dr. Michael Koren (20:34):
So interesting.
Dr. Sue Jane Grosso (20:35):
Yeah.
Dr. Michael Koren (20:36):
So your recommendations once a month,
twice a month, uh, you know.
Dr. Sue Jane Grosso (20:41):
I would say it.
.
.
I don't think you have to.
.
.
I don't want to put thatpressure on women and I think
that's one of the reasons whythey.
You know, if a woman doesn'twant to examine her breasts, I'm
not going to push her and tellher that she has to.
I think it's just, you know,becoming familiar, and you know
I would say every so often, youknow, maybe that would be every
two or three months.
You know, it's just, let's putit this way If you're in the
(21:03):
shower, pay attention, see whatyour breasts feel like, and of
course, some women will say, oh,but they're always, they feel
lumpy.
I always feel something I can'ttell, and I try to tell them.
Believe me, when there's acancer, it's going to feel
different from anything elsethat you've ever felt in your
breast, right?
So, while I don't want to saythat they have to examine their
(21:26):
breasts every single month,that's not what I'm trying to
say what I'm saying is, I think,being familiar with your
breasts, how they when you, whenyou, look in the mirror, right?
looking in the mirror.
Is there a change with the waythat your nipple looks?
Is there a change with any ofthe color of at all of your, of
your breasts?
You see a dimpling, you know.
(21:47):
Does one breast look differentfrom the other?
Size wise, I think it'simportant to to know what your
breasts look like, believe it ornot.
Sometimes women have come inand I asked them.
I said, well, how did you findthis?
And they'll say, well, myhusband found it.
I've heard that.
I've heard where my dog keptgoing to this one part of my
breast.
You know, maybe because maybethe cancer was very warm, right,
(22:11):
because of the extra blood flowor something.
I've heard that story too.
But you know, women should gettheir mammogram.
I mean, let's start with that.
Dr. Michael Koren (22:20):
Just before we get off the breast exam, any
advice vis-a-vis time of themonth for women to examine their
breasts, or doesn't matter thatmuch?
Dr. Sue Jane Grosso (22:26):
I think that's a very good question.
And I think let's bring up thequestion about breast pain,
right, because when you talkabout time of the month, it's a
woman who is menstruating okaycan sometimes have tenderness of
her breasts.
Now, most pain is notassociated with breast cancer,
pain that is cyclical, meaningyou can feel it before your
(22:49):
period and then it goes away.
You know, comes and it goes.
That's not the kind of painthat is associated with breast
cancer.
And you're right as far as thebest time to examine yourself
will be, you know, after you hadyour period.
So let's say, at that, five orseven days, it's when your
(23:09):
breasts become most quiet, asopposed to the middle or right
before your period is when women, you know, are a little bit
more tender, tend to be a littlemore full.
So and in fact we don't do thisso much anymore but when we do
breast MRI and we'll talk aboutthat at some other point we
would try to schedule it at acertain point of their menstrual
cycle, because the breasts arenot as active.
(23:30):
The breasts are very active,like right before your period.
I think most women couldprobably, you know, probably
would agree that that's whenthey feel it.
So, yeah, I mean, but you know,to have to remember when to do
it better, to just feelcomfortable, to do it whenever,
whenever you feel you want to.
Yes.
Dr. Michael Koren (23:49):
So, moving on to mammography, I know you
wanted to give some people somerecommendations with regard to
when that should be done and howfrequently.
Dr. Sue Jane Grosso (23:59):
Well, you know, I think it's an important
topic about when to startscreening mammography and the
reason why is because there hasbeen a lot of controversy and
there have been some differencesamong different organizations,
and the differences tend to bethe age group between 40 and 50,
right Between 40 and 50,.
(24:20):
It was not so long ago theUnited States Preventive
Services Task Force.
They had said that womenbetween the ages of 40 and 50
did not require a mammogram andthat is not what the American
Cancer Society said and not whatthe American College of
Radiology said.
But recently they changed theirminds and they have said that
(24:41):
women from the ages 40 to 50should get their mammogram.
So if there's any woman outthere listening anyone listening
that's been a little bitconfused with everything that
has been said.
The bottom line is you start at40.
That is the age that you start.
Now that's for women with anaverage risk.
They don't have an increasedrisk, they are just average risk
(25:02):
.
Now some organizations, thesame one I just mentioned, says
that you should get a mammogramevery two years, biennial,
between the ages of 40 and 50.
Actually they may actually saybiennial from 40 all the way to
74.
I have to check my records onthat, but the American College
of Radiology recommends that youdo it every single year.
(25:23):
So that is my recommendation.
So does also the AmericanCollege of Breast Surgeons say
from 40 every single year.
The American College ofObstetricians and Gynecologists
also says the same.
So age 40 every single year,
Dr. Michael Koren (25:39):
-a ny concerns about the radiation
risk?
I know that's been thrown outthere as a trade-off.
Dr. Sue Jane Grosso (25:49):
Right.
Well, you know, look, withanything in medicine it's always
about benefit and risk, right,you have to sort of look at what
is the benefit, what is therisk.
And with all of theseguidelines, everything that
we're talking about today, youshould always talk to your
physician, because yourphysician should be able to
guide you oh sorry, there's abug.
Their physician should be ableto guide you, they should know
the information.
If they don't know theinformation, they should call
(26:12):
their radiologist.
And I do get a lot of callsfrom my primary care, you know,
colleagues, or you knowgynecology colleagues that will
call me to ask me what should Ido?
And that's what a patientshould do is they should speak
to their doctor.
Radiation, yes, there isradiation, but it's a low dose
of radiation.
And you can see, you knowstatistics out there that will
tell you.
(26:32):
You know, one mammogram isabout 26 days of background
radiation.
And you know we're not talkingabout other parts of radiology,
but CT scans of the abdomen andpelvis, for example, a lot more
radiation than a mammogram.
Chest x-ray is a little bitlower.
So you have to sort of thinkabout the benefit versus the
(26:54):
harm.
The radiation is very low andespecially nowadays we have
digital mammography and digitalmammography is lower than film
screen mammography, which iswhere we had started.
So I could understand beingconcerned about radiation.
I get it, but the benefit faroutweighs any risk with
radiation.
Dr. Michael Koren (27:10):
And that's helpful.
So how about this concept ofhaving the study done in the
same place each year?
So it's easier to compare.
I'd love to hear your commentsabout that.
Dr. Sue Jane Grosso (27:21):
Yeah, that's a very good point.
I'm glad you brought that up.
It's very important for womento realize and know that we need
to compare to priors, becausesometimes the only way you can
detect breast cancer is whenthere's a change in the
appearance of the breastcompared to before.
So while I would tell you it isbetter to stay at the same
(27:44):
facility so that they have thesame you know all of your images
from the past I don't want tosay that you have to stay there,
because what if you findanother place that you prefer?
What's most important is to getyour prior mammograms and bring
them with you to whateverfacility if you choose a new
facility right whatever facility.
Dr. Michael Koren (28:11):
-and there aren't compatibility issues with
software and things like that,which is the bane of our
existence in modern medicine.
Dr. Sue Jane Grosso (28:15):
Nowadays not.
There were some issues when youhad different machines because
the vendors out there, the majorvendors GE is one of them,
Hologic those are probably thetwo biggest vendors.
You have Siemens, you haveother ones.
At the place that I'm at, wehave both GE and Hologic and
they're very similar and therewas a time when you couldn't
(28:37):
upload the software from onemammogram to another, but that
pretty much is non-existentnowadays.
Nowadays, if you and most placesare digital I mean you don't
film screen is not reallysomething you see nowadays so
much.
Pretty much every place isdigital nowadays.
So you go to a place you canget your mammogram, put it onto
(29:01):
a CD, and there are actuallylaws that protect women because
the facility has to give themtheir images, and they actually
there's a law out there thatsays you have to give it to them
within like 15 days Like thereare actually laws that exist to
protect women.
