Episode 52: From Screening to Treatment: Understanding Breast Cancer in 2025 with Dr. Veronica Jones

Breast cancer rates are rising, especially among younger women—but why is this happening, and what can you do to protect your health? In this episode, breast cancer surgeon Dr. Veronica Jones answers the most common questions women have about breast cancer. We talk through risk factors, genetic testing, and what dense breast tissue really means. Dr. Jones also explains what happens when a mammogram comes back abnormal, how breast cancer is diagnosed, and what treatment looks like today. If you’ve ever felt confused or anxious about breast cancer screening, this episode will give you clarity and confidence.

Find Dr. Veronica Jones at the UK Markey Cancer Center

Estimate your Breast Cancer Risk with the Tyrer-Cuzick risk assessment model

Learn more with these Breast Cancer Resources:

National Comprehensive Cancer Network

Memorial Sloan Kettering Cancer Center

Susan G. Komen

thestartinggatepodcast.com

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The content in this podcast is for general reference and educational purposes only. It is not meant to be complete or exhaustive, or to be applicable to any
specific individual’s medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis or treatment. This podcast does not create a physician- patient relationship and is not a substitute for professional medical advice, diagnosis or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different so make sure you consult your own healthcare professional before seeking any new treatment and before you alter, suspend, or initiate a new change in your routine.

Transcript

From Screening to Treatment: Understanding Breast Cancer in 2025 with Dr. Veronica Jones

[00:00:00] Before we start today's episode, I would like to quickly read you our podcast disclaimer. The content in this podcast is for general reference and educational purposes only. It is not meant to be complete or exhaustive or to be applicable to any specific individual's medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis, or treatment.

This podcast does not create a physician patient relationship, and it's not a substitute for professional medical advice, diagnosis, or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different, so make sure you consult your own healthcare professional before seeking any new treatment, and before you alter, suspend, or initiate a new change in your routine.

Welcome to the starting day. We're your host, Dr. Kitty Dotson and Dr. Sarah Sheets. Two internal medicine doctors who spent years practicing traditional primary care. Over time, we realized something was missing from modern healthcare, a [00:01:00] real understanding of how everyday lifestyle choices impact overall health.

We'll help you cut through the noise of the countless health influencers and their conflicting opinions because no matter who you follow, the basics of lifestyle medicine are at the heart of it all.

Welcome back to the starting gate. We're your host, Dr. Kitty Dotson, and Dr. Sarah Schuetz. We're continuing in our menopause and Women's health series today, and we're excited to talk about breast health. Breast cancer accounts for one in three new female cancers every year. so we wanna dive into what are the risk factors for breast cancer, both genetic and lifestyle related.

What are the screening options and treatment and how are people doing with breast cancer outcomes these days? So we have lots of questions for our guest 

and 

we're really 

excited to welcome Dr. Veronica Jones. She's an assistant professor at the University of Kentucky in surgical oncology. She did her breast oncology fellowship at Memorial Sloan Kettering Cancer Center in New York.

And Dr. Jones we're just thrilled to have you today. Can [00:02:00] you just. Give our listeners a little information about who you are and how you became a breast surgeon. 

Sure. So, you know, I grew up in the American South. I consider myself a little southern bell. I was born in Kentucky. My mom's whole family's from Kentucky.

I went to med school in Kentucky. So you know, when it came time to. Find a job. I was happy to come back. I got into breast surgery specifically because I was very passionate about women's health. I am, a born surgeon. There was nothing else for me. And so when I got into surgery, I wanted to focus on women and women's health.

So I got a really great mentor who's a breast surgical oncologist in North Carolina. Dr. Marissa Howard- McNatt, what's up? And she really encouraged me to look more into it and it's been really great. 

I'm so glad that there are people like you that say they were born to be surgeons.

'cause I got into the OR in med school and I was like, oh gosh, am not good at this. 

It's either your people, it's either your people or it's not your people. 

Not our people. That's why we became internists [00:03:00] kitty. 

That's right. Oh goodness. Can you start us off with talking a little bit about how common breast cancer is in the US.

So when I meet a woman typically she already knows she has breast cancer. Her radiologist has disclosed that information after a biopsy. So when I meet them, I'm talking to them about all their treatment options. And one thing I like to point out is that. Unfortunately she's in good company, about 320,000 women each year in the United States are diagnosed with breast cancer, and that's a lifetime risk of somewhere between 12 and 15%.

So again, it is the most common cancer in women. It is the number three cause of death in women. So there's a lot of work we need to do, especially here in Kentucky in terms of breast cancer care. 

are we seeing the rates of breast cancer go up? I feel like we're hearing that. That we're finding more breast cancer.

We are. And I think that there is a lot that goes into that. So you can think about it in terms of detection and in terms of [00:04:00] lifestyle risks. So in terms of detection everybody's aware that you should be getting at least one mammogram a year of repeat after me annual mammograms. Our mammograms are getting better.

They're getting. More high tech. Some of them are 3D. You can use contrast with mammograms in some cases. So with better technology comes more detection. So we're finding cancers before they're palpable. Before, a woman can feel something in their breast or in a lymph node. We're finding them before they're even a mass on mammogram.

