Hey, everybody, welcome to a special episode of Amy and TJ Robots. Sitting here next to me. A lot of people have been following along with us the past. I guess a couple of weeks we did a show talking about on one of the episodes talking about you not making an appointment and being over a year, a year, a year and a half a half since you win for blood work that you were supposed to have. Do I have that right as a Breastkansas riber.
I have been doing it every six months or so up until well, you know.
Yes, everything hit the fan. But we do update people recently that you have made the appointment, are going to get your blood work done very soon. And that appointment is with someone you speak so highly up all the time, Doctor Ritz.
Yes, doctor Ruth Ratz, and she is actually in the studio with us. She is my oncologist. She has been with me from the very beginning since I was oh yes, a young pop of forty when I got my breast cancer diagnosis. But doctor Ortz has been on the journey with me every step of the way. And so first of all, I'm just gonna apologize for having left so much time and space between us over the past year and a half. But it's so good to see you and we're so happy to have you in the studio with us.
So welcome. I'm happy to be here. I'm delighted to be here with both of you and Amy. You know, I stalk you, so even though I haven't seen you in person, I know you've been okay. Oh, and I see you training, I see you out there running. I know you're healthy, and I know that you take really good care of yourself.
Thank you.
So we'll update everything see you okay.
Yeah, and a couple and a couple of weeks, we've got the appointment, but we asked you to come into the studio because there's been a big headline this week with actress Olivia Munn. She's forty three years old. She let everyone know that she has just been through ten months of treatment for breast cancer. That, of course, is always a big announcement when there's someone famous who can bring awareness to the cause. But it's a unique story because she's talking about how she found her cancer. She
said she had a clearant mammogram. She said that she didn't have any of the markers for genetic testing that would make her a candidate for potentially having breast cancer, but then she said her doctor two months later had her do a breast cancer risk assessment test, and that led to more tests, which led to her finding an aggressive form of breast cancer in both breasts. And I kind of thought I knew a lot about breast cancer throughout my journey, but even I was scratching my hat.
A breast cancer risk assessment test. Please explain what that is and just put this into perspective for us.
Yes, I think we were all very shocked to hear this story and it raises an important issue, particularly for young women who were diagnosed with breast cancer. Let me just back up and talk about the man. You know, we do want everyone to have mammogram screening, but as I always say, it's not one size fits all, and for many young women, the mammogram won't show early stage breast cancer because the breast tissue is very dense in
young women and the mamogram doesn't show enough. So that's why it's really important for each individual to speak with her doctor about what are the other potential factors that could be contributing to a risk of breast cancer and do we need to change up or add something to the screening and surveillance. Now, the Breast Cancer Risk Assessment Tool could be helpful. It's a statistical model that was
developed many years ago. We've had this, you know, for probably fifteen twenty years already, and it's a simple computer model. It's free. It's available online. You can click on a website and bring it up, and it asks a few basic questions about a woman's personal history. It's really developed
for women. We know men can get breast cancer, we'll come to that later, but focusing on women, it is they ask about age, family history of breast cancer, focusing on close relations we call those first degree relatives, mother, sister, daughter, whether or not the person has had a prior biopsy of the breast that showed any atypical cells. And then
some questions about reproductive history. How old you were when you had your first menstrual period, how if you've had pregnancies, how old you were at the time of that first pregnancy. And then there's a calculation that's made that gives an estimate. I mean it's not perfect, but an estimate. You know, what's your risk of getting breast cancer in the next five years? Or over your lifetime up to age ninety and compares that to the general population.
I think that the test is what's throwing everybody right now. Okay, you tell people, tell women, go get a manogram, You tell them what age to do it, how often to do it, You go in, mamogram's clear and you should be in the clear. Now, why would you take the next step or why isn't everyone being told to take do a mammogram and go online and everybody do this risk assessment test.
Yeah, that's sort of actually a great question. We have not made that recommendation. In this case, it did lead to a diagnosis of breast cancer. I think maybe the concern is that if everyone did it, there would be kind of like mass panic because a lot of people might have a slightly increased risk. I don't know how hurt test actually, you know what the numbers were or how it came out.
So thirty seven actually was it?