So, and at our place we haverelationships with some other
institutions where we can getelectronic transfer of images as
well.
(29:21):
So I would say absolutely.
I think that what's importantis to know you need to compare
to priors.
That's the one importantmessage that we have to give.
At our facility we actually doget the patient to sign a
release and then we will contactthe other office and get them
to mail it to us.
So some places will do that foryou.
Dr. Michael Koren (29:44):
That's terrific.
So, moving on, you findsomething of concern on a
mammogram and then you have togo to another form of imaging.
So kind of walk us through whatyou do next typically CAT scan,
ultrasound why you would pickthe next modality based on what
you're seeing.
Dr. Sue Jane Grosso (30:01):
Okay, good question also.
So you start off with ascreening mammogram.
So at our place and most places, they are doing a digital
mammography and they're doingwhat's called tomosynthesis, or
it's also called 3D mammography,and that is a mammogram where
the woman will experience thatthe machine moves as they're
having their mammogram.
That's because the machine isobtaining images right At
(30:24):
different sections of the breast.
It's kind of like a CAT scan,so it slices through the breast.
It's like taking a loaf ofbread and slicing that loaf of
bread and imagine, you know,like the bread that has raisins,
right, so you would be able tocut through and you'll find a
raisin on the inside.
So it's the same thing with amammogram we get those slices.
So if I'm reading a screeningmammogram and a screening
(30:47):
mammogram is someone that doesnot have any symptoms whatsoever
If you have a lump, if you haveany symptoms whatsoever, then
you are not a screening anymore.
Then you are what we call adiagnostic mammogram.
A diagnostic mammogram meansthere's an issue, there's a
problem, and you will come inand then your exam will be
supervised, usually by aradiologist.
(31:09):
Okay, so let's stick toscreening.
So if I'm sitting and I look ata screening mammogram and I see
something abnormal, I'm goingto call that patient back for
additional imaging.
So that's called a callback foradditional imaging on another
day.
When they come back on anotherday, generally women will have
additional mammography imagesand sometimes, and oftentimes I
(31:31):
should say, they will also havean ultrasound.
An ultrasound is differentmodality, it doesn't use
radiation, it's ultrasound waves, but an ultrasound is very good
at being able to detect a mass,a cyst.
Sometimes we need todifferentiate.
Sometimes I look at a mammogramand I see a mass and I can't
(31:52):
tell by the mammography becauseit just looks white.
I can't tell if it's a solidmass or if it's a cyst, which is
just a round collection offluid, basically, which is
completely benign and nothing toworry about.
Once I get to evaluate thepatient to see what they have
and it could be calcifications,it could be a mass, it could be
(32:13):
what we call architecturaldistortion, these are all things
, that terminology that we use.
Once we find that, then we haveto decide whether that patient
is normal and leaves and comesback in another year.
Or does that patient maybe needto come back in six months, or
is this patient ready for abiopsy?
(32:36):
Nowadays, for the most part, wedo image-guided biopsies.
It used to be years ago thatwomen would go to the operating
room for the surgeon to remove apiece of tissue, right the
entire tissue, and that wouldlead to scarring, you know,
disfigurement, sometimespotentially because you're
taking.
Now, most biopsies that we doare benign.
(32:57):
They're not cancer.
So the fact that we you knowthat what has been developed as
image guided means that youcould take a patient and just by
placing a small needle into thearea of abnormality, you could
take a piece of the tissue right, a core, as we say rather than
taking the whole thing out.
(33:17):
Once that is done and that'susually done on a different day,
right, usually not the same dayas the callback the patient
then has this biopsy.
We find out what it is and ifit's abnormal, the next step is
the surgeon, right?
Dr. Michael Koren (33:33):
So the step that you described is prior to
any surgeon getting involved.
Do you have any sort of oldschool Staten Island and
surgeons that think that that'snot the best way to go out of
curiosity, or is that prettymuch accepted that there'll be a
radiologist that does the biopsy.
Dr. Sue Jane Grosso (33:49):
When I went back, when I went from
California back to Staten Islandback in 1993, at that time
surgeons still believed thatwomen should be going to the
operating room it was very hardfor them to accept that there
was this thing calledimage-guided biopsies and that
was part of what I had to teachthem.
But nowadays, years later, ithas become accepted by everyone
(34:15):
radiologists and surgeons thatthe first step in biopsy in a
patient is image-guided biopsy.
So the surgeons are completelyon board with this because that
is the standard.
It's the standard for AmericanCollege of Radiology and is the
standard for American College ofSurgeons that image-guided
biopsy happens first.
Dr. Michael Koren (34:35):
So if a woman was recommended to have surgery
first, they should be skeptical?
Is what you're saying.
Dr. Sue Jane Grosso (34:42):
Yeah, and I don't know where that would be
happening.
But image-guided biopsies and Ishould say I think it's
important to say, even thoughI'm a radiologist and I do image
guided biopsies surgeons doimage guided biopsies also.
A surgeon may see a patient inthe office and they may feel
something right?
A mass.
And many of them are trainedand they are accredited.
(35:04):
Okay, they get certified to beable to do this and they, right
there in the office, can put theanesthetic on the skin, go in,
take a piece and send it off tothe hospital.
So at our place at Summit.
Health, actually we have both.
We have surgeons andradiologists.
We both do the procedures, butI would say probably throughout
the country, most places it'sradiologists that are doing the
(35:25):
biopsies got it all right.
Dr. Michael Koren (35:27):
So then next step.
So hopefully it's benign.
If it's benign, or you go backto the usual routine, or is that
somebody at higher risk?
Uh, just, but based on the factthat I needed quote, a biopsy to
determine what their status was.
Dr. Sue Jane Grosso (35:41):
Right if let's say let me just give an
example this is a very commonmass that we see out there, a
fibroadenoma.
So a fibroadenoma presents as asolid mass and sometimes you
can tell that it's afibroadenoma just by looking at
it and you may follow it.
But maybe you can't tell, soyou do a biopsy.
(36:03):
If I do a biopsy, then I haveto do what's called assess the
concordance.
The pathologist tells me whatit is right, they look under the
microscope, they send me thereport and then I look at my
images and I look at thepathology and I say you know
what this matches, we're good,she doesn't come back again
until another year.
(36:24):
Okay, let's say I biopsy somecalcifications and it comes back
.
That it's normal.
However, maybe, for whateverreason I feel, I think I want to
bring her back in six months sothat I can do magnification
views again, just to make surethat whatever piece I took was
(36:46):
representative of the entiresample.
Sometimes it comes back andthere's something called atypia.
Dr. Michael Koren (36:53):
Mm-hmm.
Dr. Sue Jane Grosso (36:54):
So atypia.
So there's atypical ductalhyperplasia, ADH, there's
atypical lobular hyperplasia,ALH, and there's some other ones
like flat epithelial atypia.
So different types of pathology.
If a woman comes back, thepathology comes back as atypical
ductal hyperplasia.
That patient does have to go onto the surgeon and that area
(37:19):
then needs to be removed.
And the reason why is becausethere have been cases.
There are cases where theatypical ductal hyperplasia is
just something that's tellingyou something's going on and
they want to make sure there'sno DCIS ductal carcinoma in situ
, so that atypical ductalhyperplasia pathology does go on
(37:39):
for more surgery.
The other atypias that I've saidthey don't.
Now what if I do a biopsy and Ifeel that it's what we call
discordant?
Let's say it's an area thatlooks kind of suspicious.
I do the biopsy and it comesback normal.
But I say, yeah, you know, thisdoesn't seem right.
(38:00):
Maybe my needle didn't gothrough to the right place,
maybe it was a mistargeting ofsome sort, maybe the patient
moved, maybe the anestheticmoved things, that patient.
I may decide that that patientneeds to go to the surgeon to
have a larger area removed to beabsolutely certain that there's
nothing there.
