00:00:00:00 - 00:00:21:21 Unknown Welcome to the next installment of Live Well with UCI health. My name is Gina Grad. I'm from 98 seven and iHeart radio, and I'd like to introduce Doctor Tsai. It is so great to have you here. Thank you so much. Let me do a little bragging about you. And if I leave anything out, please fill us in. Board certified breast radiologist and director of breast imaging at UCI health. 00:00:22:02 - 00:00:49:18 Unknown That sounds about right. Sounds right. Okay, wonderful. Also an associate professor at the UC Irvine School of Medicine and chief of breast imaging for the Department of Radiological Sciences. Oh, I'm tired of him saying that. That's amazing. Thank you. Thank you for having me. Of course. So many important questions and such an important topic for half the population, but I have to ask you a personal question right off the bat. 00:00:49:20 - 00:01:05:10 Unknown What is dense breast tissue, and why am I always asked if I have it whenever I go in for a manicure? It's the first thing I'm asked. I'm like, I don't know. Thank you. Normal question. Thank you for that. And we get this question all the time, okay. All the time. Every day. I get it every day. 00:01:05:10 - 00:01:25:20 Unknown Okay. Tell me what would how would we know if we have it? And what do we say? Yes. So? So, listen, every woman has breast tissue made up of this fiber. Glandular, fibrous tissue and fatty tissue. Right. Okay. And the percentage of this fiber glandular breast tissue in relation to the fatty tissue. Right. Is the density of your breast. 00:01:25:22 - 00:01:55:14 Unknown Got it. So the higher the percentage of this fiber, glandular dense breast tissue that you have in relation to the fatty tissue, the denser that you'll be. Okay. And the harder it is for mammogram to kind of see through this dense breast tissue. So that is why it's such an important kind of, question that is asked. And it's such an important independent risk factor for the development of breast cancer, because it can really obscure findings that we see on mammogram. 00:01:55:17 - 00:02:17:02 Unknown Thank you so much for explaining that. Because I was told, oh, well, we don't we don't really know what we saw. So we're going to do 3-D imaging. And I was like, you, you're the boss. You tell me what to do. So I think a lot of women fall into that category. And we know that, I don't I the science, you know, my mom, let's just say she wasn't asked, you know, when she was my age, if she had that or not. 00:02:17:02 - 00:02:43:07 Unknown So I imagine we've come quite a far, sort of long way. So come over 50 to 60% of the population that we see. Yes. Oh, okay. Very common. Okay. Thank you so much. I just needed to get my question out of the way first. I'm not sure I'll have more. So breast cancer the second leading cause of cancer death in U.S women, which is so scary behind lung cancer I believe and about 1 in 8 women will be diagnosed with it. 00:02:43:09 - 00:03:04:11 Unknown Yet the mortality rate has fallen, right. So that's a great thing. And I would love for you to tell us why that is. So we can do more of it. Yeah. So the mortality rate has fallen over 44% incredible over the last few decades. Staggering rate, staggering statistics. But what it all comes down to and the reason the main reason for that really is early detection pre k. 00:03:04:11 - 00:03:38:18 Unknown And it's early detection though specifically through breast imaging okay. And the cancer screening tools that we utilize in breast imaging over the last few decades has become significantly more accurate, significantly more precise. And that allows me as a breast radiologist to find and diagnose breast cancers very, very, very earliest stages. Okay, okay. Very early stages. That's that makes a lot of sense because I have had two, very dear friends with pretty aggressive breast cancer. 00:03:38:18 - 00:03:58:18 Unknown And I. You'll probably know what this is. I certainly didn't when she said she was on a chemo called the Red devil. Oh, two people call this pretty aggressive and pretty rough, right. But she's one of the lucky ones. And they did catch it early. Yes. But that I remember, you know, my mom's friends, a few of them. 00:03:58:20 - 00:04:23:23 Unknown It felt like a death sentence, you know, and it has to be like that anymore. Yeah. And the single most important tool that we utilize for early detection for early screening is screening men. Right? Right. And mammogram helps us find breast cancers. We're talking about tiny, tiny breast cancers, right. 1 to 2mm in size. Right. Tiny tiny specks of calcium calcifications before a mass has time to develop. 00:04:24:01 - 00:04:40:16 Unknown And long, long before a patient is ever going to feel a lump clinically. Okay, so when I was growing up in sex ed class, it was all about the BSE. Okay? The breast self-examination. You do the circles and you do the thing. Do we? I don't know, do we still teach that? Or we just say get in for your mammogram. 