Everything you Need to Know about Breast Cancer Screening Changes

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Transcript

Host: Tessa Lackey:

Welcome to Prescribed Listening by the University of Toledo Medical Center, where we get health tips from experts at UTMC. I'm your host, Tessa Lackey.

In this episode, we discuss the latest changes to breast cancer screening guidelines and how they apply to you with Dr. Danae Hamouda, with UTMC oncology and hematology. In addition to discussing these new guidelines, we dig into questions a lot of people have had about cancer, like does the kind of bra you're wearing have an impact or does all breast pain relate to breast cancer or not? We also discuss genetic testing and if it's right for you. And it's important to note that this is a conversation to have with your primary care doctor. But in this episode we discuss how genetic testing works, where you can get it, and what you'll learn from it in general. For example, there's some other cancers that may be in your family that you may not realize has an impact on your own breast cancer risk. I know I didn't. So here's our conversation with Dr. Danae Hamouda.

Dr. Hamouda, thank you for joining us today. Back in May, the US Preventative Services Task Force changed the guidelines for early cancer detection for breast cancer, and it changed from 50 years old for recommendations for screening to 40 years old for those with an average risk. So what changed under these guidelines? And with the aid change under these new recommendations, how should you be looking to get screened for breast cancer?

Guest: Dr. Danae Hamouda:

Yeah, Good question, and a lot of discussion has been happening in a medical community with this new recommendation. Back in May of this year, the United States Preventative Services Task Force, which we call the USPSTF, they updated their recommendations for breast cancer screening for the average risk woman. It's currently under draft revisions and it's open for public comment, but it's expected to become a final recommendation later this year. So from 2009 until recently, the recommendation from the USPSTF was for the average risk woman to receive a screening mammogram every other year between the ages of 50 and 74. The organization didn't recommend that all average risk women aged 40 to 49 be screened, which even during that time was contrary to what other task forces advised. And instead, their stance was for a woman to make an individual decision with her doctor about breast cancer screening in the ages of 40 to 49.

So the current USPSTF recommendation is now to start breast cancer screening mammograms at the age of 40, and to continue until the age of 74 and to obtain one every other year. I think this recommendation was updated from the 2009 recommendations, largely because of two reasons. One, we're finding that more women in their 40s are being diagnosed with breast cancer compared to previously. And two, this update helps to acknowledge that screening disparities exist, particularly in different racial groups, particularly for Black women who are 40% more likely to die from breast cancer than white women and are more likely to be diagnosed in their 40s. Prior to the age of 50, compared to non-Hispanic white women, minority women are 127% more likely to die of breast cancer, 72% more likely to be diagnosed with breast cancer, and 58% more likely to be diagnosed with advanced stage breast cancer. So this update, I think, is one way to try to address that disparity.

Now, there has been a lot of controversy about breast cancer screening guidelines from different organizations, and this is largely because of different perspectives on the same research. So in short, the different recommendations come from the organizations weighing the risks and benefits of screening differently, and that's why we have a lack of consensus in these screening guidelines.

So the recommendation for the USPSTF is to offer biannual screening for the average risk woman aged 40 to 74. I feel that's the minimum recommendation and a discussion with your primary care physician or OB-GYN made to lead to recommendations for additional screening.

Host: Tessa Lackey:

Okay. So there's a lot to dig into, I think, there. And I think, first things first, when I hear that the recommendation was moved from 50 years old to 40 years old, 10 years is a lot of time. And then you have the data here to support that from what they've done for people between ages 40 to 49, they caught about just as much cases. So I guess is there anything else between that gap of time as to why they would change it 10 years earlier?

Guest: Dr. Danae Hamouda:

Yeah, and that's a good question. It is a big gap to suddenly change into. There are some other societies that recommend starting at 45, and so there's a little bit of more data from those areas. I think it's largely driven from the trials and then including these timeframes and then making it more expansive. And I do think a portion of why they made it so much lower than before is to address that disparity in those higher risk populations or the more vulnerable populations or those that have had more disparity.