Dr. Michael Koren (38:18):
Yeah, so again.
So now we're getting intosomething that's more severe in
terms of the diagnosis of cancer, and I know that you also use
MRI technology and other typesof technology.
So where do they fit in andwhat's your part of sort of
staging cancers in terms ofspread and those type of
(38:39):
concerns?
Dr. Sue Jane Grosso (38:40):
You know, for a cardiologist, Mike, you
know a lot about this.
You're asking all the rightquestions, for sure.
Well, you know, look, sometimeswhen a patient comes in for a
screening mammogram or when shecomes back for additional
imaging, sometimes I can look atit and I know that I'm looking
at cancer.
I mean, sometimes that doeshappen when you have a patient
(39:02):
that has the possibility ofcancer or you diagnose them as
having cancer.
The next step may be to get abreast MRI.
So what is a breast MRI?
That's magnetic resonanceimaging.
So breast MRI doesn't useradiation, it uses magnetic and
radial waves.
It's a completely differentmethod or technology, but a
(39:24):
breast MRI is very, very good atpicking up invasive breast
cancer.
So while with a mammogram,especially when the breasts are
dense, it may be difficult tosee.
So the patient may have cancer,but maybe I can't tell.
How big is the cancer Like?
How are we going to determineif she needs a lumpectomy or a
(39:44):
mastectomy?
You know, how do we know?
So the radiologist can look atthese images and say you know
what?
I think this patient wouldbenefit from a breast MRI.
Now, if you look at what theAmerican College of Radiology
will say, they feel that everywoman that is diagnosed with
breast cancer should have an MRI.
(40:04):
But some of our surgeons, someof our colleagues, do not
believe in that, because therehave been some studies and there
haven't been studies thatindicate that an MRI really does
affect mortality.
So not all patients that get abiopsy and diagnosed with breast
cancer, not all of them, go onto breast MRI.
Right Again, this is where youtalk to your physicians, you
(40:26):
talk to your radiologists andyou get to find out what you
need.
So now this breast MRI comesback to me again, and now I have
to read the breast MRI and thebreast MRI what it does is I get
to see the breast that has thecancer, try to figure out how
big it is, find out if there'sany more disease right, because
you could have one quadrant thathas cancer but you may have
(40:48):
cancer in another quadrant ofthe same breast.
You get to look at the lymphnodes to see if there are any in
the axilla or elsewhere.
And the great thing is that youlook at the other side, because
about four to 5% ofcontralateral breast cancers may
be there.
So it gives you an opportunity.
If the woman's going to go forsurgery, you need to make sure
(41:09):
that everything is okay right,not just one side, so that
breast MRI is going to help toabsolutely determine the extent
of disease.
Okay, now go ahead.
Dr. Michael Koren (41:20):
I was going to ask you.
PET scanning is another modalitythat people talk about.
Dr. Sue Jane Grosso (41:24):
I knew you were going to go there.
So if a woman has breast cancerand it went to her lymph nodes,
right, at that point thesurgeon or the oncologist may
say you know what I need to makesure, in order to stage this
person, I need to make sure thatthere isn't breast cancer
anywhere else, and that's wherethe PET-CT comes in.
(41:44):
So PET-CT, that's positronemission tomography, right, and
there is something calledpositron emission mammography as
well.
That's a little bit different.
But the PET-CT which, by theway,
I did do a fellowship trainingin nuclear medicine as well when
I was at NYU, and PET CT for meis one of my favorite favorite
(42:09):
technologies, and that's becauseyou look at the whole body all
at once.
The patient is injected withsome radio tracer, right, it
gets attached to glucose and itgoes from your veins, it goes
throughout your entire body andit gets picked up wherever there
is a lot of uptake with glucose.
So active cells, as you couldimagine.
(42:31):
The brain, right, our brain isvery active.
That brain lights up like youwouldn't believe.
The heart lights up like crazyCertain things.
The kidneys will light upeverything but in the breast for
the most part things are quietright and things like the liver,
the bones.
So a PET CT scan is a great wayto make sure that there isn't
(42:52):
cancer anywhere else for thatwoman with breast cancer.
So that definitely does help tostage her yes.
Dr. Michael Koren (42:59):
So interesting.
So I have a couple otherquestions.
Do you routinely look atgenetic markers for breast
cancer?
Is that part of the history?
When you're looking at theimages, does that help you, does
that hurt you?
Just curious your perspectiveon how important that is.
And if you're working in anintegrated health system you may
(43:20):
have that, but sometimes youmay not have that.
So maybe walk us through that,whether or not you recommend
those things for women that maybe at high historical risk.
Dr. Sue Jane Grosso (43:28):
Okay, well, you know one of the things that
when a woman comes in to get amammogram, we do obtain a
history.
We have a history sheet thatthey fill out, and part of that
history sheet is to find outnumber one does she have a
complaint?
We need to know if she has alump or if she has what we call
focal pain.
Right, we find out about familyhistory.
(43:50):
Who else in your family hasbreast cancer?
At what age did they developbreast cancer?
Does anybody else have ovariancancer?
And same thing is have you everhad a biopsy before?
Have you, and is there anygenetic mutation that we should
know about?
So all of that is extremelyimportant.
(44:13):
And as you bring that up, Ishould also bring up something
that's called risk assessment,because a lot of breast imaging
facilities have this.
They have programs that assessyour risk for the development of
breast cancer over yourlifetime.
So one of the ones that we likeis called Tyrer-C uzick, and I
can get into that a little bitmore later, but you're
(44:34):
absolutely right that when apatient walks in, all of her
history is very important, sothat it helps me figure out what
I need to do next.
It's not going to change how Iread her mammogram, because I'm
there to read the mammogram andfind out is there something
abnormal?
But if I find out that thewoman has this history and,
(44:54):
let's say, her breasts areextremely dense, right, and we
haven't gotten into density yet,but density is one of the
things that affects the abilityto see tumors on a mammogram.
So if that woman hassignificant history and she has
very dense breasts, I mayrecommend that she have a breast
MRI, right, or I may recommendthat she have an ultrasound, or
(45:17):
I may recommend you know what.
You need to see a breastspecialist, because you also
need to see a geneticist to findout about your markers, right,
so that patient is going to getplugged in, possibly into a high
risk program, for example.
So you're right Knowing geneticmutations?
Absolutely.
Now, remember, most women withbreast cancer do not have any
(45:40):
genetics or any family history.
85% of all breast cancers havenothing to do with family
history or genetics.
Dr. Michael Koren (45:48):
Interesting.
Welcome to MedEvidence, where we help you
navigate the Truth behindmedical research with unbiased,
evidence-proven facts Hosted bycardiologist and top medical
researcher, Dr.
Michael Koren.
Dr. Michael Koren (00:11):
Hello, I'm Dr .
Michael Koren, the executiveeditor of MedEvidence! And I
have a really, really specialguest today who is part of our
Master Series, where we take thebest and the brightest and we
have those people break downtheir area of medical expertise
and share that with ourlisteners and viewers and break
(00:32):
it down from the standpoint of apatient's journey.
And today I'm delighted tointroduce Sue Jane Grosso-R ivas
, who is an expert on breastimaging and her current position
is a breast imaging directorfor Summit Health.
But also lots of otherwonderful things on your resume
in terms of advising the FDA onaccrediting breast imaging
(00:55):
organizations, and I think, if Iremember correctly, you also
have a role as an expert withthe American College of
Radiology.
So you can break that all downfor us, Sue Jane.
But welcome to MedEvidence!Thank you so much for being part
of this podcast.
Dr. Sue Jane Grosso (01:11):
Thanks, Mike.
I'm very happy to be here andhappy to share whatever
information I can to enlighteneveryone about breast imaging.
Absolutely, thank you.
