Podcast Breast Cancer Myths Debunked

Dr. Bea: ​ Most recently, guidelines are encouraging that women starting at the age of 25 obtain a risk assessment. And that risk assessment is really pulling important information about family history, personal history, and other factors. And if one is identified as being more than average risk, for example, high risk, we know that screening should actually occur well before the age of 40, and in some cases starting at age 25. 

Courtney:  Welcome to Health Matters, your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Courtney Allison. 

For Breast Cancer Awareness Month, I talk with Dr. Vivian Bea and Dr. Evelyn Taiwo. Dr. Bea is Chief of Breast Surgical Oncology, and Dr. Taiwo is a medical oncologist at NewYork-Presbyterian Brooklyn Methodist Hospital and Weill Cornell Medicine.

With breast cancer on the rise among younger women, we discuss risk factors and the importance of screening. Dr. Bea and Dr. Taiwo also answer common questions about breast cancer, such as what age you can stop screening, and if factors like deodorants or cell phones can cause breast cancer.

Courtney: ​Dr. Bea and Dr. Taiwo, thank you so much for joining us today.

Dr. Bea: Thank you for having us.

Dr. Taiwo: Yes. Thank you.

Courtney: So to start, how common is breast cancer and what are some of the major risk factors? Why don’t we start with you, Dr. Bea?

Dr. Bea: So breast cancer is the number one diagnosed cancer in women. And the common statistic that we often hear is that one in eight women will be diagnosed in their lifetime of breast cancer. And so it’s common and I think that’s where it’s important to understand the statistics as it relates to breast cancer because, when we talk about screening, it’s important that we catch these breast cancers at their earliest stage.

Courtney: How much of the risk can be modified through things like lifestyle choices?

Dr. Bea: We know that there are modifiable risk factors as well as non-modifiable risk factors. And so for the modifiable risk factors, those are the factors that you have some control over. We know that, alcohol use, for example, is a risk factor. We know that there has been some recent news about alcohol consumption and that there are carcinogens that are in all types of alcohol. We know that smoking increases the risk of carcinogens in the body and therefore risk of breast cancer as well as other cancers.

Another important modifiable risk factor that we really have been able to pinpoint over the most recent years is overweight and obesity. We know that overweight and obesity can cause a lot of comorbidities—diabetes, high blood pressure—but guess what? It also increases the risk of cancer and in particular breast cancer. And so our programs here have focused on really looking at those opportunities to address the modifiable risk factors. 

Courtney: I think we’re seeing in the news a lot younger women being diagnosed with breast cancer. Do you have any comment on why that might be happening? Maybe Dr. Taiwo, do you wanna take this one?

Dr. Taiwo: I think the reason why that’s happening is still unclear. I think it’s a question we’re all asking. I mean, we can, you know, speculate the fact that we’re also screening. We do now realize that there’s certain groups of women who are at higher risk than other women. So we’re screened at earlier ages in women who are considered high risk, whether it’s based on family history and other factors that go into it. So I think we’re screening more, but we are definitely seeing, um, patients diagnosed early in breast cancer, other cancers as well. And I think, you know, the research is ongoing to find out why that is.

Courtney: Are the risk factors for breast cancer different from other cancers?

Dr. Taiwo: That’s a great question. I think we know in general, there’s certain things that increase your risk of all types of cancers, like Dr. Bea mentioned earlier. We do know obesity, alcohol, red meats, those are things that increase your risk of breast cancer, colon cancer, other types of cancers.

We do have data showing that women who’ve never had children, who’ve never been pregnant, have a slightly higher risk of breast cancer. Obviously having some genetic predisposition—so if you have inherited genes that could increase your risk of breast cancer. Those are sort of the, the main ones. But in general, cancers have very similar, um, risks associated with it. Obesity, alcohol, certain foods, exposures to carcinogens.

Courtney: So how important is it to get screened for breast cancer?

Dr. Bea: It is so important to get screened. We talked about the statistics as far as breast cancer incidence, in women in the United States. We also know that we have tools, where we can identify breast cancer at its most earliest stage, and in doing so, it improves significantly survival. And so screening is important, but it’s also important to understand who gets screened and when. So we know that average risk women start mammogram screening at the age of 40. Our breast societies really do support annual mammogram screening. And the reason is we know that breast cancer can develop between screenings and so pushing it off for two years or even more, is not really the best strategy to catch breast cancer at its earliest stage.

Now, I said average risk women should start at the age of 40 and continue annually. But how do we know whether we are at average risk for breast cancer? Most recently, guidelines are really encouraging that women, starting at the age of 25, obtain a risk assessment.