I have it right? Thirty seven lifetime risk. Yeah, so that is higher than the average American woman who has a twelve percent lifetime risk. So that was high enough that it triggered the extra testing by her doctor. So you know, as I was thinking about that. I mean, maybe you're right, TJ. Maybe more people should go online kind of get a rough idea where they fall out on that. But remember it's just a rough idea. So
Olivia did the right thing. She took the next step and went to her doctor and said, what does this mean.
This is also something that has been interesting to me because yeah, I had never even heard of this test was. We had to look it up and figure out what it was. But I think most people know my history that I had a mammogram at age forty because I had a work assignment, not even because I was going in there. Because at the time I was diagnosed, the recommendation was fifty, then it went to forty five, and now it's down to forty, which we're all applauding. I
know you are as well. Anyone who works with breast cancer patients is saying, yes, forty years old. But I ended up getting a sonogram after the mammogram showed abnormal. If the sonogram is a better test than a mammogram, or at least maybe a clearer test for younger women who have potentially dense breast tissue, why wouldn't there always be a sonogram or maybe even a sonogram versus a mammogram.
Well, I think you're right, Amy, And in my personal practice, when I see young women at risk for breast cancer, they haven't had breast cancer, but at risk, let's say, because of family history, or they had a concern about something and came in to be evaluated, we do always add the sonogram. Some people who are very young, I do the sonogram and I skip the mammogram because I know that mammogram's not going to show me a whole lot in someone who's very young, maybe in her thirties.
So again, you know, those screening recommendations are that everybody should do the same thing, and I think we have to tailor our recommendations to the individual person. And this risk assessment test is some thing I run in the office. I do it, and I might share that information with my patient and say, look, your risk isn't as high as we thought, or maybe it's higher than we expected, or gee, we should do some genetic testing in you
because of your family history. So you know, there are many factors we look at, and this should be one of those things that gets incorporated into risk assessment. Lots of gynecologists do it and I think that's what happened in this instance. Or doctor said, let's just run this on you and see how it comes out, like you don't know what it triggered.
It's free, and why not Why wouldn't you do that? There's no argument to not do it correct.
I mean, you know, I always say knowledge gives us power.
The sonogram versus mammogram does one? Is there a difference in cost to the or or what insurance will cover, so neither.
Of them are expensive tests. And but for whatever reason, the insurance companies and Medicare and whatever has set up this paradigm that you have to do the mammogram first. Huh before you can order the sonogram.
Huh.
Yep, it's kind of a crazy thing. I cannot understand it.
Insurance generally cover both.
Yeah, it will eventually get covered, but sometimes you have to go through the mammogram and then we can order the ultrasound and for our older patients. Actually, just this past year, Medicare changed their system so that we cannot order the mammogram and ultrasound to be done on the same day. The prus has to have the mammogram and then if we think the sonogram is indicated we order it and she has to go back a second time.
It's it's absurd and look, I have shared the story before, but I haven't here on this podcast. I was outraged when I had the first mammogram and the Mamma Van in the middle of Times Square. They just saw something suspicious. There was no nothing specific to cancer. They just said, you know what, we'd like you to get another mammogram
because something looks a little off. And so when I went to go make the follow up appointment at Nyu Lang Gone, I got a call the night before from my insurance company saying we are not going to cover this. And so NYU called me and said, you're going to have to give us your credit card if you want to keep the appointment for tomorrow. And I almost did not do it because I was annoyed A that I was going back for a second one and B that I was going to have to pay at least eight
hundred dollars out of pocket. Eight hundred dollars to a lot of people is not even an option. That's their rent payment, that's food on their table. I was lucky enough to be able to afford it, but to think that insurance companies get involved in a way where they make life so much more difficult and potentially could could be costing women lives, time, money, etc. I know you, as a doctor have to be so frustrated by this.
We are very frustrated by it. And you know that eight hundred dollars bill is probably including other costs than just the cost of doing the X ray, because we know that when we've done mass screening projects sending those vans out, for example, we can bring the cost down significantly and we don't want cost ever to be a barrier for women to get the right screening that they need,
So that's really really important. It is very frustrating. And again in our younger patients in particular, people say, oh, well, breast cancer doesn't happen in people that age, but it sure does, you know, and you know that too all too well.