So that increases the number of cases per year. But also that doesn't explain why young women are experiencing breast cancer at higher rates. So what's going into that? And that's risk factors. So a lot of lifestyle risk factors are increasing the rates of cancer that we're seeing, 

and that's something we like to talk about on this show.

What are some of those? Risk factors that we have been able to identify. 'cause I know there's still lots of research going into why is this increasing in young women, but what are some of the ones we do know [00:05:00] are putting women at risk? 

One is inactivity and obesity, unfortunately, with rising.

Inactivity, we're seeing more breast cancers and rising BMI, which,, we could argue all day about whether that's a really good measurement of somebody's health. But the research we have uses that as a tool. So rising BMI has been associated with increased breast cancer risk. Smoking increases your risk of breast cancer.

Alcohol can increase your risk of breast cancer. So generally what I tell. My patients who are in the survivorship period of their life, they've been diagnosed with breast cancer, they successfully undergone treatment, and now we're just, high risk watching them for any recurrences. I tell them to lead a generally healthful lifestyle.

I'm not asking them to cut out sugar. Sugar doesn't increase your breast cancer risk. Obesity does, , So generally healthful lifestyle, staying busy, staying active and keeping a reasonable diet. 

And I know there has been some more recent research that has shown that.

Exercise can make a [00:06:00] huge impact on survivorship, 

right? It can. And even more important sometimes to me is patient quality of life. So a lot of patient reported outcomes or prompts show that activity during and after cancer care can increase quality of life. So things that we offer at Kentucky are things like yoga, acupuncture, we encourage the folks to take advantage of things like the YMCA Silver Sneakers Program, things like that to keep active, keep their BMI reasonable, but more importantly when your body feels better, you do better. 

And what. Do we feel is happening by living a healthier lifestyle to decrease this risk?

Like what's happening in our bodies? I think 'cause connecting that sometimes helps people understand why it's important. 

Sure. There is. The ability for our body fat to increase estrogen, increasing estrogen can increase your breast cancer risk. So if we, have central adiposity, which is something that a lot of [00:07:00] women struggle with, that's increasing the risk because there is, what we call peripheral conversion of estrogen.

So more estrogen circulating through their bodies. And the most common breast cancers are estrogen sensitive.

You mentioned alcohol as well. Is there a safe amount of alcohol for women to drink? Is that once Friday night Wine. Okay. 

I tell people to be reasonable. Obviously optimally we don't drink at all, but this is Kentucky and I like my buffalo trace.

Okay. So I think keeping it reasonable, one or two drinks a week is not gonna increase your risk. I worry when people tell me they have one or two a night I worry about, over their whole lifetime that's increasing their risk of breast cancer. And other health concerns.

Yeah, 

I was gonna say we're worried about weight that is going to be contributing to that too. I wonder, just thinking about how you phrased it, Sarah, just that overall healthy lifestyle, has there been much research [00:08:00] into just inflammation in general? We know. Higher fat storage has a higher inflammation rate.

Do they think and alcohol would increase inflammation? Do they think that is correlated or, 

So I'm so glad you asked that. A lot of my research is looking into, essentially. Immune cells around breast cancers. And a lot of those are markers of inflammation. So the question that a lot of researchers are asking are these immune cells, these inflammatory cells, increasing the aggressiveness of a breast cancer?

Are they making these cancers harder to treat? And that's the hottest. Hot off the press research that's happening in breast cancer research. And it's something we have several lectures on. Every conference I go to somebody is talking about the link of inflammation, immune cells, things like that, and breast cancer care.

I love that we're looking into this so hopefully we can get better answers for our patients because I know that they're worried and they wanna [00:09:00] know how they can reduce the risk as much as possible. 

What about genetic risk? 

So genetic risk is at the forefront of a lot of people's minds. We think about genetic risk. When somebody has a lot of family members in their family that have had breast or ovarian cancer, that's when we start to worry about doing genetic testing. The first thing that I like to do when I meet a patient is to run their lifetime risk of breast cancer, as I mentioned before.

Average lifetime risk is around 12 to 15%. We consider somebody high lifetime risk if it's over 20%. And the factors that play into that are, who in your family has had breast or ovarian cancer? When did you have your first period? When did menopause start for you? Have you ever had biopsies of your breast that show atypical cells, not necessarily cancer cells, but atypical cells, or have you ever been diagnosed with breast cancer or ovarian cancer in your past?

We add all of this up and we like to use the Tyrer-Cuzick. Risk analysis score. And if it's over [00:10:00] 20%, then we recommend somebody for genetic testing, especially if they have not had it before, or no one in their family has. Or if they're a part of a certain ethnic group like Ashkenazi Jewish then we like to test their genetics.

Once we know if somebody has a genetic mutation. Then we really kick their surveillance and their screening into overdrive. So what does that look like? Instead of just an annual mammogram we would add an MRI. Every six months there's some imaging once a year, MRI, once a year mammogram.

And we see them in our high risk clinic. We have specialized nurse practitioners and physician's assistants who see these patients every six months to a year. Doing physical exams, checking in on their general health and reviewing all of their imaging. 