Dr. Michael Koren (01:21):
So Sue Jane and I had a really interesting
interaction actually at ourreunion from Harvard Medical
School and I won't say whatnumber reunion it is, because I
want to protect the innocentfrom identity theft and age
discrimination.
Dr. Sue Jane Grosso (01:35):
Very glad to hear that Most people don't
know my age, Mike.
Dr. Michael Koren (01:41):
Well.
I wouldn't know your age, exceptfor the fact that we went to
medical school together.
Dr. Sue Jane Grosso (01:51):
That's right.
I started very early.
Dr. Michael Koren (01:52):
There we go.
Yeah, that's a good thing totell people.
I love that, but anyhow.
So you shared a superinteresting story about how you
built the confidence to actuallygo into medicine and ultimately
apply to Harvard, and it wasinteresting to me because we
both have the commonality ofhaving grown up in New York City
and having experiences there,and so I'll let you get to that
in a second.
But it was a fascinatingjourney and was part of the
(02:14):
reunion, which is my favoritepart of the reunion, where all
of our classmates just kind ofshare their stories.
And one of the wonderful thingsabout getting older is that you
get very comfortable withyourself.
You use the term, you feel goodin your own skin and you're
less worried about what peoplethink and more worried about
sharing your experiences andmaybe helping other people by
(02:35):
virtue of the sharing of thoseexperiences.
Dr. Sue Jane Grosso (02:37):
Absolutely.
Dr. Michael Koren (02:38):
Yeah.
So tell us a little bit abouthow you grew up and sort of
repeat the story that you sharedwith our classmates.
Dr. Sue Jane Grosso (02:53):
Well, Mike, you know, when I wrote my
report for the reunion, Idecided that I wanted to share
my story and tell what Iconsidered the truth of who I
was.
I feel that a lot of times,people you know don't, just by
looking at me, you can't.
You know, you can't tell right,you can't judge the book by its
cover, you have no idea wherethey've been basically, and I
thought that it would be a storythat maybe would motivate
(03:14):
others or inspire others, and soI did want to tell the story
and I titled my story If youremember, it was called East
Side Story.
Dr. Michael Koren (03:21):
Yeah, I love that.
Dr. Sue Jane Grosso (03:22):
And the reason it was because I my
favorite musical was West SideStory and it was because I felt
that it kind of told my story.
Because my mother was fromPuerto Rico.
She came to United States atabout the age of 18.
And my father was a firstgeneration Italian American.
(03:43):
My grandfather came from Italyand settled in the South Bronx.
So my mother, being the, youknow, the Puerto Rican from,
let's say, West Side Story, andmy father, who was Italian, not
Polish as Tony, was in West SideStory, but you know the fact
that their union was was not acommon one back in the 1950s and
(04:04):
in fact it was a beautiful lovestory, certainly, but my mother
was not accepted by his side ofthe family and so,
unfortunately, it led to thembreaking up.
They were separated and I endedup raised by my mother alone.
So it was a single parenthousehold which then changed a
(04:25):
lot of things for me and it was,you know, living in a lower
income neighborhood, basically,and I was going to a school in
East New York and it was at atime when they started to bus
students.
It was part of thedesegregating program.
I don't know if you rememberfrom that time they were trying
(04:48):
to create equality in educationby taking students from a lower
income neighborhood and bringingthem into another neighborhood.
So I was bused from the eastside of Brooklyn to the west
side of Brooklyn and that wasBensonhurst.
So I ended up in Bensonhurstwhere there was a better
educational opportunity for me.
(05:09):
I ended up in.
It was elementary school.
I started at fifth grade, but Iremained there, even though I
moved.
You know, in Brooklyn my familymoved to several different
parts.
I continued to travel toBensonhurst and I ended up at a
high school, New Utrecht HighSchool.
That was a great public highschool.
They had honor classes.
(05:30):
So there were other studentsthat were interested in learning
, like I was, which is veryimportant to be surrounded by
people that are similar as faras their goals.
But, as you remember, the storywas that what really changed
things for me was when I went tomy high school counselor,
Sylvia June Goldberg, and I'llnever forget her.
(05:50):
I went there and you know, asmany counselors sometimes do,
right, not all of them are great, but this particular counselor
asked me what I wanted to be andI said a secretary.
And she looked at me and shesaid a secretary, and I said,
yeah, a really good secretary.
I'm going to be a bilingualsecretary.
(06:12):
I'm going to be an executivesecretary, I'm going to be the
best secretary there is.
And, by the way, I did taketyping and I was very good at
typing and very fast, and that'sone of the best classes I've
ever taken.
So, anyway, but she looked at meand she gave me the lecture
that would change everything.
She started out telling me thatI could be anything I wanted to
be, and she described thatthere was a ladder that would
(06:35):
reach to the sky and I shouldclimb this ladder to the top and
if, for some reason, I couldn'tget to the top, it was okay to
come down one rung right.
She said I could be anything.
I could be a doctor, I could bea lawyer.
And it just opened up my eyesto something I never really
thought about.
(06:56):
You know, I was very good inscience, I was very smart, there
was no doubt about that.
I was excellent in the sciences,excellent in math, and so I
thought, okay, so I guess Icould be a doctor.
And then I said, well, whatabout a nurse?
I could be a nurse too.
And she looked at me and saidwell, let me ask you this
question Do you want to tellpeople what to do, or do you
(07:19):
want them to tell you what to do?
And I thought, oh, I want totell people what to do.
And to think that at that ageI don't know, maybe I was 13, 14
years old, 15, I don't remember, but it was so clear to me.
And I went home that day to, mymother was in the kitchen
cooking some fabulous PuertoRican meal and I looked at her
(07:41):
and I said, mommy, I'm going tobe a doctor.
And she looked at me.
She goes okay, but neverexpected, never expected that I
would reach those heights.
But it was all because ofSylvia June Goldberg.
She really, she really startedme on that path.
Dr. Michael Koren (07:56):
Well, that's fabulous and we take our hat off
to her.
Is she still with us?
Is she still alive?
Dr. Sue Jane Grosso (08:02):
No, unfortunately she is not.
I have looked her up and I feelbadly that I didn't get to
speak to her to thank her.
And I even looked her up to seeif maybe she had children or
there was someone that I couldconnect with, but I have not
been able to find that.
I don't think she had children.
(08:22):
I didn't find that information,so it's unfortunate.
I did try reaching otherteachers that I did.
Dr. Michael Koren (08:27):
I'm glad that you're able to give her a
tribute.
That's fabulous.
I will say that clearly.
She was an inspiration to youand, I'm sure, to many other
students.
But she may not have understoodmedicine exactly, because in my
experience the nurses tell thedoctors what to do.
Dr. Sue Jane Grosso (08:42):
Quite right .
I mean, look, nurses extremelyimportant.
Love all of my nurses for sure.
But ultimately, you know, as aphysician, you do have to end up
making a lot of the decisions.
So you know people, even withwhat I do today, as they say,
the buck stops with me.
It's like they expect me tomake the decision for anything
(09:05):
that's going on with aparticular patient.
Dr. Michael Koren (09:07):
Yeah, absolutely, of course.
So tell us a little about yourjourney from graduating medical
school to your training.
How'd you end up gettinginvolved in breast imaging, what
was, where were theinspirations there and how you
eventually got to where you arenow, which is you which is
leading a big group at SummitHealth, and, along the way, you
can mention that we have anumber of commonalities.
(09:29):
You probably don't know this,but I was actually born in the
Bronx.
I was born at Bronx LebanonHospital and I grew up on Staten
Island, where I know that youspend some time, so maybe share
with us in the audience exactlyhow your path played itself out.
Dr. Sue Jane Grosso (09:47):
Well, you know, as you remember, Mike,
when we were at Harvard MedicalSchool, you know, when you are
in medical school, you get to domany different rotations as
you're trying to figure out whatkind of a doctor you will be.
When we were at Harvard, if youremember, they really pushed
primary care.
