Our Podcasts
Breast Assured: Conversations About Breast Health
Breast Assured is a podcast convening an essential conversation about breast health. In each episode, specialty-trained breast imaging experts (from Connecticut Breast Imaging in Danbury, CT) share current information about the field, and discuss key aspects of breast care with prominent guests. Among the topics addressed in the roundtable format will be why regular testing matters, new technological advancements, the emotions surrounding the patient journey, Covid-19 implications for breast care, and best practices for aging patients. Breast Assured’s goal is to be the reassuring and intelligent resource that’s often missing for people as they go through a diagnostic and treatment process.
Danbury’s Female Trailblazer: All About Dr. Mah’s 20+ Years in Breast Imaging Radiology at Danbury and New Milford Hospitals
Today, Breast Assured’s host Dr. Madhavi Raghu speaks with Dr. Anna Mah, the first female partner at Danbury Radiological Associates, who has been caring for patients at Danbury and New Milford Hospitals for 22 years. As the head of breast imaging in her early years, Dr. Mah discusses the differences in care and technology, the advancements made, and what it means to be a female physician. To learn more or to make an appointment, please visit our website at ctbreastimaging.org or call 203.791.9011.
00:04 – 00:29
Dr. Madhavi Raghu
Hello and welcome to Breast Assured, the podcast about Breast Health. I am Dr. Madhavi Raghu, Director of Breast Imaging at Connecticut Breast Imaging in Danbury, Connecticut. We’re so glad you can join us today. We’ll be joined by our very own Dr. Anna Mah to learn a little bit more about her background and why she decided to become a breast imager. Dr. Anna Mah has been with our practice for nearly 20 years. I hope you enjoy the conversation.
00:37 – 00:38
Dr. Madhavi Raghu
So welcome, Dr. Mah.
00:38 – 00:40
Dr. Anna Mah
Hello. Good morning, everybody.
00:40 – 00:48
Dr. Madhavi Raghu
So, Anna, Anna Mah, let’s start from the beginning. What actually got you interested in radiology?
00:49 – 01:45
Dr. Anna Mah
So I grew up in Ohio, and my father was a radiologist, and he has now retired. But my exposure to the world of medicine for a long time was really just through radiology, because that’s what I thought doctors did. I mean, obviously, I knew there were other kinds of doctors, but to me, that was like the main thing. And so when I went to medical school and then you rotate through all the different divisions and surgery and pediatrics and everything, there were other things I liked, but it just was in my mind, I guess, very familiar, and I liked the fact that you were kind of a consultant to the other doctors. You had to know a lot about everything, which is a little intimidating, but at the same time, you know, the doctors are coming to you looking for help and answers. And so, it was a part of that – I was, you know, following my father’s footsteps. But also, I liked the camaraderie of being helpful to the other physicians.
01:46 – 02:00
Dr. Madhavi Raghu
Right – no, for sure. You’re absolutely like a physician’s physician in some way. So then how did your path lead from radiology into breast imaging? Because in breast imaging, you’re almost like at the forefront of patient care.
02:00 – 02:42
Dr. Anna Mah
It’s kind of the best of both worlds to me, I guess I thought because a lot of radiology, you sit in a room by yourself and now you’re staring at a computer screen talking into a Dictaphone, and doctors do come down and talk to you about the images, but a lot of it is kind of removed from the people you’re helping – from the patients. And breast imaging was the one, you know there’s interventional radiology also, but breast imaging was one of the few things where you’re more in touch with the patients. You’re seeing the patients first. And we talk to a lot of our patients. Obviously, we do the biopsies so you’re there with the patient. You are much more integral part of their care than in some other parts of radiology. So I enjoyed that.
02:43 – 03:08
Dr. Madhavi Raghu
It’s absolutely true, because I think that, you know, patients come in, they have so many questions. And sometimes I think some of those questions are really difficult to be answered by the primary care physicians or OBGYN and as a breast imaging specialist, you know, we have some of these expertise and some of these questions that we can answer for them. So it’s a departure really from the traditional radiologist paradigm in terms of how they’re practicing.
03:08 – 03:38
Dr. Anna Mah
Right, Right, right. It does seem to me, when I was going through all the different parts of radiology, the most rewarding. Also as a woman, it’s something that I think a lot of women radiologists which are still aren’t that many, kind of feel that they should know a little bit more about. They’re going to have to do it in private practice because in a lot of private practices you’re doing everything and maybe you would have to do a little bit more of that than a man, depending on what how the private practice works. So I thought I would get to know as much as I can about it since I would have to do it.
03:38 – 04:04
Dr. Madhavi Raghu
That’s right. I mean, breast imaging is a huge part of many practices. And it’s sort of like the gateway because, you know, every woman over 40 needs to be screened anyway. Right. So they are coming in and they have to be evaluated. But I think that the difference is – and you can tell me a little bit about this – I mean, over time, I think the specialty has evolved to become more of a patient facing subspecialty.
04:04 – 04:32
Dr. Anna Mah
I think a lot of patients are very aware of where they’re going to get their breast imaging and who’s there. And I mean, I have patients I’ve been doing this now for 22 years at Danbury Hospital and in Milford, and I have patients, some patients I’ve seen for almost all that time. They come back when I’m there, which is a little flattering, they want me to read their studies. And I’ve seen them, you know, throughout many, many years.
04:32 – 04:52
Dr. Madhavi Raghu
And I think that’s really nice because one, you’re obviously extremely skilled, but secondly, I think it’s nice to actually have that continuity of care and that relationship with patients over time, which may not be possible with maybe general radiology. But it’s different for breast because, you know, these patients get to know you and you get to know them.
04:52 – 04:52
Dr. Anna Mah
Right. Right.
04:52 – 05:03
Dr. Madhavi Raghu
And sometimes they need a biopsy, sometimes they get called back. So there are multiple interactions in their time with us as well. So it’s nice that you’re able to see them over and over again.
05:03 – 05:19
Dr. Anna Mah
Yeah, I feel really privileged about that because I definitely have a cadre of patients that every year they come back and I’m like, ‘Oh, she’s back’ and they want to say hello, which is really nice. And if they ever need anything done, you know, then I see them then, which may not be so nice, but hopefully I can take it, you know, doing a good job for them.
05:19 – 05:20
Dr. Madhavi Raghu
Right, right.
05:20 – 05:29
Dr. Madhavi Raghu
Well, it’s nice because when I’m on service with you, I sometimes know that some of those patients will come in to see you. So they’re their Anna Mah’s special patients.
05:29 – 05:31
Dr. Anna Mah
Been here a long time. Yeah.
05:31 – 05:41
Dr. Madhavi Raghu
But that’s actually that’s important because I think patients need to understand that the radiologists are no longer just in a dark room behind closed doors. We actually want to get to know the patients as well.
05:41 – 05:48
Dr. Anna Mah
And if I can give them comfort that they know who that person is, they know they’re going to have a certain level of comfort with that. Yeah. That’s great.
05:49 – 05:50
Dr. Madhavi Raghu
Exactly. No, I agree with you.
05:51 – 05:56
Dr. Madhavi Raghu
So you’ve been here for 20 years. Have you been with the Danbury practice for 20 years?
05:56 – 06:12
Dr. Anna Mah
I went to medical school at Columbia in New York City. I did my residency and Breast Imaging Fellowship at Columbia. And then I took a job at Danbury Radiological Associates. And that was in the year 2000, and I’m still here.
06:13 – 06:16
Dr. Madhavi Raghu
So, at that time, were you the only woman in the practice?
06:16 – 06:39
Dr. Anna Mah
I was the only woman in the practice. I was. They had had women before. But I think my understanding, I could be wrong, but I think my understanding is, you know, at that time you had a four year partnership track. Right. So I don’t think any of them had ever stayed long enough to become a partner or if they were even on the partnership track. But yeah, I was the first, I was the only woman when I arrived, and I was the first woman partner, I believe.
06:39 – 06:52
Dr. Madhavi Raghu
Correct. So in some ways, you were essentially assigned to breast. Well, trailblazer, really? Right. So in some ways, you were expected to read breast imaging, and then.
06:52 – 06:56
Dr. Anna Mah
I was hired, you know, to be the head of breast imaging at the time. Right out of my fellowship.
06:56 – 06:59
Dr. Madhavi Raghu
Right. Right. And at that time.
06:59 – 07:06
Dr. Anna Mah
It was a much smaller right scope of practice. At that time, it was only one location and at the hospital.
07:06 – 07:21
Dr. Madhavi Raghu
And at that time was breast imaging film, or was it – I don’t think it was digital at all? What were some of the challenges with film reading? I mean, I’ll tell you that I actually have never used film. So, you know, it’s different.
07:21 – 07:53
Dr. Anna Mah
You would come in in the morning, someone would be hired to like hang up all the mammograms, the ones from the night before. You couldn’t do it necessarily, you know the way we do it now, right, one at a time, because it was more batch reading. So someone would hang up all the mammograms the night before that were done that day. And then you would come in in the morning, there’d be a whole alternator full of them and a big stack of folders with all their old ones, and you would run through the alternator and that was your screening day. And then in between, you know, they would show you diagnostic cases or do biopsies, but, you know, it’s not that different.