00:04:40:17 - 00:05:07:06 Unknown You know, we do still teach that really clinical exam should still be performed monthly rotations in yearly by physicians. Okay. But you know, the name of the game really is early detection right. Early detection. Okay. And again, mammogram will find long before a patient has a full time to fill a lung. And I'm curious how I mean, since this is all about early detection and by the way, I don't know if I'm just an outlier, but everyone says, oh, it hurts so bad. 00:05:07:06 - 00:05:25:20 Unknown It doesn't. It doesn't hurt that bad. It's not a big deal. You know, it's a little smooshy in a minute, and then we all move on and we're happy that we're healthy. We have each other on the back. Exactly. It's not a big deal. But, you know, it's it's it's not easy. And I hear women who say, you know, they don't like their breasts in compression. 00:05:25:20 - 00:05:45:11 Unknown They don't like getting mammograms. It's uncomfortable. I'm not going to lie. But listen, I hear you. Yeah, I get my mammograms every year as well. Right? Okay. Do I want to be having my breasts in compression? I really don't, right. But we're talking about the seconds that women spend exactly in compression. So this discomfort. Right. So the years and years of her life and that's years of about. 00:05:45:11 - 00:06:04:11 Unknown And you think, you know, if you if you thought this was uncomfortable like God forbid it gets worse. And now we're just talking about a palliative care situation. This is the best thing to do. Now, some of us fall into high risk categories and don't know it exactly. Can you give me some information on how we figure that out? 00:06:04:11 - 00:06:22:10 Unknown Of course, of course. So, you know, let's kind of backtrack a little before we talk about this high risk category. Let's talk about just the basics okay. So, you know, every physician that's involved in the care of breast cancer, all of our colleges, we all recommend screening mammograms starting at the age of 40, 40 for women of average risk, okay. 00:06:22:12 - 00:06:45:07 Unknown And continuing every year. So continuing annually okay. As long as someone is in good health. And it has been shown that starting at age 40, continuing annually shows the greatest breast cancer mortality reduction across all study. It's just that it's fact makes sense. And in fact, women who are considered higher than average risk may need a mammogram before the age of 40. 00:06:45:08 - 00:07:15:19 Unknown Right? Okay. So in 2021, my American College of Radiology, expanded these breast cancer screening guidelines and started to recommend that all women so age 30 should be undergoing a breast cancer clinical risk assessment. Oh, but then in 2023, they decreased the age to 25. Right. So all young women, all young women at the age of 25 should be asking their clinicians for something called a breast cancer risk assessment. 00:07:15:19 - 00:07:32:11 Unknown We've been hearing a lot in the media about this risk assessment tool. Calculator okay. Specifically, you know, you had the actress Olivia munn. She had bilateral breast cancers. I let them affect me. She came out and said that this risk assessment calculator saved her life. Okay. And what it is, it's a tool. 00:07:32:11 - 00:07:56:19 Unknown It's a series of questions okay. Personalized questions. And the answers to these questions give you a risk factor, a percent estimated risk for developing breast cancer in your lifetime. And is this more than just family history? It is. It is. So the most comprehensive assessment tool out there. What Olivia munn is referring to, we offer at UCI health is something called the tire acoustic Ibis Risk assessment. 00:07:56:21 - 00:08:24:16 Unknown Now there's many out there. Don't make me memorize that. There's a man. It's called the Ibis Tire Acoustic Risk Calculator. And there's many out there. But this is the most comprehensive. That's and that's what you use. It includes things such as personal and family history. Right. Breast but also ovarian cancer okay. How would those be related. Well, you know, patients who have had ovarian cancer or family history of ovarian cancer, oftentimes that can be linked to breast cancer genetically. 