Dorothy: [00:00:00] Today we have Dr. Mahdieh Parizi with us, who is one of our heroes, and she’s becoming a hero to many women who have military service. Dr. Parizi was our lead interpreting physician before she went on to start dedicated mammography centers at the local VA. Now, we may not even think about this, but any woman who served in the military, any woman who has made that commitment to stand up for our country, to be in battle even, and all the other things that, that a military life demands.
She is also a woman who needs health care. And with Dr. Parizi’s innovative approach to health care, to mammograms, to breast cancer, we hear about how the VA is changing health care for their military population. Dr. Parizi has started programs that are now spreading throughout the nation, and like I said, she’s one of our heroes.
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Let’s Talk About Your Breasts, a different kind of podcast presented to you by The Rose, the Breast Center of Excellence and a Texas treasure. You’re going to hear frank discussions about tough topics. And you’re going to learn why knowing about your breast could save your life.
Dr. Parizi, thank you so much for being with us today. And I’m just so happy to see you again. You were our lead interpreting physician in 2014, 2015. Brought so many new things to the Rose. I mean, I can’t thank you enough for the contributions you made to us. to our [00:02:00] patients. But tell our audience just a little bit about where you went to school, about yourself, did you always want to be a physician, those kind of things.
Dr. Parizi: Thank you. Thank you for that, um, introduction. Um, I, um, grew up in Norman, Oklahoma, where I attended, um, college, um, undergraduate school and graduate school. I did a bachelor’s in zoology, which is analogous to biology. And then this was the late 90s. At that time, uh, molecular biology was, uh, gaining a lot of force and interest. And so after completing my bachelor’s degree, I, um, at the University of Oklahoma, I completed my master’s degree in molecular biology, did a lot of, um, PCR, DNA, RNA work, and at that time, at the completion of that, I moved to Dallas, Texas, worked at UT [00:03:00] Southwestern for a few years, and I worked with two renowned oncologists, Drs. John Minna and Dr. Jonathan Orr. And at that time was my first exposure to to, um, patients with breast cancer. And so while working with Dr. Jonathan Orr, um, we worked on projects looking at circulating tumor cells in patients who were either breast cancer survivors or were newly diagnosed with breast cancer. And that patient interaction is really what started my interest in medicine, kind of getting away from benchtop research and thinking about medical school.
Dorothy: Oh my goodness, and that was pretty, uh, advanced at that in that age, I mean, at that time, because not a lot of talk about that, so how interesting that they were your mentors.
Dr. Parizi: Yes, yes, I was really fortunate. I learned a lot and, um, that, that experience of interacting with [00:04:00] patients really, interested me. And, um, that’s what prompted me to, um, attend medical school at UT San Antonio. And that’s also where I completed my radiology residency. And then about 11 years ago, I moved to Houston. And in 2013, um, I, um, completed my fellowship or subspecialization in breast radiology at Baylor College of Medicine.
Dorothy: And came to us, right? Yes. Right after that. We were so excited.
Dr. Parizi: Yes. Yes. Thank you. And that was, um, um. Working at The Rose was an amazing experience. Um, it was really the first time that I had ever had an opportunity to work at a nonprofit organization and really witnessing the compassion of the staff, um, everyone from the technologists to the navigators and seeing patients with, um, from various backgrounds, insured, um, [00:05:00] uninsured, and just seeing the compassionet’s with which the patients were being taken care of, and really great care being offered. The best technology, the expertise. And seeing how the patients were really taken care of, from diagnosis to being advocated into treatment. And so that was um, truly an honor and a privilege for me and a wonderful experience in my career.
Dorothy: Thank you for that. But you know, a lot of people don’t realize that, especially at The Rose, it is the radiologist who is telling that patient, you have cancer. That’s a little different way of doing radiology than used to be. It may be more, more prevalent now. But you were always so compassionate with our, our patients and you.
Dr. Parizi: Oh, thank you.
Dorothy: You had a way of helping them to understand, it seemed, it always seemed like to me that you wanted to educate them [00:06:00] as much as they could take and understand, but you, you always push that limit a little bit because it was like you felt like they needed to know what was going to happen next?
Dr. Parizi: Absolutely. I feel that through education, we really empower patients to be more active members of, of their healthcare process. And so that was, that was, uh, something that I did at The Rose. I learned from my, uh, fellow technologist colleagues. I learned from the navigator and really just kind of incorporated all of that into my toolbox and talking to the patients.