Do you remember that Primarycare was something that was
valued very much and I thought Iwould be a primary care
(10:08):
physician, a family physician.
I knew that I loved taking careof people.
I knew that.
I knew that I wanted toprobably be a primary care
doctor.
However, as I went through myrotations one of the rotations
that I went into, and I'll tellyou I really enjoyed all of my
rotations every single specialtythat I went through, I would go
(10:29):
.
I don't know if that happenedto you, but I'd go to psychiatry
, do something in psychiatry.
I think, oh my God, this isgreat, I could be a psychiatrist
, or I, you know, do OB, youknow OB.
And next thing, you know, Iwant to deliver babies.
So everything excited me,including surgery.
When I did it at Mass General,I thought, oh my God, I have to
be a surgeon.
But when I did radiology atMass General Hospital I don't
(10:52):
know where you did your rotation, but it was Dr.
Navaline who was in charge ofthe program.
I did it there as well.
Did you do that one?
Dr. Michael Koren (11:02):
I did radiology and surgery at Mass
General, yeah.
Dr. Sue Jane Grosso (11:04):
Okay, I did both also at Mass General, but
it was so well organized and Idon't know if you remember when
they put us into a room to sitdown and look at cases, right.
So there were these folders.
They were called the AmericanCollege of Radiology folders of
images and I know this may soundcorny and it may not.
(11:25):
It doesn't even sound like it'spossible.
However, I reached into afolder, I pulled out an image
and I put it up onto the viewbox, which is what radiology
does, and I tell you that itclicked for me.
I looked at that image and Ifelt like it was comfortable.
(11:47):
It felt like like this issomething I wanted to do.
Then, looking back, I realizedwell, when I was in high school,
I did take a course inphotography, I was very
interested in art, I lovedanatomy and I think that looking
at an image right was all about.
(12:07):
It was black and white, so thatwas photography, and then you
had to go through a differentialand you had to kind of figure
out what was going on based onthat image.
So for me, I found that veryexciting.
I thought this is and not onlythat, with radiology, it
involved all specialties right.
So it involved orthopedics,gynecology, oncology it was all
(12:34):
there for you in radiology.
However, I will say that once Istarted my radiology residency,
which was at New York University, I didn't realize that
radiologists some of them do nothave much of an interaction
with patients.
If you've heard, radiologistsare people that those are
(12:56):
doctors that don't want to seepatients, they don't want to
interact with patients, and thatwas not me at all.
So when I was doing myradiology rotation at NYU is
when mammography was juststarting to get to to to be
popular.
There was no fellowship inmammography at that time and I
met a professor that was broughtin to NYU to head up the breast
(13:20):
imaging department and that waswhere I found my patient
connection again, because in inbreast imaging we talk to the
patients when they come backwith something abnormal on the
mammogram.
We see the patients, weinteract with the patients and I
also do biopsies.
So it sort of gave me theopportunity.
(13:40):
You know how I wanted to doprocedures when I saw it in
surgery.
So it gave me a little bit ofeverything.
And not only that with um, withbreast imaging.
I was also able to do, uh, somework in the community.
So a lot of public speaking,and I wanted to help women.
I became clear I wanted to helpwomen and so I wanted to go
(14:00):
into breast imaging and I knewthat I could help them not just
individually, but being aradiologist with a specialty in
breast imaging meant that Icould get on that bandwagon
where everyone was talking aboutscreening mammography and how
it was so important.
How do you get that message outto people?
So I did a lot of work out inthe community, whether it was
radio, tv, public speaking, justtrying to bring the word out to
(14:25):
everyone about screeningmammography.
Until this day, I still do that, which is, you know, describing
the latest technology, whateverit is, to go out and educate
the people.
So for me it was a perfect fit.
I felt like I had found exactlywhat maybe I was meant to do.
Dr. Michael Koren (14:41):
Beautiful.
I love that I love that.
It's different for me.
Yes, another, you justtriggered our memory.
I remember during our MassGeneral Radiology Clerkship,
Lucy Squire was the leader whowas a female during a time
period there were a fewphysician leaders who were
female who basically had set upthe entire course and the
(15:02):
training at one point.
I don't know if that was aninspiration at all, but it was
something I remember and to mewas kind of neat to see that.
Dr. Sue Jane Grosso (15:11):
Yeah, no, it's true.
Actually, when I went to NYUthey only allow maybe one woman
per year.
Actually there were eightresidents.
There was one woman myparticular year they happened to
have they did take two women.
But even back then I meanradiology and even the practice
that I joined.
Eventually, I mean, I did go toStaten Island and I guess I
(15:32):
should digress, go back to how Iended up at Staten Island.
But when I eventually ended upin New Jersey, I was part of a
group, a private practice group,and they were predominantly all
men.
I was the second woman to joinin 2001.
So nowadays there are a lotmore women in radiology.
But Staten Island, how did I endup in Staten Island?
(15:53):
Well, when I graduated NYU, Iactually went to California for
a little while.
I was there for about a yearand a half.
I joined a group that hadconnections with University of
UCSF and also Stanford.
So a lot of the radiologistscame from those groups and I was
there and I wanted to do breastimaging as a specialty and also
(16:15):
nuclear medicine, because I didboth of those but they weren't
ready for what I wanted to do.
And in Staten Island, statenIsland University Hospital.
The person that was in charge ofthe radiology program was a
woman and she was at the cuttingedge of where breast imaging
was at that time and she createda little women's imaging center
with all new mammographymachines and at that time nobody
(16:39):
was doing breast biopsies onStaten Island.
I'm talking about the not thebreast biopsies in the operating
room, but the minimallyinvasive breast biopsies that
are image guided.
So she brought me in to createthat program, which meant that I
had to go up against surgeonsright, because surgeons were
used to taking patients to theoperating room for any biopsy,
(17:00):
many of them which were benign.
So I had to start up thatprogram, start up a screening
program, and so that was veryexciting.
That's how I ended up at StatenIsland University Hospital.
I was there for about eightyears until I had an opportunity
, you know, to come and join aprivate practice.
Again joined the privatepractice only because it was an
opportunity to start a programthat they didn't have before.
(17:21):
So I was always looking forleadership positions, something
where I could make a differenceand create a change that was
ultimately helping theindividual woman but also
helping the entire community.
Dr. Michael Koren (17:34):
Yeah, absolutely.
So we definitely both share theStaten Island parts of our
story and the desire to make adifference.
I think that's.
It's a characteristic that somepeople in medicine have and
others don't, and clearly youhave that.
So, one of the reasons I was soimpressed by your little,
speech at the time of ourreunion.
But let's transition a littlebit and talk about the patient
journey.
Obviously when you talk aboutbreast imaging you talk about
lots of people, obviously half,actually over half of the
(18:09):
American population and maybeeven some men you can throw into
that mix as well as I'm surewe'll get to that, but you talk
about something that creates alot of concern, anxiety and,
ultimately, something that isincredibly important in terms of
the early diagnosis of breastcancer and hoping to minimize
the impact of that disease.
So kind of walk us through alittle bit about general
(18:32):
recommendations for women andthen we can talk a little bit
more about people who are athigher risk and how you might
tailor the strategies for thosefolks.
Dr. Sue Jane Grosso (18:41):
Well, you know, I think let's start at the
beginning.
As far as breast health, right,how do we maintain breast
health?
And, at one time, and you mayremember this, the American
Cancer Society, right, which isone of those societies that we
look to to help us figure outwhen to get your mammogram.
You know screening, and do youremember when they would talk
(19:02):
about breast examination,self-examination?
Dr. Michael Koren (19:05):
Self-exams.
Yeah, there was a huge emphasis
Dr. Sue Jane Grosso (19:08):
And it was a big push, for this is how you
do a self-examination, and soforth.
So when they were talking abouthow to find breast cancer, they
would say get your mammogram.
And they would say examine yourbreasts.
Right, this is the way you doit.
