Annual screening mammograms can detect breast cancer at an early stage when it is most treatable, but often mammograms show other irregularities in the breasts that are not cancerous, such as cysts, calcifications, and dense breast tissue. What exactly do these findings mean? And where can women turn for guidance concerning these benign breast conditions?
Host, Jonathan Fialkow, M.D. welcomes Deepa Sharma, D.O., a primary care doctor and the lead physician at the benign breast clinic at Miami Cancer Institute.
Annual screening mammograms can detect breast cancer at an early stage when it is most treatable, but often mammograms show other irregularities in the breasts that are not cancerous, such as cysts, calcifications, and dense breast tissue. What exactly do these findings mean? And where can women turn for guidance concerning these benign breast conditions?
Host, Jonathan Fialkow, M.D. welcomes Deepa Sharma, D.O., a primary care doctor and the lead physician at the benign breast clinic at Miami Cancer Institute.
Dr. Jonathan Fialkow:
Welcome back to this health talk podcast listeners. I'm your host, Dr. Jonathan Fialkow. I'm a preventative cardiologist and lipidologist at Baptist Health, Miami Cardiac and Vascular Institute, where I'm also chief of cardiology at Baptist Hospital and the chief population health officer at Baptist Health. Annual screening mammograms could detect breast cancer at an early stage when it is most treatable, but often mammograms show other irregularities in the breasts that are not cancerous, such as cysts, calcifications, and dense breast tissue. What exactly do these findings mean? And where can women turn for guidance concerning these benign breast conditions? My guest today is uniquely qualified to provide answers. Dr. Deepa Sharma is a primary care physician with Baptist Health Medical group and the lead physician at the benign breast clinic at Miami cancer Institute. Welcome to the podcast Deepa.
Dr. Deepa Sharma:
Hi Jonathan. Thank you.
Dr. Jonathan Fialkow:
So let's dive right into this topic. So first question is what are the more common reasons that a woman will seek out care in a benign breast clinic? We'll get into the clinic itself. What are the more, maybe more common reasons that women will seek care from the clinic?
Dr. Deepa Sharma:
Well, John, the top three reasons that women will come see me at the benign breast clinic are for breast pain biopsy of the breast result review and second opinions on breast imaging results.
Dr. Jonathan Fialkow:
So if you say, for example, breast pain, soreness is actually painful to the touch or aches what or how would you define that a little bit?
Dr. Deepa Sharma:
And actually just like you said, John, there's a whole spectrum when it comes to breast pain, so it could be soreness, it could be tender to touch. It could be pain around the menstrual cycles or pain that's there all the time. So any type of breast pain that's been chronic, our patients will frequently have referred to the clinic.
Dr. Jonathan Fialkow:
So are they coming to you because the concern, it might be cancerous or just, I have a breast issue and the breast clinic is within your purview experts in managing any breast condition.
Dr. Deepa Sharma:
I think a little bit of both John, I think a lot of women, you know, want some reassurance. And I think in medicine, in medicine and practice, we tend to be more conservative. And so these are women that we do follow depending on the nature of their symptoms and their imaging results. We may have them come in for follow-ups clinical breast exams, repeat imaging. So a little bit of both.
Dr. Jonathan Fialkow:
So you mentioned as a second of the more common reasons is benign BET, a biopsy result review, which would mean a woman had a walk us through already had a mammogram that showed an abnormality and then subsequent had a biopsy or would have had other findings that led to a biopsy, give us a scenario where that would come to your attention.
Dr. Deepa Sharma:
So that's yes, a second, very common thing we see in the clinic. So typically a woman would start off by going to see either their primary care physician or a gynecologist and having a clinical breast exam followed by some sort of breast imaging, mammogram and or ultrasound are most commonly first done. Now, depending on those results, a radiologist who reviews the imaging may decide that there is a finding that they're not completely sure what exactly is going on. And they would like to do a biopsy because usually tissue, a diagnosis in tissue really tells us if something is benign or not, before, that it's just kind of called probably. And so folks will get a biopsy and then the results of the biopsy, if they're benign many times, the ordering physician just wants to have a breast specialist review and make sure there isn't anything additional that needs to be done.
Dr. Jonathan Fialkow:
What percent of the patients that you see, or that wind up in the benign breast clinic at the Miami Cancer Institute are the patients saying, "I want a higher level of review" and what percent would be sent by their doctor saying, "Hey, I want you to get a higher level of review." Can you speak to that?