The doctor oris with a living mon here help me. And again I'm familiar to a certain degree and to feel maybe familiar little more because of who I'm in love with here and the history of breast cancer. But the order someone's told to go get a mammogram, you get that mammogram. If it's clear, then there is no next step necessarily right, You're done until your next scheduled appointment.
A living your month is saying the doctor. So the clear mammogram, but still we went ahead and did the risk the risk assessment, and if they hadn't done that, then maybe they wouldn't have taken that. So I am trying to find the order and trying to get women to understand because I don't understand what the understand what they should They run out and get online see their risk assessment score and then immediately go talk to the doctor about it. Is that what everybody should be doing.
I think everyone has to be aware of what's going on in her own personal health and that family history story. Every woman should see the doctor once a year or you know, it could be a nurse practitioner or a PA, whoever the person is who's providing your health care for a GYN exam and a clinical breast exam, so sometimes you can feel something that may not show up right away on the X ray. Also, checking under the arms for lumps is very important. So the clinical breast examination
and the mammogram is the way we start. I personally, you know, as Amy knows, younger patients feel that ultrasound, that sonogram should be part of that evaluation, and then in discussing those results. It's not just when and done, you're clear, it should be a discussion afterwards, well what did my mammogram show? If there's very dense breast tissue there,
do I need a follow up test? If oh, yeah, I didn't tell you my mom had breast cancer, or my mom and her two sisters had breast cancer, or in taking that reproductive history you find out that that person had their first child over age thirty, and maybe you know other issues in their personal health that might trigger. In this case, it triggered you know, Olivia's doctor to run that risk assessment score. It's not wrong for someone to go online and do it herself. We just want
to be careful that people don't get misinterpreted. So once you run it, go in and talk to an extra about what that means and what you should do.
That.
I hear you right that a lot of women may be getting the risk assessment and don't even know it because they might be in there with their doctor. It sounds like you were saying you were asking the questions and doing the risk assessment even though the woman didn't realize that.
Then I told her. They told her about Yeah, you have to always tell them like right, what it is?
Right? And it's interesting because we've had this conversation. I was among the more than eighty percent of breast cancer patients who have no family history, so I would have been considered average risk. I wouldn't have considered myself at elevated risk. But you mentioned this to me way back when my daughters were really young. Now, but now Avis twenty one and Analyse is about to be eighteen, and you had said, because of my history, their history is now they are at an elevated risk.
Correct, So what.
Is the age because it's been so confusing for women who are of average risk when they should have their first mammogram. But what about people like my daughters whose mom had breast cancer at a young age, When should they have their first mammogram?
Is that clear? Yes? What we do is that we recommend they start seeing an expert ten years before the age at which their mom was diagnosed, so thirty round thirty.
That doesn't mean they have to go into a whole intensive thing, but they have to talk to someone who is an expert and go through their personal history, maybe run a risk assessment score, and then figure out, okay, what's going to be the best way of keeping track of them and getting started a little bit early or so we're ahead of the curve and watching closely.
I mean, obviously I had access to the best doctors in the world, you doctor Ratz and the incredible surgeons and everyone there at NYU Langona, and I had a credible insurance. For women who don't have those means or have access to healthcare like that, are they going to find it hard? Say they go online and they take this breast cancer risk assessment test and they see it's elevated significantly above that twelve percent average. What are their options?
Will they What could you suggest to them? What is your advice to them?
Well, first of all, we have an amazing network of National Cancer Institute designated cancer centers in every state of the Union, all fifty states. Now we have you know, four or five of them right here in New York City, So we have a lot of density of population and a lot of healthcare providers. In other parts of the country, it could be a big geographic distance for someone to travel to, but at least if you end up at a cancer center or a university medical center, or or
a medical center affiliated with a medical school. So we're talking about places that are a little more academic. You'll get access to someone who's an expert. There are some other organizations that are out there that provide amazing information and screening for women. Planned Parenthood is one of them. People think Planned Parenthood was only out there to provide contraception and help women if they needed to terminate a pregnancy, but actually they also provide the entry point into the
healthcare system for breast health as well. And other organizations that are out there with who can provide services at low cost or accepting insurances that are like Medicaid or public health insurance, but all the major medical centers will accept other insurances. And here in New York City, for example, in our public hospital system, Health and Hospitals Corporation HC hospitals can go in even without insurance and be seen in our breast clinic and be evaluated.