Dorothy: And so then this amazing opportunity came up. And you went on to the VA to start their first ever breast imaging center.
Dr. Parizi: Yes.
Dorothy: Yes. Tell us about that. What, what was it that attracted you? And, and were you, were you at all concerned or a little scared or, I mean, this was a big undertaking.
Dr. Parizi: I was, I was, [00:07:00] um, I was definitely, I was scared, um, and it was a very, very hard decision to leave a job that I absolutely loved and going on to an unknown. And I think the reasons were multifactorial. One of the things that I wanted to kind of explore on a personal front was was, um, academic medicine, the teaching medical students, teaching residents, um, teaching fellows, breast imaging fellows, um, and then at, at the time, the VA program system nationwide was experiencing an increase in the number of women veterans.
So the opportunity was there to kind of try my hand at starting a program from scratch and contributing to the healthcare of women veterans. And that was something that I had been very passionate about taking care of women veterans. I had had experience with that during my training in San [00:08:00] Antonio, where part of my training was completed at the VA hospital in San Antonio, um, and, um, so seeing kind of the opportunity of the number of women veterans increasing, this need at the Houston VA, um, and then combined with my interest in kind of trying my hand at teaching medical students and residents prompted that move. Um, and it was, it was a challenge. Um, it was really a, um, like many of the other, um, career undertakings I’ve had, it was really a, a, um, passion project where, um, I felt that it was something that we needed to try and do. Um, we started with a staff of two, it was myself and Um, one technologist, and then over the course of eight years, we’ve grown it to a staff of 15, um, every, everything from, um, dedicated breast imaging schedulers to [00:09:00] navigation to ultrasound, um, technologists, mammography technologists, another physician. So we’ve slowly grown, um, the program into one of the best established VA programs in the nation.
Dorothy: And it’s not just best established, it’s a leader. I mean, your program is now the model for the nation. I think that’s phenomenal. You knew that the vet was going to need a different level of care. How did you know that? And, and I know the time that we were part of that group, when we were providing the care, it was always It was a little different need there. How would you describe that?
Dr. Parizi: I think, um, I think it’s, it’s kind of multifactorial. Um, some of our women veterans have, um, a background of having experienced military sexual trauma. Um, other, um, Um, o other women veterans may have PTSD. And I think those kinds of [00:10:00] unique, um, components, um, that some of our women veterans, um, have as part of their background, um, kind of calls for, uh, um, some, something that’s more kind of veteran centric care that feeds into the bigger VA healthcare system.
So, as an example. Something that our patients really like is being able to come to the Women’s Center and seeing their primary care physician for their cardiac workup or cardiac checkup and then at that same visit being able to walk across the hallway and get their annual mammogram. And I think that’s kind of the the the thing that’s unique in terms of having, um, care on site, um, and I, and I think that’s especially important if patients have challenges with transportation and they want to [00:11:00] come to one building and kind of get everything taken care of that same visit.
Dorothy: And the VA can be very complicated when you’re trying to get around it, but yes, that made a big difference. And I, I think because of the Breast Center. Correct me if I’m wrong, but it seems like a whole women’s center kind of exploded.
Dr. Parizi: Yeah.
Dorothy: And it became so much more substantial for our women veterans. I think a lot of us forget that women have played a big role in being a part of our nation’s military and from many different angles.
And I just know, um, So many that I know personally just really kind of put off things. Now, all women put things off. We know that, but I think it always seemed like there was a, I can do this. I don’t have to have all that, you know? So I’m so glad that you’re encouraging. That preventive care as well as the education [00:12:00] piece. So, tell us more about what a woman can expect when she comes there.
Dr. Parizi: So when patients come to our clinic, um, we, we did used to have a same day model where um, our screening patients would get their results before they left. And we did that for about five years, but as our numbers grew, we had to kind of get away from that, um, just in the interest of, um, being more efficient and, and, uh, patient centric.
Um, and so when patients come to us, um, for their routine screening mammogram, we, um, do perform an intake interview where as part of that intake interview we collect information that helps us decide what the patient’s genetic risk factor may be using some various models that are available to us. And so, for instance, if a patient is considered high risk, we may recommend that they have genetic counseling that’s also performed at the VA on site, or that they may [00:13:00] benefit from additional screening, such as a screening MRI.