And that risk assessment is really pulling important information about that individual into a calculator that helps us determine who is most at risk. And within that calculator, there’s information about family history, personal history, and other factors. And if one is identified as being more than average risk—for example, high risk—we know that screening should actually occur well before the age of 40, and in some cases starting at age 25. So you have to really have a risk assessment, to really determine the best time to screen for an individual.

Dr. Taiwo: Yeah, I just wanted to just support that and reiterate the importance of screening. Screening is important. Screening saves lives. The reason why screening is important is: for most cancers, if you’re able to diagnose it at an earlier stage, then the prognosis is significantly better. The prognosis of a stage one breast cancer or pre-invasive breast cancer is significantly better than a breast cancer that’s diagnosed at a later stage. So screening allows you to diagnose a breast cancer when it’s early stage. Before you, for the most part, can feel something in the breast. 

Dr. Bea: I have another thing to add, because we get this a question in the community that, Hey, you know, I am 75. Do I need to still get a mammogram? And really the data is clear, that, as long as that person, who is 75 or older, is willing and able to undergo treatment if a cancer is found, then they should continue to get their annual mammograms. Look, we’re catching breast cancers in women who are in their eighties, women who are in their nineties, who are actually quite functional. And so, um, age should not be a determinant alone. There are many factors to consider, uh, as it relates to mammogram screening.

Dr. Taiwo: That’s absolutely important. Yeah.

Courtney: Yeah, thank you for saying that. Um, what do you tell women who are putting it off or kind of like, oh, I don’t really wanna do that this year.

Dr. Taiwo: Yeah, I know for me, the conversation I have with patients is that, you know, the dread is also the fear of actually finding something. And so I tell patients if we find something, we can do something about it. Delaying screening increases your risk of a higher stage where there’s lymph node involvement, where the lesions are bigger. I think it’s important to acknowledge the fear that patients have about finding an abnormality. Um, but I think it’s also important to encourage people that if there is an abnormality, it’s very likely treatable and you’ll be fine. And so, I wanna know what’s going on in my breast so that if there’s something in there, we can do something about it that doesn’t have to affect my quality of life for the rest of my life.

Dr. Bea: We have actually looked at this in different populations—the question of mammograms and the fear associated with it. And, Dr. Taiwo is absolutely correct. One of the components is the fear of finding something. 

But there are other components, uh, and some of those include fear of pain. During the actual mammogram. And, you know, ways to mitigate that are a few things. One is for premenopausal women to really think about, you know, their menstrual cycle and the timing of the mammogram because the breast tissue can be really sensitive during different fluctuations of hormones. So that’s one.

The other one is, um, with fear, it’s important to have support. And so having a buddy system we found is really helpful in helping women achieve that goal of getting their mammogram every year if they go together, if they have a spa day, if they go out to lunch, they make a thing out of it every year to address the fear together, but also to hold each other accountable to get that mutual goal complete.

Courtney: Maybe we could talk a little bit about what breast screening entails. We’ve talked about mammograms. There’s also sonograms, MRI, maybe self exams. Can you break down a little bit the different screening methods and why they’re important?

Dr. Bea: So we’ll start with the easiest, which is breast self examinations. In our practice, we encourage our patients to do their self-breast exams because fortunately, patients can catch a palpable mass, right? We do believe that no one knows your body like you do. Right? 

And so if you feel something or if you are checking and you know what your baseline is. I always tell patients when you go and see your your breast specialist and they do a breast exam, do a self breast exam right after because you can be a little bit more reassured that that’s normal. Then self breast exams every month so that if you recognize that there’s something different, a change in your body, you can actually speak up and advocate for yourself.

So that leads me to mammograms. The way that we look at breast tissue is with an x-ray called a mammogram for calcifications and changes in the breast. The next modality is an ultrasound or a sonogram. And we use those names interchangeably, and that’s when the breast tissue is looked underneath this probe to see if there are any changes like a mass that can then be biopsied.

And then finally, MRI is a great tool for detecting breast cancer, but we have to note that it’s not a great tool for screening alone, unless you’re identified as high risk. And the reason is that MRI is really great at picking up changes in the breast, but it’s not great at telling us whether that’s something to be concerned about.

Courtney: Thank you so much, so I wonder, could we go through some common myths together and maybe dispel them?

Dr. Bea: Sounds like a plan.

Courtney: Okay, so: no family history of breast cancer equals no risk.

Dr. Taiwo: So that’s definitely a myth. Most patients assume that if there’s no breast cancer in the family or there’s no inherited breast cancer causing gene, that their risk is minimal. We do know that majority of cancers are actually not diagnosed in patients who have this extensive family history. Only about 5 to 10% of breast cancers are associated with some inherited gene in the family. 

Courtney: OK, how about: No lump equals no cancer.