00:08:24:17 - 00:08:44:03 Unknown Okay. I didn't know that especially you know, like we talked I'm sure you heard the breast cancer BRCA Brca1 and two gene. Yes. Yes. And that became sort of more in the mainstream with Angelina Jolie. If I remember correctly, she had the breast cancer Brca1 gene and she did to get the bilateral mastectomy. Right. Removal of her ovaries as well. 00:08:44:03 - 00:09:04:02 Unknown So they can be linked and that's more an excuse my ignorance on the subject, but is that more preventative? That's preventative on her side? And what, what a choice to make. That's lesson. That's a lot. Definitely. Yes. But you know, that is is more rare in the sense that, you know, not everybody carries that breast cancer gene. 00:09:04:02 - 00:09:25:16 Unknown But it's also any personal or family history. Right? Right. So really in cancer it's also your hormonal history, your reproductive history, you know, age of your first child. If you've had children, things like this, a very detailed questionnaire. Right. And it's also, you know, history of breast symptoms, breast conditions. Right. If you had history versus history, breast biopsies, things like that. 00:09:25:18 - 00:09:46:07 Unknown And you know, thank you for mentioning breast density before. Yeah. It's the only model right now that takes into account pregnancy. Really. Yeah. Like we talked about residency. It's an independent risk factor for the development breast okay. And I would imagine I mean you know because I'm not I'm not a doctor, but I'm assuming that it's because it's more it's just harder to detect when you have that. 00:09:46:07 - 00:10:03:19 Unknown So it's it's twofold. So first of all, yes harder detect right to see through that dense breast tissue. But just in and of itself that dense fiber, glandular breast tissue is an independent risk factor which a lot of people don't realize. Oh yeah, I this is the first time I've even heard those words. So I don't know. 00:10:03:19 - 00:10:19:10 Unknown I'm so interested in taking this test. And I imagine, you know like everything else. Well I took the test. I found I googled it and I found it. Now we want to go to an actual doctor. You're right, you're right. Because the results of this test should be kind of, an entire approach. 00:10:19:11 - 00:10:43:02 Unknown Your entire team, your your clinician. Yeah. Also your breast radiologist. Okay. Because patients who, like we mentioned, average risk is 1 in 8, right? 12.5%. Yeah. And higher it's high. Yeah. That's just average risks right. And high risk. You're considered high risk when you're 20% or higher okay. And so if we get that number if it spits out the number and it's very, very high, then patients freak out. 00:10:43:03 - 00:11:01:19 Unknown We don't know what to do. Right. And so you know every patient who comes into UCI health we give them that personalized risk score. But not just that. We also give them recommendations to send them on their way. Exactly, exactly. Because if you're 20% or higher, they're really you should be starting screening mammograms at age 30. Oh, right. 00:11:01:22 - 00:11:32:04 Unknown No. Ten years before somebody would of half average risk. And these days, I can't imagine how the poor doctors, people are always coming in because they know everything, because they Google it and they know everything because Google. Yeah, because they spent five minutes, you know, typing it in. And now they're also a doctor. So congratulations to us. Do you feel like in your specific line of work, you're having to sort of manage people's expectations when they come in and they kind of think they know everything because they researched it online? 00:11:32:05 - 00:11:50:20 Unknown Well, you know, I think that could be said with with any specialty. Absolutely. But let me take breast imaging in particular. It's such a vulnerable kind of state. Yeah. Where, you know, a woman is is getting mammograms. You're practicing compression. We could potentially be telling them bad, right. In terms of any biopsies that they need or any diagnoses. 00:11:50:20 - 00:12:11:02 Unknown So women are already in this kind of heightened state anxiety. Yeah. And so I think, you know, anything that we can do to kind of alleviate that anxiety, counsel them, especially if, you know, they didn't know they were high risk, then they're getting that recommendation right. For additional imaging. Anything that we can do to alleviate that but also give guidance going forward. 00:12:11:02 - 00:12:29:21 Unknown Yeah. And put the human touch back into the process instead of just doomscrolling in the middle of the night, because you can't help yourself. Now we're talking about women. Of course this affects women. You know, it's such a high rate. But this does happen to men every now and again, I would imagine. Absolutely correct. Yeah. And have you have you personally dealt with men with breast cancer? 