07:53 – 08:04
Dr. Madhavi Raghu
It sounds like it was not as smooth of a day, right? Because you would have to sort of stop, maybe remove some films, add some films so that you can look at the diagnostic images right then and there.
08:04 – 08:17
Dr. Anna Mah
Right. Right. You know, takes a little bit more time to you’d have to take down all the films and put them in the jacket. And then there were big stacks of jackets everywhere. Takes a little bit more time, but essentially the same thing we do now. We’re just, you know, when we click and move the little images on the computer screen.
08:17 – 08:24
Dr. Madhavi Raghu
And then things move to digital. And now we have Tomosynthesis, which is a totally different way of practicing.
08:25 – 08:38
Dr. Anna Mah
Right, right. Yeah. There have been a lot of changes. At that time, you know, talking to the Dictaphone and then a human being would transcribe the reports and then they would give us a paper copy and we would sign the report. And it was very primitive, really.
08:38 – 09:01
Dr. Madhavi Raghu
Right, right, right. So I think now, you know, with access, you know, immediately dictating studies and then patients now have access to those types of reports. It’s a different practice. But I think that actually allows us to focus a little bit more on the patients, because if they want immediate reads or if they want immediate care, we’re able to deliver that as opposed to I’m envisioning there was a time gap, you know.
09:01 – 09:20
Dr. Anna Mah
Right. Obviously there have to be a time gap, right. We would dictate, a human being had to type it, it had to get printed and would come back to us probably, you know, usually the next day. So not too long still. But, you know, now it’s, you know, can be done in a matter of few minutes, you know, and then it’s automatically available for the clinician to see as soon as we dictate it. Really.
09:20 – 09:30
Dr. Madhavi Raghu
Right. And the patient too, because now they have access to their reports and to their studies. So I think that creates unique challenges in itself. Right.
09:30 – 09:31
Dr. Anna Mah
I guess overall it’s better.
09:32 – 09:45
Dr. Madhavi Raghu
Right. So in all this time that you’ve clearly have so much experience, are there any specific patient examples that have, you know, inspired you or left a mark or, you know, just a memory for you?
09:46 – 10:00
Dr. Anna Mah
There have been a lot of young people those stand out a little bit for, you know, not so pleasant reasons. I’ve been lucky enough to, you know, see a lot of people that I know personally, you know, which is also really rewarding, most of which turned out great.
10:00 – 10:11
Dr. Madhavi Raghu
And I think having those personal relationships is actually a huge part of what we do. And it’s actually nice. I think breast imaging adds a huge element of humanity to radiology in general.
10:11 – 10:13
Dr. Anna Mah
Yeah, it’s one of the few.
10:13 – 10:14
Dr. Madhavi Raghu
That’s right.
10:15 – 10:17
Dr. Anna Mah
Personal things, radiology, extremely rewarding.
10:18 – 10:28
Dr. Madhavi Raghu
One of the challenges that we are encountering now is just COVID related deficiencies in imaging in terms of patients returning for screening.
10:29 – 10:54
Dr. Anna Mah
I mean, at this point, it’s been several years. It’s been two and a half years, if people haven’t returned because they worry about COVID, they definitely need to come back now because now the time gap has been such that you really need to get back into preventative care and make sure that there’s nothing going on. I think a lot of people have returned. I feel like I mean, you probably know the numbers better than I do. Is there still a…
10:54 – 11:09
Dr. Madhavi Raghu
I mean, there’s still a lag, I think, in patients coming in. I mean, one of the other things that I actually just reviewed was the cancer deficit. So even though some patients are still coming in, we’re still not quite at the same pre-pandemic cancer levels.
11:10 – 11:11
Dr. Anna Mah
Implying that it’s out there.
11:11 – 11:32
Dr. Madhavi Raghu
Implying that it’s out there, but that means patients may be coming in at a later stage or, you know, more locally advanced cancer. So I think it is important to come back for screening. One of the other questions that patients and referring doctors ask is the impact of vaccines and whether they should delay their screening mammograms as a result of the vaccine.
11:33 – 11:55
Dr. Anna Mah
I think if you just had the vaccine or a booster, it might be wise to delay it a little bit or, you know, try to schedule your vaccine for right after your mammogram, if you could do that because of the lymphadenopathy issue. You know, so you don’t want to have to have to come back again and worry about why the lymph nodes are big. So not necessary if it’s just doesn’t work out that way. It’s okay.
11:55 – 12:10
Dr. Madhavi Raghu
And I think some of these lymph nodes are prominent even up to six months, actually. So, you know, I mean, we were doing six month follow ups on some of these. But even that data is changing and evolving. And I think we’re pretty good about picking out which ones are reactive.
12:10 – 12:20
Dr. Anna Mah
Yeah, I think that, you know, it’s died down a little bit. We’re very well aware of it, so. It’s okay if it doesn’t work out for scheduling that way. But if you can, try to have your vaccine the next day.
12:20 – 12:35
Dr. Madhavi Raghu
Right, exactly. But I think that shouldn’t hold people back. I mean, they should still seek screening. I mean, not just for breast cancer screening, even colorectal cancer screening. All of these different preventative health screenings have come down. So it’s important to take care of ourselves.
12:36 – 12:41
Dr. Madhavi Raghu
So in the last few minutes that we have, I want to ask you some personal questions.
12:41 – 12:42
Dr. Anna Mah
Okay.
12:42 – 12:45
Dr. Madhavi Raghu
So you have a couple of kids?
12:45 – 13:01
Dr. Anna Mah
Yeah, I have two kids. My older son is 21. He just graduated from college. And then my daughter is 19 and she’s a second year in college. So we’re at home alone now, which is different. But it’s good. It’s all good. Yeah, they’re very well.
13:02 – 13:05
Dr. Madhavi Raghu
Quite a challenge early on in your career, I’m sure balancing.
13:05 – 13:08
Dr. Anna Mah
Yeah, it all went by in such a blur.
13:08 – 13:10
Dr. Madhavi Raghu
That right – that’s what most people say.
13:10 – 13:33
Dr. Anna Mah
Yeah, yeah, when they’re small as it is, but you’re so busy. At that time, really, and when they were small, I was working full time, I was taking call, working weekends. My husband was very, very helpful. He, you know, he took care of the babies at night by himself. We didn’t have any live in or anything. I did have a nanny, you know, when they were very young. Yeah, but yeah, it went by so fast.
13:33 – 13:57
Dr. Madhavi Raghu
And I think it’s actually nice as a woman and a woman, female physician, you know, I’m sure that even when patients come in, you know, they do relate to us because we do see so many working women and mothers who come in for breast care. And it is nice to have, again, another point to connect with the patients. Yeah definitely. So what do you do for fun in your spare time?
13:58 – 14:22
Dr. Anna Mah
Let me think what I do it for fun. I have a little dog, that’s my baby now. I like to knit. You know, it sounds funny when you say it, but that’s probably one of my, you know, that’s my hobby, I guess you could say. So, yeah, at home, I’m always working on a project. I read a lot. See friends. I have a sister that’s nearby, so I see her quite often.
14:24 – 14:24
Dr. Madhavi Raghu
Oh, that’s cool.
14:24 – 14:25
Dr. Anna Mah
Yeah.
14:27 – 14:37
Dr. Madhavi Raghu
Well, I just want to thank you for making the time and telling us a little bit about yourself and what drives you to be the breast imager that you are. Thank you. We’re very lucky to have you in the practice.
14:37 – 14:38
Dr. Anna Mah
Oh, thank you for having me.
14:42 – 14:59
Dr. Madhavi Raghu
Thank you all so much for listening. If you enjoyed this podcast, please like and subscribe wherever you listen to your podcasts. Also, share it with a friend. But most importantly, if you or your loved ones haven’t had a screening mammogram, we urge you to get one today. See you all next time.
Becoming the First Female Chair of Radiology: Dr. Bakhru’s Journey to the Breast Imaging Profession, Mammography During COVID, and the Importance of Support Systems
Breast Assured host Dr. Madhavi Raghu speaks with Dr. Seema Bakhru to learn about why she decided to specialize in breast imaging, how her experience aided her role as Assistant Program Director of Residency at Norwalk, and led to her becoming the first female Chair of Radiology for Danbury, Norwalk and New Milford Hospitals. The breast imaging specialists also discuss getting your mammograms and other screenings during COVID, and the importance of teamwork and support systems within and outside of the office. To learn more or to make an appointment, please visit our website at ctbreastimaging.org or call 203.791.9011.
00:04 – 00:38
Dr. Madhavi Raghu
Hello and welcome to Breast Assured the podcast about Breast Health. I am Dr. Madhavi Raghu, Director of Breast imaging at Connecticut Breast Imaging in Danbury, Connecticut. We’re so glad you can join us. Today we will be joined by our very own Dr. Seema Bakhru to learn a little bit more about her background and why she decided to become a breast imager. Dr. Bakhru, is also the Chair of Radiology at Danbury, Norwalk and New Milford Hospitals. Hope you enjoy the conversation. Welcome, Dr. Bakhru!