Dr. Deepa Sharma:
Actually, since the benign breast clinic is a consultation, so you would be referred by your primary care physician or GYN to get to us. Most of them have already seen their primary care or GYN doctors, but we do have, I'd say probably 30% of women who would just like some reassurance on the results, a little bit more explanation into what that result means and what the next steps are. And I really do think it's great when women are motivated to make sure that they're following up on their breast care.
Dr. Jonathan Fialkow:
Oh, agreed. Going back to the mammogram, not the woman who finds something on a self exam, but a mammogram, how often would a mammogram lead to follow up testing? I mean, in your experience, how many mammograms or just this as a result, everything is what it is and how many then would wind up with additional testing? And what's the more common, additional testing based on the mammogram finding.
Dr. Deepa Sharma:
So I don't think that I could give you like a numeric percentage, but I can say that we start off with doing a screening mammogram, which gives us an idea of the pictures of the breast tissue of whether the imaging is going to be sufficient to determine if we can get a good view of the breasts. I also like to throw the caveat in, and it's usually on most mammogram reports that a mammogram alone is not completely sufficient. You should still have a clinical breast exam because there are times that a physician or a person can feel something that an imaging test cannot detect. And so both are really important to have, but usually nowadays with technology being so great, we have these 3D mammograms that sometimes we need a little bit more information. So we may ask for additional imaging, which is common and also an ultrasound to augment the mammogram, but the fundamental is still the mammogram and then some augmented options.
Dr. Jonathan Fialkow:
So I don't presume to put myself in the woman's position, but you can clearly see how confusing this world of mammography findings, breast findings are, speak a little bit to the reason behind establishing the benign breast clinic at the Miami Cancer Institute. What was the vision that led to its putting this successful program together?
Dr. Deepa Sharma:
Yeah, you're absolutely right, Jonathan, there is a lot of confusion. And I think that one of the reasons I love being part of the benign breast clinic is my ability to educate women on breast health screening and imaging. And I think that's one of the reasons why I love what I do. The benign breast clinic was established by our chief of breast surgery, Dr. Jane Mendez, who wanted to have a comprehensive breast care center at the Miami Cancer Institute. And she came from a program where there was a benign breast clinic established to review the chronic conditions that were non-malignant or non-cancer for followup and for education. And we still work alongside the breast surgeons. So should there be a need for further evaluation or a procedure? The patient is part of the system and can just be seen by the breast surgeons in a timely and efficient manner.
Dr. Jonathan Fialkow:
You mentioned some of the more common conditions that are reasons that women seek care. Let's go through relatively quickly some of the specific conditions I'll throw at you, and you can say this is what we find, or this concern has cancer or what the issues are. So, the first one is breast pain. What do you usually find if that's a fair question in a woman who comes because of pain in the breast?
Dr. Deepa Sharma:
So breast pain is one of those tough ones because we don't have a cure for it. As a doctor, we like to have a plan to eradicate the symptom. And that's one that's really hard to do. The most important thing that we do is first identify that there's been some imaging, up to date imaging, to make sure that the tissue is healthy. If the imaging is fine, we do a clinical breast exam to make sure we're not missing a lesion. Like I mentioned earlier, since all imaging isn't completely comprehensive and then we follow. So, frequently we may have a patient that we see come back in three to six months for serial breast exams to make sure that nothing's evolving or changing before we kind of graduate them. And, and breast pain is complex to the breast tissue is so complex. It's made of fat, glands, lobes, lymph nodes, blood vessels. It's really a diverse tissue and it's hormone sensitive, stress sensitive, caffeine sensitive. So it's really multifocal in the world of breast pain. And that's one reason why it's great to have a breast specialty team involved so that we can kind of manage that. Like we would other specialty conditions like we do with you and cardiology.
Dr. Jonathan Fialkow:
Sure. So, so I appreciate that the reassurance that it's not cancerous is part of, I would presume what the woman is seeking relief of the pain, as you said, not always easy to do it is secondary. Do breast cancers often present with pain?
Dr. Deepa Sharma:
Not often, but you know, we, we don't want to say absolutely yes or no, but not often. And, also, I'll add to what you said, those first two things absolutely right. Reassurance treatment. And then I like to add surveillance just to make sure that nothing's evolving.
Dr. Jonathan Fialkow:
So breast pain would be a certainly worthy indication to seek an evaluation at the time breast cancer. How about cysts? Again, this comes up a lot.
Dr. Jonathan Fialkow:
Speak a little bit about what they are and how they would be evaluated when it gets to your attention.
