Episode 74 - Breast Cancer Screening - a podcast by Rio Bravo Family Medicine Residency Program

Episode 74: Breast Cancer Screening. 

Salwa and Veronic discuss who, how, and when to screen for breast cancer. The Pfizer COVID-19 vaccine was authorized for use in children 5-11 years of age.

Introduction: Pediatric COVID-19 Vaccines
By Lam Chau, MS3, Ross University School of Medicine

On November 2nd, 2021, the CDC endorsed a unanimous recommendation to allow the use of the Pfizer COVID-19 vaccine for children ages 5-11 years of age. The White House has secured 28 million pediatric doses of the Pfizer vaccine, enough to cover every child ages 5-11 within the United States without cost. 

The official CDC recommendation is that all children aged 5 and older get vaccinated, regardless of past infection history. The Pfizer vaccine for children is given in two doses, 3 weeks apart.

Individuals older than 12 are given a 30-microgram dose, while pediatric individuals are given a 10-microgram dose. For extra precaution, the pediatric vaccine vials are being shipped with a unique orange cap to clearly distinguish itself from higher dose vaccines. Clinical trials with the lower dose vaccine demonstrated a strong antibody response and a prevention rate of symptomatic COVID-19 of 90%. 

The reported side effects were minimal, and no serious adverse events or myocarditis were reported during the trials. The vaccination of children cannot be understated. The benefits go well beyond just the physiological processes of vaccination. It will foster a safer environment for our children and help improve their emotional and social development. 

While there is still a lot to be done to end the pandemic, this recent announcement is an enormous step in the right direction in returning to normalcy. 

This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. 

___________________________

Breast Cancer.   
By Salwa Sadiqali, MS3, Ross University Medical School; Veronica Phung, MS3, Ross University School of Medicine; and Hector Arreaza, MD.  

 

Salwa: Welcome back from Spooky season! Did you see all the flyers and advertisements about Breast cancer awareness last month? 

Veronica: I did! It’s because October was breast cancer awareness month.

Salwa: And spooky season, and of course pumpkin spice season! I got my dose of pumpkin spice this morning. Well, every morning to be exact, Starbucks is my second home. What do you know about breast cancer? 

Veronica: Well...breast cancer is the most commonly diagnosed cancer worldwide. And, fun fact, I know that Angelina Jolie had an increased risk of breast cancer, so she had surgery to remove them.

Arreaza: I remember it being all over the news back in 2013. It caused “The Angelina Effect.” There was an increase in people searching about breast cancer on the internet. Let’s dive into this topic a bit more. What exactly is breast cancer?

Salwa: It’s a process in which normal cells of the breast start growing too quickly, out of control. It can happen in males too, but it’s much rarer.

Veronica: And there are different types of breast cancers that originate from the different types of tissue in the breast. There’s ductal carcinoma, lobular, inflammatory, Paget’s, and phyllodes to name a few. 

Salwa: Not only are there different types of breast cancers, but some can also be hereditary meaning mutated genetic information is passed on from generation to generation.

Arreaza: That’s what happened with Angelina Jolie. She had a BRCA1 gene mutation. 

Veronica: BRCA1 and BRCA2 mutations are the most common causes of hereditary breast cancer. Normally, the BRCA gene helps make proteins that repair damaged DNA. When this gene is mutated, it can’t make those proteins, so damaged DNA stays damaged. But this only makes up 5-10% of all breast cancers.

Salwa: Exactly! Here’s an interesting fact, women of Ashkenazi Jewish heritage are at a much higher risk of developing a BRCA mutation. There are several other genes that are also linked to hereditary breast cancer. But those genes aren’t that common. Non-hereditary breast cancers are much more common - they make up about 85% of breast cancers. 

Arreaza: Ok so you two gave us a lot of good information, but do you know how to screen for breast cancer?

Salwa: When and how often you screen depends on which guidelines your physician is following. Generally, you’ll get a mammogram, basically an X Ray of the breast. 

Veronica: The US Preventative Screening Task Force or USPSTF is a panel of experts that uses medicine-based evidence to make screening and vaccination guidelines. These guidelines are reviewed and updated yearly. For breast cancer, the USPSTF recommends women ages 50-74 have a mammogram every other year. 