00:38 – 00:40
Dr. Seema Bakhru
Thank you so Madhavi. It’s such a pleasure to be here.
00:41 – 00:54
Dr. Madhavi Raghu
I’m so excited that you’re here, as well. So, you know, we’re doing a series on getting to know all our different breast imagers. And I just wanted to, you know, really start with your journey. How did you choose radiology?
00:55 – 01:17
Dr. Seema Bakhru
So, you know, it was interesting because radiology was probably the last specialty for me. I thought, who would want to sit in the dark all day long in a little tight reading room and just read cases all day long, that just really didn’t seem appealing to me when I was in medical school at all. So, I was actually planning on going into internal medicine and likely gastroenterology was what my interest was.
01:18 – 01:57
Dr. Seema Bakhru
But then I actually couldn’t get into a sub-internship on my fourth year of medical school until August. So, I had July to kind of play around with and I thought, what can I do that will make me shine during rounds in August? And I thought radiology was a perfect pick because I thought I would be the imaging girl on the team rounds. And so, I would be able to, you know, that was my way to stand out, basically. So, I ended up doing a radiology elective in July of my fourth year of med school and I loved it. It was so interesting, you know, I think we have the perspective of seeing almost every single patient that comes through because almost everyone has some form of imaging.
01:57 – 01:58
Dr. Madhavi Raghu
Correct.
01:58 – 02:47
Dr. Seema Bakhru
And you get to see so many different pathologies, so many different disease processes. And I have to give credit to my mentor, Petra Lewis, who ran the program there. She did an amazing, phenomenal job with a lot of input, with a lot of teaching, and I came out of that rotation thinking, wow, actually radiology is pretty cool and interesting. But I was still hung up, you know, I still thought I wanted to do internal medicine. So then September came along, I did my sub-I, I asked all the medicine residents that I was meeting, you know, I’m so torn, I don’t know what to do. Should I do radiology, should I do medicine. And every single one told me to do radiology, even though their chosen field was internal medicine. So that basically made the decision for me. And I’m really glad that I went into it. I’ve never regretted that I’m a radiologist.
02:47 – 03:16
Dr. Madhavi Raghu
You know, it’s so interesting because just talking to some of our other colleagues, many report the same type of experience where radiology was just never part of the medical school curriculum. And that’s true. You know, and I think most of us just sort of stumbled upon it because we just happened to see it. Right. You know, we don’t have enough women that go into radiology for sure. But it’s almost like, luck, in terms of how people really just fall into radiology.
03:16 – 03:18
Dr. Seema Bakhru
It is. It is. It’s like destiny.
03:18 – 03:40
Dr. Madhavi Raghu
It really is. And then, of course, many of us ended up choosing breast imaging as a subspecialty, which is really different from other aspects of radiology. Right, right, right. We’re now patient facing – exactly. So how did you decide upon breast imaging and, you know, were there any specific experiences that led you to that decision?
03:40 – 04:16
Dr. Seema Bakhru
It was really the patient aspect of it because, you know, like I mentioned before, the thought of just sitting in a dark cave of a room and just reading off of a computer all day long, it really wasn’t that appealing to me. I really miss that patient interaction. You know, that’s one of the things that I really enjoy as part of medicine. That’s why I went into medicine in the first place. And I think when you’re just sitting behind a computer, it’s so easy to forget that these aren’t just pixels and dots on a on an image – this is an actual patient, you know, has certain concerns, who has anxiety about their diagnosis, who’s coming to you with a symptom. I think you forget that.
04:16 – 04:44
Dr. Seema Bakhru
And breast imaging was really appealing to me because you get that daily reminder. You know, you’re talking to the patients, they’re super anxious and you’re trying to calm them down. You know, you’re doing procedures as well. So, it wasn’t just a matter of just reading cases, you’re also doing something hands on as well. And then even the follow up, you’re giving them the biopsy results. So, I felt like in that way I got that internal medicine component. Yeah. Things that I liked about internal medicine, you know, I thought it was a really good mix.
04:45 – 05:14
Dr. Madhavi Raghu
Right no, I totally agree with you. I mean, it really brings a sense of humanity. Yes. To what we do. And just that continuity of care, being able to see the patients year after year. I know we’ve had some radiologist who have a following. Yeah. And as I’m sure you do as well, you know – patients that like to come see you year after year for your skill set. Was there a moment during your training or anything that just sort of solidified your decision to pursue breast imaging? Did you ever have second thoughts or anything like that?
05:14 – 05:25
Dr. Seema Bakhru
No. I mean I don’t think I really had second thoughts. Like I said, I think it was just a really good mix for me, for cases, for, you know, procedures and for patient interaction. And that was really what I was looking for.
05:25 – 05:26
Dr. Madhavi Raghu
Right. Right.
05:26 – 05:49
Dr. Madhavi Raghu
I know that for a period of time you actually served as the Assistant Program Director for the residency at Norwalk, again, speaking to your experience – just in terms of your experience as a resident and your decision to pursue breast imaging – what were some things that you tried to implement for those residents so that they could have a good breast imaging experience?
05:49 – 06:30
Dr. Seema Bakhru
Sure. So I think the most key thing is really
to have the residents be hands on. So they really
should be looking at all the cases, making up their own interpretation and then
with the procedures, you know, starting to get comfortable with the procedures.
Because for me, I was so terrified the first time I had to do a procedure, my
attendings said, Oh, well, you can do the lidocaine. And I thought to myself –
I have a million thoughts going through my head – What if I don’t give enough?
What if the patient is in pain? What if I don’t do it properly? And so such a simple thing was just terrifying for me, right? As
a medical student, as a resident. So I think just kind
of easing their fear is getting them practice.
06:30 – 06:56
Dr. Seema Bakhru
Well, you know, one of the things that Dr. Boroumand did, she’s our core faculty for breast at Norwalk, she brought in chicken breasts for the residents so that they could practice doing that, practice holding the biopsy device, practice using the lidocaine. So I think that was really useful just to get a familiarity with it, because if you don’t know what you’re getting into, then how do you know if you’re going to like it or not? So you really need to have that hands on experience.
06:56 – 07:05
Dr. Madhavi Raghu
Right, I mean, that’s actually good life advice, you know? I mean, you just don’t know what you’re going to choose until you’re, you know, actually in the middle or in the thick of that.
07:06 – 07:20
Dr. Madhavi Raghu
And certainly, I think as the Program Director or the Assistant Program Director, it really probably called upon some of your some of your leadership skills, you know, and you probably did a lot of learning during that time period. So what was your experience like?
07:20 – 07:59
Dr. Seema Bakhru
Sure, I mean, I think the best experience is when residents come up to you and say, we had a great rotation or they say they want to go into breast because of the rotation that we’ve put together. That’s really heartening and that means that you’re doing the right thing. The whole point of being an attending to residents is really to spark their excitement, their interest, and really, you know, guide them in their career paths as well. And it’s so nice to meet even residents who say they’re going into a different specialty; they say they want to continue doing breast as well because they enjoyed it so much and they really feel like the educational component is amazing on the breast rotation.
08:00 – 08:22
Dr. Madhavi Raghu
Breast imaging, breast cancer screening, it’s really for the masses for any woman over 40 and it really it lends itself into population health, it lends itself in to, you know, health care disparities. Right, so I think it’s really critical for residents to have familiarity and understanding of the bread and butter aspects of breast imaging.
08:23 – 08:38
Dr. Seema Bakhru
Yes. Yes, absolutely. And, you know, again, because we see these patients, we talk to these patients, sometimes they speak a different language. So getting used to communicating with them through an interpreter, these are all life skills that they need to develop. And I think the breast section really does a good job of that.
08:39 – 08:43
Dr. Madhavi Raghu
Correct. And I think those are important skills just as a physician, even as a human being to have.
08:44 – 09:02
Dr. Madhavi Raghu
So let me ask you a little bit about now that we’re talking about screenings, your thoughts of screenings during COVID. I know that the volumes dropped. I don’t think they’re quite back to the pre-pandemic levels, but just in terms of speaking to patients about their concerns, in terms of seeking screening, what are some of your thoughts?
09:02 – 09:45
Dr. Seema Bakhru
I myself am guilty of this during COVID. I think we basically shut down everything and kind of closeted ourselves into our home. I even took my daughter out of school for a whole year, and I think we all had those fears about COVID. But the truth is, is that we have a very safe environment. You know, we are taking additional cleaning protocols, disinfecting protocols. We’re all still wearing masks. It’s actually very safe for you to get your mammogram in terms of you actually catching COVID. I don’t know of any cases, honestly, that have come through that they’ve actually caught COVID from having their mammogram or ultrasound. We do try to move patients through as quickly as we can so that you’re not waiting around and you’re not unnecessarily exposed.
09:46 – 09:58
Dr. Madhavi Raghu
Well, actually, that’s a that’s a really good point, because in Connecticut, breast imaging patients are coming in with the comprehensive script. Right, so that allows us to move from screening to biopsy. So, I mean, do you want to explain a little bit about what the comprehensive script is.