Host: Tessa Lackey:

And then, typically, these mammograms and these screenings are covered by most insurances?

Guest: Dr. Danae Hamouda:

Yeah, correct. In the US, insurers are required to cover annual mammograms for women ages 40 and over.

Host: Tessa Lackey:

So if insurance covers it annually, would your recommendation be to get it annually versus bi-annually then?

Guest: Dr. Danae Hamouda:

I think, for most women, I would recommend that. If we did a risk calculator or if they're older or have other comorbidities, have different characteristics of their breast cancer risk, I might be more comfortable with biannual. But I think there's a little bit of nuance and capacity to have that discussion with your physician, knowing that you are eligible to have it annually, and you may be able to do biannual depending on your situation.

Host: Tessa Lackey:

Okay. So it just depends on you and your body and your makeup and all of the things that come with it?

Guest: Dr. Danae Hamouda:

What's important to you and your risks. Yep.

Host: Tessa Lackey:

Okay, gotcha. So let's dig into average risk versus high risk. So what would you define as an average risk?

Guest: Dr. Danae Hamouda:

Yeah, this is an important part to cover. This recommendation applies only to the average risk woman. So we need to know who is that average risk woman. The average risk woman is someone who has these four characteristics. Number one, no personal history of breast cancer. Number two, no significant family history of breast cancer. Number three, does not have a pathogenic mutation in one of our breast cancer risk genes. And number four, has not had radiation to the chest wall before the age of 30. Now, for these average risk women without a significant family history of breast cancer, the lifetime risk of developing breast cancer is 12%. That's one in eight women. And these are women, again, with no personal history of breast cancer and no significant family history of breast cancer.

Host: Tessa Lackey:

With a family history of breast cancer. So how far does that go back in your family? Is it like your parents, or could it be your cousin or your third cousin or something like that?

Guest: Dr. Danae Hamouda:

Yeah, when we do a calculations and looking at breast cancer risk, we include up to our third degree relatives. So parents, aunts, uncles, cousins, grandparents, those are all included and important to discuss when we talk about your individual breast cancer risk.

Host: Tessa Lackey:

So what would be the recommendations would you say then for someone who's high risk?

Guest: Dr. Danae Hamouda:

Yeah, so women who are at a high risk of breast cancer may benefit from additional screening above what's recommended for the average risk woman. So again, the USPSTF updated guidelines apply only to the average risk woman. How do you know if you're average or high risk? Well, it's a little complicated. We look at a lot of breast cancer risk factors like age OB-GYN history, family history, breast density, and others to calculate that risk. And so we use different models for this calculation with one of the most common being the IBIS model. It's also called the Tyrer-Cuzick model. And this includes a lot of these risk factors. We put in your individual characteristics, family history, and they take some risk calculations and give you an estimate of what the lifetime risk of breast cancer may be.

Now, with that calculation, if it does exceed a 20% lifetime risk of developing breast cancer, we would recommend additional screening for you. And that may include annual mammograms starting at the age as early as 30, annual breast MRIs starting as early as the age of 25, and an annual clinical breast exam.

Host: Tessa Lackey:

And you get an annual breast exam technically at your yearly Pap smear that you go with your OB-GYN. So you had mentioned that your OB-GYN history has something to do with your... If you are considered high risk or not. The cervical cancer screening that you get at those appointments every year, that plays a role in that?

Guest: Dr. Danae Hamouda:

Yeah, I think that's a good opportunity to have that discussion since the age of starting your period, the number of pregnancies you've had, the age of your first live birth, all of those characteristics can go into the overall risk of developing breast cancer. So, oftentimes, and women tend to see their OB-GYNs maybe a little more frequently than their primary care physicians when they're in good health. So that's one really good opportunity to have some of those risk calculations as to whether or not doing additional screening would be helpful, often where some of those genetic testing referrals may come from, and having that discussion often is led from that visit.