Some patients who are very high risk benefit from going to our oncology clinic, um, for the breast cancer prevention clinic, where they may get chemo prevention to help reduce the risk of developing breast cancer. So it’s a very comprehensive care where not only are we performing, um, the patient’s annual imaging, but we’re also looking at their risk and whether we can do anything to mitigate that risk, lower the risk of developing breast cancer. For patients that live far away, or that we percieve as having some anxiety or that patient really wants to know their exam results, those screening patients will get their results before the patient leaves the clinic. And then, the same also for biopsies. If there are patients that live far away and we see something concerning on the mammogram, um, or if it, or we perceive that the patient may not come [00:14:00] back once we recommend a biopsy, we try to do as much of the, um, patient’s care at that, at that visit.
Everything from biopsy to even seeing oncology if possible at that same visit. Um, so we really try to, um, cater to each patient’s needs and and um, really focus on that, on that patient’s needs.
Dorothy: And it is amazing in some ways why women would not go back to have a biopsy but they don’t. I mean there’s, It’s scary. Sometimes it’s easier not knowing.
Dr. Parizi: Absolutely.
Dorothy: And, and in, in, you’re within the VA Medical Center, right? So do you think there’s a certain level of comfort when they come there and see other vets or, you know, it just seems like it would be a different type of community to go into?
Dr. Parizi: Absolutely. That’s such a great question. Um, patients, I feel that our women veterans do, um, [00:15:00] really like coming to a clinic where, perhaps see fellow veterans and, and there is a connection. Even we, we see a certain level of socialization in the clinic setting. Um, and I think that that really does make patients feel comfortable being able to connect to a fellow veteran.
Um, we try, we’ve tried to make our clinic setting very, um, kind of non, um, sterile, kind of taking away the hospital feel out of getting a mammogram. So all of our patients get these plush pink robes. We have decorative items, snacks, um, drinks available for patients, um, because there, as, as you mentioned, there is a lot of anxiety that all patients, and maybe, even a little bit more for some of our women veterans experience. And so anything that we can do ki to kind of alleviate that, that that anxiety, we try to do that.
Dorothy: Right. So talk about the number of women you’re [00:16:00] seeing now.
Dr. Parizi: So we are seeing, there are approximately um, 25,000 women veterans, if I’m correct, 25,000 women veterans that are registered at the Houston VA. Um, in the next five years, we are looking at placing breast imaging clinics in some of our C boxes, such as Conroe and, um, and I believe it’s Katy. Katy and Conroe.
Um, and so we’ll be growing our screening sites out into the community. Um, currently we have two machines, um, we just purchased a third machine that we’ll be accrediting in the near future, um, and so we’re growing those numbers, we’re growing the technology, um, I think in the next two to three years we’ll add on contrast enhanced mammography as an additional modality. Um, and our goal is to just increase, um, increase Um, outreach to the [00:17:00] patients, increase our screening pool, um, and we have kind of a multi pronged approach for how to, to increase those numbers.
Dorothy: That is so significant. I mean, so many women are being served there. So what do you love most?
Dr. Parizi: What I love most is being able to find a breast cancer early. Um, to be able to save a woman’s life by finding that cancer early is, uh, probably gives me the most joy. Um, and, and, When we save a woman’s life, it’s not just that, that woman, that one life we’re saving, it really affects their family.
It affects their bigger social network. And so for us as a team, the technologists, myself, our navigator, to have that impact in our patient’s life is um, is really our why. Um, once a year we have a breast cancer survivor celebration. [00:18:00] Um, this year it’s on October 22nd. Um, and this is when our, our, some of our survivors are asked to speak. They come to this event and they talk about their experience. The good and the bad of, um, what they went through in being diagnosed with breast cancer and, um, their treatment. And just that seeing our survivors come back and talk about their, their experience, um, the vast majority of which is very positive of how the VA was able to help them in that journey is, is my why.
Dorothy: Right, but that is so important that you actually encourage that the bad, the things that didn’t go just right.
Dr. Parizi: Yes.
