You're listening to I Choose Me with Jenny Garth. Hi, everyone, welcome to I Choose Me. This podcast is all about the choices we make and where they lead us. October is Breast Cancer Awareness Month, and I know that many of us have been affected by breast cancer, and as women, I think it's something that has crossed all of our minds at some point. Breast cancer is something that I believe every woman thinks about at some point in our life.
I know it has personally touched my life, and because of Breast Cancer Awareness Month, I wanted to make sure that we had this conversation because if we can get one woman listening today to go out and get a mammogram or ask for a mammogram, then this episode has served its purpose. My guest today is the medical director of Surgical Breast Oncology at Christas Saint Vincent in New Mexico. Please welcome doctor Amani John Bacar to the I Choose Me Podcast.
What a pleasure it is to meet you. It's so nice to meet you too. Who knew we'd be here together? Yeah?
I never imagined I would meet Jenny Gorth ever, so that is amazing.
Oh my gosh, it's so funny that you say that you'd never imagine that we would meet. But here we are, and we're talking about something so so important, and I'm really grateful that you're here because we're going to just break all of these myths down. We want to know all the details, all the things that we need to know. I think a lot of women don't get mammograms because maybe they think they're too young, or they're concerned that it's going to hurt, or they just don't want to
think about it. But for someone listening today who's never had a mammogram before, let's talk about the process. I mean, I've had many mammograms at my age, I can I can speak to the level of uncomfortability. But from your perspective, does that scare women away?
And what is it like?
So full disclosure, I'm thirty seven, so I haven't yet gotten a mammogram myself.
Amazing to know. But wait, wait, that brings me to this question. What is the age where where women I've forgotten it's been so long.
It's forty.
It's forty, and so for someone who is of average risk, forty is the age that's when you should definitely start getting your mammograms. Someone who is high risk, who has a high rist family history should come see someone like me, a breast specialist and get established in a high risk breast clinic and potentially start imaging sooner in the twenties even or thirties.
Okay, that's funny because I was just talking to someone who is thirty seven today and she said she hadn't gotten a mammogram, and I was concerned. But now I know that we don't start this process until we're forty, so that is already I've learned something, and I'm very, very grateful. But I can sort of speak to the comfortability of it. I mean, it's not like I want
to go get a mammogram. It's not leasant, but it's not the worst thing ever either, And it's so quick like when they do, yeah, they do put your boob in a machine and flatten it down like a pancake.
Yep.
But it's momentary, and we women have endured way worse. So even if you're uncomfortable for you know, five seconds while they're taking the image, it's invaluable the information that you are going to get and the peace of mind that you're hopefully going to get knowing that you're all clear. Okay, so we learned already something super super big. How long does it take to get results? Like for in my experience, it's taken about a week maybe.
Yeah, usually a week.
So I'm here in San Fe, New Mexico, and oftentimes if patients need a biopsy, the radiologists or one of the texts will tell them right then and there, like, hey, we see something on your mammogram, you need a biopsy, or hey see something on your mammogram, you need another mammogram, or maybe an ultrasound, And so usually the.
Turnaround is pretty quick.
If it's a normal result, then they may get like a letter or a notification through their phones, you know, their chart on their phone that everything's normal, within like a.
Week or so. Yeah.
I've never had that moment where they say, oh, yeah, we need to take this again, or I need to call somebody and have them come look at this.
Well that's great, that's awesome news. Yeah, that would be a little scarier.
I want to talk to you about the b r C A one and b r C A two genes.
Yeah, how do we test for those?
That is a great question, because that's something that I'm extremely passionate about.
Good.
So we have a blood test that looks at eighty one different genes BRACO one in two, as well as other genes like CHECK two, PALB two, other genes that really increase the risk for breast cancer, but also other types of cancers like ovarian cancer, pancreatic cancer, prostate cancer, colon cancer. And that's a blood test that can only
be ordered by a physician. It's not the same thing as a medical you know, twenty three and me or something like that that has to be ordered by oftentimes a genetic counselor, or it can be ordered by an oncologist like myself, a surgical oncologist or a medical oncologist. And I see patients for that in the office all
the time. And people who have a high risk family history should talk to their primary care doctors about it and say, hey, I have a high risk family history, I have someone in my family diagnosed with none of those cancers, especially one of those cancers under the age of fifty. Where do I go next for testing? And it may be different in every community and a lot of places. They might say you need to see a
genetic counselor. But here in Santa Fe, I do a lot of that and I moved to Santa Fe about nine months ago and I've probably done genetic testing for over one hundred and twenty patients so far.
