October 7, 2025 • 17 mins
Dr. Tsai, board-certified breast radiologist & director of breast imaging at UCI Health, talks with ALT 98.7's Gina Grad about breast cancer risk assessment, testing, timelines, treatment & more on this episode of Live Well With UCI Health.
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Episode Transcript
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Speaker 1 (00:00):
Welcome to the next installment of Live Well with UCI Help.
My name is Gina grad I'm from ninety eight seven
and iHeartRadio and i'd like to introduce doctor Zai.
Speaker 2 (00:09):
It is so great to have you here.
Speaker 1 (00:11):
Thank you so much. Let me do a little bragging
about you, and if I leave anything out, please fill
us in. A board certified breast radiologist and director of
breast Imaging at UCI Health, does that sound about right?
Speaker 2 (00:23):
Sounds right? Okay, wonderful.
Speaker 1 (00:25):
I'm also an associate professor at the UC Irvine School
of Medicine and Chief of breast Imaging for the Department
of Radiological Sciences. Ooh, I'm tired just from saying that.
That's amazing. Thank you, Thank you for having me. Of course,
so many important questions and such an important topic for
half the population. But I have to ask you a
(00:46):
personal question right off the bat. What is dense breast tissue?
And why am I always asked if I have it?
Whenever I'm going through a mammogram is the first thing
I'm asked. I'm like, I don't know, is that's a
normal question?
Speaker 3 (00:59):
Thank you for that. And we get this question all
the time, okay, all the time.
Speaker 2 (01:02):
Every day. I get it every day.
Speaker 1 (01:03):
Okay, tell me, how would we know if we have it?
Speaker 2 (01:07):
And what do we say? Yes? So listen, every woman does.
Speaker 3 (01:10):
Breast tissue is made up of this fiberglandular fibrius tissue
and fatty tissue, right, And the percentage of this fiberglandular
breast tissue in relation to the fatty tissue is the
density of your breast. So the higher the percentage of
this fiberglandular dense breast tissue that you have in relation
to the fatty tissue, the denser that you're okay, and
(01:31):
the harder it is for mammogram to kind of see
through this dense breast tissue. So that is why it's
such an important kind of question that is asked, and
it's it's such an important independent risk factor for the
development of breast cancer because it can really obscure findings
that we see on mammogram.
Speaker 1 (01:49):
Thank you so much for explaining that, because I was told, oh, well,
we don't we don't really know what we saw, so
we're going to do three D imaging and I was like, you, you're.
Speaker 2 (01:57):
The boss, you tell me what to do.
Speaker 1 (01:58):
So I think a lot of women fall into that category,
and we don't know that.
Speaker 2 (02:03):
I don't know the science.
Speaker 1 (02:05):
You know, my mom, let's just say she wasn't asked,
you know, when she was my age if she had
that or not. So I imagine we've come quite afarne away.
Speaker 3 (02:13):
So come over fifty to sixty percent of the population
that we see. Yes, Oh, okay, very common, Okay, thank
you so much. I just needed to get my question
out of the lay first.
Speaker 2 (02:22):
I'm sure I'll have any more.
Speaker 1 (02:25):
So press cancer the second leading cause of cancer death
in US women, which is so scary, behind lung cancer,
I believe, and about one in eight women will be
diagnosed with it. Yet the mortality rate has fallen, right,
So that's a great thing, and I would love for
you to tell us why that is so we can
do more of it.
Speaker 2 (02:43):
Yeah.
Speaker 3 (02:43):
So the mortality rate has fallen over forty four percent
credible over the last few decas staggering, right, staggering statistics.
But what it all comes down to and the reason
the main reason for that really is early detection. And
it's early detection though specifically through breast imaging and the
cancer screening tools that we utilize.
Speaker 2 (03:02):
In breast imaging.
Speaker 3 (03:03):
Over the last few decades has become significantly more accurate,
significantly more precise, and that allows me, as a breast
radiologist to find and diagnose breast cancers very very very
earliest stages.
Speaker 1 (03:16):
That makes a lot of sense because I've had two
very dear friends with pretty aggressive breast cancer. And you'll
probably know what this is. I certainly didn't when she
said she was on a chemo called the Red Devil.
A lot of people call them pretty grittel and pretty rough.
But she's one of the lucky ones. And they did
(03:36):
catch it early, yes, but that I remember, you know,
my mom's friends, a few of them dining it. It
felt like a death sentence, you know. And it has
to feel like that anymore. It used to be.
Speaker 3 (03:47):
And the single most important tool that we utilize for
early detection, for early screening is screening memgram and mammogram
helps us find breast cancers. We're talking about tiny, tiny
breast cancers, right one to two million in size, right,
tiny tiny specks of calcium calcifications before a mass has
time to develop, and long long before a patient is
(04:08):
ever going to feel a lump clinically.
Speaker 1 (04:10):
Okay, So when I was growing up in sex said class.
Speaker 2 (04:14):
It was all about the b s.
Speaker 1 (04:16):
Okay, the rest self examination and you do the circles
and you do the thing.