Host: Tessa Lackey:

Yeah. So speaking of genetic testing, Jill Martin from the Today Show recently was just diagnosed with breast cancer. Have you heard about what happened?

Guest: Dr. Danae Hamouda:

No.

Host: Tessa Lackey:

What happened was, from what I had watched an interview with her, she was going through the process of getting genetic testing, and in the midst of the process, she found out she had breast cancer. And so the interview was her going through the process of surgery and whatnot too with a surgeon from New York. So on the topic of genetic testing, if someone knows that they're high risk or they're concerned about breast cancer, what would be your recommendation in terms of genetic testing from what we do at UTMC?

Guest: Dr. Danae Hamouda:

Yeah, I think they all go with the same high risk risk calculator. What do I do to try to individualize my screening strategy, risk reductions? I think knowing your family history is really important and to bring that discussion up with your primary care physician and ask them if you would benefit from having additional screening. Do I meet criteria for genetic testing? Is there someone you'd like me to talk to more because you're concerned about my family history or my personal history? And those could all be good reasons to meet with a genetic counselor or a high risk cancer clinic to consider those next options.

Host: Tessa Lackey:

So is it something that we offer at UTMC, though? If you went to your doctor, it is something that we can do here?

Guest: Dr. Danae Hamouda:

Yes, absolutely. I see patients in a high risk cancer clinic. Many of my patients are people who have a strong family history of breast cancer, and they're worried about what their risk might be, and they're interested in knowing whether or not they have a hereditary predisposition or if they need to start their screening before the age of 40. So absolutely. There's a place that we could just dedicate time and really talk about their cancer risk, make some recommendations for screening, and then talk about risk reduction.

Host: Tessa Lackey:

And then, is genetic testing... And again, obviously this is going to depend on your conversation with your doctor and your own makeup and your body, but is it something that you can do when you're younger than this 40 year old recommendation for screening?

Guest: Dr. Danae Hamouda:

Yeah. Some of the guidelines do recommend to have that initial discussion and evaluation starting at the age of 25 with your primary care physician to see what your eligibility is for screening for breast cancer risk and whether you would meet criteria for genetic testing. Genetic testing has really come a long way since the last 20 years, especially the last, maybe five to 10 years. Initially, the tests were very expensive. Every gene cost a couple thousand dollars, took a long time to do, very labor-intensive. Now, as technology has gotten better, we're able to do these tests in multiple parallel so we can have the results come back much quicker, and we can look more expansively at a much reduced cost. So you might get this ancestry genetic testing done. That's done in a similar way, looking at other stuff, but you can go through a medical grade testing to look for cancer risk genes at an out-of-pocket cost of maybe up to $250. So it's much more affordable.

So because it's had some improvements in our efficacy as well as the affordability, there's a lot of discussion as to expanding the criteria of who can have testing. But certainly, if you have a family history of breast cancer, if you have three family members with third degree relative having breast cancer, that's enough to have that conversation. If you have a young family member who was diagnosed, that's enough to have a conversation. So I think, over time, we'll continue to expand who's eligible, but at the very least, having that conversation to look at what your risk may be and whether you would be currently eligible for genetic testing can be really impactful.

Host: Tessa Lackey:

Okay. And then, on a standard level, what would make you eligible for genetic testing?

Guest: Dr. Danae Hamouda:

If you have three family members with history of breast cancer at any age, if you have any family member with breast cancer diagnosed before the age of 50, family members with breast cancer that's triple negative less than the age of 60, any family member with pancreatic cancer or a high grade prostate cancer. Those are all things that can be related with breast cancer risk. So we could use that kind of information to decide whether you've meet the eligibility criteria to have the genetic testing done.

Host: Tessa Lackey:

I'm glad that you brought up prostate cancer and pancreatic. That's very interesting. I know for me, in my own world, I've had family members that I've had both of those, but I wouldn't have thought about either of them for being related to breast cancer. That's interesting.