Amazing. Yeah, Yeah, I think it's so important because you need to know what your risks are. You need to know what you're what you're starting with, I.
Mean exactly, and what you're inheriting from people.
You know.
I spoke to a patient in the clinic today who didn't really have a very convincing family history but then ended up having a Braco one mutation, and so it's a scenario where we can't guess, and so the only way to know for sure is to do the genetic testing. And it does get approved by insurance for people who meet the NCCN criteria to get tested, and so I don't see a lot of problems with insurance coverage not
being there for that kind of testing. And if you do find out you have a mutation like Braco one or two, then you could be eligible for things like breast MRIs to do more screening and just to make sure that if you do develop something that we do in fact, catch it early.
Oh thank god, the insurance is taking care of us in this respect. Okay, So, but if you test positive.
For the BRCA gene, right, what does that mean in terms of your risk of getting breast cancer?
So that risk depends on which Braco gene that you inherit, and kind of also on your family history. But in general, for the Braco one and two genes, the risk for a future breast cancer it can be anywhere between forty and eighty percent. And so that's a pretty high level of risk. And as you know, you probably know Angelina and Joelee had a braco one mutation as well. And sometimes people do choose to remove both breasts prophylactically or
before they develop any kind of cancer. Sometimes they choose to remove the ovaries for similar reasons, to reduce that risk as much as possible. And like you said, those options are only really available to you if you know that you have one of those mutations, if you know your risk.
I mean, that's the key. Education. Awareness, advocacy for yourself is the.
Key, absolutely one hundred percent, because it's it's hard enough as women right to get get our complaints taken seriously and to get heard, and you know, going back to your earlier point about mammograms, I know that they're uncomfortable and for patients who have had medical trauma, they may even be traumatic. And if that was the way that we screened for testicular cancer for men, we would have something better by now.
Right, Oh right, that's a good point, it is, And so we you know, we have this kind of squishing the breast, sort of archaic technology.
We have mammograms because it's something that mostly women need to get done and people women are very strong, and so we sort of just we deal with it.
Do you think there's anything and yeah, do you think there's anything in the pipeline of experience better for us?
Absolutely?
So I can see that there are some studies being done of some new technologies that can work as well as mammograms, and then also of things that are a little bit more curved, like the human breast, so it's a little less of the squishing involved. And so some of those technologies are being trialed right now and I think are going to come out in the future. Not quite there yet. So right now, the a mammogram is still the standard of care.
And it is uncomfortable, you know. It sucks.
It's not a fun thing to do. No one looks forward to it, that's for sure. But you're right, like the information it gives you in just like a few minutes of discomfort or even pain is so invaluable. And it's peace of mind or figuring out what's next and if you need some kind of surgery.
What you need to do, what you need action you need to take. I just want to be clear.
If you test negative for the BRCI gene, does that mean that you won't get breast cancer?
So that's a great question.
It It doesn't mean that you'll never get a future breast cancer. It just means that your risk is average, like along with the rest of the population. It's not elevated because of a bad gene that you inherited from one of your parents. And something else that I hear oftentimes about the BRACA mutation is that like women are the only ones who can inherit it, and that is totally not true.
You can get that mutation from your dad as well. Really, what happens with men when they have it? Same thing men, So the men can get breast cancer. Actually, BRACA one does increase the risk for male breast cancer. For men, we worry a little bit more about aggressive prostate cancers. Prostate cancer is typically not a very aggressive thing in men, but in people who are Braca mutation carriers it can be.
And we also still worry about the pancreas as well, and as well as like skin cancers like melanomas, and so men who have the Braca mutation also need to be watched carefully in you know, cancer specific screening clinics, so that way an oncologist can keep a closer eye on them as well.
So you heard it here. Men and women are both affected by the barca meat and need both men and women should get tested.
Absolutely. Wow, I didn't know that. Thank you.
I'm going to go to a question from one of our listeners. This is from re West five to two four. Why has there been such a huge increase in breast cancer cases in the past twenty or so years.
That is a great question that I get all the time and clinic and I will say, there's a lot of different resource that's being done about it. Some of it may relate to environmental exposure, some of it may relate to microplastics, some of it may relate to more processed food because it's not just breast cancer that we're seeing. We're seeing it in like colon cancer as well.