Speaker 2 (04:19):
Do we I don't know, do we still teach that
or would just say get in for your mammogram. I
know we do still teach that. Okay.
Speaker 3 (04:25):
Really, clinical exams should still be performed monthly, creations and
yearly by physicians. Okay, but you know, the name of
the game really is early detection, early detection, okay. And again,
mammogram will find long before a patient has a time
to fill alone.
Speaker 1 (04:40):
I'm curious how I mean, since this is all about
early detection. And by the way, I don't know if
I'm just an outlier. But everyone says, oh, it hurts
so bad. It doesn't It doesn't hurt that bad. It's
not a big deal, you know. It's a little smushy,
and then we all move on and we're happy that
we're healthy.
Speaker 2 (04:57):
We pat each other on the back. Exactly. It's not
a big deal. Well, but you know, it's not easy.
Speaker 3 (05:02):
R And I hear women who say, you know, they
don't like their breast and compression, they don't like getting mamograms.
It's uncomfortable. I'm not gonna lie, but listen, I hear you.
I get my mamograms every year as well, right, Okay,
do I want to be having my breast and compression.
I really don't, right, But we're talking about the seconds
that women.
Speaker 2 (05:18):
Spend exactly in compression.
Speaker 3 (05:21):
This discomfort, right, will save years and years of our lives.
Speaker 1 (05:24):
And that's years all about. And you think, you know,
if you thought this was uncomfortable, like God forbid, it
gets worse. And now we're just talking about a palliative
care situation. This is the best thing to do. Now,
some of us fall into high risk categories and don't
know it exactly. Can you give me some information on
how we figure that out?
Speaker 3 (05:42):
Of course, of course, So you know, let's kind of
backtrack a leave before we talk about this high risk category.
Speaker 2 (05:47):
Let's talk about just the basics. Okay.
Speaker 3 (05:49):
So you know, every physician that's involved in the care
of breast cancer, all of our colleges, we all recommend
screening mamograms starting at the age of forty forty woman
of average risks and continuing every year, so continuing annually
for as long as someone is in good health. And
it has been shown that starting at age forty continuing
annually shows the greatest breast cancer mortality reduction amazing across
(06:12):
all su It's just fact, it's fact, right, And in fact,
women who are considered higher than average risk may need
mammogram before the age of forty right. Okay, So in
twenty twenty one, my American College of Radiology expanded these
breast cancer screening guidelines and started to recommend that all
women so age thirty should be undergoing a breast cancer
(06:35):
clinical risk assessment. But then in twenty twenty three they
decreased the age to twenty five. Right, so all young women, Yeah,
all young women at the age of twenty five should
be asking their clinicians for something called a breast cancer
risk assessment.
Speaker 2 (06:49):
Okay, And what is that? What is that?
Speaker 3 (06:52):
We've been hearing a lot in the media about this
risk assessment tool calculator. Specifically, you know, you had the
actress Olivia Mound, she had bilo lot of breast cancers
by a lot of mess tectomies. She came out and
said that this risk assessment calculator saved her life.
Speaker 2 (07:05):
And what it is. It's a tool.
Speaker 3 (07:07):
It's a series of questions, Okay, personalized questions and the
answers to these questions, give you a risk factor, a
percent estimated risk for developing breast cancer in your lifetime.
Speaker 1 (07:18):
And is this more than just family history?
Speaker 2 (07:21):
It is?
Speaker 3 (07:22):
It is so the most comprehensive assessment tool out there.
What Olivia Mund's referring to we offer a UCI health
is something called the Tiraku ibis RISTI ASSESSM.
Speaker 2 (07:31):
Now, there's many out there.
Speaker 1 (07:32):
Don't make me memorize that I should get that doesn't
there's many.
Speaker 3 (07:35):
It's called the Ibis tire Cusic Risk Assessment Calculator, and
there's many out there, But this is the most comprehensive.
Speaker 2 (07:41):
That's and that's what you use.
Speaker 3 (07:42):
It includes things such as personal and family history, right,
breast but also ovarian cancer.
Speaker 2 (07:48):
Okay, how would those be related?
Speaker 3 (07:50):
Well, you know patients who have had ovarian cancer or
family history of a varying cancer oftentimes that can be
linked to breast cancer genetically. Okay, and know that especially
you know, like we talked, I'm sure you heard the
breast cancer BRCA, BRACA one and two gene.
Speaker 1 (08:05):
Yes, yes, And that became sort of more in the
mainstream with Angelina Jolia, if I remember correct exactly.
Speaker 3 (08:11):
She had the breast cancer BRAKA one gene, and she
loved to get the bilateral mess eectomies right removal of
her ovaries as well, so they can be linked.
Speaker 1 (08:19):
And that's more excuse my ignorance on the subject. But
is that more preventative. That's to preventative on her side,
and what a choice to make. It definitely is Listen,
that's a lot. It definitely is.