Now, does insurance cover all that testing?

Because I know. A while back it was really challenging to get that covered, but it's gotten better. It's gotten much better. Great. That's why we like 

to run that score and document it because if it's over 20%, it's really [00:11:00] in the best interest of our payers to cover this enhanced screening. 'cause if we find something early that's much more treatable.

So we really do run the score, document it, and if it's over a certain percent, our insurance covers it.

And a lot of people are doing genetic testing just on their own. They find things online that they can do. Is that something that you would recommend for a woman that's concerned about it? 

I think if a woman is concerned, I think the first place to start is talk to their primary care physician or talk to their O-B-G-Y-N.

And then that way they can get linked in with a breast specialist. But if somebody has access to that kind of testing on their own. I don't necessarily recommend against it. I think it'd be very paternalistic of me to tell somebody what they can and cannot test. However the majority of breast cancer cases are not genetic.

So about 10 to 15% of people who have breast cancer we're gonna find a gene. , The likelihood of finding one is pretty low. So if somebody has access to that [00:12:00] kind of testing, great. I just would really caution interpreting those results with a medical professional. 

And I know sometimes people are using those to avoid mammograms.

I would say that the validated way that we are lowering the deadly nature of breast cancer is screening screening, screening, especially in October.

We shout it from the rooftops. Make sure you get your at least annual mammogram. It is validated. It has been shown to save lives, so I would never replace adequate screening with a test like genetic testing. 

Speaking of that, 

Sarah. You turned 40 recently. I know. Have you scheduled your mammogram? It's time.

No, I have my annual, I have my annual exam coming up. So thanks for reminding me because I'm so excited. When it comes to that, there have been difference from different societies on when to start breast cancer screening. What as a breast cancer surgeon, what do you recommend that people do for when [00:13:00] to start?

So my mentor in residency. Was much more a fan of yearly. I think the interval rates of breast cancer discovery between two years is pretty low and that's why some societies say every other year is fine. But we feel much more comfortable with yearly. And I think. That, that has played out anecdotally to be true because during COVID, we had a lot of folks that weren't able to access their breast imaging centers.

And so we had an increased rate of later stage diagnosis because of that. So to me that means the best way to keep somebody safe is a yearly. Mammogram, they are relatively quick, they're easily accessible. We have imaging centers. We even have mobile mammography units that operate outside of a van.

And there's many ways to access these. Insurance readily covers it. I've. Never had to do a prior authorization for a mammogram. So I think yearly mammogram is what I would prefer, but this is in a [00:14:00] high level conversation between a patient and her primary care physician or her O ob, GYN.

I definitely saw that after COVID patients were scared to come in and maybe didn't come in to see me or didn't come in anywhere for two years. And then I felt like. We were diagnosing this left and right.

And it just put a lot of people off track. And I hear that over and over as I'll have a patient that said, this is their first mammogram in five years, and I think back what happened five years ago?

Oh, COVID. Yes. And you got your postcard every year. It's time to schedule your mammogram if those postcards stop coming. It's just one thing that. Slips the mind. 

And I know there is lots of fear around mammograms. Lots of women are worried by getting a mammogram every year that they're gonna increase the risk of other issues.

Can you speak on that? 'cause I know this is something that in primary care had to discuss a lot, right? 

I do. Have a lot of folks that are concerned that their yearly mammograms have [00:15:00] landed them with a breast cancer because of the radiation. And what I like to reassure them is that the level of radiation in a mammogram is as low as the level of radiation in flying from New York to L.A..

Being on an airplane is, recreational for the most part, the mammogram can save your life. I think that when we talk about level of risk the mammogram is able to find a cancer again before it's something that you can feel even when it's just a haziness on the mammogram.

And that means all treatment options are open to you. So that risk of radiation is much lower than the risk of skipping the mammogram and having a later stage breast cancer. 

And a lot of patients wish that instead of a mammogram, they could just have a breast ultrasound. Had a lot of patients that felt like.

It caused a significant discomfort to them and distress and I had at least a few people ask me every year, can't you just order me an ultrasound instead? 

Yeah. So I really wish we could, I really wish we could, and my [00:16:00] radiology colleagues would love that for you. They don't wanna cause you pain.

They don't want you to be uncomfortable to the point where you don't want to come for the mammogram. But unfortunately an ultrasound has not been validated to save lives like a mammogram has. It's a really good adjunct, so it's something good that we can use in addition to other imaging. For example, young woman before the age of screening comes to our office and has something she can feel in her breast, the first thing we would do as an ultrasound because in that age category we're thinking.

Might be a fibroadenoma or some other benign process in the breast. So it is good at what it does, but what it does is not as good at screening as mammogram. 

And then the other situation that happens is some women, after they've had their first mammogram, they are noted to have fibrocystic breast.

And then it becomes a question is the mammogram the best option for me? Or should I be doing MRI? What is the advice you typically go through in that? Sure. And also 

it might just be called dense breast if you're 

[00:17:00] Yes. If you've 

seen 

that on your imaging. That's right. And our radiologists are.

