00:00Hi, it's Nicole from 92.5 XTU, and I'm Marissa from the Preston and Steve Show on 93.3 WMMR.
00:09And we're joined today by Dr. Nicole Milkiewicz, a breast surgeon at Virtua Health and part of the
00:15Penn Medicine Virtua Cancer Program, which is based in South Jersey. How are you today, doctor?
00:20Good, thanks. How are you guys?
00:22Great. I mean, clearly, best name ever, you too, Marissa, but I mean, two brilliant Nicoles on
00:28the call. I mean, one talks for living, the other saves lives. We got this. I always say, like,
00:35not curing cancer here, people, and this doctor is. So there we go. So you have one rying up on
00:41the Nicole scale for me. Well, Dr. Milkiewicz specializes in treating breast cancer, but let's
00:46start with cancer prevention. Should every woman be getting mammograms regularly? I think we know
00:51the answer to this one. Yes, definitely. So we do recommend that women would have a mammogram
00:58done every year, and we recommend starting at age 40. There's actually great news. The U.S.
01:05Preventative Service Task Force finally just updated their recommendations to agree with
01:10the other cancer societies. So now everyone is in agreement. Age 40 is the time to start,
01:16and we recommend every year. Because it used to be multiple years, correct? In between?
01:22Mm-hmm. There were some other organizations that were recommending maybe starting later
01:29or every other year, but we now know that annual mammograms save the most lives, and that is the
01:38way to go. Important message. Absolutely. In fact, one of my old coworkers, she was just diagnosed,
01:43and she said that it was stage one, but the spot wasn't there a year ago when she got her yearly
01:48mammogram. So she's doing great, thank God. But like, this is literally, she just texted me like
01:53a couple weeks ago about it. So let's talk about self-exams. How often should we be doing those?
01:59So we used to always recommend that women do self-exams once a month, but there's been some
02:06concern that that can cause a lot of people anxiety. They may not really know exactly what they're
02:11feeling. So we try to talk more now about having self-breast awareness, meaning just to know how
02:20your breast normally looks when you get out of the shower, or to have a general idea of how your
02:25breasts usually feel is really more important. That way, if there may be a change, that would be
02:33something you could report to your doctor. But I always tell my patients that, well, I think that is a
02:39really good thing to have that self-breast awareness. The most important thing is getting
02:44that mammogram every year, because as you said, you know, the great news about mammograms is we can
02:49catch cancer at an early stage when things are really small. I mean, years before it would be big
02:56enough to feel. Right. So, and, you know, I do always give patients that caveat, but I think knowing
03:02what's normal for you can be very helpful. Yeah. And the technology now is amazing with the research
03:09and the science. So the technology of 3D, 4D mammogram and the machines we have, like, sometimes
03:16I don't think women realize how important that is and what the technology has done over the last few
03:21years that they can detect things in a very early stage. Yes, exactly. Which can lead to smaller
03:28surgeries, sometimes even people not needing chemotherapy or needing less radiation. So
03:35the earlier we can diagnose something, the better. Wow. Well, speaking of technology, if a patient has
03:41been told they have dense breasts, is there a test that they can take that is different than a mammogram?
03:47Yes, that's a great question. We get that a lot. So many women have dense breast tissue that is just
03:53based off of how their tissue looks on the mammogram. It's very common. It's just what some people are born
03:58with. You can't change it. Unfortunately, people that have dense breast tissue, that is one of many
04:06risk factors for breast cancer. And the thing that's tough about that is it can make certain things harder
04:14to see on a mammogram. So a mammogram is still important for showing us some findings, but any woman that has
04:21dense tissue, we would talk to them about the option of doing some extra screening that's in addition to
04:28the mammogram. So if someone qualifies, we could potentially do a breast MRI. You have to have a
04:37certain risk of breast cancer in order for insurance to cover that, unfortunately. But if someone has dense
04:45tissue, even if they're not in that high risk category, they could consider having an ultrasound.
04:50So that's something that we order frequently, which is so, again, goes back to the technology
04:57and the options that you have now. What about if you have breast implants? Should you still do a
05:01mammogram? Yes. Yes, you definitely should still continue with annual mammogram. They can still see
05:08what they need to see. They will move the implant around. It may not be the most comfortable thing,
05:13but I would definitely recommend they still have that done. Yeah. All right. Now I've been wanting to ask
05:18both our shows are very entertainment driven. We are always scouring the news. And when a woman talks
05:24about her health, our alert, you know, go up and we want to share all the news. Now, Olivia Munn last
05:31year talked about a risk calculator that she had taken. It was a test and the test. So I'm going to
05:38read the story here. So when she was in the news, it's because her doctor had said she had a complete
05:43breast cancer risk calculator, which led to her getting more tests and finding breast cancer.