Go into the shower, so on andso forth.
I don't know if you know this,but they no longer recommend
(19:28):
that you do breastself-examination.
Dr. Michael Koren (19:30):
Interesting.
Yeah, I haven't heard thatlately and that makes complete
sense, but you're absolutelyright.
It was a huge point of emphasisabout how to do self-exams and
what time of menstrual cycle youdo it and all that sort of
thing.
Dr. Sue Jane Grosso (19:44):
Right, exactly, but they don't
recommend it anymore.
But I'm going to tell you that,as a person in this specialty,
I still think women should dobreast self-examinations.
The reason they stoppedrecommending it is because, when
they looked at the studies, thestudies didn't show that it
made a difference.
(20:05):
Right, but I can tell you storyafter story of the woman that
has come to me and has found herown breast cancer.
Okay, so, yes, we're going totalk about how you should get
your mammogram right, but Ireally want to emphasize how
women have been their ownadvocate and they have saved
(20:27):
their own lives by finding theircancer, because they felt
something and they came in tosee the doctor.
Dr. Michael Koren (20:34):
So interesting.
Dr. Sue Jane Grosso (20:35):
Yeah.
Dr. Michael Koren (20:36):
So your recommendations once a month,
twice a month, uh, you know.
Dr. Sue Jane Grosso (20:41):
I would say it.
.
.
I don't think you have to.
.
.
I don't want to put thatpressure on women and I think
that's one of the reasons whythey.
You know, if a woman doesn'twant to examine her breasts, I'm
not going to push her and tellher that she has to.
I think it's just, you know,becoming familiar, and you know
I would say every so often, youknow, maybe that would be every
two or three months.
You know, it's just, let's putit this way If you're in the
(21:03):
shower, pay attention, see whatyour breasts feel like, and of
course, some women will say, oh,but they're always, they feel
lumpy.
I always feel something I can'ttell, and I try to tell them.
Believe me, when there's acancer, it's going to feel
different from anything elsethat you've ever felt in your
breast, right?
So, while I don't want to saythat they have to examine their
(21:26):
breasts every single month,that's not what I'm trying to
say what I'm saying is, I think,being familiar with your
breasts, how they when you, whenyou, look in the mirror, right?
looking in the mirror.
Is there a change with the waythat your nipple looks?
Is there a change with any ofthe color of at all of your, of
your breasts?
You see a dimpling, you know.
(21:47):
Does one breast look differentfrom the other?
Size wise, I think it'simportant to to know what your
breasts look like, believe it ornot.
Sometimes women have come inand I asked them.
I said, well, how did you findthis?
And they'll say, well, myhusband found it.
I've heard that.
I've heard where my dog keptgoing to this one part of my
breast.
You know, maybe because maybethe cancer was very warm, right,
(22:11):
because of the extra blood flowor something.
I've heard that story too.
But you know, women should gettheir mammogram.
I mean, let's start with that.
Dr. Michael Koren (22:20):
Just before we get off the breast exam, any
advice vis-a-vis time of themonth for women to examine their
breasts, or doesn't matter thatmuch?
Dr. Sue Jane Grosso (22:26):
I think that's a very good question.
And I think let's bring up thequestion about breast pain,
right, because when you talkabout time of the month, it's a
woman who is menstruating okaycan sometimes have tenderness of
her breasts.
Now, most pain is notassociated with breast cancer,
pain that is cyclical, meaningyou can feel it before your
(22:49):
period and then it goes away.
You know, comes and it goes.
That's not the kind of painthat is associated with breast
cancer.
And you're right as far as thebest time to examine yourself
will be, you know, after you hadyour period.
So let's say, at that, five orseven days, it's when your
(23:09):
breasts become most quiet, asopposed to the middle or right
before your period is when women, you know, are a little bit
more tender, tend to be a littlemore full.
So and in fact we don't do thisso much anymore but when we do
breast MRI and we'll talk aboutthat at some other point we
would try to schedule it at acertain point of their menstrual
cycle, because the breasts arenot as active.
(23:30):
The breasts are very active,like right before your period.
I think most women couldprobably, you know, probably
would agree that that's whenthey feel it.
So, yeah, I mean, but you know,to have to remember when to do
it better, to just feelcomfortable, to do it whenever,
whenever you feel you want to.
Yes.
Dr. Michael Koren (23:49):
So, moving on to mammography, I know you
wanted to give some people somerecommendations with regard to
when that should be done and howfrequently.
Dr. Sue Jane Grosso (23:59):
Well, you know, I think it's an important
topic about when to startscreening mammography and the
reason why is because there hasbeen a lot of controversy and
there have been some differencesamong different organizations,
and the differences tend to bethe age group between 40 and 50,
right Between 40 and 50,.
(24:20):
It was not so long ago theUnited States Preventive
Services Task Force.
They had said that womenbetween the ages of 40 and 50
did not require a mammogram andthat is not what the American
Cancer Society said and not whatthe American College of
Radiology said.
But recently they changed theirminds and they have said that
(24:41):
women from the ages 40 to 50should get their mammogram.
So if there's any woman outthere listening anyone listening
that's been a little bitconfused with everything that
has been said.
The bottom line is you start at40.
That is the age that you start.
Now that's for women with anaverage risk.
They don't have an increasedrisk, they are just average risk
(25:02):
.
Now some organizations, thesame one I just mentioned, says
that you should get a mammogramevery two years, biennial,
between the ages of 40 and 50.
Actually they may actually saybiennial from 40 all the way to
74.
I have to check my records onthat, but the American College
of Radiology recommends that youdo it every single year.
(25:23):
So that is my recommendation.
So does also the AmericanCollege of Breast Surgeons say
from 40 every single year.
The American College ofObstetricians and Gynecologists
also says the same.
So age 40 every single year,
Dr. Michael Koren (25:39):
-a ny concerns about the radiation
risk?
I know that's been thrown outthere as a trade-off.
Dr. Sue Jane Grosso (25:49):
Right.
Well, you know, look, withanything in medicine it's always
about benefit and risk, right,you have to sort of look at what
is the benefit, what is therisk.
And with all of theseguidelines, everything that
we're talking about today, youshould always talk to your
physician, because yourphysician should be able to
guide you oh sorry, there's abug.
Their physician should be ableto guide you, they should know
the information.
If they don't know theinformation, they should call
(26:12):
their radiologist.
And I do get a lot of callsfrom my primary care, you know,
colleagues, or you knowgynecology colleagues that will
call me to ask me what should Ido?
And that's what a patientshould do is they should speak
to their doctor.
Radiation, yes, there isradiation, but it's a low dose
of radiation.
And you can see, you knowstatistics out there that will
tell you.
(26:32):
You know, one mammogram isabout 26 days of background
radiation.
And you know we're not talkingabout other parts of radiology,
but CT scans of the abdomen andpelvis, for example, a lot more
radiation than a mammogram.
Chest x-ray is a little bitlower.
So you have to sort of thinkabout the benefit versus the
(26:54):
harm.
The radiation is very low andespecially nowadays we have
digital mammography and digitalmammography is lower than film
screen mammography, which iswhere we had started.
So I could understand beingconcerned about radiation.
I get it, but the benefit faroutweighs any risk with
radiation.
Dr. Michael Koren (27:10):
And that's helpful.
So how about this concept ofhaving the study done in the
same place each year?
So it's easier to compare.
I'd love to hear your commentsabout that.
Dr. Sue Jane Grosso (27:21):
Yeah, that's a very good point.
I'm glad you brought that up.
It's very important for womento realize and know that we need
to compare to priors, becausesometimes the only way you can
detect breast cancer is whenthere's a change in the
appearance of the breastcompared to before.
So while I would tell you it isbetter to stay at the same
(27:44):
facility so that they have thesame you know all of your images
from the past I don't want tosay that you have to stay there,
because what if you findanother place that you prefer?