Speaker 3 (08:32):
But you know that is is more rare in the
sense that not everybody carries that breast cancer gene. But
it's also any personal or family history of right bressover
mar in cancer. It's also your hormonal history, your reproductive history,
age of your first child, if you've had children, So
it's a very detailed questionnaire. And it's also you know,
history of breast symptoms, breast conditions, right if you had
(08:54):
history of bressys, history of bress biopsies, things like that,
and you know, thank you for mentioning breast and city before. Yeah,
it's the only model right now that takes into account prestensity.
Speaker 2 (09:05):
Really.
Speaker 3 (09:05):
Yeah, Like we talked about restdency, it's an independent risk
factor for the development rests.
Speaker 1 (09:10):
Okay, And I would imagine, I mean, you know, because
I'm not a doctor, but I'm assuming that it's because
it's more it's just harder to detect when you.
Speaker 2 (09:17):
Have that, so it's it's twofold.
Speaker 3 (09:19):
So first of all, yes, harder to detect, right to
see through that dense breast tissue, But just in and
of itself, that dense fiberglandular breast issue is an independent risk.
Speaker 2 (09:28):
Factor which a lot of people don't realize.
Speaker 3 (09:30):
Right.
Speaker 1 (09:30):
Oh, yeah, this this is the first time I've even
heard those words, so of course I didn't know. And
this is another I'm just gonna use you for my
just a personal.
Speaker 2 (09:39):
Place all day consultation.
Speaker 1 (09:41):
Yes, a friend of mine was told that she was
too she's in her forties and she's too young to
start going through menopause, even though she started showing signs
of it. And the doctor said that there's a higher
risk of certain cancers when you go through menopause too early,
and that could include breast cancer. Is that something that's
on your radar or maybe she would like a second
(10:02):
opinion on that.
Speaker 2 (10:03):
You know, that's a really really good question.
Speaker 1 (10:05):
Yeah, I know, it's very specific, very specific.
Speaker 3 (10:07):
And you know when I mentioned that these risk assess
been calculators taken to account our hormonal history. Yes, it's
years of our personal exposure to our body's hormones. All right,
So we're talking about estrogen, right, gesterone. You know, when
we're pregnant, we have a huge load of estrogen exposure.
So you know, from the time that you have your
(10:27):
first period to when the time that you have menopause.
The longer that time is, the longer your potential exposure
to the hormones. Right, and some some breast cancers are
hormonally driven, Some are driven by estrogen, some are driven
by progesterone. So the age that you develop menopause or
go into menopause, it does affect and change your breask.
Speaker 2 (10:47):
Okay, so there's there's something there.
Speaker 1 (10:49):
I'm so interested in taking this test, and I imagine,
you know, like everything else. Well, I took the test,
I found I googled it, and I found No, we
want to go to an actual doctor.
Speaker 3 (10:58):
You're right, You're right, because the reason of this test
should be an entire approach, your entire team's your your clinician,
but also you're breast radiologists. Okay, because patients who, like
we mentioned, average risk is one in eight right, twelve
point five percent, right, and high risk it's high and
that's just average risks, right, right, and high risk. You're
(11:18):
considered high risk when you're twenty percent or higher, okay.
Speaker 2 (11:21):
And so if we get.
Speaker 3 (11:22):
That number, if it spits out a number and it's
very very high, then patients.
Speaker 2 (11:26):
Figure out we don't know what to do. And so
every patient who.
Speaker 3 (11:28):
Comes into UCI Health we give them that personalized risk score,
and not just that, we also give them a recommendation.
Speaker 1 (11:35):
To send them on their right exactly exactly, because.
Speaker 3 (11:37):
If you're twenty percent or higher, then really you should
be starting screening mammograms at.
Speaker 2 (11:41):
Age thirty home right now.
Speaker 3 (11:44):
Ten years before somebody would have average risk.
Speaker 1 (11:47):
And these days, I can't imagine how poor doctors people
always coming in because they know everything because they googled
it and they know everything because Google. Yeah, because they
spent five minutes, you know, typing it in and now
they're also a doctor. So congratulations to do you feel
like in your specific line of work you're having to
manage people's expectations when they come in and they kind
(12:09):
of think they know everything because they researched it online.
Speaker 3 (12:12):
Well, you know, I think that could be said, with
any specialty, absolutely, but breast imaging in particular, it's such
a vulnerable kind of state where you know, woman is
getting mamgrams, your breast is in compression, right, we could
potentially be telling them bad news rise in terms of
any biopsies that they need or any diagnoses. So women
are already in this kind of heightened state of anxiety. Yeah,
(12:35):
and so I think you know, anything that we can
do to kind of alleviate that anxiety, counsel them, especially
if you know they didn't know they were high risk,
then they're getting that recommendation, right for additional imaging, anything
that we can do to alleviate that, but also give
guidance going forward.
Speaker 1 (12:50):
Yeah, and put human touch back into the process instead
of just doom scrolling in the middle of the night
because you can't help yourself. Now we're talking about women.
Of course this affects women, you know, such a high rate.
But this does happen to men every now and again,
I would imagine absolutely correct.
Speaker 2 (13:05):
And have you have you personally dealt with men with
breast cancer?