Guest: Dr. Danae Hamouda:

Yeah, it's not intuitive at all, and it's a newer recommendation over the past two years that now any family member with a history of pancreatic cancer is eligible to have testing for these breast cancer risk genes.

Host: Tessa Lackey:

And then, with Jill Martin had talked about this in her interview a little bit. On her father's side of the family had tested for a breast cancer gene. So breast cancer isn't just something that is on your mom's or a female member's side of the family. You can have it on both.

Guest: Dr. Danae Hamouda:

No, you can inherit it from mom or dad's side. It doesn't discriminate. Much less likely for a man to have breast cancer, but it can come from either side and they may express other types of cancer.

Host: Tessa Lackey:

Yeah, that's really interesting. So when I've heard people talk about genetic testing in my own world, I've heard people who have opened the discussion that they've said, "Would you get it done? And then would you want to know?" So for people who are mulling it around and trying to figure out if they would want to get this done and if they would want to know if they have the genes or not, what would you say to them?

Guest: Dr. Danae Hamouda:

I mean, that's a really tough decision to come to. What I think is we are what we are, and if we know that we're at a higher risk of developing cancer, if we can do things to reduce that risk or to improve your survival, then that can be really impactful. So I think you can be more proactive. We have additional screening. We have other risk reducing lifestyle modifications that we can offer in standard practice. And even for some of those other cancers that are harder to screen for, like pancreatic cancer, we do offer some additional screening for those who are at the highest risk. So we're really trying to get to a point of understanding a person's risks and modifying our recommendations for screening if you're at a higher risk to be able to ideally never have a cancer develop. And if God forbid it were, that we would find it at an earlier and curable stage.

Host: Tessa Lackey:

And then, if you can, especially with something like the recommendations here, if you do get the genetic testing and you realize that you have genes that may potentially lead to breast cancer, your risk can go from getting a biannual mammogram to getting an annual mammogram, and you can catch it sooner, right?

Guest: Dr. Danae Hamouda:

Yeah. Go from biannual to MRI with a mammogram and other risk reducing strategies.

Host: Tessa Lackey:

Just be on top of it and be ready for it in the case something comes. That's really awesome. So what would be some signs and symptoms that people would notice if they suspected they had breast cancer?

Guest: Dr. Danae Hamouda:

The most common presentation before the diagnosis of breast cancer is through a screening mammogram. So that really highlights the importance of this screening modality for breast cancer. The second most common presentation is feeling a lump in the breast. And usually, this isn't caught when the woman is doing their usual breast checks. It more often happens when they're in the shower and they notice that's that little firmness in my breast. I didn't notice that before. Or they're changing their clothes and they notice a lump that they hadn't noticed before. So that would be the most common way you may notice a change that could be found to be cancer. Most lumps that you feel are not cancer, but we want to take it seriously and take a look at that. And it would be important to come to see your primary care physician, have a breast exam. It may need further imaging to get a better idea of how it looks and whether this is a cyst or something benign or something that requires further workup.

Host: Tessa Lackey:

I'm glad that you mentioned cyst. In my own world, I have people that have cysts and they have to get an ultrasound done. I think it's yearly that they get it done. But just because you have a lump doesn't mean that it's automatically breast cancer.

Guest: Dr. Danae Hamouda:

Yes. Right. Yeah. And most of the time, the lump is not breast cancer, but we don't know that until we do some further looking, and we want to take that seriously. Most breast cancers aren't painful either. So some of the cysts can be more tender, especially with the cyclical changes. With PMS, you may have more tenderness around the areas. So that's typically less likely to be related with breast cancer.

Host: Tessa Lackey:

With your hormones as a woman, your hormones change every week in your cycle, right? In your luteal phase of your hormones as a woman, your breast can be more tender. So if you start to feel any of that, is that something that you could feel and may think that it's something like a lump or cyst, or is this just the time where you just bring it up to your doctor and then you go from there?