Mandated to report the density of a breast on their mammogram report, so it will say extremely dense breast tissue or scattered fibro glandular densities. All of that means is how much tissue in the breast is fibrous, kind of dense breast tissue versus kind of. Fatty breast tissue. And so when I think about mammogram for dense breast, it's still the best first choice.

If my radiologist says, this breast is so dense, I can't get a good read on it, then that's a good reason to have an MRI. An MRI is extremely sensitive, and when we say sensitive and medicine, we mean if you do a test, you're gonna find not just bad things, but things that don't matter too. So you know, it's, it can lead to.

Unnecessary biopsies, it can lead to a lot of callbacks. And so we save MRI for those at the very highest risk. 

 I have a personal question 'cause I've been debating MRI for myself 'cause I do have a [00:18:00] higher risk of breast cancer and I have been concerned about if I get an MRI, 'cause it's done with contrast.

 If I get an MRI with contrast every year, I'm 42, so I would do that for 30, 40 years. And that's a lot of contrast doses. I know you can see deposits of contrast in the brain after a few doses. Nothing has ever been shown to be detrimental from that, but that still leaves me some concern. Can you advise me?

Sure. So there is contrast involved with MRIs and we would never give that contrast to somebody who has unhealthy kidneys. So if somebody had chronic kidney disease. We spare them that contrast load. It can stay in the body after repeated doses but it hasn't been shown to cause harm to patients.

So I would still say if you're at a high risk and you and your healthcare team deem it necessary for you to have an MRI, I don't think it's putting you at [00:19:00] risk to have that contrast once a year over your lifetime.

So many women, as soon as they hear I have to be called back, they immediately think I have cancer. . What else could it be that we're seeing on some of the screening that would make someone have to come back for a biopsy or additional imaging that we're trying to clarify whether it's cancer or not. 

Sure. There are a lot of things that can look abnormal on a screening mammogram that warrants extra imaging like a diagnostic mammogram.

Some things like, benign tumors of the breast fibroadenomas there's dense breast tissue that can look abnormal depending on the angle that they're looking at. Cysts in the breast can look abnormal depending on the imaging modality. So there are a lot of things that we can call a woman back for that never end up being cancer on the way to cancer, pre-cancer, anything like that. So that anxiety is real and it's valid. I would never tell someone, don't worry. But what I would say is that a common adage we have in surgery [00:20:00] is pathology is king. There's nothing that beats, the knowledge of a biopsy and that pathology.

Evaluation by our specialists. So until we have the biopsy, I would say a lot of times these things are benign processes and we're just making sure that we're keeping you safe. 

And I think one frustration I heard a lot from my patients, and I think it's just good for women to know in general, is that your screening mammogram is covered by insurance.

If you have to go back for diagnostic studies. You will have some sort of payment with that depending on what your insurance is. . I felt like a lot of my patients were caught really off guard 'cause they thought that would be totally covered. It was all part of this screening mammogram they were doing.

So just make sure you are aware that there could be a cost depending on your insurance with that. I think it is still obviously so worth it to do that study. But the other frustration [00:21:00] I had from patients was they might go down the road of getting that diagnostic mammogram, having a biopsy. It was benign.

But now the next several mammograms are not screening mammograms anymore. They have to be diagnostic for a period of time. I don't know what. That is so then again, it's not fully covered by insurance. Next year's mammogram will not be fully covered by insurance. , This is a problem. All doctors are frustrated by too.

Don't blame your doctor or the radiologist. It's not their fault. They're not, it's not their fault. It's the system. It's the system. So just be aware. So that you can plan accordingly, unless you have any other thoughts on that, Dr. Jones? No, 

that's exactly right. And it is something that, it tears me up because it's not a small issue for a lot of women.

It's the difference between being able to then afford their healthcare or a vacation for their family. It's a huge deal. I will say that almost every facility I've ever worked at does have financial assistance. It's not charity. It's helping to make sure you can do what you need to do to stay [00:22:00] healthy.

So it's never a problem and I've never met a doctor that has a problem with you asking. Okay. Is there anything that y'all can help me out with so that I can get that MRI or I can get that? Diagnostic mammogram you want, and I guess I should probably explain the difference between screening and diagnostic mammograms as well.

Yes. So your screening mammogram is every year and it's, it's the test that we have found can catch a lot of cancers. However, if we see something abnormal on a screener or a screening mammogram the next step is diagnostic mammogram. It's a little bit finer of a study so they can see a little bit more.

And even more importantly, it can be 3D. So tomosynthesis is a 3D mammogram. And there's extra angles. So you know they're looking at even more pictures of the breast to try to see what it is they saw on screening mammogram. It's often paired with an ultrasound. So that's the difference.

If you have your screener, they see something, they do the diagnostic, they do a biopsy, it's benign. Great. See you in six months for another [00:23:00] diagnostic. That kind of carries forward for about two years, and then they let you go back to yearly. So that's where we're coming from naming all of these different mammograms.

It's important to know the difference. And that's the difference. The diagnostic is just. More diagnostic 

and most insurances now I think are covering the 3D screening mammogram. So would there ever be any reason not to go ahead and. Do the 3D think if it's offered, do 

it. Yeah.

