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Mammo day!

[00:00:00] Good morning. It's Tuesday and it's mama's day off. Do you know what that means? First of all, it's my first day off in two weeks and I'm pooped. So a mama's day off means two things. One, I get to be extra blingy cuz I'm not doing any pelvic exams today. I know you thought extra blingy, like could I get even more bling? 

Sisters, you don't know how much more blingy I could get. More is more Sometimes. I know many of you don't ascribe to that ideology. Clearly I do. Second, I'm getting my mammogram. So we are gonna use that opportunity for some mammogram teaching. This is not gonna be the typical mammogram saves lives conversation because that is a fact. 

Mammograms save lives, period. Okay, we're gonna do the mindset. Stop freaking out about the mammo. Because you know what? I get a lot of, I am so scared that I'm gonna have an abnormal mammogram. I hear that all the time. But Shiva, I'm just so scared [00:01:00] that I'm gonna get a phone call about an abnormal mammogram. 

I'm just so scared that I'm gonna hear the words. You have to come back for an abnormal mammogram, or, I'm just so scared that I'm gonna hear those words. You need a biopsy. So here's the deal. The fact is this, you. If you start getting your mammogram somewhere between the age of 35 and 40, which is what the current guidelines say, 35 or 40 for your baseline. 

And then most guidelines, and again, when I say most guidelines, you can abide by whatever guidelines you want. You should talk to your doctor. I kind of abide by the guidelines that say 35 or 40 for your baseline, and then every year after 40, there are certain task forces that are more liberal in allowing you to wait until even 40 or 50 and allowing you to go every two years. 

These are your. No one is here to dictate to you what you have to do. We are here to educate you and then you make your choices, but you have to make your choices based on realistic ideals of what you are willing to accept. If you stretch out the guidelines and you get screened less [00:02:00] frequently, that means you are willing to accept that you may pick up a cancer later. 

Screening more frequently has good and. Screening means that you might pick up a cancer earlier, that's great, but it also means you might have more false positives. So screening starting for me in my practice and my sister, as I always say to you guys, if you were my sister, 35 or 40, the majority of my patients honestly do start at 35. 

Um, and then every year, certainly after 40, sometimes after 35, depending on a shared conversation where I. This is what I would do, uh, depending on risk factors. Obviously, if they have other risk factors like strong family history, then I strongly encourage them to get genetic testing if they want, meaning family history of one first degree relative or a few second degree relatives with breast cancer, particularly at younger ages like premenopausal or ovarian cancer or colon. 

Or nowadays we're finding out uterine cancer, [00:03:00] melanoma at prostate cancer, pancreatic cancer can also be associated with breast cancer. So those are important conversations to have with your doctor to decide if you should get referred to a genetics counselor. Now you go for your mammogram, you get called back. 

The likelihood of an abnormal mammogram, meaning that you have to have a biopsy, is like a couple of percent, right? So there's a huge number of abnormal mammogram. And only something like, I wanna say, 2% of ab. Those abnormal mammograms will then need a biopsy. And of those that need a biopsy, something like 60 to 70% will be benign. 

So pause for a second and hear what I just said. If you get called back for an abnormal mammogram, two percent-ish, maybe less, will need a biopsy. And of that 2%, 60 to 70. Will be normal, will not have cancer. Okay? So that means huge number are gonna get, get the phone call. Hey, it was [00:04:00] irregular. No need to freak out. 

So when you guys say to me, I'm so scared, my response is, why are you going to waste the feeling of fear and the trigger of fight or flight and the trigger of cortisol when the likelihood is everything's gonna be okay? And when it's just so common, a huge number of mammo. Are found to be abnormal because it's a screening test, and this is important for you to know screening tests purposefully. 

There's a definition of screening tests. They're meant to have a high number of ability to pick up a lot of people with a disease and a very early stage, which means we have to accept a certain number of false positives. We know that when we screen a population, which means by definition, these are an asymptomatic population. 

These are not women who have felt something. These are women who walk in no symptoms. They're going in for their annual yearly screening mammo. We know that a huge number of them are going to have abnormal mammograms. That will be normal. If every single woman invokes that feeling of, oh my God, fear, [00:05:00] she's triggering her cortisol, she's wasting her ability to use that fight or flight when she needs it, which is when, when she's being chased by an animal in the wild or when she's, God forbid, being chased by like a human down the street in Central Park. 