We don't have a really.
Great answer for it right now. We're still trying to figure that out.
Yeah, I mean, I've heard a lot of discussion about microplastics lately, and then you start thinking about moment to moment in your life and how much you're exposed to plastics, like all day long. I just literally yesterday throughout my plastic cutting boards that I've had for a minute because I saw that when you chop into it, it releases little microplastics and then you cook that up with your sautee vegetables.
Yeah, it's I mean, I think the research on the microplastics is pretty compelling, and there's a lot.
Of things that we need to do to be.
A little bit more environmentally sound that I think will help our health as humans, not just with not developing cancer and especially cancer at younger ages, but also in a lot of other disorders as well. And so I think that research is going to pan out and show that being climate conscious will help our health in the long run.
I just heard Katie Couric talking about breast density I have a question from a listener here, Ashley Holliback. Where can women get an ultrasound if they have dense breaths, since you now need one when a mammogram isn't enough.
So this is the question I get a lot in the clinic now, as I'm sure you've heard, when you get your mammogram results, they have to report on how dense your breasts are, and that just happened in the last month or so.
Wow.
So people who do have dense breasts or category C or D breasts, they are recommended to also have an ultrasound. Sometimes they may even be recommended to have an MRI for screening. Usually the same mammography place that does the mammogram can also do an ultrasound. It just depends on your regional location on if they can also do the MRI.
The tricky part is getting the insurance to approve it, because insurances haven't one hundred percent caught up with those recommendations yet, and so a lot of times I see patients like this who do have dense breasts, and then I order the ultrasound with the mammogram, and I order both of them going forward, so that way they can just get both done in one visit, but typically the same place where you got the mammogram can do the ultrasound.
You may still need to have a doctor like your primary care doctor or your obi juyan order it and write that dense breast is the reason.
Why I have a question going back to the age that we should start getting mammograms. You said it was forty, but what if breast cancer runs in your family, maybe it runs in both sides of your family, should you start getting screened earlier?
Yeah, absolutely so.
I have seen many patients who have a risk of breast cancer because they have you know, their mom, for example, passed away of breast cancer when she was thirty six, So that kind of patient doesn't need to wait until they're forty to start getting imaging. Usually we don't start doing breast MRIs for someone who's higher risked for breast
cancer until the age of twenty five. That's the earliest we typically do those, but sometimes we'll do a clinical breast exam with an oncologist like myself earlier than that, depending on what the family history is. So if you do have young people in your family in their thirties
and forties who have been diagnosed with breast cancer. My recommendation is to check out a high risk breast clinic in your area and talk to them about when you should start that screening, because you're right, Jenny, it could be earlier than forty, and waiting until forty may be too late for some people.
Yeah, I mean they say that with heart disease too. If you're genetically dispositioned to it correct, you need to start having checks more frequently. Earlier on you said you said twenty five was the age that you usually start.
Yeah, so twenty five is the earliest recommendation I've seen for any kind of breast imaging, even for some one with a known BRACA mutation. Usually they'll say start MRIs at twenty five, no earlier than twenty five.
Rarely. I would say.
There probably are people out there who have had mothers and sisters who have had breast cancer in their twenties, and for that, I think that we would have to take on a case by case basis.
Yeah, I mean, the statistics are crazy that, you know, breast cancer is affecting women much younger today.
It is, and it is too absolutely and it's it is surprising, you know, the youngest patient that I've heard of, not that I've personally seen, but that one of my colleagues has seen with breast cancer was nineteen. Yeah, and it's especially hard at that age because you know, you go and see a doctor at nineteen, you may not have a primary care doctor. So you go see someone at an urgent care and they say you're too young for breast cancer.
This is a cyst.
And so my recommendation for anyone, really any age, if you feel a lump in the breast, no one's physical exam is good enough. I'm a surgical oncologist who primarily examines patients with breast cancer all day long, every day, and even I can't tell the difference between something that is a cyst or something that's a cancer, or something that's some other type of lump in the breast. And so no doctor, no nurse practitioner, no PA, no one's
physical exam is enough. So if you feel a lump, ask them to order some kind of imaging, a mammogram. If you're too young for a mammogram, typically they won't do a mammogram for somebody who's under thirty, ask for an ultrasound, but some sort of breast imaging is needed to look at that lump in more detail.
Don't let anyone.