05:49Tell us about this risk calculator. Is it something that virtual practices?
05:53Yes, definitely. So we see a lot of women, of course, that have cancer, but we also see a lot of women
05:58who don't have breast cancer who may have dense tissue or other benign breast problems or a family history of
06:05breast cancer. So we always perform this risk assessment for almost all our patients that we seek.
06:12So that's something that we can do. It is a calculator that uses many different factors
06:19to estimate a woman's lifetime risk of breast cancer. And if that risk is above 20%,
06:28that qualifies a woman to have that extra screening with MRI. And we follow all of those patients annually
06:36in our high risk clinic.
06:37That's interesting. Yeah. So what are a few risk factors?
06:43So there are a lot of risk factors that unfortunately we cannot control, which a lot of those are hormone
06:51related. So if a woman has ever had pregnancies and had a live birth at an older age, that's a risk
07:00factor compared if you're at a younger age, when you have your first baby, women that are at an older
07:05age when they go through menopause is a risk factor. When they're at a younger age of starting their
07:11menstrual cycles, that's a risk factor. And then there are many other things, breast density as well
07:18as a big one. Some factors we can control. Those would be things like smoking. There's been some link with
07:28alcohol use. There's also a link with breast cancer and weight. So women who are overweight do tend to
07:36have higher rates. They've also found people who exercise can have lower rates. So it's a combination
07:44of things that we can and cannot change.
07:47Yeah. And then I'm assuming obviously the genetic factor, right? If it runs in your family,
07:51the BRCA gene, a lot of women are very aware of that. My cousin, unfortunately passed away from
07:57breast cancer and she had the BRCA gene, but this was 14 years ago and it wasn't as widely tested
08:02even 14 years ago that it was now. Right. You're exactly right. I think now we have,
08:07we know so much more about genetics than we knew even, you know, 10 or 14 years ago. So we do also
08:14have a genetics program at Virtua where if a woman does have a family history of breast cancer,
08:21we can have them meet with genetics, get the testing done. And if it comes back to show a gene
08:26mutation, we can talk to them about how do we manage that? What are your options? You know,
08:31what are the next steps? So we also see a lot of patients with that situation too.
08:37All I'm hearing is listen to your doctors and get that exam. Now, if somebody has a
08:44suspicious mammogram finding, what are the next steps? How do they find the perfect program?
08:50So if somebody has an abnormal mammogram, then typically the next step for many would be
08:58to be referred to a breast surgeon for evaluation. Here, we work very closely with our radiologists
09:04to review imaging. If a woman needs to have a biopsy, you know, of course we arrange that to be done.
09:11I think the important thing is, especially if we're dealing with something that looks like a cancer,
09:15you want to go to a place that has a lot of experience with treating breast cancer. So you
09:20want to look for, you know, doctors that are trained in breast cancer care, not only the surgeons, but at
09:28Virtua, we also work very closely with our medical oncologists, radiation oncologists, and plastic surgeons
09:35as part of the Virtua Penn program. So I think it's important, you know, the surgeons are one piece,
09:43but you want to go somewhere where you're going to have that whole team that's taking care of the
09:48patient. Yeah, sure. So the Penn Medicine Virtua Cancer Program is located in South Jersey with
09:55offices in Morristown, Voorhees, and Washington Township. And this is your reminder to get and schedule your
10:03yearly mammogram. And by the way, we're going to put a link to that quiz in our webpages so that you can take it
10:10yourselves too. But if you are concerned about a lump or a positive mammogram, the team at Virtua Health will
10:15get you in to see a breast cancer specialist within 48 hours. And honestly, that's sometimes unheard of,
10:21because some people have to wait months and months and months to see a specialist. So this is priceless.
10:26Yes. Well, to schedule your mammogram or to make an appointment, visit Virtua Breast Care and the Penn
10:32Medicine Virtua Health Care Program. All you have to do is visit Virtua.org. Thank you so much,
10:38doctor, for joining us for today's Virtua Stay Well Health chat. We're going to help lots of people out
10:44there. As always, share this with your friends and your loved ones, because you've got to look at your
10:49mammogram and tell everybody to schedule theirs as well. Don't be afraid to check out your boobs.
10:53Have you been looking at yours the entire time? Oh, yeah. I always have. I think women are always
10:58like, oh, we have to be modest. I was like, I'm always, I'm always checking. How do they look?
11:03What's going on? Thank you for everything that you do, doctor. We appreciate you.
11:07Thank you so much. Thank you. Thanks for having me.
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