Salwa: The American College of Obstetrics and Gynecologists recommends mammograms starting at the age of 40 and repeating the test every year or every other year. While the American Cancer Society recommends annual mammograms from 40 to 54 years of age and then every other year for women 55 years or older. 

Veronica: Dr. Arreaza, you see a lot of patients and I’m sure you’ve referred plenty of them for breast cancer screening. How do you decide which guidelines to follow? 

Arreaza: When you have a patient between 40-50 years old, you have an opportunity to talk about screening, and make a shared decision. 

The USPSTF recommends that women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or an ancestry associated with BRCA1/2 gene mutation be screened with an appropriate brief familial risk assessment tool. Women with a positive result on the risk assessment tool should receive genetic counseling and, if indicated after counseling, genetic testing.

Some instruments use to assess the need for BRCA mutation screening include Ontario Family History Assessment Tool, Manchester Scoring System, Referral Screening Tool, Pedigree Assessment Tool, 7-Question Family History Screening Tool, International Breast Cancer Intervention Study instrument (Tyrer-Cuzick).

Salwa: What about the self-breast exams? I remember those were recommended all the time.

Veronica: That’s a great question! Current research suggests that doing a self-breast exam doesn’t necessarily help detect tumors early – whether cancerous or not. And, sometimes, while doing self-breast exams you may feel a lump that’s actually normal breast tissue and it may cause unnecessary anxiety. That being said, you should always know how your breasts normally look - as in are they symmetrical, how the nipples look, how the skin normally looks. And of course, if you notice any changes or have any concerns, please visit your primary care provider. 

Arreaza: Breast awareness. The USPSTF recommends that clinicians offer to prescribe risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, to women who are at increased risk for breast cancer and at low risk for adverse medication effects.

Salwa: As medical students, we have the opportunity to work with different departments in the hospital. I’m currently doing my surgery rotation and Veronica completed hers in September. As part of the rotation, we had the opportunity to work at the Breast Clinic with Dr. Snyder. We saw a lot of patients from CSV because their PCPs were screening them for breast cancer and all those women were able to get the higher level of care they needed. Find available resources in your community for free screening mammograms. For example, Cancer Detection Program/Every Woman Counts by Clinica Sierra Vista.

____________________________

Now we conclude our episode number 74 “Breast Cancer Screening.” October was breast cancer awareness month, but it is not too late to remind everyone of the need to screen for breast cancer. Whether you follow the American Cancer Society, the USPSTF or the ACOG guidelines, just do not forget to screen. Even without trying, every night you go to bed being a little wiser.

Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Lam Chau, Salwa Sadiqali, and Veronica Phung. Audio edition: Suraj Amrutia. See you next week! 

_____________________

References:

AAFP Signs Off on Pediatric COVID-19 Vaccine Recommendations, American Academy of Family Physicians, November 3, 2021. https://www.aafp.org/news/health-of-the-public/20211103covidvaccchildren.html?%20cid=DM63464&bid=188450701

 

ACS Breast Cancer Early Detection Recommendations. American Cancer Society. (n.d.). Retrieved October 11, 2021, from https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html.

 

Basu, N.N., Hodson, J., Chatterjee, S. et al. The Angelina Jolie effect: Contralateral risk-reducing mastectomy trends in patients at increased risk of breast cancer. Sci Rep 11, 2847 (2021). https://doi.org/10.1038/s41598-021-82654-x

 

Breast cancer information and support. Breastcancer.org. (n.d.). Retrieved October 10, 2021, from https://www.breastcancer.org/.

 

Breast cancer: Screening. Recommendation: Breast Cancer: Screening | United States Preventive Services Taskforce. (2016, January 11). Retrieved October 10, 2021, from https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening. 

 

Practice Bulletin Number 179: Breast Cancer Risk Assessment and Screening in Average-Risk Women. (2017). Obstetrics and gynecology, 130(1), e1–e16. https://doi.org/10.1097/AOG.0000000000002158

 

Further episodes of Rio Bravo qWeek

Further podcasts by Rio Bravo Family Medicine Residency Program

Website of Rio Bravo Family Medicine Residency Program