I was just at a conference and folks are presenting data about contrast enhanced mammography. That's not something that most breast imaging centers have, but it's showing promise as something that's more diagnostic than a mammogram. But not quite as sensitive or expensive or long as an MRI.

So I think it's gonna be a happy medium for some folks that are maybe at intermediate risk. Should we do a contrast enhanced mammogram? And again, we would not give that contrast to somebody who's struggling with kidney [00:24:00] disease already. And if they have it, once a year over a lifetime, it's not gonna wreck their kidneys either.

Another question that happens and there's a lot of confusion. Do women need to be doing self-breast exams? 

Okay. 

So 

again, I know I keep talking about Dr. Howard- McNatt. I think she hung the moon. And I remember when we got the guidelines that said don't do self exams, and she was hopping. Okay. How dare you tell somebody not to, do a breast exam?

I think. What the guideline was trying to say is that, , a woman may not be able to do a clinical exam. So something that we learn in medical school or in nurse practitioner school. Sure. But I think it's important to know what your breast feels like. I call it breast awareness. It might not be an exam, but be aware of the contour, the shape, the texture of your breast, what the skin looks like.

Is it thick in some parts, is there redness that comes and goes? Or is it a new redness to your breast? Being aware of your nipple, is it inverted [00:25:00] and it has been your whole life or is that new for you? Being aware of how your lymph nodes feel under your arm. Lymph nodes are the first place that breast cancer likes to travel if it's leaving the breast.

So just being aware of are there lumps there and they're always there. Nothing to worry about. Or is this new? Breast awareness is what I counsel all my patients to do. So telling a woman not to do a self-exam is just the epitome of paternalistic medicine to me. 

I love the 

term awareness. 

I, yes, because I don't know, in practice there were so many of patients and I've had friends like.

They're the ones that found their cancer. Like how can we tell people not to do that? Not to 

do that? Yeah. I grew up with an aunt that had a clinical breast exam hangup thing in her shower, so she was constantly doing her breast exams and I, I love that. I think it's great to put it in part of your routine, but I would also say.

If you did not feel your breast mass, don't blame yourself. Don't blame yourself for not doing a good [00:26:00] enough job. There's no shame in that. That's why you have medical professionals to help you out and do those yearly breast exams. So be aware of , your normal breast and that way if something's abnormal, you're the first to know and you can tell someone 

in one piece of advice.

I think that's helpful for some women. Is. How long, if something is changing cyclically in their breast, how long should a patient. Wait to see if it goes away before calling their doctor to have an exam. 

Sure. So I would say, it depends on age groups. So if somebody's premenopausal, perimenopausal, they're still having menstrual periods, I would say go through one cycle.

And if this is something persistent throughout the cycle and it doesn't go away once you're, past your period, I think it's worth talking to your provider, your PCP or your OB GYN just so that they can do the exam too. Maybe get an ultrasound, just take it off the table. 

And how about for women that have breast implants?

What's your recommendation for them? You still need to do 

your [00:27:00] mammogram. So if you had implants to augment your breast and you've never had a mastectomy, you still have breast tissue and you can do a mammogram. It's important to let your imaging center know that you have implants that way they can be a little bit more gentle with your mammogram and they'll add extra views to try to make sure they can see.

All the way back. So don't skip them. But it is important to let us know so that we are aware and we don't rupture your implant. 

So they are okay to do traditional mammograms 'cause that's always the question. That's right. 

That's right. Their plastic surgeons might also add on an MRI every few years to check on the health of the implant itself.

But, the traditional mammograms are still safe. And to that point, we talk about other folks who have had some breast surgery and should they have. A mammogram. So I'm thinking about folks who have maybe top surgery. That's not a full mastectomy. It's not like a mastectomy for reducing their risk of breast cancer or removing their entire breast because they have breast cancer.

It's somewhere in between. So they, there [00:28:00] is some residual chest tissue. These folks should still have, yearly. Physical exams mammograms are still possible. There is still enough tissue to image and it's important not to miss anything.

So anybody who's had top surgery, you should still talk to your doctor about how best to screen yourself. 

And before we leave testing, how long does a breast MRI take? 

 So it can take anywhere from 20 to 30 minutes on average. And generally there are some places that have open MRIs some places don't.

If you're worried about claustrophobia or anything like that, talk to your doctor. We're very happy to come up with a way to keep you comfortable during the exam. We cannot give you general anesthesia. But we can come up with ways to make sure you're nice and comfortable and calm and you can get the image that you need to take care of yourself.

Okay, so , we'll move on from screening at this point. So I think we've got her point across. Do your mammogram right, do 

your mammograms, do your 

mammogram, mammograms. Let's talk about a patient who has had a screening [00:29:00] mammogram. Let's walk our listeners through what actually occurs here.

They've had a screening mammogram. They have found a spot. They went back for that diagnostic imaging and got a biopsy. While they're waiting for results, what typically happens here? Just so a patient knows, because I feel like they are typically sitting at home and they're so confused. Who's gonna call me with my results?