Speaker 3 (13:08):
Yes, I have to diagnose several in my career. Well,
let me tell you, breast cancer is so so rare
in male patients, right, we're talking about it counts for
about one percent of all the breast cancers that we diagnose. Okay,
so unfortunately, women are one hundred times more more likely
to get breast cancer.
Speaker 2 (13:24):
And that's why. You know, routine mammograms are not recommended
in men. But is the same treatment for men. It
would be.
Speaker 3 (13:31):
The same treatment, correct, correct, But you know men, We
always encourage our male patients anytime they have any symptoms, okay,
don't ignore them, any breast symptoms, please, don't ignore them,
any lump, any swelling, any dissearch, come in for that mammogram,
because we have absolutely diagnosed cancers in male patients.
Speaker 1 (13:47):
Oh my god, I can't imagine how jarring that would
be because, like you said, women are sort of used
to knowing that this bad news is possible. But for
a man to say, no, no, you don't understand, I'm a man,
this isn't possible.
Speaker 3 (13:58):
It's possible, no, and they shouldn't ignore their symptoms, right,
And what would.
Speaker 1 (14:02):
A symptom be for a man? Would it be different?
Speaker 3 (14:05):
It would be a very similar at a lump, yeah, yeah,
a lump, you know, swelling, Okay, and you sort of
pain in around the breast nibble area. And sometimes we
also see nibble discharge, oh specifically in a bloody nibble discharge.
Speaker 2 (14:17):
Okay, so just anything.
Speaker 3 (14:19):
And I always tell my patients you know your body
the best, right, Okay, anything that's out of your realm
of normal always come in.
Speaker 1 (14:25):
That's such great advice because you know, especially as a woman,
you think, well, you know, breast tenderness is this, but
is it related to my period? And I you know,
you just have to figure out, like no, Tuesday before
my period. It always feels like this, and like you said,
I'm the only one who would know that.
Speaker 3 (14:39):
But listen, you know, like I said, you know your
body the best, right exactly. You are your best advocate exactly.
So anything out of the realm of what you feel
is normal. You have to advocate for yourself.
Speaker 2 (14:49):
And it's it's interesting.
Speaker 1 (14:51):
Just on another personal note, I had a breast reduction
a few years ago, and they were the insurance company
to their credit, was very aggressive on making s I
didn't have any breast cancer issues because hey, I get it.
If you're foot in the bill, you don't want to
start over again. I understand that. So I feel very
fortunate that they were so aggressive about it before the surgery.
(15:11):
But that doesn't mean in any way that I'm off
the hook now, right, No, definitely.
Speaker 3 (15:16):
And I don't know if you're of the age, you
don't you probably let you don't look like it, you
don't look like it. But certainly, you know, even patients
who have had you know, prior augmentations, you know, a reductions,
should absolutely be considering screening men.
Speaker 1 (15:30):
Well, in that conversation, I am actually that makes me
curious about people with implants. It's you know, very common.
You know, people have them all the time, and they're
so real looking these days, you cannot tell the difference.
Is it harder to diagnose breast cancer and somebody with implants?
Speaker 3 (15:46):
You know, I'll tell you it's it's it's kind of
a couple of layers here, right, So patients are always
worried about resums when they come in in terms of
the mammogram, right, first of all, is us being able
to see the rest issue, but also how does that
mammogram affect the actual plants?
Speaker 2 (16:00):
Can help make it lopsited?
Speaker 1 (16:01):
Exact?
Speaker 2 (16:02):
Yeah, exactly.
Speaker 3 (16:03):
So our technologists are well trained, well versed in doing
mamograms and all patients, especially breast implant patients, okay, And
they have a technique where they manually kind of protect
the impunt, bring that impunt back, push that impunt back
manually with their hands so that we are able to
visualize that breast tissue better.
Speaker 2 (16:22):
So there's actually a different system.
Speaker 3 (16:23):
There is a difference. There's a different technique that is utilized.
And it's actually additional more images that we take in
patients with impults because we know that that implant can
hide that brust tissue.
Speaker 2 (16:33):
That is so good to know. I just figured it
would just be harder and that's just part of the risk.
But no, they know what they're doing.
Speaker 1 (16:39):
And you know, I know we kind of talked about this,
but what would you tell somebody who's just like, I
don't know, I just don't want to do it.
Speaker 2 (16:44):
I've heard too that it's uncomfortable. I've just heard too
many horror stories. Yeah, exactly, like we talked about. Yeah,
I hear you, Okay, I definitely hear all women hear you.
I get them every right as well.
Speaker 3 (16:56):
Right, it's not comfortable, it's not okay, But like I said,
the couple seconds of discomfort saves years and years of
our lives and to me, that's that's worth.
Speaker 2 (17:06):
That's a great trade off. Mammogram saves lives.
Speaker 1 (17:08):
And natally do that is the takeaway doctor, say, thank
you so much for your time. Oh no, thank you
for having me literally going to save people's lives. And
we are so grateful to you to for you know,
talking to us and having this great conversation.