00:12:29:21 - 00:12:50:12 Unknown Yes, I have diagnosed several in my career. But let me tell you, you know, breast cancer is so, so rare in male patients, right? We're talking about it. It accounts for about 1% of all the breast cancers that week diagnosed. Okay. So unfortunately women are 100 times more more likely to get breast cancer. Right. And that's why, you know, routine mammograms are not recommended in men. 00:12:50:12 - 00:13:11:02 Unknown But it is the same treatment for men. It would be the same the same treatment. Correct? Correct. But you know, men, we always encourage our male patients any time they have any symptoms. Okay. Don't ignore them. Any symptoms, please don't ignore them. And a lump is swelling and you come in for that mammogram because we have absolutely diagnosed cancers in male patients. 00:13:11:02 - 00:13:27:19 Unknown Oh my God. I can't imagine how jarring that would be because like you said, women are sort of used to knowing that this bad news is possible. But for a man to say, no, no, no, you don't understand. I'm a man. This isn't possible. It's possible. No. And they shouldn't ignore their symptoms. Right. And what would a symptom be for a man? 00:13:27:21 - 00:13:45:18 Unknown Would it be different? It would be a very similar lump. Yeah, yeah a lump, you know, swelling. Okay. Any sort of pain in the, around the, the breast nipple area. And sometimes we also see nipple discharge specifically in a bloody nipple discharge. Okay. So just anything and I always tell my patients, you know, your body the best, right? 00:13:45:18 - 00:13:46:05 Unknown Okay. 00:13:46:05 - 00:14:04:22 Unknown anything out of the realm of what you feel is normal, you have to advocate for yourself. And it's it's interesting. Just on another personal note, I had a breast reduction a few years ago and they were the insurance company, to their credit, was very aggressive on making sure I didn't have any breast cancer issues because, hey, I get it. 00:14:04:22 - 00:14:21:18 Unknown If you're footing the bill, you don't want to start over again. I understand that. So I feel very fortunate that they were so aggressive about it before the surgery. But that doesn't mean in any way that I'm off the hook now, right? No, that's an ill developed. Definitely. Okay. I don't know if you're of the age you don't you probably you don't look like it. 00:14:21:18 - 00:14:43:18 Unknown You don't look like it. You. But certainly, you know, even patients who have had, you know, prior augmentations like, you know, reductions should absolutely be considering treatment. Well, in, in that, in that conversation, I am actually that makes me curious about people with implants. It's, you know, very common. You know, people have them all the time, and they're so real looking. 00:14:43:18 - 00:14:59:22 Unknown These days, you cannot tell the difference. Is it harder to diagnose breast cancer in somebody with implants? You know, I'll tell you, it's it's it's kind of a couple layers. Yeah. You're right. So patients are always worried about precedents when they come in in terms of the mammogram. Right. Versus us being able to see the process. You. 00:15:00:02 - 00:15:26:15 Unknown But also how does that mammogram affect, that is don't make it lopsided like that. Yeah. Exactly. So our technologists are well-trained, well versed in doing mammograms and all patients, especially breast implant patients. Okay. And they have a technique where they manually kind of, protect their implant, bring that implant back, push that impact back manually with their hands so that we are able to visualize that breast tissue better. 00:15:26:15 - 00:15:42:16 Unknown So there's actually a difference. There is a difference is that there's a different technique that is utilized. And it's actually additional more images that we take in patients with us because we know that that implant can hide that breast tissue. That is so good to know. I just figured it would just be harder. And that's just part of the risk. 00:15:42:16 - 00:16:00:07 Unknown But no, they know what they're doing. And you know, I know we kind of talked about this, but there are women out there. You know, if I have to drag a friend there and and do it, you know, this is premature. And shudder ever. And the mammogram. Hey, I'm a good friend, but what would you tell somebody who's just like, I don't know, I just don't want to do it? 00:16:00:07 - 00:16:20:19 Unknown I've heard too, that it's uncomfortable. I've just heard too many horror stories. Yeah. You know, exactly like we talked about. Yeah, I hear you. Okay. I definitely hear all women. All women. I've done, I hear you, I get them every right as well. Right, too. Not comfortable. It's not okay. But like I said, the couple seconds of discomfort saves years and years of our lives. 00:16:21:00 - 00:16:37:07 Unknown And to me, that's that's where that's a great trade off mammogram saves lives and Natalie deal that is the takeaway. Doctor Smith thank you so much for your time. Oh no thank you. This is literally going to save people's lives. And we are so grateful to you too for, you know, talking to us and having this great conversation. 00:16:37:11 - 00:16:43:10 Unknown Thank you for having me.