Dorothy: Because that is true. I mean, I think, I think whenever I’m listening to someone talk about, uh, their diagnosis, they’re about to have everything and, and you know this as a physician, but they’ve been given a schedule and this and this and this will happen. And, you know, invariably I find myself saying, well, don’t be worried if it [00:19:00] doesn’t happen right on schedule because many times it doesn’t. And you know something else will be needed. I’ve had so many of our patients say that was the best thing to know. Because you know how scared you get. Oh, it’s not on schedule. Oh my gosh, why is this happening? You know, and we all go down that rabbit hole of this must be bad. So yeah, that is so good to be able to share that way.
Go back to 2020. Did you see, like every breast center did, uh, a drop in the women that were coming in for their needs for their annuals, their preventive?
Dr. Parizi: Yes, we did. Um, we probably had a 30 to 40 percent decrease in the number of our, um, patients who were coming in. Um, and we really worked hard at, being creative and how could we get, how could we safely take care of our patients and get the patients back in? Um, so some of the things that we did is, um, during the [00:20:00] weekends, we opened up our screening clinics, even though we were limited staffing wise in terms of our technologists, our technologists were very passionate about coming in.
And so we spaced out our patients, of course, time wise, um, also spatially we had to space our patients out, but we brought them in on the weekend. We took care of those patients. And then we kept, over the last, um, probably several years, we really, um, grew our navigation team to see how we could get those patients back in who were dropping off and not coming in for their screening exam. And we did that through the Women’s Health Center, um, grew their navigation team. Um, in breast imaging, we hired a navigator. And our navigators over the course of the last several years since 2020 really worked to bring those patients back.
Dorothy: And so this is from the get go, from the phone call to remind them, or from, is that what you’re saying? These are navigators who, their total [00:21:00] job is to get you back.
Dr. Parizi: Yes, absolutely. To get the patients back to, um, Our patients are able to self schedule their annual mammogram, which has helped. That was something else that we implemented. But then also if, um, for example, if a diagnostic needed to be, um, for a patient needed to come in for a diagnostic exam, we had, we had our navigators, uh, contact the patient’s PCP to ensure that the orders were in. And so it was kind of a multifactorial approach.
And then the other thing that we realized is education, both staff education and patient education. So throughout the year, not only at our C boxes, but also at the main VA. We have various patient education events where we actively encourage our patients to schedule their annual mammogram. And then once a year we have a symposium that’s a multidisciplinary symposium. It’s a six hour symposium geared at primary care clinicians. [00:22:00] And this symposium covers everything from diagnosis to the treatment of breast cancer. And we have participants from surgery, oncology, genetics, psychosocial support. And the main theme, um, every year is we encourage our PCPs to put in that screening mammogram order. And so that was kind of every year. By doing that this past year, we had over 400 attendees attend our symposium. So just kind of that multi pronged approach has really helped to grow our screening orders and kind of, um, overcome what COVID, uh, did.
Dorothy: Well, and, and we have to remember, you know, I, I sometimes get annoyed at the, uh, recommendations from the U. S., United States Preventive Services Task Force. Because, you know, it goes along the line of, ask your doctor. In the little bit of time that doctor has to see you. You know, just, just somehow, [00:23:00] systematically including that recommendation for a mammogram may not be top of mind for him or her. Because it’s not the patient’s top of mind, she’s come in for something else. So I think that’s so important that we remember the PCP is our, is the most important part of all this, this program, because you can’t do anything if you don’t get the women in.
Dr. Parizi: Absolutely. Absolutely.
Dorothy: Did you see, have you seen any, Uh, late stage cancers as a result of delay?
Dr. Parizi: We have. We’ve seen late stage cancers, um, as a result of the delay. Um, especially I would say the first two years, um, after COVID, um, we, we saw quite a few late stage cancers.
Dorothy: We started seeing it about a year after. I mean, it was, it was like we were going, well, I’m not sure this is really going to be a thing. And then all of a sudden we were saying, um, yeah, that’s, uh, that’s been one of the phenomenas of, of COVID. That so many [00:24:00] cancers have been found at a different stage now. So you’ve mentioned this twice about the C boxes. I have this image in my head of a box somewhere. So what does that mean exactly?
Dr. Parizi: So, um, the C boxes stands for Clinical Based Outpatient Clinic.
Dorothy: Basically a clinic that’s outside the VA that’s to serve the patient. Right. So I just want to be sure that we realize, not every Vet has to go to the VA. That you do have these clinics in other parts sections of town. But also in other cities, so that there is that care that they can find, you know, transportation is a huge barrier for anyone. And so I think that’s so important. And the fact that you’re thinking about putting mammogram centers in them.