Can you give some perspective to this Olivia mun story that it's getting a lot of attention. She's a famous person. She put it out there, and that's great to bring attention to. But just how rare is a case like hers, and that a mammogram didn't catch something, you'd then take a risk assessment, and the mammogram missed that she has this aggressive form of breast cancer in both breasts. Is this that kind of an anomaly of a case here.
Well, I think it's not so unusual in our young patients where the mammogram is not necessarily the best test because of that dense breast tissue. And maybe she had an ultrasound or an MRI or something. She had both, she had both after the risk assessment test. I know they keep saying this is an aggressive form of breast cancer, but I think that's a strong word. She chose that word. And I'll give you a little biology lesson here. Breast cancer is not just one disease. There are many types
of breast cancer. She really has an intermediate form. I think that luminole B I've I've never even heard of it.
So we have four molecular subtypes of breast cancer. Luminal A B and then the her too enriched or her too new positive breast cancer, and then the basoloid breast cancer, which is unfortunately called triple negative, which is kind of not a great name, But what that's referring to are the three receptors that we look at that give us a lot of information about the biologic behavior of that cancer, and that's the estrogen and progesterone receptors, the hormone receptors.
Those are the luminal A and B cancers. And then there's the her too positive that's her too new positive and triple negative means there's no receptors present for estrogen, progester on her too new. All three of those are absent, and that helps us to determine what treatments to use in targeting the cancer and making sure we're treating that
individual with the right kind of treatment. So, the estrogen positive breast cancers are all luminal and we subdivide them into A and B, and there are tests that we can use that help us figure out which subtype it is and that helps us determine if we should add chemotherapy to just the anti estrogen endocrine therapy. And Amy knows about that. Yes, I do do genomic assays. One of them is called the acotype test. There's also a
mamma print test. There are several tests we can run on the tumor tissue that tells us Okay, we know it's estrogen receptor positive, but are there other factors at play here which tell us, well, maybe we need to add a little something else to the treatment.
And I'm sorry, just a quick thing.
So it's not super super aggressive, but it's a little more aggressive than.
The you said, not super aggressive and not necessarily an anomaly because a mammogram isn't the best test for a younger woman. When you say young in your world, when you talk in breast cancer and women young, what is the age we're talking about when you're thinking.
Young, less than forty five?
Okay, yeah, she's forty three.
Yeah she's forty three.
And you know, it is remarkable hearing you talk about there have been so many advances. I mean even when I was diagnosed ten years ago, I got the ANCA score and you were able. That was I remember you sat me down and you said, sorry, you got chemotherapy ahead of you because my AUNCA score was I believe intermediate. And you can actually predict or at least say whether or not what your chances are of having it recur and become metastatic. So I think mine's intermediate.
It was, And it's not just that score. We also look at the clinical factors, age, size of the tumor, did any cells get into the lymph node? And we put all of that together. So you know, nothing in medicine is just like an on off switch. It's not just one thing that determines what we do. It's kind of all of the information and then that soft thing we call clinical judgment. That's why you can't replace me with a robot just yet. Isn't she great?
Isn't she great? I love doctor writ You know. I can't believe I let a year and a half go without coming into see But when stories like this hit the news, I know a lot of women go into panic mode, and you don't want people to overreact. But also it's not a bad thing because this type of story brings awareness where women suddenly start to take their health a little bit more seriously and think, oh wow, it could happen to me. What is your reaction when
you see celebrities come out and explain what happened. I mean, they might not get all the facts exactly right, but the general idea is to warn and make women aware.
I'm always proud when someone steps forward to share something that's deeply personal, deeply intimate, and be able to open up to the public and say, learn from my story. I'm sharing this with you to help you. And that's a tremendous gift and I think that for people to do that is very, very courageous.
This obviously raises awareness, but this is living a month story and all of the back and forth about this breast cancer or risk assessment test. Where would you caution us in this story? You want the word out there, but where do you caution everybody in listening to the story.
Well, I always caution people not to panic, but I would say the test is available. And I think Amy's right. I think the more that people are aware of their health, the better they're going to be able to take care of themselves. So if a woman says, gee, I'm a little concerned about this, I'm going to go online and run that essay on myself, you know, see where my
number comes out. Then make sure though that we have the support system for her so she can follow up, maybe even make that appointment with your doctor first, or go into your healthcare provider and say i'd like to do this, maybe we can do it. Together. I mean it takes about three minutes to punch the numbers in on the computer, so then you're not just sitting there and then can't get an appointment to see your doctor for two months and you're all in a panic about it.