09:58 – 10:41
Dr. Seema Bakhru
Sure, so the comprehensive script is something that your physician can order for you. And it basically starts with a screening mammogram and it provides basically an order from your ordering physician for us to do whatever else is necessary for your diagnosis. So, for example, if there’s an abnormality on your mammogram, typically we need to go back to your provider to ask for a separate prescription for a diagnostic mammogram or ultrasound. If you already have the comprehensive script in place, that order is already included within your initial script. So if we see an abnormality immediately on your mammogram and you’re still there. We can actually do your diagnostic imaging immediately after that, typically.
10:41 – 11:06
Dr. Seema Bakhru
So that really saves you an extra trip and saves you quite a bit of additional time. After that, if you need a biopsy that’s also included within that comprehensive script. So again, we don’t need to keep on going back to your doctor and asking for another prescription. We can just carry you through forward and really expedite your care so that you don’t have to make three separate trips to our center. We can just potentially even do all of it in one trip.
11:06 – 11:17
Dr. Madhavi Raghu
I agree. I mean, it’s really great for patients and I think it’s going to be great for our referring doctors. As well for patients who have fears related to COVID, I think this this should really help with that as well.
11:17 – 11:19
Dr. Seema Bakhru
Correct. Correct. Yes. Because you don’t have to keep coming back.
11:19 – 11:27
Dr. Madhavi Raghu
Right. Exactly. And to the extent that we can, we offer, you know, same day reads so that patients don’t have to come back again and again for additional imaging.
11:28 – 11:39
Dr. Seema Bakhru
Yes. And I think that’s nice for the for the patients, too. You know, they have an immediate answer. They don’t have to wait to get a letter in the mail or wait for their, you know, referring provider to call them back with the results. This way they know.
11:40 – 11:44
Dr. Madhavi Raghu
Right. I agree with that. I agree with that. And we try to make that happen as much as possible.
11:44 – 11:54
Dr. Madhavi Raghu
What about vaccines? Everybody now is at a different stage in terms of where they are in the whole vaccination process. Do you think that should prevent someone from getting a mammogram?
11:54 – 12:49
Dr. Seema Bakhru
No absolutely not. You know, particularly if you’re someone who actually has a symptom, if you are feeling a lump or you have some nipple discharge, you know, please do not wait to get your mammogram just because you just got your COVID vaccine. If you’re a regular, you know, you’re just coming in for your screening mammogram, just know that sometimes the vaccine can cause some enlargement of your lymph nodes in your armpit region. But just make a note. The technologies will ask you at the time of the exam, you know, when was your last COVID vaccination? What arm was it in? For the most part, we can usually clear that if you tell us that you just had a COVID vaccine a week ago on your left and we see some enlarged lymph nodes on your left, we usually just let that pass by. It’s pretty rare that we’re calling you back for that because this is a known side effect of the vaccine. Just make sure that you make a note of when you had your last COVID vaccination and which side you had it on.
12:50 – 13:20
Dr. Madhavi Raghu
I agree. And I think you make an excellent point, which is if you have something symptomatic like a lump or nipple discharge, it doesn’t matter where you are with your vaccination process. You have to come in and, you know, be seen by your doctor and definitely be referred for imaging so that we can sort that out. Yes, absolutely. I think one of the things that we’re we’ve seen and observed is that although we’re not seeing as many cancers as we did pre-pandemic, the cancers that we are seeing are at a more advanced stage because of this.
13:20 – 13:53
Dr. Seema Bakhru
Right and like you said, you know, I think a lot of women put off their screenings because of the pandemic and, you know, fears of going in for what may be an unnecessary exam. You know, I would just encourage all women to come in and just have your mammogram done, have all your regular not just mammograms, but anything, you know, whether it’s just seeing your general practitioner again or, you know, going for that colonoscopy you’ve been putting off – yes that colonoscopy – you know, it’s important to take care of your health because if we can catch it early, the cure rates are amazing.
13:53 – 14:01
Dr. Madhavi Raghu
Absolutely. I mean, especially for breast cancer, you know, localized early-stage breast cancer, the five-year survival rate is basically close to 100%.
14:01 – 14:02
Dr. Seema Bakhru
Exactly, exactly.
14:02 – 14:03
Dr. Madhavi Raghu
So that’s where we want to be.
14:03 – 14:13
Dr. Seema Bakhru
Right. And early detection is really the key. And early detection really happens with your screening modalities, with mammograms, with ultrasounds. And that’s why we really encourage you to come in.
14:13 – 14:33
Dr. Madhavi Raghu
So switching gears, I want to actually highlight some of your recent career accomplishments. So Dr. Bakhru, is now our newest Chair of Radiology for Danbury, Norwalk and New Milford Hospitals. And it’s a great accomplishment. So, first of all, congratulations.
14:33 – 14:42
Dr. Seema Bakhru
Thank you. Thank you Madhavi. It’s a tremendous honor and the group chose me and I really thank the group that they have the confidence in me to do this.
14:42 – 15:06
Dr. Madhavi Raghu
Well, I think you’re the right person for the job. You clearly have the skill set and the temperament, but you’re also the first woman Chair of Radiology in the area. So I think it’s that’s a tremendous honor for the group, not just perhaps for you, but, you know, it’s a real honor to be able to have someone like you in that position.
15:07 – 15:37
Dr. Seema Bakhru
Tremendous honor, tremendous responsibility. And, you know, I look to my fellow radiologists to help guide me. I’m really looking forward to making some improvements to the practice and really bringing us together as a team. I think, again, with COVID, because we were so siloed in our own little separate worlds, we weren’t doing department meetings together, we weren’t really doing any of those social events that we used to do together. I think we’ve become a little bit disconnected. And, you know, one of my goals is really going to be to bring us all together to be one cohesive team.
15:37 – 16:02
Dr. Madhavi Raghu
Right. And I think that team approach is not only relevant in just your job as the leader or as a Chair, but also just in all of breast imaging as well. I mean, it’s really the team that starts from the schedulers all the way to the to the patients, to the doctors. But as a Chair, I really appreciate the fact that you consider yourself as a member of the team, because that’s truly the future of leadership.
16:02 – 16:32
Dr. Seema Bakhru
Yes. No, I mean, we’re all members of the team. And I think sometimes people think, oh, well, it’s only the doctor who’s doing this or something. But really, every single member of the team, like you said, from schedulers to technologists to the secretaries who are taking in your information, we’re all part of a chain. And if any part of that chain breaks down, that affects everything else downstream. So it’s really important that we’re all cohesive as a team and that each link within the chain is as strong as possible.
16:32 – 16:33
Dr. Madhavi Raghu
I completely agree.
16:33 – 16:44
Dr. Madhavi Raghu
Well, I think that it’s fantastic that you’re here in this role and you’re here to shepherd the group. So on a personal level. Tell us a little bit about your personal life. I know you have a couple of children.
16:44 – 16:52
Dr. Seema Bakhru
Yeah. So I have two daughters. One is six and the other is three. So they definitely keep me busy outside of the office.
16:53 – 17:11
Dr. Madhavi Raghu
That’s great. But I think that, you know, you serve as a great role model for so many people in the group and even our residents. I mean, it’s no longer a woman who’s balancing work and life. Right. It’s all of us men, women who are balancing just life in general. And how do you do it? You have so much on your plate.
17:12 – 17:28
Dr. Seema Bakhru
I think you have to have a good support system. I think that’s really key. My husband also has a very busy job as well that’s very demanding. My nanny is amazing. I will say, you know, that is definitely key. And you need to have someone who’s reliable.
17:28 – 17:28
Dr. Madhavi Raghu
Right.
17:28 – 18:00
Dr. Seema Bakhru
Who you know, can you can depend on. My parents are actually moving from Massachusetts to my neighborhood. So they are going to be living down the street from me, which I think is huge. And I’m so grateful that they’re willing to do that for me. That means that I can be at work and I can focus on my work. I’m not worrying about who’s taking care of my kids. Yeah, who is taking care of the house, you know, what’s going on. It’s an amazing, tremendous point for me that I know that I have people that I can depend on to take care of my kids.
18:00 – 18:02
Dr. Madhavi Raghu
Well, I mean, I think you really do need a village.
18:02 – 18:03
Dr. Seema Bakhru
You do, you do. Absolutely.
18:03 – 18:05
Dr. Madhavi Raghu
Sounds like you have a town.
18:06 – 18:18
Dr. Seema Bakhru
Yes! Well, you know, that was always our goal. Actually, our goal was always to take over a block with our family, basically. So have, you know, our siblings and our parents all live on that one block, a little cul-de-sac of our own.
18:18 – 18:40
Dr. Madhavi Raghu
For sure. For sure. But I also think, you know, you’re serving as a great role model for your own children. I mean, for them to see that it’s great to be able to do what you do and it’s okay to get the help that you need to do your job well. I think there was always a pressure in the past for one person to be a singular, heroic figure in the family. Gone are those days.
18:40 – 18:54
Dr. Seema Bakhru
Yes! No, definitely. And, you know, my six-year-old comes up to me and she says, well, I want to be a doctor and I want to be an artist and I want to be a scientist and I want to be a singer. And I say, good, great, you can do it. You can do all of it.
18:54 – 18:56
Dr. Madhavi Raghu
And you should tell her that you’re going to move in with her.