Speaker 2 (17:21):
Thank you for having me. You see, ihealth provides exceptional healthcare.
Visit ucihealth dot org for more information.
Welcome to the next installment of Live Well with UCI Help.
My name is Gina grad I'm from ninety eight seven
and iHeartRadio and i'd like to introduce doctor Zai.
Speaker 2 (00:09):
It is so great to have you here.
Speaker 1 (00:11):
Thank you so much. Let me do a little bragging
about you, and if I leave anything out, please fill
us in. A board certified breast radiologist and director of
breast Imaging at UCI Health, does that sound about right?
Speaker 2 (00:23):
Sounds right? Okay, wonderful.
Speaker 1 (00:25):
I'm also an associate professor at the UC Irvine School
of Medicine and Chief of breast Imaging for the Department
of Radiological Sciences. Ooh, I'm tired just from saying that.
That's amazing. Thank you, Thank you for having me. Of course,
so many important questions and such an important topic for
half the population. But I have to ask you a
(00:46):
personal question right off the bat. What is dense breast tissue?
And why am I always asked if I have it?
Whenever I'm going through a mammogram is the first thing
I'm asked. I'm like, I don't know, is that's a
normal question?
Speaker 3 (00:59):
Thank you for that. And we get this question all
the time, okay, all the time.
Speaker 2 (01:02):
Every day. I get it every day.
Speaker 1 (01:03):
Okay, tell me, how would we know if we have it?
Speaker 2 (01:07):
And what do we say? Yes? So listen, every woman does.
Speaker 3 (01:10):
Breast tissue is made up of this fiberglandular fibrius tissue
and fatty tissue, right, And the percentage of this fiberglandular
breast tissue in relation to the fatty tissue is the
density of your breast. So the higher the percentage of
this fiberglandular dense breast tissue that you have in relation
to the fatty tissue, the denser that you're okay, and
(01:31):
the harder it is for mammogram to kind of see
through this dense breast tissue. So that is why it's
such an important kind of question that is asked, and
it's it's such an important independent risk factor for the
development of breast cancer because it can really obscure findings
that we see on mammogram.
Speaker 1 (01:49):
Thank you so much for explaining that, because I was told, oh, well,
we don't we don't really know what we saw, so
we're going to do three D imaging and I was like, you, you're.
Speaker 2 (01:57):
The boss, you tell me what to do.
Speaker 1 (01:58):
So I think a lot of women fall into that category,
and we don't know that.
Speaker 2 (02:03):
I don't know the science.
Speaker 1 (02:05):
You know, my mom, let's just say she wasn't asked,
you know, when she was my age if she had
that or not. So I imagine we've come quite afarne away.
Speaker 3 (02:13):
So come over fifty to sixty percent of the population
that we see. Yes, Oh, okay, very common, Okay, thank
you so much. I just needed to get my question
out of the lay first.
Speaker 2 (02:22):
I'm sure I'll have any more.
Speaker 1 (02:25):
So press cancer the second leading cause of cancer death
in US women, which is so scary, behind lung cancer,
I believe, and about one in eight women will be
diagnosed with it. Yet the mortality rate has fallen, right,
So that's a great thing, and I would love for
you to tell us why that is so we can
do more of it.
Speaker 2 (02:43):
Yeah.
Speaker 3 (02:43):
So the mortality rate has fallen over forty four percent
credible over the last few decas staggering, right, staggering statistics.
But what it all comes down to and the reason
the main reason for that really is early detection. And
it's early detection though specifically through breast imaging and the
cancer screening tools that we utilize.
Speaker 2 (03:02):
In breast imaging.
Speaker 3 (03:03):
Over the last few decades has become significantly more accurate,
significantly more precise, and that allows me, as a breast
radiologist to find and diagnose breast cancers very very very
earliest stages.
Speaker 1 (03:16):
That makes a lot of sense because I've had two
very dear friends with pretty aggressive breast cancer. And you'll
probably know what this is. I certainly didn't when she
said she was on a chemo called the Red Devil.
A lot of people call them pretty grittel and pretty rough.
But she's one of the lucky ones. And they did
(03:36):
catch it early, yes, but that I remember, you know,
my mom's friends, a few of them dining it. It
felt like a death sentence, you know. And it has
to feel like that anymore. It used to be.
Speaker 3 (03:47):
And the single most important tool that we utilize for
early detection, for early screening is screening memgram and mammogram
helps us find breast cancers. We're talking about tiny, tiny
breast cancers, right one to two million in size, right,
tiny tiny specks of calcium calcifications before a mass has
time to develop, and long long before a patient is
(04:08):
ever going to feel a lump clinically.
Speaker 1 (04:10):
Okay, So when I was growing up in sex said class.
Speaker 2 (04:14):
It was all about the b s.
Speaker 1 (04:16):
Okay, the rest self examination and you do the circles
and you do the thing.
Speaker 2 (04:19):
Do we I don't know, do we still teach that
or would just say get in for your mammogram. I
know we do still teach that. Okay.