Dr. Bea: Not true. Early stage breast cancer typically does not develop as a lump. For example, mammograms detect calcifications. You will not feel a calcification by doing a self-breast exam. You can still have breast cancer without having a lump, which is why it’s so important to get that annual mammogram in addition to doing your breast checks.

Courtney: How about: the radiation from mammograms cause cancer?

Dr. Bea: When we wanna actually quantify how much radiation you get from a mammogram, it’s essentially the same as getting on a plane and flying cross country and back, which we all do, right? So for, for that radiation exchange in detecting a breast cancer at its earliest stage and increasing the ability to survive, we believe that it is a small quantity of radiation that you’re exposed to.

Courtney: So we’ve touched on this a little bit, but how about a myth like: I don’t have to get a mammogram until I’m 50 years old.

Dr. Taiwo: The general guidelines and the consensus is age 40 is the age to get screened for a woman who’s considered average risk. The average age of breast cancer diagnosis in the US is about 61. But in certain communities it’s actually younger. We know in black women, um, they tend to be younger when they’re diagnosed with breast cancer and then when they get diagnosed with a more aggressive form of breast cancer, these women are often much younger. So assessing what the risk is, there are patients who need to get mammograms as early as age 25, but generally the consensus is age 40.

Courtney: Does risk actually increase with age?

Dr. Taiwo: Yes. Cancers are cells that are dividing and mutating in the body, and as you get older, the risk of an abnormality happening while normal cell generation is happening in the body, the higher the likelihood of mutations and cancer development. 

And even going back to that age thing, I think a lot of that really was, if you think about it, just this general discrimination of older people in medicine. I think there’s just always this assumption: you’re older, there’s really no need to worry about your general health. We’re living longer now. We’re more aware of our bodies and what it takes to be healthy. So if a patient is older, but they’re functional, they’re active, they’re still part of society. There’s no need to treat them differently than you would treat someone who’s younger.

Courtney: So how about: men don’t get breast cancer?

Dr. Bea: Not true. Men actually have breast tissue. And we know that 1% of the population in the United States, men, will get breast cancer. What we really should take away though is that because men don’t have the opportunity to get mammogram screened, typically the partner will find a palpable mass, so there’ll be a change in the skin or a nipple discharge or nipple changes, and that is the first sign of clueing us in, but then the cancer has grown. And so, uh, you know, the takeaway is I think men should also do their own breast exams because men do have breast tissue and can develop breast cancer.

Courtney:  Any other myths you hear that you’d like to dispel?

Dr. Taiwo: I still get questions periodically where patients are concerned about the use of deodorant. They’re concerned about underwire bras. They’re concerned about cell phone use and how that increases the risk of breast cancer. And I think those are all valid concerns, but we don’t have data showing that the use of deodorant, or the use of a cell phone, or underwire bras increase the risk of breast cancers.

Courtney: That’s good to know. I’ve definitely heard the deodorant one and I’ve been concerned about that. Thank you. OK, so last myth: I am healthy so I won’t get breast cancer.

Dr. Taiwo: We do get patients who show up really concerned about, I don’t drink alcohol. I work out all the time. I do what I’m supposed to do and I still have breast cancer. Sometimes, and most times, cancers occur because they do. You know, whether it’s your predisposition, whether it’s the environment that you’re in that you have no control over. So being healthy definitely reduces your risk. Patients who exercise, patients who eat healthy, and patients who are very aware of things that need to be done to stay healthy are doing things to reduce your risk. Risks doesn’t necessarily mean cause. So you could be doing things to reduce your risk doesn’t necessarily mean you won’t get cancer, but at least you’re doing what you can to reduce that risk. 

Oftentimes it’s not ’cause you did something wrong. These things just happen ’cause the cell sgo outta control. And so if we’re able to identify the cells early, if you’re doing the things to mitigate your risk, you’re doing what you can. And then the rest is really just what happens in the body and things that researchers are trying to figure out—how do we actually prevent cancers from happening? Um, so that’s the work for us clinicians, work for researchers, but being healthy helps reduce your risk. Doesn’t prevent you from getting cancer.

Courtney: These are such important messages. Dr. Taiwo, Dr. Bea, thank you so much for this conversation and all this just amazingly helpful information for people. It’s always such a pleasure to talk with you.

Dr. Taiwo: Thank you. 

Dr. Bea: Thank you for having us. This was amazing.

Dr. Taiwo: yes, yes, yes. 

Courtney:  Our many thanks to Dr. Vivian Bea and Dr. Evelyn Taiwo. I’m Courtney Allison. 

Health Matters is a production of NewYork-Presbyterian. 

The views shared on this podcast solely reflect the expertise and experience of our guests. To learn more about the work that Dr. Bea and Dr. Taiwo do with patients, check out our show notes. New York Presbyterian is here to help you stay amazing at every stage of your life. 

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