Reassure you that by physical exam a lump is nothing.
Absolutely, such good advice, Such good advice. And listen to your instincts too, I.
Mean absolutely absolutely. And I see it with my young patients. I see this really awesome where they are bounced around, you know, they see someone at some urgent care. Then they go somewhere else and that person says, you're too young for breast cancer. This might be an infection, and
they put them on some me inabiotics. Then this whole time things are progressing, the lump is growing, and then they finally get established with a primary care doctor and the primary care doctor says, oh, and then they get sent to me.
If you have no history with family breast cancer none, m h. I have very very little family history of breast cancer. And I don't remember what age I must I may I must have been forty when they ordered me to get my first manmigram. And you're saying that's the age if you if you're not worried that you have in your family.
Yeah, forty is the age.
And they there were kind of differing recommendations on that as well. Like one governing body in the US said fifty, and one said forty. And now everybody says forty because we are seeing, as you commented, the incidents in young women rising, and so it's really worth it to start it at forty. It's a pretty safe test to do very very very small radiation dose that is totally worth it for the benefit.
Yeah, I was going to ask you that, Like what I get concerned about my exposure to so much radiation. One because I travel a lot, so I always get worried going through those machines.
Yeah, And everybody says, oh, it's.
Fine and don't worry, but I do worry. And so getting some sort of a screening can can cause concern for people that they're going to get too much radiation for sure.
And I get told that often. You know, people are like, what about the radiation and risk with a mammogram. So here in Santa Fe, New Mexico, we are at seven thousand feet, so we're at pretty significant We have a higher radiation risk anyways, because we're a little bit closer to the sun.
Okay, But in.
Order to actually see a problem from the radiation that you get from doing a mammogram, you'd have to get a mammogram every single day for an entire really actually every day for the rest of your life, and then you might might have a slight increase in the risk of developing a future cancer due to that radiation. But as long as you're not getting a mammogram every day, which no one is, it's pretty safe. The scanners in the airport are even less radiation than a mammogram, so totally safe.
I mean, okay, thank you, you're making totally safe like those.
I mean you could get like probably I would say you could get like easily ten thousand of those, and you'd be fine in terms of your annual radiation dose.
If you travel like thirteen thousand miles, you know, you travel from la to Europe and back in a year, then that's about the same amount of radiation that you're getting from a mammogram, and mammogram is totally If you live at sea level, the amount of radiation you get from a mammogram is about the same amount you would get from seven weeks of just background radiation just living
at sea level, So totally totally safe. Not really significantly increasing your radiation exposure and worth doing despite that risk.
Yeah, what you're saying about this, what'd you just call it background expiation?
Yeah, background exposure? Yeah, that is scary.
Well, it's just you know, it's we all get some radiation from the sun, right if we're living at high elevation like I am, or if we're living at sea level, we also get radiation from minerals in our own body breaking down. And that's totally normal, and Okay, it's a
really small dose. And so there's actually the EPA, the Environmental Protection Agency, has a like radiation dose calculator that you can use, which I recently used because I was making a TikTok on the radiation exposure you get from a mammogram, and you can calculate like how much radiation exposure do you get in your home based on like where you live and how many miles you travel a year if you're an avid traveler, and if you have veneers and if you have radon in your home and
things like that, and overall it's the amount of radiation you get.
There are different sources.
You can get it from your right, but it's a really, really really low dose that is not going to increase anyone's risk of having problems from the radiation at all.
I recently decided that I didn't want any of my do we have a microwave right that is under the cab counter level, it's down below like right where ovaries are, And so I recently put a big sign up on the floor, nobody stand right here when the microwave is on.
Yeah, that's I mean, that's fair.
Although I will say in that calculator, how close you stand to your micro is not in there.
So oh my gosh, I'm going crazy. I'm trying all the things. Wow.
Another question I have for the women who are giving them mammograms, the technicians, I know they go behind that little wall, but they're still right there all day long, every single day.
That is a great question too.
So they typically for those ladies, they have like it's a little badge, a thing on their badge, and it's something that their ID hangs from.
And what that does.
Is it actually like kind of measures the radiation dose that they get exposed to. And that's something that they have to like turn in and it gets counted so that way we can.
Be sure that their radiation exposure is safe.
And then you know, any kind of job in the hospital where you're giving X rays of any kind, they wear those little badges that will actually help calculate that dose and make sure that no one's getting to a point where you know, they're getting too much radiation exposure. And so it's that's pretty tight regulated by like hospital, by memorgraphy centers, and so they are totally safe too, don't worry.