18:56 – 19:00
Dr. Seema Bakhru
When my time comes, I’ll retire and support her.
19:01 – 19:15
Dr. Madhavi Raghu
But that’s so important to have that mentality that we’re going to support each other. It’s actually fantastic. Well, I just want to thank you Seema for joining us today. I mean, it’s just so tremendous that you are part of our practice and you do such great work and take such good care of patients.
19:15 – 19:19
Dr. Seema Bakhru
Thank you so much Madhavi. And I have to say, it’s a pleasure working with you as well.
19:19 – 19:42
Dr. Madhavi Raghu
Okay. Thank you. Thank you all so much for listening. If you enjoyed this podcast, please like and subscribe wherever you listen to your podcasts. Also share it with a friend. But most importantly, if you or your loved ones haven’t had a screening mammogram, we urge you to get one today. See you all next time.
The Imaging Experience: Getting to Know Your Technologist
On this second episode of Breast Assured: Conversations About Breast Health, fellowship-trained breast imaging expert and Director of Breast Imaging, Dr. Madhavi Raghu, and Radiologic Technologist, Ana Newsome, are joined by a breast navigator to discuss the important role the technologist plays during the imaging experience and for breast health in general.00:05 – 00:25
Dr. Madhavi Raghu
Hello, and welcome back to Breast Assured: Conversations About Breast Health. I’m your host, Dr. Madhavi Raghu, and I’m the director at Connecticut Breast Imaging based in Danbury, Connecticut. Today, we were talking with one of our very own mammography techs, Ana Newsome, about her journey in the field of breast imaging. Hope you enjoy the conversation!
00:33 – 00:39
Dr. Madhavi Raghu
So let me introduce Ana today, so, Ana, welcome to the show. We’re so excited that you’re here today.
00:39 – 00:40
Ana Newsome
Hello. Thank you for having me.
00:40 – 01:12
Dr. Madhavi Raghu
So, Ana is a very important member of our team. She is, she is essentially the artist. She is the person, the front line who actually meet and greets patients and actually positions patients for the mammogram. So, Ana, before we get started, I know that a lot of patients come in and they may be a little anxious about their mammogram. What are some things that you would say to them to help alleviate some of the anxiety that they may have related to the test?
01:12 – 02:05
Ana Newsome
The most important is communicating with your patient and trying to make them as comfortable as possible. I know it’s probably not the most comfortable exam to be done. However, sometimes just a way of talking to them and making them calmer just seems to alleviate the anxiety of having this test done. So, what I typically do, is just as I’m positioning the patient, I tend to talk to them, tell them to breathe through it and just kind of distract them a little bit from what I’m doing and positioning and compressing the patient just to kind of keep their mind off of that specific portion of the exam, whereas I’m just talking to them, telling them to breathe and before you know it, I’m where I need to get and the compression is there and we do the exposure.
02:05 – 02:40
Dr. Madhavi Raghu
You’re right, it goes pretty quickly. I think that typically we obtain two images per breast, so in two different projections. So, one projection allows us to see very deeply into the breast and it’s called the oblique view. And then the other projection is sort of from top to bottom. So I think between those images, the breast is released from compression. So, I know that you work very closely in in getting the patients positioned properly – what are some challenges that you may have encountered while positioning a patient?
02:40 – 03:16
Ana Newsome
We have certain patients with either limited range of motions with their shoulders due to surgeries or due to some injuries. So again, I just tell the patient and try to tell them to let me know as far as they can do. If you start off that way instead of just saying, “Hey, you need to do this,” say, “Hey, tell me how much you can do,” it kind of gives them a little bit of, “Oh ok, I did. I was able to get where I’m supposed to get.” So, I think communicating is number one and just to kind of make them comfortable.
03:16 – 03:55
Dr. Madhavi Raghu
And, you know, we encourage patients even if they have disabilities or if they have any limitations, as you pointed out, including shoulder related issues or if a patient is in a wheelchair, it should not preclude them from getting a mammogram, which is a very important test. Now I know that we are, we provide Tomosynthesis. All our mammograms are done Tomosynthesis, which is which is also called a 3-D mammogram, and the benefits are that it’s it allows us to leaf through the breast. We can look at the breast one through one-millimeter slices and really find subtle cancers or findings that would not be apparent on a 2-D mammogram.
03:55 – 04:20
Dr. Madhavi Raghu
In addition to that, the number of callbacks that are associated in screening with the Tomosynthesis study, it’s reduced compared to a 2-D mammogram. Now our patients, when they get the Tomo study, is it a bit longer, in your opinion, than in the conventional 2-D mammogram? And if so, do you talk to them throughout the screening mammogram as they’re getting these images?
04:21 – 04:41
Ana Newsome
As far as time, if any, very little. I mean, we’re still in the room, I believe the same amount of time you’re still explaining to them, it’s still the same positions. The breathing may be a little different, but as far as time wise, very little. Yeah, I think it’s very important to have the 3-D done.
04:41 – 05:17
Dr. Madhavi Raghu
That’s right. Like I said, we are 100 percent Tomo, so we offer it to every patient, regardless of their age and their breast density, they are offered screening with Tomosynthesis. Now I know that one of the biggest issues for a lot of women is pain that’s encountered during the mammogram and generally the technologists I know do a great job working with patients to alleviate that discomfort. So, what are some of your tips, both in terms of positioning the patient and also just the patient’s experience in helping them feel comfortable during a mammogram?
05:17 – 06:04
Ana Newsome
Yeah, I think this is a lot of questions, especially for first time patients that are having a mammogram, is the pain because I think they hear so many stories. First, I start off to let them know, “Hey, don’t worry about that. You know, you do your best. I will try my best to make this as comforting as possible for you. Go nice and slow.” You don’t necessarily need to do a fast exam. I think spending time with the patient explaining to them prior to you doing everything sometimes makes them feel a little better. And I think letting them know that they did a great job just makes them feel better. Say, “Hey, oh my God, you’re right, I was able to do it,” and they are coming back next year before you know it and say, “Hey, this was not as bad as I thought it was going to be.”
06:04 – 06:12
Dr. Madhavi Raghu
What is your experience in terms of pain that may be experienced by one person compared to another? Is it the same for everybody?
06:13 – 06:25
Ana Newsome
That’s a great question. I think everybody has a different pain tolerance and threshold, and not everybody is going to necessarily have the pain or discomfort as another patient. So it’s very different.
06:25 – 06:55
Dr. Madhavi Raghu
That’s really important to mention that because while for some patients, it may be uncomfortable, that’s really where the technologist can partner with the patient and help them get through study, which is very important for them to have a screening mammogram in the first place. So I know that patients – first time patients – our baseline patients have a lot of questions related to their mammogram and we want them to have a good experience and we want them to come back year after year. And some patients may get called back and it’s the scary experience.
06:55 – 07:26
Dr. Madhavi Raghu
So one of the services that we offer through Connecticut Breast Imaging is that all baseline patients do you get a phone call to prepare them for the screening mammogram and the subsequent experience or any potential downstream imaging that may stem from the screening mammogram. So here, to discuss some aspects of that conversation is Emma, who’s our navigator. So Emma, can you tell us a little bit about what do you speak to patients about with respect to a baseline mammogram and what to expect?
07:26 – 07:52
Emma Hansen
Of course, thanks for having me back on the podcast. So, when we call baseline patients before the exam, we really just start by asking if they have any questions that need to be answered just to kind of open the conversation. Explain the procedure to them from start to finish so that when they show up to the office and Ana does their mammogram, they know a little bit more about what to expect. And that seems to alleviate a lot of the anxiety right off the bat, just kind of knowing what you’re going into.
07:53 – 08:23
Emma Hansen
We then explained to them that afterwards you may need to come back for additional imaging for a couple of reasons, and we let them know that after your baseline mammogram, that’s when you’re most likely to receive a call to come back for additional imaging. And we explain that the reasoning for that, of course, is that we don’t have any old mammograms to compare to, so we don’t know what’s normal for their breasts yet. So, you know, we explain to them that any discrepancy are radiologists are going to be extremely cautious and they’re going to want to do additional imaging.
08:23 – 09:01
Emma Hansen
We also let them know that a lot of baseline patients find out that they have something called dense breast tissue and dense breast tissue, just as you know, is thicker breast tissue makes the mammogram harder to see through. And so we let patients know that if they get a phone call from our office saying that they have dense tissue and their doctor recommends an ultrasound, that that is not a bad thing. And it doesn’t mean that there’s anything wrong with their breast or anything that they need to be scared of. So those are really the two types of additional imaging that we cover with them. And I have had patients tell me that it does make it less scary if they do receive those phone calls because they know what to expect.
09:02 – 09:49
Dr. Madhavi Raghu
No, I think that’s a really important phone call to make because I think patients are scared and patients are uncertain about what to expect. And unfortunately, breast cancer is very prevalent in society, and we all know individuals who have breast cancer or who’ve suffered through breast cancer, so understandably, it can be a very scary and overwhelming experience. And that’s right, you’re absolutely right, there are patients for whom a screening ultrasound or a complete breast ultrasound is recommended. And so those appointments may be made at the time of screening mammogram or potentially after the screening mammogram has been read because once the radiologist has interpreted the mammogram as a heterogeneous lesions or extremely dense, then those patients are recalled for a potential ultrasound.