Something very realistic, right? Something where, luckily it's rare, but luckily you need those emotions to be able to be trigger. So that you can actually utilize that response. You don't wanna utilize that response on a daily basis when you just found out that your kid got an F, or you just found out that you have an abnormal mammogram or an abnormal pap smear. 

These are everyday things that will happen to us. So let me repeat. Abnormal mammogram, very common need for a biopsy. Actually, not so uncommon likelihood that the biopsy is going to be cancer, not very common. And furthermore, if that biopsy is. Meaning no one has felt anything. It was just seen on the mammogram. 

A large proportion of those cancers will be early cancers, meaning D C I S, ductal [00:06:00] carcinoma and ctu, which some people will call stage zero cancer or preinvasive. Meaning it is the cancer that is found before it has broken past this, um, pathological membrane called the basement membrane, which is something that the pathologists see under the micro. 

So DCI S, which is stage zero cancer, or it'll be found often at stage one, which unfortunately is called invasive cancer, which does not mean that it is invaded into the lymph nodes. It just means it is invaded past this basement membrane. D C I S stage one cancers. Even stage two cancers are early breast cancers that can be treated. 

Stage three and four nowadays can be treated as well, but those typically aren't just found on a mammogram. Most of the time people will have felt something so. mammogram, abnormal, likely known biopsy, likely just a call back because they need to squeeze your breast a little further or look at a more, more focused area, or do an ultrasound. 

Okay? If you need a biopsy, likely it's gonna be normal. If it's not [00:07:00] normal, and it turns out you have cancer, does that suck? Hell yeah. Of course I had cancer. It sucked. But does it suck within a framework of you can get through it? Absolutely. And that's what you really care about. I'm pretty sure that if you really examine your feelings right. 

You don't necessarily care that you would ever be diagnosed with cancer. You care that you would be diagnosed with cancer and that you think you wouldn't survive it. So take a second and examine what I said. Is it the word cancer that strikes fear in your heart? No, it's the word cancer equaling death, which is what our world has taught us to believe. 

It's a very learned concept. We have decided in our mind, right, our model is cancer equals death, and that model is patently wrong, nowaday. With the treatments that we have, with the fact that we have early detection, cancer does not equal death for the vast majority of us who have cancer. In my family alone, family of four, two parents, two children, me, my mother, my father, my sister, 50% of us have had cancer. 

I had [00:08:00] ovarian cancer. My father had kidney cancer. We are both alive and kicking, right? 50% of us, we had a pretty high success rate, right? And that's not unusual. The majority of humans on this earth who have been diagnosed with cancer have. Because of early detection and because of treatment. Is that always the case? 

Of course not. But examine your feelings. Why are you allowing yourself to invoke fear? Is it because I don't think I can go through treatment? No. You know yourself, you're strong. Every single woman watching me right now has been through some shit. Some big, big, big shit, and I'm saying shit, not shit today because it's big shit. 

Like if you've been through a lot of stuff in. , you've been through it and you've gotten through it and you probably haven't even reminded yourself that you've gotten through it. So it's not the cancer that you're worried about. It is the not surviving the cancer, I think, and that's where I really want to remind you, get your screening tests, get your mammogram so that if God forbid, something happens, you catch it early, get your colonoscopy. 

The guidelines for colonoscopy got reduced from 50 to 45. Fight with your insurance companies. If they decline it because they're supposed to cover it, because [00:09:00] the guidelines switch from 50 to 45, will they? I don't know. We need to collectively fight with them, right? If you are having a pap smear, talk to your doctor about what guidelines she adheres to. 

You should be getting it anywhere from every one to five years, depending on how old you are, your risk factors, what you and she or he decide together. Okay? These are all things that you can do to reduce your risk. Doesn't mean that you're gonna eliminate the diagnoses of cancer for any of us, but it means that you will likely survive them. 