Dr. Deepa Sharma:
Cysts are very common that we see on breast imaging. There are three different main types of cysts. We see simple cysts, and then we have a complex now simple sister ones that we don't usually worry about. There they look kind of like an air bubble on the imaging. They're nice and clear, and we can just follow those. Sometimes they can be a little tenders. So depending on how symptomatic a woman is, we may schedule her for a drainage of the fluid from the cyst. The more complex cyst on imaging may sometimes require a biopsy to prove that they're benign. So sometimes women will be directed for a biopsy with those. But typically speaking, I usually explain that cysts occur in all the organs of our body. We can see them on our skin and our kidney or liver all, all over the place. So, in the breasts as well, they're very common in, and it depends on what we see with what we do next.
Dr. Jonathan Fialkow:
Fibroadenomas another common finding. Speak a little bit to what they are and how we deal with how we address them.
Dr. Deepa Sharma:
Fibroadenomas very common. Like you said, many of them end up getting a biopsy to prove that that's what they are a fibro adenoma they can in some women grow and be painful. And so depending on the size and how bothersome they are, they may consider surgical excision, but that would be for comfort above all. And, and they tend to be what we call low risk lesions, which means that they do not have a high likelihood of malignant transformation. And so, these are ones that will also follow in the benign breastfed.
Dr. Jonathan Fialkow:
Do they affect the reliability of a mammogram?
Dr. Deepa Sharma:
The reliability? No, they don't affect the reliability of the mammogram. Just oftentimes though, in a initial mammogram, they'll ask for a biopsy where they'll mark it with a clip so that in the future, we know exactly what we're dealing with.
Dr. Jonathan Fialkow:
And the last one I'll bring up for the discussion and something that you and I are involved with developing out. What about breast arterial, calcification, finding of calcification in the arteries within the breast? Is there any significance to that?
Speaker 3:
So we do see calcifications in the breast and I'm looking forward to our venture together on that as it relates to cardiovascular disease, but there are different types, just like cysts, there are different types of calcification. So we look for without getting too technical, the quality and the quantity. And so in the world of breast tissue, we really don't like to see things that are growing, changing, or increasing in number. So anytime there's calcifications that look like they're changing or concerning, those can also be biopsied. And, but you can also have benign calcifications, which we see frequently as well. So you know, more, more to be seen with them,
Dr. Jonathan Fialkow:
Right? And there's some data that perhaps arterial calcification may be a marker of a higher cardiovascular risk. And again, that's what we're exploring a little further. So more to come on that as well. A few of the final points, if we could just in the interest of time. So, if a woman is referred to the benign breast clinic by their primary doctor or otherwise, what can they expect? Is there a specific experience that we're looking to build?
Dr. Deepa Sharma:
So, typically a woman would be referred by either her GYN and primary care physician. We do request that they have up to date imaging of the breast, and that would mean breast imaging within the last six months. In addition to collecting their history, a discussion of risk factors, their images are also reviewed by a breast radiologist so that we can ensure that there's been an appropriate evaluation radiographically. And then we kind of come up with a plan based on what we're seeing. So the plan could be related to surveillance. It could be additional testing, it could be a biopsy, but there's usually some sort of plan that we come together to work on.
Dr. Jonathan Fialkow:
Are men ever referred to the breast benign breast clinic?
Dr. Deepa Sharma:
Yes, actually we do see male patients. And I would say, I probably see a few every single week, a very common reason that we'll see males referred to the benign breast clinic is for a condition called gynecomastia, which is enlargement of breast tissue in males. There are a lot of different reasons, both hormonal, non-hormonal medication, non-medication alcohol, marijuana related. So it's multifactorial, but it is something we do see in the clinic.
Dr. Jonathan Fialkow:
And as some of the cardiac medications produce that we're sensitive towards recognizing that it's not just, it's not an overweight person with fatty breast, it's true breast tissue in a man. So there's a discern. So that's a great resource as well. Well, again, really information love. You're a way to articulate these different conditions that can be confusing. And again, love having the benign breast clinic at Miami Cancer Institute, a resource for our patients in the community. Any other final points you'd like to either reiterate or bring up that we didn't discuss in regards to a blind breast conditions?
Dr. Deepa Sharma:
Thank you, John. I just want to say that it's October, so it's breast cancer awareness month and I encourage women everywhere to get checked. I, I say that in my hat is primary care. And then also in benign breast, getting checked means, checking yourself, having your doctor check you, and then also going for your breast imaging and staying on top of it.
Dr. Jonathan Fialkow:
Wonderful information as we noted the earlier identified the more treatable and better outcomes. Well, thanks again, Deepa and to our listeners as always, if you have any comments, thoughts, or ideas for future topics for this podcast, please email us@baptisthealthtalkatbaptisthealth.net that's Baptist health talk@baptisthealth.net. Thanks for listening until next time stay safe.