Do I just show up in oncology office and they tell me I have breast cancer? What happens? Sure. So 

on average from the abnormal mammogram to biopsy, there's . Maybe a week. And then the biopsy results are available. Typically, the first person to tell you is that imaging center, a radiologist, a radiology tech a advanced practice provider in the imaging center are the first ones to disclose to you that a breast cancer has been found and they're making the appropriate referrals, and often they end up in the breast surgeon's office first.

The reason being. Typically these cancers [00:30:00] are, early stage and we're able to do surgery before any need for chemotherapy or other medications. Sometimes I have patients see the medical oncologist at the same time. Sometimes we need to coordinate our care and maybe do some treatment before surgery.

And then that case, that's the way we go. We try to make sure that somebody can see everybody they need to see hopefully on the same day. But typically they see their breast surgeon first. 

Yeah. And. one thing to be aware of. If you do have a breast biopsy is some systems have electronic records, and it is possible that you will be the one to see this first.

This was one of my biggest frustrations when I knew I had a patient getting a biopsy. I would be refreshing my screen all day trying to make sure I got to it before them. But your Dr. May not get to it before you, and so you may be the first one to see it. Know, someone is gonna call you. Soon and walk you through what's gonna happen next.

[00:31:00] So just be aware and if you feel like you can't handle looking at it without hearing from your doctor, just don't open it until they call you. 

That's right. I think there were new guidelines in place that these results should be available to you as a patient at the same time as they're available to your physician.

And I think that's great for a lot of people, but it can cause a lot of anxiety for some. So I completely agree. I have had patients and I said, turn off notifications for MyChart. I will call, I swear, I will call you the minute I see your pathology results. And that can be really helpful to some people.

 And so you mentioned. Someone is likely to come see you first, which I think is always surprising for people. And so for a standard early stage breast cancer, can you just. Walk us through what that patient is experiencing. 

Sure. So they'll see me first. They have gotten maybe a phone call that they have at breast [00:32:00] cancer, and they're getting, referred to the right people.

So my job in that first consult is to walk them through what the pathology results mean. Walk them through their staging, the stage, of the diagnosis, and then what our treatment options are. So oftentimes I tell them what the breast cancer cells look like under the microscope. And then important things like hormone receptors.

So you know, what kind of factors are making this breast cancer grow? Is it estrogen and progesterone sensitive? Or is it this, other protein called HER two. Those are important factors to know for treating their breast cancer. And then, at the end of the day, I am a surgeon, so we talk about the surgical options and what I think might be best for them.

And for people that catch this early is it still possible that people can just have lumpectomies or are most people getting full mastectomies at this point? 

 What we have learned over a long period of time is that folks who have a lumpectomy and potentially with radiation versus those who have [00:33:00] mastectomy live equally long or what we call same overall survival.

So they are equally safe. Now, not everybody can have a lumpectomy and just to back up a lumpectomy is removing the tumor itself and a little normal tissue around it to get clean margins. A mastectomy removes the entire breast tissue with or without reconstruction after that.

So some people go flat. Some people get an implant or use their own body tissue to rebuild the breast. Some people are not eligible for a lumpectomy. Say that mass is a significant portion of their whole breast size. It wouldn't make sense to me, cosmetically or oncologically to do a lumpectomy. Oncologically, I'd be worried that I'm leaving behind cancer cells and cosmetically I'm already removing most of the breast tissue, so it makes more sense to do a mastectomy.

There are other factors involved in that decision as well, like maybe that breast cancer is, close to the skin or close to the muscle than it is safer to do a mastectomy. In some of those cases, 

I had a lot of patients concerned about their potential anxiety [00:34:00] around having breast cancer when they were trying to decide between a lumpectomy, and a lot of them would think, I feel like I would just feel better having a bilateral mastectomy, both breasts.

And never have to worry about it again. Do you hear that from patients a lot? Only every Tuesday. 

And it makes sense, right? Just take it all. Yeah, just take it all. Yeah. That's what they, that's what they 

felt like would make 'em feel 

better. And that makes sense. You never wanna thank, I do one option and then, God forbid, seven to 10 years from now, I have another issue with my breast.

What if I should have just done both, and I blame myself. What I like to remind people or tell people is that one, again, they're equally safe operations in most cases, but also we have a lot of research that shows that folks who have the double mastectomy, so removing the breast that has cancer and the other breast that does not have breast cancer, does not make you live longer.

So there's no increase in overall survival for having a double mastectomy. Now we [00:35:00] do talk about and do a lot of double mastectomies. For example, folks who have the BRCA mutation that lowers their overall lifetime risk of breast cancer significantly. And it's a part of our guidelines to at least discuss that.

But I need to caution people that a mastectomy does not mean they will never ever have a breast cancer on that side of their chest, again, it is still possible to develop a breast cancer. Dr. Jones, why is that possible? Because a mastectomy removes 90 to 95% of their breast tissue, but never 100%.

There's always gonna be just a little bit right under the skin and that I cannot remove. so. It'd be important to keep up with physical exams with your medical professional. If there was ever any lump or bump in on the chest wall or in the lymph nodes under the arm, we would do an ultrasound plus or minus a biopsy.