Speaker 3 (04:25):
Really, clinical exams should still be performed monthly, creations and
yearly by physicians. Okay, but you know, the name of
the game really is early detection, early detection, okay. And again,
mammogram will find long before a patient has a time
to fill alone.
Speaker 1 (04:40):
I'm curious how I mean, since this is all about
early detection. And by the way, I don't know if
I'm just an outlier. But everyone says, oh, it hurts
so bad. It doesn't It doesn't hurt that bad. It's
not a big deal, you know. It's a little smushy,
and then we all move on and we're happy that
we're healthy.
Speaker 2 (04:57):
We pat each other on the back. Exactly. It's not
a big deal. Well, but you know, it's not easy.
Speaker 3 (05:02):
R And I hear women who say, you know, they
don't like their breast and compression, they don't like getting mamograms.
It's uncomfortable. I'm not gonna lie, but listen, I hear you.
I get my mamograms every year as well, right, Okay,
do I want to be having my breast and compression.
I really don't, right, But we're talking about the seconds
that women.
Speaker 2 (05:18):
Spend exactly in compression.
Speaker 3 (05:21):
This discomfort, right, will save years and years of our lives.
Speaker 1 (05:24):
And that's years all about. And you think, you know,
if you thought this was uncomfortable, like God forbid, it
gets worse. And now we're just talking about a palliative
care situation. This is the best thing to do. Now,
some of us fall into high risk categories and don't
know it exactly. Can you give me some information on
how we figure that out?
Speaker 3 (05:42):
Of course, of course, So you know, let's kind of
backtrack a leave before we talk about this high risk category.
Speaker 2 (05:47):
Let's talk about just the basics. Okay.
Speaker 3 (05:49):
So you know, every physician that's involved in the care
of breast cancer, all of our colleges, we all recommend
screening mamograms starting at the age of forty forty woman
of average risks and continuing every year, so continuing annually
for as long as someone is in good health. And
it has been shown that starting at age forty continuing
annually shows the greatest breast cancer mortality reduction amazing across
(06:12):
all su It's just fact, it's fact, right, And in fact,
women who are considered higher than average risk may need
mammogram before the age of forty right. Okay, So in
twenty twenty one, my American College of Radiology expanded these
breast cancer screening guidelines and started to recommend that all
women so age thirty should be undergoing a breast cancer
(06:35):
clinical risk assessment. But then in twenty twenty three they
decreased the age to twenty five. Right, so all young women, Yeah,
all young women at the age of twenty five should
be asking their clinicians for something called a breast cancer
risk assessment.
Speaker 2 (06:49):
Okay, And what is that? What is that?
Speaker 3 (06:52):
We've been hearing a lot in the media about this
risk assessment tool calculator. Specifically, you know, you had the
actress Olivia Mound, she had bilo lot of breast cancers
by a lot of mess tectomies. She came out and
said that this risk assessment calculator saved her life.
Speaker 2 (07:05):
And what it is. It's a tool.
Speaker 3 (07:07):
It's a series of questions, Okay, personalized questions and the
answers to these questions, give you a risk factor, a
percent estimated risk for developing breast cancer in your lifetime.
Speaker 1 (07:18):
And is this more than just family history?
Speaker 2 (07:21):
It is?
Speaker 3 (07:22):
It is so the most comprehensive assessment tool out there.
What Olivia Mund's referring to we offer a UCI health
is something called the Tiraku ibis RISTI ASSESSM.
Speaker 2 (07:31):
Now, there's many out there.
Speaker 1 (07:32):
Don't make me memorize that I should get that doesn't
there's many.
Speaker 3 (07:35):
It's called the Ibis tire Cusic Risk Assessment Calculator, and
there's many out there, But this is the most comprehensive.
Speaker 2 (07:41):
That's and that's what you use.
Speaker 3 (07:42):
It includes things such as personal and family history, right,
breast but also ovarian cancer.
Speaker 2 (07:48):
Okay, how would those be related?
Speaker 3 (07:50):
Well, you know patients who have had ovarian cancer or
family history of a varying cancer oftentimes that can be
linked to breast cancer genetically. Okay, and know that especially
you know, like we talked, I'm sure you heard the
breast cancer BRCA, BRACA one and two gene.
Speaker 1 (08:05):
Yes, yes, And that became sort of more in the
mainstream with Angelina Jolia, if I remember correct exactly.
Speaker 3 (08:11):
She had the breast cancer BRAKA one gene, and she
loved to get the bilateral mess eectomies right removal of
her ovaries as well, so they can be linked.
Speaker 1 (08:19):
And that's more excuse my ignorance on the subject. But
is that more preventative. That's to preventative on her side,
and what a choice to make. It definitely is Listen,
that's a lot. It definitely is.
Speaker 3 (08:32):
But you know that is is more rare in the
sense that not everybody carries that breast cancer gene. But
it's also any personal or family history of right bressover
mar in cancer. It's also your hormonal history, your reproductive history,
age of your first child, if you've had children, So
it's a very detailed questionnaire. And it's also you know,
history of breast symptoms, breast conditions, right if you had
(08:54):
history of bressys, history of bress biopsies, things like that,
and you know, thank you for mentioning breast and city before. Yeah,
it's the only model right now that takes into account prestensity.