09:50 – 09:59
Dr. Madhavi Raghu
Now, another question that that frequently comes up is deodorant. What do you tell patients when they come in and what is the protocol for deodorant?
09:59 – 10:28
Ana Newsome
So, we typically, you know, right off the bat, we’re changing the patient first, and I always ask, “do you have any either powder, creams or any type of deodorant on?” And if you do potentially arrive to your exam with deodorant, no problem. We do have some wipes in the dressing room for you to wipe it off, just in case something shows up in the image that can potentially be mistakenly misclassified as something else, and they have no problem usually doing it.
10:28 – 10:57
Dr. Madhavi Raghu
So, one of the issues that we used to see with deodorant in the world of 2-D mammography, is that deodorant can produce calcifications in the axilla or the armpit region, and we know that cancers do occur in that area. Now with Tomosynthesis we’re able to tell if the calcifications are in in the skin, but those calcifications may mask an underlying smaller mass or even suspicious calcifications.
10:57 – 11:45
Dr. Madhavi Raghu
So to make the exam clearer, that is why we actually ask patients to wipe the deodorant off. It helps us, as radiologists, interpret the exam more accurately. Once a mammogram is performed, typically, the results are available, I think, usually within 24 hours. And then, you know, our patients are going to get called back – they are called back by our navigator and they’ll call back and potentially, you know, they have to return for additional imaging, our navigators will explain what that means and what needs to happen for the patient. So when patients return for what’s called a diagnostic mammogram for extra pictures, what are some things that you talk to patients about to help them with their anxiety? Because I know that that can be very scary for many patients.
11:45 – 12:22
Ana Newsome
Yes, they get nervous right away. So as I bring them in, you know, again, I tried telling them, you know, try not to be nervous. Let’s get through the exam. We’ll go as smoothly as possible and you will potentially know your results today. And that just seems to calm them down a little bit instead of having to wait another 24 hours for their results. Typically, here we have a radiologist on site and we verify that they don’t need any more additional imaging or an ultrasound. And I just let them know you will know your results by the end of the exam, so don’t worry.
12:22 – 13:04
Dr. Madhavi Raghu
That’s right. I think that’s one of the differences between a diagnostic mammogram and a screening mammogram. So all diagnostic patients are evaluated by the radiologist – the imaging is evaluated before the patient departs. So if the patient needs to undergo a biopsy, we’ll go in and speak with the patient, discuss the results and if possible, even perform the biopsy the same day or very shortly thereafter. So patients have the opportunity to speak with the physician, with the radiologist who interpreted the exam so that they leave with a peace of mind or with a plan in place. And I think that’s really important.
13:04 – 13:34
Dr. Madhavi Raghu
Sometimes patients may need to have an ultrasound after the diagnostic mammogram. Again, we do that very immediately right after the diagnostic views so that the patients don’t have to wait or have to return for additional imaging. We try to put all of that together at one time. And again, the patients will have the opportunity to speak with a radiologist. So I think that, you know, we all have just to kind of switch gears a little bit, we all have a reason for doing the things that we do.
13:34 – 13:53
Dr. Madhavi Raghu
I would love to know what motivated you to become a mammography technologist because I truly believe that what you do, what your colleagues do, is so critical for creating important images that are helpful for all these women. So I just want you to share with us as to what drove you to become a mammo tech.
13:53 – 14:53
Ana Newsome
That’s a great question, because personally, I had to do a mammogram myself and at the imaging facility that I went to, I didn’t have a good experience. You know, from the check in, to the tech, to the leaving, to so many questions – it was a first mammogram myself, and the tech was not very comforting, you know, and as we discussed previously, it is not the most comfortable test. You know, you’re very nervous. You don’t know what to expect. You don’t know what to do. You’re very tense. And I just kind of thought to myself, you know, if only that tech was a little bit more passionate, maybe my exam and my anxiety wouldn’t have been so bad. So I thought to myself, “Hey, maybe I can give this a try,” you know, because it’s a very personal test, you know? And if I can try to make somebody comfortable and make their exam that much more – or less I should say – anxious, you know, that’s a goal I wanted to make.
14:53 – 15:18
Ana Newsome
So once I started training in mammo, I actually really enjoyed it. You know, I enjoyed making the patient leave out of there knowing, “hey, this was not so bad,” you know. And not having the experience I had. And having a potential smile on their face, you know, and that’s what kind of drove me to proceed to this route in the radiology field.
15:19 – 16:08
Dr. Madhavi Raghu
And, you know, in my years of practicing breast imaging, I can tell you that patients may remember a physician’s name, but they always remember their technologist’s name. And I think that’s key. I mean, they come in and they ask for the same person, sometimes year after year – and that is a true compliment to the person who, you know, initially started them on their breast imaging journey. So we have great value and reverence for what you do as technologists because, you know, if the patients have a really good experience and a thoughtful experience then they are actually probably going to be more likely to adhere to screening guidelines, and that’s really important. So I really want to thank you for your time and for discussing your point of view. And thank you, Emma, for your contribution as well.
16:09 – 16:10
Emma Hansen
Thanks. Thanks for having me back.
16:14 – 16:40
Dr. Madhavi Raghu
Thanks for listening. We would greatly appreciate if you like and subscribe to our podcast on Apple, Spotify or wherever you’re listening. Share our podcast with a friend. To help us raise awareness and make breast health a priority for everyone. You can also check us out at our website at ctbreastimaging.org to learn more or to make an appointment. Thanks, and see you next time.
The Experts’ View on Mammograms: What to Know for Ultimate Breast Health
On this first episode of Breast Assured, fellowship-trained breast imaging experts, Dr. Madhavi Raghu and Dr. Jaime Szarmach, are joined by a breast navigator to discuss their roles in breast health, how one picks a breast center and a breast radiologist, and the impact of COVID-19 on breast imaging.00:03 – 00:56
Dr. Madhavi Raghu
Hi, everybody. My name is Madhavi Raghu, and I am a radiologist who specializes in breast imaging. Welcome to our podcast Breast Assured: Conversations About Breast Health. We are kicking off our first episode for Breast Cancer Awareness Month and we are recording from our office at Connecticut Breast Imaging at Danbury, Connecticut. I am here today with two esteemed guests, Dr. Jaime Szarmach and Emma Hansen. Dr. Jaime Szarmach is also a fellowship trained breast imager, and she has just joined our practice. Secondly, we have Emma Hansen, who is the manager for Connecticut Breast Imaging and a navigator at our practice. Today, we’re going to touch upon a few topics related to how one picks a breast center and the basics of what constitutes a breast radiologist.
00:56 – 01:23
Dr. Madhavi Raghu
And finally, we will discuss the impact of COVID 19 on breast imaging. Dr. Szarmach, we’re so excited that you’re here, I think for our audience, perhaps you can just clarify, first of all, what is a radiologist? What does the training entail? And secondly, you are a breast imager. So what does that mean? What does it mean to be fellowship trained?
01:23 – 01:55
Dr. Jamie Szarmach
Hi, Dr. Raghu, I’m Dr. Jaime Szarmach. It’s a pleasure to be here and nice to meet everyone out there today. A radiologist is a physician. After four years of medical school, physicians choose to do a residency, and radiology is one of the choices. A radiology residency is five years. You do one year of medicine or surgery, and then four years of radiology, and a radiologist essentially uses pictures to diagnose abnormalities. They use all sorts of imaging – ultrasound, X-ray, MRI – to make diagnoses for patients.
01:55 – 01:56
Dr. Madhavi Raghu
So that’s great.
01:56 – 02:00
Dr. Madhavi Raghu
I mean, I think that sounds like it’s a lot of training and specialized training.
02:00 – 02:15
Dr. Jamie Szarmach
It is. You have to know, you know, the entire body and every possible process that happens in the body, and what the imaging appearances is of that. So, at the end of your five-year residency, you can choose to do a fellowship or not. And a lot of people choose to become an expert in one area.
02:15 – 02:25
Dr. Jamie Szarmach
I chose to do a fellowship in breast imaging, which would include breast MRI, breast ultrasound, mammography, breast biopsies and also biopsies of the armpit or axilla.
02:25 – 02:39
Dr. Madhavi Raghu
Well, that sounds like it’s extensive training for breast imaging. So, would it be appropriate to say that when patients come into a breast center, that their studies are often read by breast imagers?
02:40 – 02:56
Dr. Jamie Szarmach
I think the majority of people reading breast imaging studies in the country just have five years of training and are general radiologists. There certainly are many imaging centers where somebody with a fellowship, an expert in breast imaging who had a year extra of training would be reading your studies.
02:56 – 03:09
Dr. Madhavi Raghu
So, what is the advantage of having one’s mammogram or breast ultrasound or even their procedure being performed by somebody who’s specialized in breast imaging? What is it that they’re bringing to the table?