Yeah, that's that's good to know. I was worried what you were saying before. We were talking about before about the the age being much younger. Now, Yeah, that women are discovering that they have is so alarming. But and in your right, they get shuffled around and they get discredited, and they people don't believe them or want to do anything.
How and you said that advocating for yourself, But what if you're a young girl and you're in you know, wanting to know more about your health, even if you you know, don't have breast cancer in your family genes that you know of, how do I get my voice heard as a young woman in a doctor's office?
Also an excellent question.
So it is harder for women, right, the things that get diagnosed mostly in women, get longer to be diagnosed because they get diagnosed mostly in women. So things like endometriosis that I'm sure you've heard of, it's basically can cause pretty debilitating pain, abdominal pain. It takes an average of eight years to get diagnosed in women. Why because people will discredit women like what you're saying. They'll say, oh,
you're just anxious. Oh that pain is just in your head, and that we see it all the time with many different diagnoses. Breast pain, that's one that I get asked about a lot as well. We don't have great answers for what causes breath pain or how to stop it because it's something that almost exclusively impacts women, and seventy percent of women in their lifetime will experience breast pain at some point.
So it's hard.
It's a really challenging thing. Even for me as a female surgeon, going to the doctor and having the doctor listen to my concerns as a healthcare professional can be challenging.
So I think it goes.
Back to what you said earlier, Jenny, trust your gut, listen to your instincts. If you feel like something's wrong and no one's listening to you, then find another physician that will and right, And studies have shown that like patients who are women tend to be heard better by physicians who are women. So finding a physician who is a woman who is going to take the time and
listen to you. Studies have also shown that women physicians spend longer listening to their patients and are more empathetic. I think that will make a huge difference as well, if you're able to choose to see women physicians, because it will help you be heard.
It will also help us be heard.
Oh my gosh, I know, no one really ever talked about that, about choosing a female physician that you know, that wasn't really a conversation.
It was just go to the doctor, and it was usually a man.
And yeah, it was even more uncomfortable because it was a man and you're talking about sensitive things and it exactly what it feels.
Right.
Nowadays, we have those options though, because like more than fifty percent of medical students are women, and so there are more and more women in a lot of different specialties. Now surgery is not one of them. Still overwhelming majority are men, but more there are more coming up through the ranks now, and so I think we'll see those those numbers shift soon. And so choosing women physicians or
you know, women wear nurse practitioners. Women who are PAS, like women are more likely to listen to other women when it comes to symptoms like a lump in the breast that just won't go away.
That's also very valuable information. So how does eating a healthy diet and not drinking alcohol and exercising, does that actually decrease the risks of getting breast cancer? Because we talk so much about being healthy and eating healthy and getting exercise, and I know that all of those things directly affect heart disease, But what about breast cancer.
It's kind of a mixed bag.
So have I seen patients who follow a you know, vegan, plant based, completely organic diet, exercise every day? You know, I'm here in New Mexico, as I mentioned, so everyone here is in amazing shape because they live at high elevation and they're also very outdoorsy. Have I seen lots of those patients who do end up with a breast cancer?
Yes, I have.
And I've also seen patients who, you know, who didn't live a healthy lifestyle at all, who also end up with breast cancer. I think living a healthy lifestyle is important for as you mentioned, things like heart disease and not having a heart attack or a stroke. I think it can slightly decrease the risk of a future breast cancer.
But there's no one diet that can prevent breast cancer, because if there was, then we would all be on it right and we would have studies that definitively show beyond this diet and you'll never develop breast cancer or some other type of cancer.
And I think moderation is really important.
You know, not drinking alcohol or drinking it in small quantities when you do is important.
Yeah, I was going to ask you about alcohol, like, does drinking alcohol put you in a higher risk?
Lightly but not a lot. You know, it's I think it puts you at higher risk for things like pancreatic cancer, for example, but not as much for breast So I mean that's not saying that you go out and drink whatever you want. I think it's moderation is key to having a good long life.
With a good quality of life.
But I don't think that, you know, living the healthiest lifestyle is something that can definitively prevent breast cancer. And so something I talk about often with my patients and the clinic is sugar. You know, I hear the myth all the time that sugar feeds cancer, and so some multile get diagnosed.