Speaker 2 (09:05):
Really.
Speaker 3 (09:05):
Yeah, Like we talked about restdency, it's an independent risk
factor for the development rests.
Speaker 1 (09:10):
Okay, And I would imagine, I mean, you know, because
I'm not a doctor, but I'm assuming that it's because
it's more it's just harder to detect when you.
Speaker 2 (09:17):
Have that, so it's it's twofold.
Speaker 3 (09:19):
So first of all, yes, harder to detect, right to
see through that dense breast tissue, But just in and
of itself, that dense fiberglandular breast issue is an independent risk.
Speaker 2 (09:28):
Factor which a lot of people don't realize.
Speaker 3 (09:30):
Right.
Speaker 1 (09:30):
Oh, yeah, this this is the first time I've even
heard those words, so of course I didn't know. And
this is another I'm just gonna use you for my
just a personal.
Speaker 2 (09:39):
Place all day consultation.
Speaker 1 (09:41):
Yes, a friend of mine was told that she was
too she's in her forties and she's too young to
start going through menopause, even though she started showing signs
of it. And the doctor said that there's a higher
risk of certain cancers when you go through menopause too early,
and that could include breast cancer. Is that something that's
on your radar or maybe she would like a second
(10:02):
opinion on that.
Speaker 2 (10:03):
You know, that's a really really good question.
Speaker 1 (10:05):
Yeah, I know, it's very specific, very specific.
Speaker 3 (10:07):
And you know when I mentioned that these risk assess
been calculators taken to account our hormonal history. Yes, it's
years of our personal exposure to our body's hormones. All right,
So we're talking about estrogen, right, gesterone. You know, when
we're pregnant, we have a huge load of estrogen exposure.
So you know, from the time that you have your
(10:27):
first period to when the time that you have menopause.
The longer that time is, the longer your potential exposure
to the hormones. Right, and some some breast cancers are
hormonally driven, Some are driven by estrogen, some are driven
by progesterone. So the age that you develop menopause or
go into menopause, it does affect and change your breask.
Speaker 2 (10:47):
Okay, so there's there's something there.
Speaker 1 (10:49):
I'm so interested in taking this test, and I imagine,
you know, like everything else. Well, I took the test,
I found I googled it, and I found No, we
want to go to an actual doctor.
Speaker 3 (10:58):
You're right, You're right, because the reason of this test
should be an entire approach, your entire team's your your clinician,
but also you're breast radiologists. Okay, because patients who, like
we mentioned, average risk is one in eight right, twelve
point five percent, right, and high risk it's high and
that's just average risks, right, right, and high risk. You're
(11:18):
considered high risk when you're twenty percent or higher, okay.
Speaker 2 (11:21):
And so if we get.
Speaker 3 (11:22):
That number, if it spits out a number and it's
very very high, then patients.
Speaker 2 (11:26):
Figure out we don't know what to do. And so
every patient who.
Speaker 3 (11:28):
Comes into UCI Health we give them that personalized risk score,
and not just that, we also give them a recommendation.
Speaker 1 (11:35):
To send them on their right exactly exactly, because.
Speaker 3 (11:37):
If you're twenty percent or higher, then really you should
be starting screening mammograms at.
Speaker 2 (11:41):
Age thirty home right now.
Speaker 3 (11:44):
Ten years before somebody would have average risk.
Speaker 1 (11:47):
And these days, I can't imagine how poor doctors people
always coming in because they know everything because they googled
it and they know everything because Google. Yeah, because they
spent five minutes, you know, typing it in and now
they're also a doctor. So congratulations to do you feel
like in your specific line of work you're having to
manage people's expectations when they come in and they kind
(12:09):
of think they know everything because they researched it online.
Speaker 3 (12:12):
Well, you know, I think that could be said, with
any specialty, absolutely, but breast imaging in particular, it's such
a vulnerable kind of state where you know, woman is
getting mamgrams, your breast is in compression, right, we could
potentially be telling them bad news rise in terms of
any biopsies that they need or any diagnoses. So women
are already in this kind of heightened state of anxiety. Yeah,
(12:35):
and so I think you know, anything that we can
do to kind of alleviate that anxiety, counsel them, especially
if you know they didn't know they were high risk,
then they're getting that recommendation, right for additional imaging, anything
that we can do to alleviate that, but also give
guidance going forward.
Speaker 1 (12:50):
Yeah, and put human touch back into the process instead
of just doom scrolling in the middle of the night
because you can't help yourself. Now we're talking about women.
Of course this affects women, you know, such a high rate.
But this does happen to men every now and again,
I would imagine absolutely correct.
Speaker 2 (13:05):
And have you have you personally dealt with men with
breast cancer?