So maybe schedule that appointment and say this is something I'd like to discuss with you, and go over all the other factors. Other risk factors for developing breast cancer are, for example, alcohol, use too much drinking no good, don't drink every day, don't drink more than two drinks if you're going out to a party. You know, alcohol can be a big risk factor. Keep a healthy body weight. You don't have to be super skinny, but a healthy
body weight. Physical exercise is important. Amy knows that. I think it's been a big factor in really keeping you healthy and getting you through the side effects of treatment.
Oh yeah, to even be able to tolerate tomoxifen as long as I did. You know, I think staying active kept my joints working, because that's a big complaint. You know, some of the meds that they put you on makes you not want to exercise. But if you can push through it, then you can get to the other side of it, and you can make it work and stay on it for as long as possible, which obviously reduces your risk of recurrence, which is what we're all looking for.
I have a question if can you, as a woman, go into your doctor and say I just want a sonogram and could you insist on it? Can you pay for it yourself if your insurance won't pay for it? If you have the means, what are your rights or options as a patient if you think you want something.
I think you should have that discussion with your doctor, and I think most doctors would agree to, you know, work with you in getting the right test done for you. Sometimes we have to finesse the order in which we do things. Sometimes, even at the cancer center, I have to call the radiologist and say, you know, I'm not doing that mammogram on this thirty two year old. It's not happening. Just do the ultrasound, pick up the phone
and you know, make that phone call. But we can usually get things done in the right sequence and appropriately for each patient.
The test is available on the National Cancer Institute website and they say they've had a huge spike. Please caution, as women of color, black women, in particular, I think here that I think they've tried to update the tool over time, but it might not be as accurate. For women of COLT.
May actually underestimate the risk and we're not sure why that is. And it's not even because when we do genetic testing we can find a particular gene. We haven't identified that yet. They also caution that for Asian women born outside of the United States, the test and Hispanic women born outside of the United States it may not
be accurate. And that's because when the test was developed decades ago, it was validated on a population of pre dominantly Caucasian women, so there could be some caveats there. If a woman has a history of what we call non invasive breast cancer DCIS or LCIs, the tool is not accurate. If the person knows she has a genetic mutation like BRCA one or b r c A two or another genetic mutation that could increase the risk of cancer, the test is not accurate. So all of those kind
of disclaimers are the in the small print there. You know when you open up the click on the internet to open up the test.
I have a question for any woman who is listening right now. What you mentioned the things you can be doing to prevent cancer or to lower your risk of cancer, But what in terms of monitoring and making those appointments, what should women be doing at what age? Can you give us kind of that rundown, So anyone who's listening knows, Okay, if I'm this age, I should be doing this. If I'm that age, I should be doing this. How often should I be doing it?
I'm going to start really young. I think any young woman who is sexually active should have an exam with a gynecologist or a gyn healthcare provider once a year. Make sure everything's okay, and that's also checking for infections or other conditions, and be sure it includes a breast exam. I think that all women from early age eighteen on check yourself every month. The best time to do a self breast examination is right after your period is finished.
That's when the breast is going to be the softest and the least tender. As a lot of women know, they feel fluctuations during the month with that monthly cycle, So once things have quieted down, check yourself, poke around under the arms, make sure there are no lumps or bumps. If someone has a concern, any concern at all. Something feels weird, this looks odd, my skin color changed, there's a discharge from the nipple, something's painful. Go in and
get it checked out. May turn out to be nothing, but check it out. So that's for all women. I would say from late teenage years on, go in at least once a year for checkup, and check yourself every month. In terms of when to start breast imaging, that's that ultrasound or the mammogram or if necessary, an MRI, that's where tools like this risk assessment tool might really help
us figure out. Okay, we have a general guideline that says start in your forties, but maybe someone needs to start earlier because of a family history or some other factor in her health. So that's where we should maybe have our healthcare providers run that risk assessment tool when
someone's coming in. Really, it literally takes three minutes. Now, I don't think every eighteen year old needs it, but maybe when we're starting to get into those early thirties, that will trigger the provider, whether that's a nurse or a doctor or who's ever seen that woman, say yeah, did anyone in your family ever have breast cancer? You know or did you have? You had any pregnancies? How
old were you when that first baby was born? And that then we can plug those numbers into the tool and see where we're.