So yeah. Yes, a double mastectomy. I'm asked about a lot and I just walk somebody through why we offer it sometimes and why we would, maybe not in others. 

Now beyond [00:36:00] surgery, we've had so many advancements in treatments for breast cancer. Can you just elaborate a little bit on. How that has improved over the last decade or two and what women now have as options and improvement in outcomes?

Some women are eligible for something called endocrine therapy or anti-hormone therapy if they're breast cancer, looking at their breast cancer cells under the microscope, we see that they have. High levels of estrogen or progesterone receptors that signal to us that estrogen and progesterone are encouraging these cancer cells to grow.

Then after their breast cancer surgery they might be taking an anti-estrogen pill. Something like. Anastrozole or Tamoxifen, and that lowers the risk of a breast cancer recurrence or it coming back in the future. That is not available to everyone. It really depends on your cancer's biology.

So it's something that, I discuss with you as your surgeon. [00:37:00] I discuss with your medical oncologist, and I get you that referral as well. There have been a lot of exciting developments in the highest risk breast cancers Things like triple negative breast cancer, the cancers that are not estrogen or progesterone sensitive and don't have high levels of.

The HER two protein or the patients who have really high levels of the HER two protein, or what we call her two positive breast cancers. There's a lot of immunotherapy that's being developed. There are new protocols that combine chemotherapy with this immunotherapy. And we've seen up to 70% pathologic complete response rates with these medications.

And when I say PCR pathologic complete response, a patient. Has a breast cancer, we give them these special medications and at the time of surgery we find that there is no breast cancer left. So that, is an incredible result and that can happen and, in between 50 and 70% of the time.

Tumor biology really plays. Huge into the treatment options. And we are getting [00:38:00] really exciting results with some of these new medications. That is amazing. It is amazing. That is, it's amazing. That's why, I was so interested in breast cancer care because our research moves fast and it's really effective and it changes lives now.

We have a quick pathway between proving that a medication is safe to take and works, and then making sure it's available on the market. 

I do think that helps with the fear that there's. Such a rise in breast cancer and we're finding it, but knowing on the other side of it is we have come so far with the treatment that we're really able to make a huge difference in women's lives that we once.

We're unable to. That's right. That's right. 

Can you give us a little more on that? How often are women dying from breast cancer these days? And I feel like we're seeing ads on TV all the time of people living with breast cancer for long periods of time. Can you tell us a little bit about what's going on with that?

Yeah we have a lot. Of databases in the United States that give us cancer statistics. And one of the [00:39:00] more exciting cancer statistics is that the risk of dying from breast cancer has been falling year by year for the last couple of decades. So that to me means we are finding cancers earlier.

Like we were just saying, our breast cancer treatments are improving. The risk of dying from your breast cancer really depends on the stage of diagnosis. But early stage breast cancers we're seeing folks, survive and live as long as they otherwise should have been.

so something that we always find very helpful on this show is helping debunk some myths that might be going around on social media. And I know that you probably get lots of questions about what patients are seeing on social media. Can you just give us some of that advice of what your counseling patients on?

. 

One thing that comes up from time to time is this concept of thermography or kind of an, a heat map of the breast. It does not replace your mammogram. Again, they are not validated to save lives. And so it hasn't been [00:40:00] proven to be as safe.

Some folks are worried about getting their mammograms right after a COVID vaccine. That's, I, the COVID vaccine can make your lymph nodes a little bit more inflamed, so they're worried if I get it too soon now I'm gonna have to have biopsies. I would never delay your screening because of a vaccine.

If the nodes look abnormal on imaging, we take it all into context. So we will ask you, have you had any recent vaccines? And we'll take it into context. I hear a lot about aluminum deodorants or antiperspirant. They have not been directly linked to the risk of breast cancer. And then underwire bras no bras have ever been shown to cause breast cancer.

They're uncomfortable but they've never been directly linked to increased breast cancer. 

I had not heard anyone say that before. Yeah. 

Oh yeah. Yeah, I've heard I've heard it in the last couple of weeks. Another concern is that sugar and soy feed your cancer. What we talked about before is that sugar can increase your body [00:41:00] fat.

Body fat can increase your risk of cancer. It's not. Sugar feeding the cancer. You don't have to give up that mudslide dessert because you, you know, are worried about increasing your cancer risk or making your cancer grow. It just hasn't been shown to, it's the excess calories that carry the risk.

And then the last thing is a biopsy's gonna make my cancer spread. That's something that we debunked a while ago. We looked at is that needle? Causing the cancer cells to spread. We have not shown that to be true. It's something that we studied because if we do a biopsy and they have, a mastectomy, are we seeing cancer cells all over the breast now?

And we did not see that. 

I wanna go back to the soy specific one that you mentioned. 'cause I know that was a huge fear for a long time. Oh, I eat a lot of soy products. I've caused this and research has shown that is not the case now. That's right. I just wanna, I want to make sure we emphasize that because we, we really like, , that plant-based protein as an option when we're talking about that on the show and really helping women feel comfortable eating that, [00:42:00] not thinking that they're increasing their breast cancer risk.