What's most important is to getyour prior mammograms and bring
them with you to whateverfacility if you choose a new
facility right whatever facility.
Dr. Michael Koren (28:11):
-and there aren't compatibility issues with
software and things like that,which is the bane of our
existence in modern medicine.
Dr. Sue Jane Grosso (28:15):
Nowadays not.
There were some issues when youhad different machines because
the vendors out there, the majorvendors GE is one of them,
Hologic those are probably thetwo biggest vendors.
You have Siemens, you haveother ones.
At the place that I'm at, wehave both GE and Hologic and
they're very similar and therewas a time when you couldn't
(28:37):
upload the software from onemammogram to another, but that
pretty much is non-existentnowadays.
Nowadays, if you and most placesare digital I mean you don't
film screen is not reallysomething you see nowadays so
much.
Pretty much every place isdigital nowadays.
So you go to a place you canget your mammogram, put it onto
(29:01):
a CD, and there are actuallylaws that protect women because
the facility has to give themtheir images, and they actually
there's a law out there thatsays you have to give it to them
within like 15 days Like thereare actually laws that exist to
protect women.
So, and at our place we haverelationships with some other
institutions where we can getelectronic transfer of images as
well.
(29:21):
So I would say absolutely.
I think that what's importantis to know you need to compare
to priors.
That's the one importantmessage that we have to give.
At our facility we actually doget the patient to sign a
release and then we will contactthe other office and get them
to mail it to us.
So some places will do that foryou.
Dr. Michael Koren (29:44):
That's terrific.
So, moving on, you findsomething of concern on a
mammogram and then you have togo to another form of imaging.
So kind of walk us through whatyou do next typically CAT scan,
ultrasound why you would pickthe next modality based on what
you're seeing.
Dr. Sue Jane Grosso (30:01):
Okay, good question also.
So you start off with ascreening mammogram.
So at our place and most places, they are doing a digital
mammography and they're doingwhat's called tomosynthesis, or
it's also called 3D mammography,and that is a mammogram where
the woman will experience thatthe machine moves as they're
having their mammogram.
That's because the machine isobtaining images right At
(30:24):
different sections of the breast.
It's kind of like a CAT scan,so it slices through the breast.
It's like taking a loaf ofbread and slicing that loaf of
bread and imagine, you know,like the bread that has raisins,
right, so you would be able tocut through and you'll find a
raisin on the inside.
So it's the same thing with amammogram we get those slices.
So if I'm reading a screeningmammogram and a screening
(30:47):
mammogram is someone that doesnot have any symptoms whatsoever
If you have a lump, if you haveany symptoms whatsoever, then
you are not a screening anymore.
Then you are what we call adiagnostic mammogram.
A diagnostic mammogram meansthere's an issue, there's a
problem, and you will come inand then your exam will be
supervised, usually by aradiologist.
(31:09):
Okay, so let's stick toscreening.
So if I'm sitting and I look ata screening mammogram and I see
something abnormal, I'm goingto call that patient back for
additional imaging.
So that's called a callback foradditional imaging on another
day.
When they come back on anotherday, generally women will have
additional mammography imagesand sometimes, and oftentimes I
(31:31):
should say, they will also havean ultrasound.
An ultrasound is differentmodality, it doesn't use
radiation, it's ultrasound waves, but an ultrasound is very good
at being able to detect a mass,a cyst.
Sometimes we need todifferentiate.
Sometimes I look at a mammogramand I see a mass and I can't
(31:52):
tell by the mammography becauseit just looks white.
I can't tell if it's a solidmass or if it's a cyst, which is
just a round collection offluid, basically, which is
completely benign and nothing toworry about.
Once I get to evaluate thepatient to see what they have
and it could be calcifications,it could be a mass, it could be
(32:13):
what we call architecturaldistortion, these are all things
, that terminology that we use.
Once we find that, then we haveto decide whether that patient
is normal and leaves and comesback in another year.
Or does that patient maybe needto come back in six months, or
is this patient ready for abiopsy?
(32:36):
Nowadays, for the most part, wedo image-guided biopsies.
It used to be years ago thatwomen would go to the operating
room for the surgeon to remove apiece of tissue, right the
entire tissue, and that wouldlead to scarring, you know,
disfigurement, sometimespotentially because you're
taking.
Now, most biopsies that we doare benign.
(32:57):
They're not cancer.
So the fact that we you knowthat what has been developed as
image guided means that youcould take a patient and just by
placing a small needle into thearea of abnormality, you could
take a piece of the tissue right, a core, as we say rather than
taking the whole thing out.
(33:17):
Once that is done and that'susually done on a different day,
right, usually not the same dayas the callback the patient
then has this biopsy.
We find out what it is and ifit's abnormal, the next step is
the surgeon, right?
Dr. Michael Koren (33:33):
So the step that you described is prior to
any surgeon getting involved.
Do you have any sort of oldschool Staten Island and
surgeons that think that that'snot the best way to go out of
curiosity, or is that prettymuch accepted that there'll be a
radiologist that does the biopsy.
Dr. Sue Jane Grosso (33:49):
When I went back, when I went from
California back to Staten Islandback in 1993, at that time
surgeons still believed thatwomen should be going to the
operating room it was very hardfor them to accept that there
was this thing calledimage-guided biopsies and that
was part of what I had to teachthem.
But nowadays, years later, ithas become accepted by everyone
(34:15):
radiologists and surgeons thatthe first step in biopsy in a
patient is image-guided biopsy.
So the surgeons are completelyon board with this because that
is the standard.
It's the standard for AmericanCollege of Radiology and is the
standard for American College ofSurgeons that image-guided
biopsy happens first.
Dr. Michael Koren (34:35):
So if a woman was recommended to have surgery
first, they should be skeptical?
Is what you're saying.
Dr. Sue Jane Grosso (34:42):
Yeah, and I don't know where that would be
happening.
But image-guided biopsies and Ishould say I think it's
important to say, even thoughI'm a radiologist and I do image
guided biopsies surgeons doimage guided biopsies also.
A surgeon may see a patient inthe office and they may feel
something right?
A mass.
And many of them are trainedand they are accredited.
(35:04):
Okay, they get certified to beable to do this and they, right
there in the office, can put theanesthetic on the skin, go in,
take a piece and send it off tothe hospital.
So at our place at Summit.
Health, actually we have both.
We have surgeons andradiologists.
We both do the procedures, butI would say probably throughout
the country, most places it'sradiologists that are doing the
(35:25):
biopsies got it all right.
Dr. Michael Koren (35:27):
So then next step.
So hopefully it's benign.
If it's benign, or you go backto the usual routine, or is that
somebody at higher risk?
Uh, just, but based on the factthat I needed quote, a biopsy to
determine what their status was.
Dr. Sue Jane Grosso (35:41):
Right if let's say let me just give an
example this is a very commonmass that we see out there, a
fibroadenoma.
So a fibroadenoma presents as asolid mass and sometimes you
can tell that it's afibroadenoma just by looking at
it and you may follow it.
But maybe you can't tell, soyou do a biopsy.
(36:03):
If I do a biopsy, then I haveto do what's called assess the
concordance.
The pathologist tells me whatit is right, they look under the
microscope, they send me thereport and then I look at my
images and I look at thepathology and I say you know
what this matches, we're good,she doesn't come back again
until another year.
(36:24):
Okay, let's say I biopsy somecalcifications and it comes back
.
That it's normal.
However, maybe, for whateverreason I feel, I think I want to
bring her back in six months sothat I can do magnification
views again, just to make surethat whatever piece I took was
(36:46):
representative of the entiresample.
Sometimes it comes back andthere's something called atypia.
Dr. Michael Koren (36:53):
Mm-hmm.
Dr. Sue Jane Grosso (36:54):
So atypia.
So there's atypical ductalhyperplasia, ADH, there's
atypical lobular hyperplasia,ALH, and there's some other ones
like flat epithelial atypia.