At to that question. I'm so bad. I keep going back to this test this tool here, but there might be a breakdown that lets people know if your number is this, if your numbers this, But can you tell people here because a lot are going to go on and fill this out. So a living you moone's number was a thirty seven percent, and that's way, way, way high. But where do you start seeing numbers you and someone else doing it online to where you should be a lot?
That's a great question, TJ. Because people are going to be doing this right. So we say that the average lifetime risk of breast cancer for an American woman is about twelve percent. So if you punch it in and your lifetime risk that's going to age ninety is fourteen percent, I wouldn't get too too worried about it. But if you if you're coming up, you know, let's say, and I'm kind of just making this up honestly, but you know, twelve percent, So if you're starting to hit closer to
twenty percent, twenty five percent. She was above thirty percent. That's a higher risk. It also gives you a number within the next five years on that risk assessment tool. So the lifetime risk my hers was thirty seven percent, but I don't know what the number came out, because it gives you both within the next five years. If that number is significantly higher, you may want to go in sooner. So, for example, We're going to calculate a patient risk, and I'm going to make up the answers
to the question. Let's see how it comes out. So the first question is does the woman have a medical history of DCIS or LCIs. The other thing it asks, by the way, is has she had radiation treatment to the chest area because that increases the risk of breast cancer significantly, and sometimes we give that radiation treatment to young women who have lymphoma. We don't do it so much anymore, but we used to. So I'm gonna say no,
no history of those things. Is there a mutation in BRCA one, BRCA two, any genetic mutations, I'm gonna say no. What age patients you want is to look at.
Let's do let's do forty five.
Forty five? Okay, forty five, so I'm gonna put that in. By the way, the essay starts at age thirty five, so a twenty eight year old can't use this. It's not valid. Oh okay, so it starts at age thirty five, So I'm going to pick forty five. What is the patient's race or ethnicity, and the choices here are white, African American, Latina, Asian, American, Native American, or Alaskan Native or unknown let's go black, okay, And has the patient ever had a breast biopsy with a benign meaning a
non cancerous diagnosis. I'm going to say no, right, most women haven't had that.
And as we feel this out, can you depending on what you do in your life year to year, your number can change. How do you take the test year to year?
All right, that's right exactly, because things right, things are going to happen. Then we get into those questions about your reproductive history. What was the woman's age at the time of her first menstrual period. They give us three choices. A very young age which would be before age eleven, then kind of twelve to thirteen, which sort of average, and the third choice would be fourteen or older.
To the average.
Let's give her the average twelve to thirteen, and the age of the of her first child, so either no births or what age she was when she had a baby. Let's say twenty nine. So then okay, you're right on the edge because it goes twenty five to twenty nine. A's thirty or older. Let's give her twenty nine.
Yeah, I just use my birth age. I mean my age when I gave birth. That's like, yeah, that's great.
I wish.
I was born in nineteen twenty nine.
No, and what about that family history? Does she have a mother, sister, or daughter who had breast cancer? I don't know.
What do we say? Say one?
Okay, let's say her mom had braains. Okay, okay. So this is now for this individual person, and I'm calculating her risk. The risk of her developing cancer within the next five years eight fifty is only one point four percent. Wow, that's a little higher than the average risk, which is zero point nine percent for the general population. So she's not in major big trouble this year. Over the course of her lifetime, her risk is a little bit higher
fourteen point four percent. Compared to nine point five percent.
I'm actually surprised because with a mother who had cancer, being African American, that's actually a surprisingly low number to me, is it to you?
Well a little bit? Yeah, wow, but.
You get that number. That woman just filled that out. She sees fourteen point four. Now what do I do?
She says, Okay, what she really should see is in the next five years it's one percent. So don't panic, but pick up the phone. Make sure you have that appointment to see your doctor. Check in your calendar. Did I do a mammogram last year? Am I up to date? If not, go in to see your doctor. Bring this information and say I want to review this with you. Am I doing enough screening? Is there something we should add to this? Gee, my mom had breast cancer, but
we never did that genetic testing thing. Should I speak to the genetic counselor so, you know, follow up on all of those issues, Doctor Ratz.