Oh it's a myth.
Yeah, there's no definitive study that, like, you know, if you cut out sugar, it will help diminish the size of your breast cancer, help shrink it, help treat it, anything like that.
And so there's some studies that have been.
Done that will show some kind of association, but it's not a very strong one. And so I see patients all the time that have been diagnosed with a breast cancer and their family members will say, well, you have to cut out all sugar right now, Like that's it. You know, you're you have to be done with it because it's going to feed your cancer and then your cancer is going to grow. And that's that's really that's it's that's a very simplistic way of looking at it,
and that's not it. There's no definitive causal uh causal relationship where if you eat a lot of sugar, then you're definitely going to get cancer, because otherwise then you would see a higher incidence of cancer and people who are diabetic, for example, And that's we don't see that. And so if I have a patient who's asking me like, hey, how should I change my diet after getting diagnosed with
breast cancer, I say, a healthy diet is important. But you know, if you have something that you really love eating, you know, you love ice cream, you love flawing, whatever, I'm never going to say don't eat that. Don't eat the things that are going to bring you joy while you're going through treatment, because treatment is hard enough as it is.
First of all, who would ever say I love flawn? Sorry, I.
Love it that giggly texture. I am right, Okay, yeah it's great.
And in New Mexico here we have like really really authentic flawn.
So okay, maybe I just need to go to New Mexico and try the good stuff.
What about soy? What about soy?
Because I've always heard I mean, I fed my babies once they were off breast milk. I gave them the only option back then was to give them a soy formula, right, and I wasn't sure if I was doing the right thing.
Also a great point. I hear that one too, Like soy and the estrogen link is there. You know, people will say, well, if you eat a lot of soy, then it might increase your risk for an estrogen related breast cancer, and really the studies are not definitive about that either.
So I don't tell I don't advise you to cut out soy.
I think if you like soy, great, enjoy SOI I don't think that there's a real reason to cut anything specific out of your diet if you've been diagnosed with the breast cancer to keep it from growing or spreading, or you know, to keep to prevent breast cancer. I think if you want to prevent breast cancer or catch it early, really the most important thing to do is to get your mammogram once a year.
Okay, So speaking of estrogen, let's talk about hormone replacement therapy HRT. Yeah, does it increase your chances of breast cancer? And what do we need to know associated with that?
It does increase the chance very slightly, based on pretty large studies that have been conducted. So when I'm talking to patients, I have patients who are even in my high risk clinic because they have a family history that I do think that HRT is worth trying for them.
I think that menopausal symptoms are like many other things that are almost exclusive to women, not talked about enough, and sometimes they can be extremely miserable and really alter the quality of your life, right, And so it's a risk versus benefit situation, like, Okay, the risk of breast cancer is slightly higher, but the benefit is that, you know, I'll get to sleep at night, I won't have these terrible night sweats. You know, I won't wake up in the middle of the night and wonder what it is
I'm doing. I won't have menopause brain those kinds of things. And so oftentimes I think that the benefit.
Of HRT really outweighs the risk.
The only patients that I really say should not be on HRT are the patients who have already been diagnosed with breast cancer, and it is a breast cancer that responds to estrogen. In that case, not a good idea to be on hormone replacement therapy. But for others, I do feel that in general, the benefits outweigh the risks, and I think that it's something that more women should be on. Mm HM.
I agree.
Breast implant illness has been getting talked about more openly. More and more women are having their implants removed. Are there any correlations between breast implant illness and breast cancer?
Not that I know of.
I have not seen any correlation between breast implant associated illness and breast cancer. Breast implant associated illness is kind of You're right, it's getting a lot more traction in these last few years, but it's still a diagnosis that they will do a full work up and make sure that there's not something else that's causing these symptoms before
removing implants. But I think there's a growing body of evidence that it's its own thing and should be considered earlier, you know, before doing the whole million dollar workup in women who have implants.
I can't believe. I was told.
I would remember hearing messaging when I was younger that said, if you get breast implants, it reduces your chances of get breast cancer.
Yeah.
I I've heard that as well from a few patients. It really it doesn't change.
The risk at all.
Yeah, I think you know it doesn't, right, And when someone has an implant and then they get a mammogram, they sort of move the implant out of the way and then get the native breast tissue in for the mammogram and they're still able to see what's going on. Sometimes having an implant, you know, that was placed for an augmentation purpose, can change the treatment options that are available to you if you do get diagnosed with breast cancer.