So different types of pathology.
If a woman comes back, thepathology comes back as atypical
ductal hyperplasia.
That patient does have to go onto the surgeon and that area
(37:19):
then needs to be removed.
And the reason why is becausethere have been cases.
There are cases where theatypical ductal hyperplasia is
just something that's tellingyou something's going on and
they want to make sure there'sno DCIS ductal carcinoma in situ
, so that atypical ductalhyperplasia pathology does go on
(37:39):
for more surgery.
The other atypias that I've saidthey don't.
Now what if I do a biopsy and Ifeel that it's what we call
discordant?
Let's say it's an area thatlooks kind of suspicious.
I do the biopsy and it comesback normal.
But I say, yeah, you know, thisdoesn't seem right.
(38:00):
Maybe my needle didn't gothrough to the right place,
maybe it was a mistargeting ofsome sort, maybe the patient
moved, maybe the anestheticmoved things, that patient.
I may decide that that patientneeds to go to the surgeon to
have a larger area removed to beabsolutely certain that there's
nothing there.
Dr. Michael Koren (38:18):
Yeah, so again.
So now we're getting intosomething that's more severe in
terms of the diagnosis of cancer, and I know that you also use
MRI technology and other typesof technology.
So where do they fit in andwhat's your part of sort of
staging cancers in terms ofspread and those type of
(38:39):
concerns?
Dr. Sue Jane Grosso (38:40):
You know, for a cardiologist, Mike, you
know a lot about this.
You're asking all the rightquestions, for sure.
Well, you know, look, sometimeswhen a patient comes in for a
screening mammogram or when shecomes back for additional
imaging, sometimes I can look atit and I know that I'm looking
at cancer.
I mean, sometimes that doeshappen when you have a patient
(39:02):
that has the possibility ofcancer or you diagnose them as
having cancer.
The next step may be to get abreast MRI.
So what is a breast MRI?
That's magnetic resonanceimaging.
So breast MRI doesn't useradiation, it uses magnetic and
radial waves.
It's a completely differentmethod or technology, but a
(39:24):
breast MRI is very, very good atpicking up invasive breast
cancer.
So while with a mammogram,especially when the breasts are
dense, it may be difficult tosee.
So the patient may have cancer,but maybe I can't tell.
How big is the cancer Like?
How are we going to determineif she needs a lumpectomy or a
(39:44):
mastectomy?
You know, how do we know?
So the radiologist can look atthese images and say you know
what?
I think this patient wouldbenefit from a breast MRI.
Now, if you look at what theAmerican College of Radiology
will say, they feel that everywoman that is diagnosed with
breast cancer should have an MRI.
(40:04):
But some of our surgeons, someof our colleagues, do not
believe in that, because therehave been some studies and there
haven't been studies thatindicate that an MRI really does
affect mortality.
So not all patients that get abiopsy and diagnosed with breast
cancer, not all of them, go onto breast MRI.
Right Again, this is where youtalk to your physicians, you
(40:26):
talk to your radiologists andyou get to find out what you
need.
So now this breast MRI comesback to me again, and now I have
to read the breast MRI and thebreast MRI what it does is I get
to see the breast that has thecancer, try to figure out how
big it is, find out if there'sany more disease right, because
you could have one quadrant thathas cancer but you may have
(40:48):
cancer in another quadrant ofthe same breast.
You get to look at the lymphnodes to see if there are any in
the axilla or elsewhere.
And the great thing is that youlook at the other side, because
about four to 5% ofcontralateral breast cancers may
be there.
So it gives you an opportunity.
If the woman's going to go forsurgery, you need to make sure
(41:09):
that everything is okay right,not just one side, so that
breast MRI is going to help toabsolutely determine the extent
of disease.
Okay, now go ahead.
Dr. Michael Koren (41:20):
I was going to ask you.
PET scanning is another modalitythat people talk about.
Dr. Sue Jane Grosso (41:24):
I knew you were going to go there.
So if a woman has breast cancerand it went to her lymph nodes,
right, at that point thesurgeon or the oncologist may
say you know what I need to makesure, in order to stage this
person, I need to make sure thatthere isn't breast cancer
anywhere else, and that's wherethe PET-CT comes in.
(41:44):
So PET-CT, that's positronemission tomography, right, and
there is something calledpositron emission mammography as
well.
That's a little bit different.
But the PET-CT which, by theway,
I did do a fellowship trainingin nuclear medicine as well when
I was at NYU, and PET CT for meis one of my favorite favorite
(42:09):
technologies, and that's becauseyou look at the whole body all
at once.
The patient is injected withsome radio tracer, right, it
gets attached to glucose and itgoes from your veins, it goes
throughout your entire body andit gets picked up wherever there
is a lot of uptake with glucose.
So active cells, as you couldimagine.
(42:31):
The brain, right, our brain isvery active.
That brain lights up like youwouldn't believe.
The heart lights up like crazyCertain things.
The kidneys will light upeverything but in the breast for
the most part things are quietright and things like the liver,
the bones.
So a PET CT scan is a great wayto make sure that there isn't
(42:52):
cancer anywhere else for thatwoman with breast cancer.
So that definitely does help tostage her yes.
Dr. Michael Koren (42:59):
So interesting.
So I have a couple otherquestions.
Do you routinely look atgenetic markers for breast
cancer?
Is that part of the history?
When you're looking at theimages, does that help you, does
that hurt you?
Just curious your perspectiveon how important that is.
And if you're working in anintegrated health system you may
(43:20):
have that, but sometimes youmay not have that.
So maybe walk us through that,whether or not you recommend
those things for women that maybe at high historical risk.
Dr. Sue Jane Grosso (43:28):
Okay, well, you know one of the things that
when a woman comes in to get amammogram, we do obtain a
history.
We have a history sheet thatthey fill out, and part of that
history sheet is to find outnumber one does she have a
complaint?
We need to know if she has alump or if she has what we call
focal pain.
Right, we find out about familyhistory.
(43:50):
Who else in your family hasbreast cancer?
At what age did they developbreast cancer?
Does anybody else have ovariancancer?
And same thing is have you everhad a biopsy before?
Have you, and is there anygenetic mutation that we should
know about?
So all of that is extremelyimportant.
(44:13):
And as you bring that up, Ishould also bring up something
that's called risk assessment,because a lot of breast imaging
facilities have this.
They have programs that assessyour risk for the development of
breast cancer over yourlifetime.
So one of the ones that we likeis called Tyrer-C uzick, and I
can get into that a little bitmore later, but you're
(44:34):
absolutely right that when apatient walks in, all of her
history is very important, sothat it helps me figure out what
I need to do next.
It's not going to change how Iread her mammogram, because I'm
there to read the mammogram andfind out is there something
abnormal?
But if I find out that thewoman has this history and,
(44:54):
let's say, her breasts areextremely dense, right, and we
haven't gotten into density yet,but density is one of the
things that affects the abilityto see tumors on a mammogram.
So if that woman hassignificant history and she has
very dense breasts, I mayrecommend that she have a breast
MRI, right, or I may recommendthat she have an ultrasound, or
(45:17):
I may recommend you know what.
You need to see a breastspecialist, because you also
need to see a geneticist to findout about your markers, right,
so that patient is going to getplugged in, possibly into a high
risk program, for example.
So you're right Knowing geneticmutations?
Absolutely.
Now, remember, most women withbreast cancer do not have any
(45:40):
genetics or any family history.
85% of all breast cancers havenothing to do with family
history or genetics.
Dr. Michael Koren (45:48):
Interesting.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.
NFL Daily with Gregg Rosenthal
Gregg Rosenthal and a rotating crew of elite NFL Media co-hosts, including Patrick Claybon, Colleen Wolfe, Steve Wyche, Nick Shook and Jourdan Rodrigue of The Athletic get you caught up daily on all the NFL news and analysis you need to be smarter and funnier than your friends.