Speaker 3 (13:08):
Yes, I have to diagnose several in my career. Well,
let me tell you, breast cancer is so so rare
in male patients, right, we're talking about it counts for
about one percent of all the breast cancers that we diagnose. Okay,
so unfortunately, women are one hundred times more more likely
to get breast cancer.
Speaker 2 (13:24):
And that's why. You know, routine mammograms are not recommended
in men. But is the same treatment for men. It
would be.
Speaker 3 (13:31):
The same treatment, correct, correct, But you know men, We
always encourage our male patients anytime they have any symptoms, okay,
don't ignore them, any breast symptoms, please, don't ignore them,
any lump, any swelling, any dissearch, come in for that mammogram,
because we have absolutely diagnosed cancers in male patients.
Speaker 1 (13:47):
Oh my god, I can't imagine how jarring that would
be because, like you said, women are sort of used
to knowing that this bad news is possible. But for
a man to say, no, no, you don't understand, I'm a man,
this isn't possible.
Speaker 3 (13:58):
It's possible, no, and they shouldn't ignore their symptoms, right,
And what would.
Speaker 1 (14:02):
A symptom be for a man? Would it be different?
Speaker 3 (14:05):
It would be a very similar at a lump, yeah, yeah,
a lump, you know, swelling, Okay, and you sort of
pain in around the breast nibble area. And sometimes we
also see nibble discharge, oh specifically in a bloody nibble discharge.
Speaker 2 (14:17):
Okay, so just anything.
Speaker 3 (14:19):
And I always tell my patients you know your body
the best, right, Okay, anything that's out of your realm
of normal always come in.
Speaker 1 (14:25):
That's such great advice because you know, especially as a woman,
you think, well, you know, breast tenderness is this, but
is it related to my period? And I you know,
you just have to figure out, like no, Tuesday before
my period. It always feels like this, and like you said,
I'm the only one who would know that.
Speaker 3 (14:39):
But listen, you know, like I said, you know your
body the best, right exactly. You are your best advocate exactly.
So anything out of the realm of what you feel
is normal. You have to advocate for yourself.
Speaker 2 (14:49):
And it's it's interesting.
Speaker 1 (14:51):
Just on another personal note, I had a breast reduction
a few years ago, and they were the insurance company
to their credit, was very aggressive on making s I
didn't have any breast cancer issues because hey, I get it.
If you're foot in the bill, you don't want to
start over again. I understand that. So I feel very
fortunate that they were so aggressive about it before the surgery.
(15:11):
But that doesn't mean in any way that I'm off
the hook now, right, No, definitely.
Speaker 3 (15:16):
And I don't know if you're of the age, you
don't you probably let you don't look like it, you
don't look like it. But certainly, you know, even patients
who have had you know, prior augmentations, you know, a reductions,
should absolutely be considering screening men.
Speaker 1 (15:30):
Well, in that conversation, I am actually that makes me
curious about people with implants. It's you know, very common.
You know, people have them all the time, and they're
so real looking these days, you cannot tell the difference.
Is it harder to diagnose breast cancer and somebody with implants?
Speaker 3 (15:46):
You know, I'll tell you it's it's it's kind of
a couple of layers here, right, So patients are always
worried about resums when they come in in terms of
the mammogram, right, first of all, is us being able
to see the rest issue, but also how does that
mammogram affect the actual plants?
Speaker 2 (16:00):
Can help make it lopsited?
Speaker 1 (16:01):
Exact?
Speaker 2 (16:02):
Yeah, exactly.
Speaker 3 (16:03):
So our technologists are well trained, well versed in doing
mamograms and all patients, especially breast implant patients, okay, And
they have a technique where they manually kind of protect
the impunt, bring that impunt back, push that impunt back
manually with their hands so that we are able to
visualize that breast tissue better.
Speaker 2 (16:22):
So there's actually a different system.
Speaker 3 (16:23):
There is a difference. There's a different technique that is utilized.
And it's actually additional more images that we take in
patients with impults because we know that that implant can
hide that brust tissue.
Speaker 2 (16:33):
That is so good to know. I just figured it
would just be harder and that's just part of the risk.
But no, they know what they're doing.
Speaker 1 (16:39):
And you know, I know we kind of talked about this,
but what would you tell somebody who's just like, I
don't know, I just don't want to do it.
Speaker 2 (16:44):
I've heard too that it's uncomfortable. I've just heard too
many horror stories. Yeah, exactly, like we talked about. Yeah,
I hear you, Okay, I definitely hear all women hear you.
I get them every right as well.
Speaker 3 (16:56):
Right, it's not comfortable, it's not okay, But like I said,
the couple seconds of discomfort saves years and years of
our lives and to me, that's that's worth.
Speaker 2 (17:06):
That's a great trade off. Mammogram saves lives.
Speaker 1 (17:08):
And natally do that is the takeaway doctor, say, thank
you so much for your time. Oh no, thank you
for having me literally going to save people's lives. And
we are so grateful to you to for you know,
talking to us and having this great conversation.
Speaker 2 (17:21):
Thank you for having me. You see, ihealth provides exceptional healthcare.
Visit ucihealth dot org for more information.
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