Guest: Dr. Danae Hamouda:

Yeah, I mean, you can definitely let your doctor know that you have this tenderness, that your breast tissue is more sensitive when your female hormones are quite high, and that's typically related to the hormone changes and not related with breast cancer risk. And you may feel like a cyst or things, but we would still want to be sure that that is that and nothing else, especially if you notice it's the same with every cycle, that you have the similar kind of symptoms and feelings, that's reassuring.

Host: Tessa Lackey:

Yeah. And then, for anyone who's listening to this and is trying to understand what happens with their body over the course of their period, if you download an app called Flo, F-L-O, you can track all of that stuff. So if you notice that you have breast tenderness at, say, during the second to third last week of the month or whatever, you can track all of that and then see where it goes to. But ultimately, when in doubt, talk to your doctor.

Guest: Dr. Danae Hamouda:

Yeah. I think it can be so hard to remember all of those, did I feel this way last month?

Host: Tessa Lackey:

Yes. Yes. Seriously. Yes.

Guest: Dr. Danae Hamouda:

Life is too busy.

Host: Tessa Lackey:

It is. Yes. I've been doing the Flo app all through 2023, and it's helped me learn so much about my body and just through, just as a woman, what happens to you and what is what kind of a thing.

Guest: Dr. Danae Hamouda:

It's amazing way you can track. And the temperatures, it's really cool.

Host: Tessa Lackey:

Yes, yes. Okay, getting back into mammograms, when you go in for a mammogram, if someone's listening to this and they've been avoiding it or they've never had one, or they fall under this new recommendation where they need to start getting them, what can you expect from a mammogram?

Guest: Dr. Danae Hamouda:

I think the very first time, it's a bit of anxiety because it's a bit of the unknown. But when you arrive for the mammogram, you'll undress from the waist up and you'll be given a gown to wear. Before you come to your visit, you want to not put on deodorant, lotions, oils, or perfumes on the day of the exam because it can interfere with the machine. So then, during the mammogram, it'll be you and a trained technician will be the only ones in the exam room. The tech will help to position your breasts one at a time in between two plastic imaging plates, which will then apply some pressure and then take X-ray images. If it's a 3D mammogram, multiple images will be taken from different positions, and the entire exam takes about 10 minutes.

Host: Tessa Lackey:

So what's the difference between a 2D mammogram and a 3D mammogram?

Guest: Dr. Danae Hamouda:

So a 2D mammogram is a two-dimensional image of the breast. So if you think of the traditional, I don't know, Grey's Anatomy, where they stick the X-ray onto the light, that's a 2D mammogram. Now, a 3D mammogram is something that can become three-dimensional. We also call this a mammogram with tomosynthesis. And this uses multiple low dose X-rays done at different angles, which can then be reproduced to have a three-dimensional image of the breast. And this allows the radiologist to view the pictures in a different way, and it can help with better cancer screening and detection. So using this procedure, the breast is viewed as many thin slices. It's then combined into a 3D picture, and then the radiologist can use it to investigate the cause of any breast problems, breast masses, pain, nipple discharge, and those things. The benefits of a 3D mammogram is that it can allow for a better visualization leading to earlier detection of abnormalities in the breast. It gives us clearer images, which can provide a greater level of detail when examining the breast, and it can avoid unnecessary biopsies.

Host: Tessa Lackey:

From what you've been saying about mammograms, outside of just screening for breast cancer, it sounds like you can catch other things that are going on as well too. So is that the case?

Guest: Dr. Danae Hamouda:

Yeah. With a mammogram, we can get quite a bit of information. One portion of information from a mammogram that can be really impactful when we're trying to determine breast cancer risk is breast density. So on each of your mammogram reports just became a federal law, although it was a state law in many states, including Ohio for many years, that the report should state the overall classification of how the breast looks in terms of cancer risk, but also should include the breast density. And there's four categories of breast density, the most dense breasts to heterogeneously dense to more fatty. And those breast tissue that appear to have more density can be a little bit harder to see through on the mammograms, but also, a higher breast density has an increased risk of developing breast cancer independent of how it looks under the mammogram. So that can be used as part of our risk calculation as to what a person's overall risk could be of developing breast cancer.