03:09 – 03:43
Dr. Jamie Szarmach
With the mammogram, you definitely will get a more accurate read, and what that means is somebody who has more experience is likely to find more cancers on a mammogram, and they’re likely to dismiss more things as normal that truly are normal, less false positives. So, a more accurate read. As a fellowship trained breast imager, this is all I do every day. Patients who come to our center or to any mammography center have a lot of anxiety, and we’re specially trained and well experience in dealing with anxiety and fear and getting them through their imaging as well as any procedures that they may need.
03:43 – 03:54
Dr. Madhavi Raghu
So, you know, a lot of women and patients wonder about this, and I personally also wonder about it. How does one pick a breast facility? What are things that they should be looking for?
03:55 – 04:06
Dr. Jamie Szarmach
Definitely, the equipment is important. You can only see what your equipment will let you see. So, I would definitely look for a center that has 3-D or Tommo synthesis, 3-D mammography. I would also look at who’s reading the study – are they fellowship-trained breast imagers? Is this is all they do? I would also look at, with the facility, is it just a screening facility or can they offer diagnostic imaging, which is, if there’s an abnormality on your screening mammogram, what do you do next? Can they handle that? Do they perform biopsies at the facility? Can that practice handle that? Do they have a system in place to sort of get you from your screening and if there were an abnormality to diagnosis? Personally, I would also want a breast center where there were not only imaging but also, you know, surgeons, if I might need one, or other breast health professionals in case you needed them.
04:44 – 04:49
Dr. Madhavi Raghu
Absolutely. I think having coordinated care is actually critical for a patient’s health.
04:50 – 05:04
Dr. Madhavi Raghu
So, what about being able to talk to the radiologist? I mean, I can attest to this when my mother goes in for her mammogram, I don’t know that she gets the opportunity to speak with her radiologist. So, are we, you know, is this something that patients should ask for? Is there a value in that?
05:05 – 05:34
Dr. Jamie Szarmach
Absolutely. If a patient has a question about their exam while they’re there, they should absolutely ask to speak with the radiologist if there is one on site. Sometimes is not one on site, then the radiologist can always give you a call, or sometimes somebody else at the facility might be able to answer your question. If you have a question about the report, you should absolutely contact the facility and somebody should get back to you with a satisfactory answer to your question. I know at my own facility, wherever I am, if there’s a patient that wants to talk to me, I’m always happy to talk to them.
05:34 – 06:15
Dr. Madhavi Raghu
Right, and I think having that open door communication is actually key because I think patients have so many questions related to just navigating through their breast health. You know, which brings up an interesting point in addition to looking for expertise at a breast center. We are currently in the midst of a pandemic. Whether we’re at the beginning or tail end, it’s hard to tell. Maybe I’m going to direct this question for Emma: what are the things that they should look for in terms of the center’s cleanliness and policies related to COVID, and perhaps you could also walk us through the process of, you know, checking a patient in?
06:15 – 06:58
Emma Hansen
Yeah, absolutely. So hello, everyone my name is Emma. It’s nice to be here today. Some things to look for when you go into any office, but particularly in, you know, we’re doing this in our office is advanced cleaning techniques. So, any office should have already been cleaning, you know, after every patient. But we are taking the extra time here, before and after every patient to clean any surface that you as a patient or us, as technologists, radiologists, anything we’ve touched gets wiped down and then is allowed to dry thoroughly. Linen is changed between every patient if you’re having an ultrasound and of course, fresh gowns should be a given.
06:58 – 07:46
Emma Hansen
Currently at our office, the process as Dr. Raghu asked, when you walk in, we have a hand sanitizing station right when you walk in. So that’s the first thing you’ll see. Our women at the front desk, the ladies are great at trying to reduce the paperwork that you’re going to be given. But if you do have to sign anything, you are given your own pen. And we do not ask for that back. That is for you to keep. You are the only person who has touched and used that pen. The technologist will come and get you from the waiting room. We open the door for you, so you walk right through. We get you changed, like I said in the fully wiped down cleaned dressing room, and then we bring you directly into the mammo or the ultrasound room. So we really try to lower the amount of rooms that you are in so that you know you are touching less things; everything we know is clean.
07:46 – 08:07
Emma Hansen
And, you know, from that time, it really is just about, like I said, fully disinfected rooms making sure that our hands are clean. We, as techs and radiologists, wash in and out, and try to explain what that means, either using the hand sanitizer or actually washing our hands any time we enter or leave the exam room.
08:07 – 08:19
Dr. Madhavi Raghu
So that’s great. I mean, that sounds like a very thorough process. Now, when a patient has to check-in, are they getting checked in virtually in the car or do they have to walk into the building to get checked \-in?
08:19 – 09:09
Emma Hansen
Currently, if there is paperwork that we’re able to send ahead of time, which for certain exams there are, we will send that to them. We will also try to take updated information over the phone at time of check-in as well so that when they come in, we’ve kind of expedited that process. Currently, patients are coming in, you know, to check-in. Previously, at the height of COVID, we were having patients call from their car and they were not coming in until the time of their exam, which is something that we are prepared to do again you know, as cases rise. But at the moment, patients are allowed to come in. Masks are mandated, obviously, and we are actually a fully vaccinated office. So, all staff, vendors, anyone that comes in and out regularly has to be vaccinated so our patients can know that everyone taking care of them has been fully vaccinated.
09:09 – 09:45
Dr. Madhavi Raghu
Exactly. And I think that’s actually a very important point to make that everybody is vaccinated and that we’re taking all the appropriate precautions to make sure patients and staff are protected appropriately. As we know, one of the things that’s happened with the COVID-19 pandemic is the fact that we’ve seen a dip in screening mammograms. So, I don’t know if Dr. Szarmach, if you want to speak to the fact that, you know, first of all, maybe you want to explain to us what is an interval cancer because this is one thing that we are seeing more of and the impact it has on the patient.
09:45 – 10:33
Dr. Jamie Szarmach
Interval cancers are cancers that are not detected on mammography. They’re cancers that are detected in between normal screening intervals and with COVID, women were holding off on their mammograms and having a longer interval between screening exams, so more cancers were being detected in other ways. The important thing now is to know it is safe to come in and have your mammogram. You know, we’re taking the precautions that are necessary and waiting could be more detrimental to you because cancers are when they’re found smaller and earlier on mammography, they’re more easily treatable and the treatments are less aggressive and have less effect on the patient. So, it is important, and I don’t think that patients should wait now that we have appropriate precautions in place and all of the staff has been vaccinated. It is safe and patients should come in and have their mammograms.
10:34 – 11:15
Dr. Madhavi Raghu
So, yeah, so we do see some, you know, we’re seeing interval cancers, but then we’re also seeing cancers that are in patients who haven’t come in for screening for perhaps two years or so. And you know, my understanding is for the average risk woman, we’re recommending annual screening mammography, and I think that it’s important to get patients back on that cycle. You know, I think there’s been recent data to suggest that cancer screenings dipped by nearly 90 percent during COVID times, so I think it’s about time to kind of start bringing patients back in. So, in terms of the interval cancers though, maybe you can speak a little bit about the type of patients we see them in, maybe younger, do they have denser breasts?
11:15 – 11:32
Dr. Jamie Szarmach
The interval cancers tend to be more aggressive cancers, and yes, they tend to be seen in younger patients with denser breasts, and they tend to be more aggressive cancers. So, it’s important for a woman to know her risk and to know maybe about other screening modalities that may be available, you know, depending on her risk.
11:33 – 11:38
Dr. Madhavi Raghu
And I think that’s why it’s important for patients to really not delay something like this.
11:38 – 12:04
Dr. Madhavi Raghu
Now, the other thoughts I wanted to get from you is societies have made some mention about potentially changing the date of one screening mammogram based on their vaccine. If a patient desires to get their COVID 19 vaccine, the question is, should we have patients delay their screening after their first or second dose? Do you think it makes a difference?
12:05 – 12:46
Dr. Jamie Szarmach
We’re not having patients wait to delay their screening exams. They’ve already waited because of COVID, so we don’t want them to wait any longer. We understand that the vaccine can cause the lymph nodes in the armpits to swell. We understand it has a certain appearance to it. We’ve become very comfortable with that appearance and in an average risk woman who comes in for a screening mammogram who just had a vaccine. A lot of those cases, you know, we can safely say that it’s normal, even if they do have, you know, some enlarged lymph nodes as long as the woman is of average risk and the clinical story fits. So I don’t think any woman should delay their screening mammogram exam because they’ve recently had the COVID vaccine.
12:46 – 12:53
Dr. Madhavi Raghu
You know, in addition to the COVID-19 vaccine, we’re heading into the fall season, it’s flu vaccine time.
12:54 – 12:59
Dr. Madhavi Raghu
Can you speak a little bit about the impact of the flu vaccine on mammography?
13:00 – 13:43
Dr. Jamie Szarmach
We’ve known for years that vaccines, flu vaccine, tetanus vaccine, a lot of the pneumonia vaccine can cause the lymph nodes to react on the side that you get the vaccine. Early on with the COVID vaccine in December, we started seeing the large lymph nodes in patients, sometimes on the mammogram or the ultrasound, and we suspected that it was from the vaccine because we had already had the experience in the past with other vaccines doing this. So it’s important to know if you do go get your screening mammogram and you are told that you have enlarged lymph nodes on the side that you recently had a vaccine, usually we’ll do a short interval follow up and it resolves – not to be too worried, but to definitely follow up.
