Jamie Monticelli:
This is MedTalk, presented by HCA Midwest Health. I'm Jamie Monticelli with Dr. Anne Kobbermann, MD, board certified and fellowship trained breast surgical oncologist at the Sarah Cannon Cancer Institute at Overland Park Regional Medical Center with HCA Midwest Health.

Jamie Monticelli:
As a lot of hospitals and doctor's offices limited patient appointments and surgeries during the beginning of the pandemic, a concerning side effect of the shutdown started to emerge. With fewer screening exams, patient visits and surgical procedures, breast cancer care, including mammograms, took a frightening hit. Regular breast cancer screening save lives, but early in the pandemic, the American Cancer Society recommended that doctors postpone any routine breast cancer screenings or intervention to protect at-risk patients from potential exposures or illness.

Jamie Monticelli:
Delaying those appointments didn't just mean delaying regular breast exams. For some, it meant delaying preventative treatments like chemotherapy, designed to keep cancer from coming back. Coronavirus is very real, but we have to all do our part to slow the spread and protect ourselves from COVID-19.

Jamie Monticelli:
And so we're here to talk about why breast cancer does not stop in the face of the pandemic. So it was alarming to me to read that in March of this year alone, compared to U.S. averages recorded from 2017 to 2019, medical records data showed a staggering drop of more than 90% in routine screenings for breast, cervical and colon cancers. Why is that so concerning?

Dr. Anne Kobbermann:
That's of great concern. Screenings have definitely been down this year, and the problem with that is we limit our ability to identify breast cancers and precancerous changes [inaudible 00:01:37]. And it was appropriate to do. We had a lot of trusted guidance from the Centers for Disease Control, which helped us identify what we should delay in hopes to protect our most vulnerable patients. But the concern of course with that, is as we delayed some of those things, are we putting people at risk for delayed diagnosis of cancer, and ultimately, delayed treatment?

Jamie Monticelli:
Tell me exactly why mammograms are essential when it comes to detecting breast cancer.

Dr. Anne Kobbermann:
So a certain percentage of breast cancers will be identified on clinical exam, however, the masses we tend to identify in clinical exams are quite a bit larger than those that we identify on mammogram.

Dr. Anne Kobbermann:
So mammogram is a tool that allows us to identify cancer at earlier stages, and it also is helpful at identifying cancers that don't develop as part of a [inaudible 00:02:30], where we would never feel it until it was to a late stage.

Dr. Anne Kobbermann:
And the most important take home for that is breast cancer, when it's detected early and at a localized stage, the five-year survival is greater than 99%. So it's incredibly important that we identify those cancers as early as possible.

Jamie Monticelli:
What's the rule of thumb for who should be getting a mammogram every year?

Dr. Anne Kobbermann:
It's so confusing isn't it?

Jamie Monticelli:
Uh-huh (affirmative).

Dr. Anne Kobbermann:
It seems like the guidelines have changed many times. In general, we recommend with average respect or starting at the age of 40 having annual mammograms, until at which time they would no longer do anything about the results, and usually for most people that's after the age of 75, although that depends a little bit on overall health.

Dr. Anne Kobbermann:
Now, if you have other risk factors, family history, personal risk factors that put you at higher risk, you may want to work with your doctor to start screening earlier than 40.

Jamie Monticelli:
And we'll get to the risk factors here in a second also, but should women still get their annual screening during the pandemic while that's still going?

Dr. Anne Kobbermann:
Yes. The short answer is yes, women should continue to do routine health maintenance, screenings for all types of cancers and other medical conditions. With breast cancer, especially if you have concerns about your breasts, you're finding new and different stuff that's worrisome, don't delay that. But we are recommending continued routine screening mammography just for the things that we mentioned earlier so we don't delay diagnosis.

Jamie Monticelli:
Okay. Let's talk about those guidelines for when women should be screened and those risk factors. What are the things that we should be looking to in our backgrounds that might put us at higher risk?

Dr. Anne Kobbermann:
Family history is obviously a big one. So family history of breast or ovarian cancer, and you should pay attention to both your mom's side of the family and your dad's side of the family because you can inherit genetic material from your dad that can affect your risk. Smoking, alcohol use greater than two alcoholic beverages a day can increase risk, obesity and sedentary lifestyle are really big things that can contribute. If you've had previous biopsies that showed concerning precancerous changes that increases your risk, and certainly use of hormone replacement after menopause may increase your risk.

Jamie Monticelli:
Are there certain COVID-19 risk factors that women should consider before they get screened?

Dr. Anne Kobbermann:
I think the big thing is you want to make sure you're going to an environment that's safe and doing appropriate cleaning, that the techs are going to be wearing masks, that you're going to be protected. If you are a high risk person over the age of 60, have other active cancers under treatment, have pulmonary problems or lung disease, that it may be worth contacting the mammogram screening facility prior to going in to see if, A, they're going to be able to protect you, and B, perhaps you can schedule the first appointment of the day or the last point of the day where you can have a little bit more time where other patients aren't there.

Jamie Monticelli:
What if I don't have any symptoms? Can I put off a health screen?

Dr. Anne Kobbermann:
You know, the risk of delaying your mammogram by a month or two is pretty minimal. The problem that we run into is once people delay it a month or two, they kind of forget when they had it lasts. And then all of a sudden, it's three years and they haven't had a mammogram. So yes, the short answer is, is something bad going to happen to you if you don't have a mammogram this month and you have it next month instead? No, you're going to be in the same place that you were. But if you delay the mammogram now and don't do it until three years from now, there's a bigger chance that something bad could happen.

Jamie Monticelli:
I feel like this is always a question we have to ask and always information we need to put out there. If you are concerned about COVID-19 and just the health risks and concerned about being in a hospital or in a screening center where there are sick people, potentially, what are the questions, you covered this a little bit, but what are some of the things that you can ask ahead of time so that you know what kind of environment you're going into?

Dr. Anne Kobbermann:
I think you want to know what their cleaning policy is. You know, what are they doing with the machine in between patients? The mammogram technologists are obviously very close to you when you're having a mammogram. You want to know what their expectations are from you about wearing a mask and other things while you're there to help protect them from you. And do you want to know kind of what their waiting room policy is.

Dr. Anne Kobbermann:
In the past, a lot of women would go together to get their mammogram and do it in a group. And now, we're really recommending not bringing guests with you, not going in a group, trying to minimize the amount of people that are there at any given time. And so I think knowing what to expect and knowing what they expect from you as well is important before you go.

Jamie Monticelli:
And last question, if you get that info, you have asked the questions and now you have this information and there's something in there that you're not comfortable with, some part of that doesn't feel safe enough to do, what options do you have? Can you ask that they do something differently or clean something more? What are your options there?

Dr. Anne Kobbermann:
I mean, I don't think there's ever a problem with asking. I mean, if it's unreasonable and they tell you no, then you can make a decision, but it may be that they can make reasonable accommodations for you, like I said, to make sure you're the very first patient of the day, or to allow extra time for you in between you and the next patient so you have extra time where there's not going to be crossover of other people.

Dr. Anne Kobbermann:
And so if you do have medical issues that put you at an enhanced risk for COVID-19, which people have, and we don't want those people to also be diagnosed with late stage cancer, the best thing to do is call and raise those concerns beforehand. Because most of the places are going to want to work with you to help you feel safe, but also make sure you're getting appropriate medical care.

Jamie Monticelli:
All right. That's great information. Thanks to breast surgical oncologist, Dr. Anne Kobbermann. This has been MedTalk, presented by HCA Midwest Health. I'm Jamie Monticelli.