Host: Tessa Lackey:

Getting regular mammograms, depending if it's biannual or annually, what can you do to reduce your risk for breast cancer outside of these?

Guest: Dr. Danae Hamouda:

The biggest risk factors for developing breast cancer are being a woman and getting older. So there's not a lot that we can do about those things, but there are other things that we can do to reduce our risk. And number one is exercise. We would recommend at least 150 minutes a week of moderate intensity exercise. The more, the better. Exercise, exercise, exercise. If we could put that in a pill and prescribe that for cancer risk reduction, that would be my number one prescription. So it's really important, something we don't talk about often enough, but that can have a significant impact on several cancer risk reductions, including breast cancer.

Number two is with weight control. We would like a woman to try to attain and maintain her ideal body weight, which is typically within the BMI of 20 to 25. Portions of why this is more applicable for breast cancer risk is the adipose tissue can secrete estrogen, which then increases our risk of the most common type of breast cancer. So weight control is a really important lifestyle modification that you can do to reduce your risk of breast cancer.

And number three is low to no alcohol. So we would advocate for the less alcohol, the better, and certainly, less than three drinks per week, not to exceed one drink per time as we know that alcohol intake does increase the breast cancer risk.

Host: Tessa Lackey:

To reduce your risk for breast cancer, if you are working out 150 minutes a week, does your bra you are wearing depend on any of that?

Guest: Dr. Danae Hamouda:

Yeah, yeah. Does that have impact on your breast cancer risk? Having a well-fitting bra can help to reduce breast pain, especially when you're working out, especially if you have larger breasts. So it's important to have something that's comfortable, but it does not have a link between increased risk of breast cancer.

Host: Tessa Lackey:

Okay. So just, in general, 150 minutes a week working out is going to reduce your risk. It doesn't matter if you're working out that part of your body or not.

Guest: Dr. Danae Hamouda:

[inaudible 00:26:06].

Host: Tessa Lackey:

Okay. And then, in prep before this podcast and looking at different things, there was some different questions that I had seen a lot of that I wanted to bring up that I felt were pretty valid that I've heard from other people as well too. So does something like carrying your phone in your bra, because if you're a woman listening to this and you have bought pants before, whoever designed women's pants don't make the pockets all big enough for you to put them in sometimes. And if you don't want to carry your purse, sometimes that's the only option. But all in all, does that increase your risk for breast cancer?

Guest: Dr. Danae Hamouda:

And we have now the packs that you can wear around your [inaudible 00:26:47]. So that's helped a little bit. But yeah, the pockets would be nicer if they can get that sorted through. But the carrying the phone in the bra, there's not been good data to support that there is an increased risk of breast cancer developing. Now, there were some early case reports in the early 2000s, three or four that were described, but these women were having their cell phone on their breast 10 hours plus a day, and these were just those three case reports not replicated. So it could've been from other factors in a confounder. So there are some cases in the literature, which is, I think, where some of this discussion had originally come from, but we haven't found it to be replicated through.

Host: Tessa Lackey:

Okay. Gotcha. And then, we talked a little bit about the type of bra you're wearing. So in general, the type of bra you're wearing, whether you're going to the office or just hanging out around the house, does it have an impact on your breast cancer risk?

Guest: Dr. Danae Hamouda:

Nope. No credible research that shows differences with wearing a bra or not wearing a bra or with the presence of an underwire or not.

Host: Tessa Lackey:

Does your breast size have an impact on your risk?

Guest: Dr. Danae Hamouda:

The breast size doesn't impact your risk, but the breast density could. Two different features, but not the breast size. That doesn't have an increased risk.

Host: Tessa Lackey:

And anybody, whether you are a smaller breast person or a larger breast person, the density could be different no matter what?

Guest: Dr. Danae Hamouda:

Yep.

Host: Tessa Lackey:

So in a mammogram is a great way to check that.