But it's not that's not a reason not to get an implant for someone who wants one.
Speaking of moving the implant around, if someone's considering or having to face being considering a mass sectomy or a double mass ectomy, can you walk us through that process and what that entails and the recovery. I mean that sounds very scary.
Yeah, sure, I'm happy to do that.
So I do see a lot of patients who have chosen to remove one breast or both breasts, and that decision is really a very personal decision, you know it. I think that there's some patients that have a larger cancer for which it would be a good idea, But there's some who have small cancers that just, you know, they don't want to get a mammogram on that side again, or they don't want to get mamogram on either side, and they just want to, you know, for their own
peace of mind. They tell me, you know, doctor Jambacar, I'm going to be awake at night thinking about potentially having to get another biopsy sometime in the future, and I want to remove both breasts. And if that's the case, then you know, that's your decision now, you know.
For me, I have a lot.
Of different tools to help my patients have the best recovery possible, and one of them is something called an experal peck block, which is like a numbing injection that gets done to the muscle, the peck muscle, which is the muscle that's behind the breast, and that medication lasts for like seven days, and so typically my patients go home the same day after a two to three hour surgery and they're able to do their normal activities shower,
wash their hair, et cetera. The next day, and most of them take zero opioid pills at all because of that medication.
It blocks the pain receptors.
It blocks the muscle, it numbs the whole muscle, and so it numbs the breast tissue in front of the muscle. And it's really something that's been used that most places in the country, but not everywhere it should be used everywhere.
In New Mexico.
Mine is actually the only hospital and the only surgeon who's doing it, and I'm hoping to spread that message so.
More people do it. I know in La quite a few people are doing it, but I think.
That it is It's something that has been a huge game changer, especially in the last couple of years since the pandemic started, to make the recovery better for patients who have breast cancer. And then you know, the next day you could be walking around, showering, moving your arms,
doing all of your normal stuff. Usually you will feel kind of sore for probably two or three weeks, but this helps tremendously because it really takes the edge off the first few days, and patients do sometimes need ice pads or tilenyl and advil to kind of get them through that.
And then the.
Reconstruction process, which sometimes can be started at the same time as removing one or both breasts, sometimes needs to be done in a separate surgery. It just sort of depends on what type of reconstruction the patient chooses.
I see, so in some cases, if you have to have your breast removed, you can have the reconstruction done in that same operation.
You can.
But something I always counsel patients is, even if you're able to start it at the same time, oftentimes there is a second surgery or maybe in an office procedure or something that's needed because remaking breasts is a work of art and making sure everything's symmetric, either with the side you still have left or making both sides of the same like this not like this right, Like that's that's a work of art, and it takes it takes a
very skilled plastic surgeon who's extremely dedicated to reconstruction to do a good job.
And sometimes it can take.
You know, up to a year to do all the procedures that are done to where the patient and the plastic surgeon everyone's happy with how things are.
And so it's an art.
We don't want to rush that process, but sometimes it can be started and most of it done, you know, at the time of the mask stept tomy.
Wow, so interesting. Well, first of all, how often should we be giving ourselves self exams, which means feeling around the breast for any unusual lumps that are new.
Right, I'm kind of like, I'm not a huge proponent for self breast exams. I think that it's important to be kind of aware of what your breasts feel like, you know, once every few months, kind of examine yourself in the shower. But you know, I think that the old teachings that you should be doing a self breast exam once a month isn't really what we follow now because self breast exams don't catch cancers very often, and more often than not is the imaging that catches it.
So for me, you know, with my patients, I really stress the importance of regular mammograms and if you are high risk, getting enrolled in a high risk breast clinic where they can watch you more often. But just in general, having an awareness of what your breasts feel like, you know, once every few months, I think is totally okay. And I also often have patients that come seeing me after having being dinosed so the breast cancer say, you know, Douc,
I didn't feel anything. I don't really do breast exams, And I tell him, you know, no reason to feel bad about that, Like that's okay, you went and got your mammogram and now we're here, so I'm really happy that you got your mammogram.
Yeah, because sometimes it is an indicator to someone that something might be awry, so it is the impetus for them to go into the doctor. What are some other warning signs, say, we're not checking our breast warning even if we do, we didn't feel Are there other signs that women should be aware of.