That's right. Along those same lines, I would like to caution against any miracle cures, like a detox or a supplement that says it's gonna cure your cancer. Most of these are not gonna hurt you, but I don't have any evidence to say that they're gonna cure the cancer either.

I really like for folks to be. A part of their healthcare decisions and make choices that make them feel good. It's important to let us know what supplements you're taking. Some of them do increase your estrogens, and we would like to know about that. But there is nothing currently on the market that's a tea or a supplement that's going to take your cancer away.

So it's important to let us know what you are taking, but be aware of anything that is a definite cure. 

And more so just. Working with your oncology team in. Going through appropriate treatment and then adding these lifestyle factors into your treatment as well, because that combination is powerful.

That's right. That's 

right. And I would never tell someone that the only way is [00:43:00] western medicine. That's not true. We call it integrative health. , There are things that can integrate well into your cancer care that's not going to hurt you and can make you feel really good.

Things like yoga. Acupuncture, Reiki therapy. These are things that we can offer you. And a lot of times they're a part of your cancer center but they don't take the place. 

And I think for our listeners, sometimes patients are nervous to bring up some of these things to their doctors, but I really do encourage you all to have those discussions because many times your doctors are open to combining this as part of your treatment plan.

They just wanna be in the loop and know what's going on. So they make sure that any sort of alternative option that you may be doing in conjunction isn't interfering with your treatment plan. 

That's right, and I would always say be your own best advocate as well. If you're meeting a lot of resistance to things like this or you don't feel heard ask for a second opinion.

If this provider is not willing to, talk you through their concerns or [00:44:00] talk to you about what you would like to do, it might not be the best fit for you therapeutically. 

I think that's great advice. We've already talked about social media might give some misleading advice.

Do you have any recommendations where people can go to learn more reliable Yes. Information. 

Two places I often send folks to when I'm in that first consult and I say, Dr. Google can be super scary and so can chat, GPT. So there are some reputable places I like to send people to. One of them is.

nccn.org. It's one of our guideline producing organizations. And then I also send folks to the Memorial Sloan Kettering website. Both of these places have patient facing information. It puts things more into layman's terms, but also. Are really specific. So they take into account your tumor biology, your age category your risks, and tell you the information that your healthcare professionals are gonna go over with you, other places to look, or Susan b Komen.

And there are [00:45:00] other, I generally tell people.edu.org. Those are good places to start. And hopefully get some high level evidence. And a little less TikTok. A little less TikTok. A little tiktoks. Okay. A little less TikTok when you're making healthcare decisions.

Yes. 

Yes. We'll put links to those in the show notes. And can you tell people how someone might come see you if they're in this situation? 

I want you to know if you're going through this you're struggling to feel heard. You're, you just want a second opinion. You wanna hear all of your options. I'm always here. I'm always happy to see someone. Your professional can refer you to the University of Kentucky Breast Center.

Or you can reach out to us directly. 

. Not everyone's getting the chance to be here with you in person, but I would say Dr. Jones really seems like someone that can just really walk you through this and make you feel comfortable and make you feel confident in your care.

Thank you.

I'm gonna do just a quick little summary. You touched on so many [00:46:00] great points today, so this was really helpful. On average, women have about a one in eight chance in their lifetime of developing breast cancer and.

When you do one of these scores, which your doctor might do for you, they might find that you have a higher risk. If you do, then they might suggest further testing, like genetic testing or further imaging. If you're at that normal risk, we are gonna recommend screening mammograms every year, starting at 40.

Don't miss it. Don't worry about if things are coming up. Just schedule it and get it done, and if there's more that you need to do after that, your doctor will talk to you. Remember, there are things you can be doing on a day-to-day basis to reduce your risk. It's thought that. Excess body weight, alcohol being inactive and having a poor diet accounts for about [00:47:00] 20% of cancer cases.

So if you can be working on those things, minimizing your alcohol moving, remember it doesn't have to be going to some sort of cycle bar class or just get up, move throughout the day, walk, make sure you're getting some fruits and vegetables in, and all of those things will work together to reduce your risk.

 after following through with your mammograms, know that if there is something abnormal, you're gonna have to do further testing and. The imaging center will walk you through the steps that need to come after that, you might be seeing the breast surgeon, you might be seeing an oncologist, and just realize that they're gonna point you in the right direction and make sure that you get the therapy that you need, and they will talk to you about all the options, whether or not they are.

Hormonal, chemotherapy and all the different surgical options, and you can be part of making the best decision and treatment plan for [00:48:00] you. So , hopefully this was helpful in understanding your own breast health and maybe even helping a friend or family member understand what they're going through as well.

So next week. We're gonna be changing 

subjects. Yes. We're putting ourselves on the spot, aren't we? Dr. Dotson, we're gonna be talking to Dr. Juliana Hauser about women's sexual health. So this is a topic that many people feel uncomfortable talking about, so we're putting ourselves out there and gonna have a discussion with her because she is a.

Specialists and known nationally for her work in this area. So please join us next week for that. And if you like what you're hearing on this show, don't forget to follow our show. Leave us a review. It really helps us and helps our show continue to grow. , See you next time.