Guest: Dr. Danae Hamouda:

Yeah, that's the best way to see how much fibrous tissue we have. Yep.

Host: Tessa Lackey:

Okay. And then, another thing that a lot of people seem to have questions about online was, is all breast pain a sign of cancer?

Guest: Dr. Danae Hamouda:

Most breast pain is not cancer, and most breast pain cancers do not cause pain. The most common causes of breast pain are hormonal changes, like PMS and breast cysts or trauma, an accidental bruise you might not realize had happened. So those are the vast majority of breast discomfort. If you do have pain that doesn't go away, especially if you have a lesion that you're noticing and it's present over time, absolutely to have a discussion with your doctor and have an exam would be warranted.

Host: Tessa Lackey:

Okay. So talk to your doctor about any discomfort is a lot of the moral of the story.

Guest: Dr. Danae Hamouda:

Yeah. If it persists over time, yeah.

Host: Tessa Lackey:

Okay. And then, with self exams, whether you're in the shower or however you do it. Now, we are on a podcast, so obviously it's hard to visually show that.

Guest: Dr. Danae Hamouda:

It's hard to demonstrate. Yeah.

Host: Tessa Lackey:

Yeah. So is there an effective way to check yourself for breast cancer when you're at that time in the shower or you have a moment to yourself?

Guest: Dr. Danae Hamouda:

Yeah. Breast self exams aren't the best way to screen for breast cancer. There was a big study done in Shanghai looking for the possible benefit of using breast self exams, and they randomized these women to either doing a self-breast exam, and they were taught how to do that versus not doing a breast self exam, and there was no difference in death and no difference in the diagnosis of breast cancer seen. So this strategy as a cancer screening tool on its own, for the average risk woman, not very good. But what I do recommend for women is to be familiar with their breasts, so to know how the breasts feel. And if you notice something is different, then to talk to your primary care physician for an evaluation.

Oftentimes, these are caught. What I ask my patients to do is when they're in the shower and they're cleaning, just to make sure that they feel familiar with their breasts. Not to do it too often, maybe once a month, ideally around the same time of the month if you're premenopausal, since we have some changes with our hormones, and to bring any concerns to your primary care physician.

Host: Tessa Lackey:

We were talking about tracking apps earlier. This seems like a really good time to use it. Even if you just... For example, I am a Google Calendar fiend. So even just giving yourself a little task in your Google Calendar saying, "Hey, double check while you're in the shower today," just as a small reminder for yourself, it seems like it would help a lot too. I know, for me, I would be the person to be like, "Oh, yeah, I should do that this month," but I did it on the first and it's now the 20th, or something like that.

Guest: Dr. Danae Hamouda:

Yeah, just add it to your self-care routine once a month.

Host: Tessa Lackey:

Yes. It really is self-care, though, honestly, to be able to just double check that and do that for yourself and that peace of mind that comes with it.

Guest: Dr. Danae Hamouda:

Absolutely.

Host: Tessa Lackey:

Okay, so how can someone schedule a mammogram?

Guest: Dr. Danae Hamouda:

You can schedule a mammogram at the University of Toledo Medical Center Department of Radiology by calling the phone number (419) 383-3936, and to schedule your appointment there. They offer breast imaging with our mammograms 9:00 to 3:00 on the weekdays.

Host: Tessa Lackey:

Okay. And then, if you have any additional questions about breast cancer, just to reiterate, talk to your doctor. If you're experiencing breast pain, talk to your doctor and they can take the necessary steps for you and your own body from there.

Guest: Dr. Danae Hamouda:

Yes.

Host: Tessa Lackey:

Thank you again, Dr. Hamouda, for joining us today and helping us to understand our own breast cancer risk. If you'd like to schedule an appointment at the Eleanor N. Dana Cancer Center with questions about your cancer risk or for cancer screening, you can call the number listed in our show notes. And if you like this episode, don't forget to hit subscribe so you don't miss another episode of Prescribed Listening with health news and tips from our experts at UTMC. Thanks for listening. We'll see you next time.