Yeah, so nipple discharge, like new onset nipple discharge on one side in particular, especially if it's bloody, that's something that you need to get some breast imaging for. And oftentimes breast pain. You know, if you feel a new pain somewhere, especially if it's just in one spot not the whole breast. Whenever I see patients with breast pain, I go ahead and order an ultrasound just to check it out and make sure there's nothing going on as well.
And then also if you have any kind of skin changes, so skin looks kind of stick in one spot, nipples, kind of itching and scaling, all of that stuff should be checked out with breast imaging.
Such a good information. I didn't know any of that. Thank you.
What is the one thing you would say that you hope our listeners take away from this conversation that we've had today.
I think you've already sort of touched on it, which is that it's so important for women to advocate for themselves. So if you have a high risk family history, ask your primary care doctor to refer you to a hig risk breast clinic so you can talk about genetic testing, maybe get diagnosed with something like Bracco one and two if that's running in your family.
Or just be watched more closely.
And if you feel a lump, advocate for yourself to get some type of imaging, a mammogram, an ultrasound, something, because no one's physical exam is good enough. So it's really important for women to use our voices because we already don't get heard enough. So advocate for yourself, educate yourself. And that's really my mission. I try to post a lot of stuff on social media so that way I can help women advocate for themselves.
Yeah, I mean it's so easy. I've been in this position to be in the doctor's office and them to tell you whether something's wrong or something's not wrong. Either way, I think to myself, well, they're the doctor, they must know. I guess I'll just go with that.
Well, here's the dirty little secret we don't know. And as a doctor, like we you know, physical exam and looking at how a patient looks and trying to put the pieces together with what they're telling you. It's those are great tools, but they're not everything. And if you, as someone who's seeing a doctor, feel in your gut that you know they're not hearing me, they don't know the whole story, something must still be wrong. Like, don't be afraid to get a second opinion. You know what
we talked about earlier. Find a female physician that will be willing to listen to you.
Yes, go, ladies. We need more female doctors, more female surgeons, more females everywhere we do.
We absolutely do in every field, we will benefit from having more women.
Before I let you go, doctor Amani, I want to know what was your last I choose me moment.
I would have to say that it was today doing this podcast. So I spoke to my clinic team and I was like, listen, I have this really exciting opportunity to be on Jennygart's podcast. I'm really excited about meeting her. So if you can just make sure that I can get home on time so I can participate. And that's how I'm choosing me. And they made it happen and I was able to be here today. So I'm so excited for this opportunity. Thank you so much for having me on.
Oh I love that.
I love that because this is the greatest opportunity for you to educate more women, and I know that that's so important to you.
Yes, it is.
That's definitely my mission, not just in my clinic, but also the women out there on social media to try to help them, help empower them to advocate for themselves.
As the mother of three women, I thank you from the bottom of my heart for all that you do and the education that you're dispensing to people.
Well, I really appreciate everything you're doing and all of the information you're providing through your podcast and helping me have this platform to talk to women and so we can get more women to get their mammograms.
Yes, yes, thank you so much for your time. I hope you have a great night you too. All right, take and enjoy your flown.
Oh, thank you, just delicious. You got to give it another chance.
I'll come and see you and we can have some flawn together. I think that'd be a good idea.
That if you haven't been to Santa Fe recently been to Santa Fe.
Oh my gosh, you're missing out. It is such a magical city.
I got to tell you I moved here from Houston, and I was like, oh my god, I strongly recommend you come.
I love that of ringing endorsement. Yes Santa Fe, yes okay, and mammograms yes both okay.
Thank you so much, thank you for having me on.
I want to thank doctor Ramani John Bacar for coming on our podcast today. I know none of us like to talk or think about cancer, but it is important for all of us to understand the warning signs and understand why it's crucial for us to get our mammograms. As we continue to choose ourselves each week, I want to challenge you this week. It's going to be an obvious one, but maybe this conversation has inspired you. I want to encourage you to have that I choose me
moment and get your mammogram. Or maybe you and a friend, or you and your sister, or you and your daughter go get them together, make a mammogram date out of it. I encourage you to share your story and your mammogram experience on our social media and use the hashtag I Choose Me. Let's all inspire each other and be brave and look out for each other and for our bodies.
Thanks for listening to I Choose Me. You can check out all of our social links on our show notes, rate us, review the podcast, give us your comments, tell us everything you want to tell us, and don't forget to use the hashtag I Choose Me. I'll be right here next week. I hope you choose to be here too,