I just thought of something because as you plug those numbers and that information in, that would have been me except for that I didn't have a family history, I didn't have a close relative who had breast cancer, and I was forty not forty five. So my number would have been probably even lower than that because I.
Might as well yes and no, I mean I don't know. We'd have to put it in and see.
But by those questions, I'm fairly certain I would not have had a high percentage. And yet and yet I had I had, I had stage two breast cancer. It had spread to my lip notes. So you know, I wouldn't want people, and I know you wouldn't want people to go on take this test and think I'm good, I don't have to get a mammogram. I'm good, I don't have to go in every year and get tested, and that could happen.
That could happen. And that's what I was getting back to before, where it's not just one thing. This is helpful, but remember check yourself. Go every year to see the doctor and have a clinical breast exam, and make sure that starting at age forty there's some kind of screening, and if you're at higher risk, start at a younger age. Doctor RATZ, do you have anything else? Babe?
I didn't want to just s well.
I was trying to put in your numbers and at your risk it does come out very very low.
Yeah, And I wouldn't want someone to have a false impression that somehow they're not going to get breast cancer because this test told them their number was low.
It doesn't substitute for all those other things we need to do to take care of ourselves.
I remember sitting, Oh, I could get emotional hair sitting at NYU, I was about to probably see you in a few hours, and didn't realize going in for my follow up man and kind of getting nervous because they kept asking me to come back and get new images and new images, and I was trying not to get scared. So I started looking up my chances as a forty year old, otherwise healthy woman, and I said, oh, I got a one percent. I got less than a one
percent chance of having breast cancer. And I put myself at ease, and I told myself to stop freaking out that I almost certainly didn't have it. And even when they found something when I had to have a biopsy, I was like, it's gonna be benign. So when I was told I had breast cancer and I saw you, I believe about an hour later, I couldn't have been more shocked. I didn't think it could happen to me.
What did you get that said it was one percent? Where'd you get that?
It's just the average.
I mean, if you are of, if you have no family history, if you're relatively healthy. I knew I was thin. I knew I exercised, I knew I ate well. I found an average risk. A woman in my age had a less than one percent chance of developing.
An I said, because I just feeled her answers out on this assessment. It came point six percent.
See that chance less than one percent?
Yet and yet I had breast cancer. So I just want to I wanted to point that out right. So none of these tools are fool proof. They're helpful, but I think you're writing Amy, we want to make sure that people still follow up and do all the other things they need to do to stay healthy.
And look our best to Olivia mon and congratulations and thank you really for putting this out there and sparking these discussions. And I bet you the fact that she has done this is going to save lives that we don't even realize. But doctor writes, before you go, can you please talk to this one for me? And you know I've stayed on her about it, but if you can give her a little reminder of just how important it is for her to keep up with those appointments.
It is important. And what I love the most about my practice is all the people who come in for their once a year check up twenty years later and they're fine. And even for some of my young patients who come in and tell me that they've had a baby since they were diagnosed, see those babies or you know, celebrating other life events and it is just fantastic. So it makes me happy, and then I know you're healthy.
So I think the other thing that happens is once someone does have a cancer diagnosis, anything else that comes up we want to know about. Not because it means the cancer is coming back, but you know, we sort of have a lot of ownership around our cancer patients, and I think as oncologists, we like to know that you're well, and we also want to make sure that you're doing all the other screening tests you need to do. You know, that colonoscopy, No one wants to talk about it, right,
Who's going to remind you about that? You know? So there are other things that we like to just check our boxes and make sure everybody's healthy and come in for your checkos well, doctor Ortz.
I am so so happy you came in and you came to see me before I came.
To see you.
But I am going to be there on March twenty six, so we can catch up then, and I will have my girls get their baseline mammogram at the age of thirty after everything I just heard you say, and with a sonogram, with the sonogram, you're right with the sonogram, and that was part of what we were talking about.
So I think so many women are going to be so grateful for your perspective and your information and thank you, thank you just for being you, and thank you for helping me over this past decade and for the decades to.
Come, for the decades to come, and to everyone out there, don't panic. You're going to be fine.