13:43 – 13:59
Dr. Madhavi Raghu
So basically, you’re saying that if one were to receive their vaccine, be it COVID-19 vaccine or any other vaccine, it should not deter them from getting their screening mammogram?
Dr. Jamie Szarmach
Precisely.
Dr. Madhavi Raghu
And not every abnormal lymph node is due to cancer?
14:00 – 14:04
Dr. Jamie Szarmach
Correct. There’s many other reasons that a lymph node might be swollen.
14:04 – 14:10
Dr. Madhavi Raghu
Should a patient be alarmed if the patient is advised to come back in a few months?
14:10 – 14:29
Dr. Jamie Szarmach
The patient shouldn’t be alarmed. There’s definitely characteristics of lymph nodes when they’re reactive to something that’s benign, not cancer that we look for. And then we recommend a short interval follow up. And there’s characteristics that suggest malignancy, or cancer in a lymph node that we look for, and we would be more likely to suggest a biopsy.
14:29 – 14:41
Dr. Madhavi Raghu
Well, it sounds like you are so seasoned that you probably are well versed in distinguishing one versus the other. And when you say short interval follow up, what are you talking? What is the time frame?
14:41 – 14:52
Dr. Jamie Szarmach
So usually what we’ll do is either a three month follow up. Usually it’s ultrasound that we used to see the lymph nodes in the armpit, or we’ll do a six month ultrasound, depending on our level of concern.
14:53 – 15:02
Dr. Madhavi Raghu
We’re heading into October and it has a special significance for people like you and I. So maybe you want to talk a little bit about Breast Cancer Awareness Month?
15:02 – 15:11
Dr. Jamie Szarmach
October is Breast Cancer Awareness Month. It’s a very busy month, lots of women like, and we encourage them to come out and have their screening mammograms in October.
15:11 – 15:33
Dr. Madhavi Raghu
So I think it’s important to get the word out and really encourage patients, not just for breast cancer screening, but all types of cancer screening and also resume normal health care appointments, because, you know, we are getting safer and we want patients to return and help us take care of them. So Breast Cancer Awareness Month is right around the corner and we encourage you to get your screening mammograms.
15:33 – 15:41
Dr. Jamie Szarmach
If you’re 40 years old and you haven’t had your screening mammogram yet or older, October is a great month to get your screening mammogram done.
15:41 – 15:49
Dr. Madhavi Raghu
And as you mentioned, you know, our facility is offering patients Tomosynthesis, which I think allows us to see through the breast better.
15:50 – 15:55
Dr. Madhavi Raghu
Do you want to speak a little bit about what Tomosynthesis is and the advantages of Tomosynthesis?
15:55 – 16:49
Dr. Jamie Szarmach
Tomosynthesis was FDA approved in February of 2011, in the United States. I started reading Tomosynthesis Exams myself in August of 2011, so I have a lot of – over a decade of – experience with 3-D mammography. And you can use Tomosynthesis and 3-D mammography interchangeable – they’re the same thing. And what we found very early on with adopting this new modality, was that we were finding more cancers, significantly more cancers in the mammograms where the patient had had Tomosynthesis. And we were also able to dismiss more things as normal. Our cancer detection went up and then our callback rates for things that were abnormal went down because we were able to know more normal things as normal, and have less false positives. The downside to Tomosynthesis is it can add radiation to an exam, but now we’ve developed ways to reduce that so that the radiation dose is roughly equivalent to what it used to be.
16:49 – 16:53
Dr. Madhavi Raghu
Correct. And for the audience, maybe you might want to explain what a callback is. What does that constitute?
16:54 – 17:08
Dr. Jamie Szarmach
A callback is when we see something we deem as abnormal on a screening mammogram and we ask the patient to come back for either additional mammographic views or possibly ultrasound, to try and determine if it’s a significant finding or if it’s a normal finding.
17:08 – 17:25
Dr. Madhavi Raghu
Right, and that’s obviously a scary experience I can imagine for many patients that I get to speak to as well. So, when patients return for additional imaging or diagnostic work, you know, what is it? How do you what do you typically do for those patients?
17:25 – 18:06
Dr. Jamie Szarmach
So, each patient is different, they’ll come back for either additional mammographic views, ultrasound or both, and they will not leave the facility without their results is the important part. They’ll have their imaging and then the doctor will go over the results with them. Sometimes everything is normal and the patient can return back to a routine exam next year. Other times we deem that a short interval follow up is necessary. And sometimes, the patient needs a biopsy and the physician reading interpreting the exam will go over everything with the patient in full detail as much as the patient needs before the patient leaves the facility, and any other appointments that may be necessary will be scheduled at that time.
18:06 – 18:53
Dr. Madhavi Raghu
Basically, what we’re saying is that, you know, if patients do get their COVID vaccine, we’re encouraging them to come back in for their screening mammograms and should that mammogram reveal any sort of abnormality in the patient, have them return for additional imaging. When they do return, we have a physician on site who will speak to the patient and explain the process. I think that one of the other benefits of our practice is that we have navigators that can also help patients navigate through the system and through the process. So Emma, I’m sure that, you know, patients must call and ask you about their screening mammograms, especially if it’s abnormal. What are some things that you tell patients to help them deal with some of the worry and anxiety related to an abnormal screening mammogram?
18:53 – 19:28
Emma Hansen
So, we do actually, as navigators get quite a few phone calls from nervous patients, it’s very common and that’s part of what we’re there for is to help walk them through it. We actually have started a process of calling our baseline mammograms before they come in. And the reason we do that is, you know, we can alleviate some fear by letting a patient know what to expect during the exam. But we also call them to let them know that, you know, after your baseline exam, you are more likely to be called back. And the reasoning for that, you know, of course, is because we don’t have anything to compare it to.
19:28 – 20:02
Emma Hansen
So we’re kind of, you know, going in, you know, it’s our first time looking at the breast. And of course, as radiologists looking for breast cancer, our radiologists are going to be extremely cautious. And so we let patients know that most of the time when they’re called back, we are being extremely cautious. You know, we always let them know that a doctor will be on site the same day, and that actually helps a lot of patients to know, you know, it’s nerve wracking to know that you have to come back. But to know that you’re going to know, you know, and speak to a radiologist before you walk out the door kind of alleviates a lot of that fear for a lot of the patients.
20:03 – 20:30
Dr. Madhavi Raghu
Agreed. I think that having the ability to speak to a professional about the screening mammogram and the subsequent findings, is always helpful. And that’s really important for patients to know that because we’re here to care for them and we’re here to support the patients. And I think that the whole practice works as a team to help care for the individual and walks them through, from screening all the way through biopsy.
20:30 – 20:52
Emma Hansen
Exactly. And I do think that we’re all very interconnected in that sense: the technologies work with the radiologists, who work with us, the breast navigators, who then, you know, can work with the surgeons if necessary. And I think the fact that we all work together so well leads to better care for the patient from the time of initial screening until the end when they get those results. So, I do think that makes it more effective for them as patients.
20:52 – 21:20
Dr. Madhavi Raghu
And the advantage for patients, for coming, you know, to a dedicated breast facility is that not only are the physicians specialized in breast imaging, but also the technologists, I think, are really highly skilled in various aspects of breast imaging – so maybe you could speak to that a little bit in terms of the mammography technologists and the ultrasound technologists? Do they receive special training?
21:20 – 22:08
Emma Hansen
Yes. So to do mammography or breast ultrasound, there are specialties. So they come after you are taught general X-ray or general ultrasound. So similarly to how Jamie is specially trained in breast, so are the technologists. To do mammography, you actually have to sit for a national test to perform mammograms, and that is a very long, very expensive test. So all of them mammographers here have sat and passed that test. I will say that working alongside a fellowship-trained breast radiologists, they are constantly teaching us. So I think that makes us better technologists because that’s not something that you receive working just anywhere. But you do get that more when you work with those fellowship-trained radiologists.
22:08 – 22:33
Dr. Madhavi Raghu
And I will say that I learned a lot from the technologists that are so highly skilled because they’re often teaching me about positioning and what is possible and what we can do for the patients, so I think it’s actually a two way street. And very often are our technologists are the face, the front, of what we do for our patients. So having dedicated and committed technologists, caring for patients is actually goes a very long way.
22:33 – 22:50
Dr. Madhavi Raghu
Well Dr. Szarmach, this was so helpful. I really want to thank you for your time and for your expertise and for explaining a lot of these processes. And I also want to thank you, Emma, Emma Hansen, for coming on the podcast and explaining some of the processes that we have in place to keep our patients safe.
22:50 – 22:52
Dr. Jamie Szarmach
Thank you for having me.
22:52 – 22:53
Emma Hansen
And thanks for having me too.
22:55 – 23:15
Dr. Madhavi Raghu
Thank you everyone for listening. We are thrilled that you joined our conversation today. We encourage you and your loved ones to get your screening mammogram without delay. You can find us wherever you get your podcasts, including Apple or Spotify. Also visit us on our website at ctbreastimaging.org.