Can we survive every single thing? Much like my car analogy, which I will talk about later this week. Hang on if you haven't heard it, cuz I talk about it a lot, but I haven't posted about it in a while because we take risks every single day. So again, my mammogram today, I'm hoping I'm gonna get a clean, like, Hey, your mammogram's fine. 

But I know full, full well there's a chance that they might find something and I might have to go back and I hope that they don't. But if I do have to go back, I am not gonna let myself get invoked with fear. I'm gonna say to myself, the likelihood is my follow up will be. And [00:10:00] if I need a biopsy, the likelihood is the biopsy will be fine. 

And if that biopsy turns out to be something, the likelihood is it will have been caught early and I will still be fine because fine to me is not, wow. Your body is perfect and is never gonna go through anything. Fine to me is, am I still alive and kick him? That's fine. To me, that is what I am aiming for, right? 

I don't feel or worry about. Ability to get through the rest of my life. I'm 51 and I'm gonna be, I'm, I'm aiming for like late eighties, early nineties. I don't expect that I'm gonna get through this unscathed. In fact, I expect that I will get through this scathed. I've already been scathed, it's gonna happen again. 

So I expect that, but I expect that I'll be able to get through these things. And the more I expect myself to get through it in perfect condition, the worse I'm gonna get. Because then every single time I hear the littlest thing that's gonna ding this exterior, I'm gonna freak out. And that's not valuable to me. 

That is not gonna help me. [00:11:00] So again, I implore you. Please, please, please do not let yourself invoke fear at the littlest things that are common. Abnormal mammograms are common. One other quick word about mammograms and screening. I hear a lot of you guys get upset that when you've had a screening mammogram and in certain states, like in con. 

An ultrasound screening for dense breasts, meaning if your breasts are dense, which the other word is fibrocystic, which means they're kind of either firm and hard or lumpy, bumpy. If the alt, if the mammogram says they are dense enough, then you need a screening ultrasound as well that would be covered by your insurance, even if you have a high deductible, because screening tests are still covered, even with high deductibles. 

If you unfortunately have an abnormal mammogram, a. Because they couldn't see something well, or they saw something that they need to focus on more, or you need a biopsy where they have to do a further mammogram, a further biopsy, a further ultrasound. Those are now considered diagnostic tests. Those are not covered. 

If you have a high deductible, [00:12:00] including for me, I have a $13,000 deductible. That is not something that your gynecologist, your internist or the radiologist can recode as screening or preventative. These words that the insurance company will sometimes say to you, oh, just have your doctor recode it as. A diagnostic follow up test like, oh, you had an abnormal mammogram. 

Come back so we can look at your right breast. That can never be a screening test ever again. It's not our choice. It is the way the coding system works. It is outta the hands of the doctor. So do not be angry at your doctor. Your doctor hates the system. Your doctor would just assume the insurance company cover it because she knows that you've paid into that system and she gets paid by that shitty system and she does not get paid well. 

So again, I need you guys to understand this system because maybe together we can fight it, but right now you are getting screwed by the insurance companies and we as the doctors are getting screwed by the insurance companies. But it is nothing that we can do about it. We cannot recode it as. Unless it is truly screening, which means you walked in for your annual exa and your annual screening test. 

The minute [00:13:00] you go back for a follow up, it is no longer a screening test. It is now a diagnostic test. That's true for a follow-up pap smear. If you had a follow-up anything, you go to your internist for your yearly exam and your internist finds out that your anemic and now you have to go back for follow blood work three months. 

That is no longer screening. And if you have a deductible, unfortunately you are responsible just as I am, and I get no write offs because any write off to me from the hospital or radiology departments is considered a kickback, so we don't get discounted. We pay every dime of that $13,100 deductible. 

Okay? It sucks. Trust me, it sucks, but I want you guys to understand it so that you don't get angry at us and you understand what's going on with your system. Okay? Mammogram don't be. It's normal to be nervous. You hear me say it all the time. Nerves are normal. Don't be scared. Don't waste your fear on something that is really common, that you're likely gonna be fine over and wish me luck, right? 

Or I shouldn't say luck, wish me what is likely gonna happen, which is likely it's gonna be fine. And if [00:14:00] it's not fine today, it will end up being fine. Okay, bye.