Dr. Parizi: Yes, we’re very excited.
Dorothy: Good for you.
Dr. Parizi: Thank you.
Dorothy: My gosh.
Dr. Parizi: Hopefully in another five years or so.
Dorothy: Yeah. Yeah. So, Dr. Parizi, you sit on several national councils, [00:25:00] advisory boards. Do you pick up anything different in Texas when you’re in those meetings and listening to other physicians talk?
Dr. Parizi: I think there’s a lot of commonality. I think the patient challenges are similar. The obstacles to care are, are similar, and I think that the, the challenges are similar, but the passion and care is also similar. And so I find that the desire is really there for many of the VA to start their own breast imaging program, um, to kind of have that, um, centralized care at the VA where the patients can go to multiple, uh, VA related visits at that same, same office visit. And so I found, I found a lot of commonality, probably more commonality than, than differences.
Dorothy: Well, and that’s, that says a lot for what the VA is trying to do and the changes they’re [00:26:00] making and you know, it’s all good news for our military veterans. So my goodness.
What else can we do? It’s kind of like the next step. I love that part. So you are, uh, and I don’t want to get personal, but you are a mother of a young child.
Dr. Parizi: Yes.
Dorothy: And yet, holding a full time clinical position, as well as professorship, as well as all the other councils you were on. What do you find most challenging about being a mother and a physician, and a responsible person within your position?
Dr. Parizi: I think I’m just kinda balancing and juggling it all. Um, especially, um, I have a very rambunctious five-year-old. And so, um, sometimes it’s a challenge. Um, but I think that, um, I’m really, um, blessed that, um, I look at my job [00:27:00] not as something that I have to do and it’s just, it’s something that I really enjoy and I think that I’m really fortunate in that sense.
Kind of having an amazing team, have, having wonderful patients. I think that makes, um, the challenge of balancing things a lot easier. But I think it’s just always a challenge just to balance things, and I feel that as women we tend to take care of everyone. We take care of our significant others. Our children. Our Aging Parents, Our Career, and sometimes we forget to take care of ourselves. And so that can be a challenge and it’s something that I have to remind myself and also remind our patients that you can’t really take care of anyone else unless you take care of yourself.
Dorothy: And I think, I think that also makes it a little [00:28:00] easier for you to relate to patients because you’re so right. Women will tend to take care everything else, everyone else, and put themselves last. That’s a huge message. What’s a message you want to send to a woman today?
Dr. Parizi: I think that, unfortunately, in light of confusing recommendations out there by the United States Preventative Services Task Force, to some degree American Cancer Society. I think that the most important thing that, that I reiterate to our patients, to my family members, to friends, is that annual mammography saves lives.
And annual mammography for the average risk patient, a patient who doesn’t have a family history of breast cancer, who’s completely average risk, and a mammography should start at the age of 40. And I think if there’s one thing that I can tell [00:29:00] anyone about, um, mammography, that, that would be the message.
Dorothy: Oh yes, such an important message. And so important for us to realize that those recommendations impact physicians and how they decide. Do their sur— you know how they encourage women to have it. So we as women need to say, I really wanna have my man mammogram. I really wanna do it annually.
Dr. Parizi: Yes.
Dorothy: I wanna start at 40. We, we have that ability to say that.
Dr. Parizi: Yes, absolutely. We have to be advocates.
Dorothy: Yes.
Dr. Parizi: For our, our own health. And, um, and as, as far as I, as I know, um, there’s still a moratorium on health insurance covering mammography. So. Um, an insurance company should not be able to deny annual mammography to a woman starting at the age of 40.
Dorothy: And if they do, then there needs to be, we, we need to say, why is that, what, what changed? And it could change. So, you know, that’s, that’s so important for women to know, no matter what. [00:30:00] Have that annual mammogram.
Dr. Parizi: Absolutely.
Dorothy: So fun to have you with us today. It’s been such a long time and we are so proud of you, so proud to have one of our physicians start something so important for our veterans.
Dr. Parizi: Thank you so much. It’s a privilege and an honor to be here. The Rose will always hold a very, very special place in my heart.
Dorothy: Oh, Dr. Parizi, that’s so sweet.
Dr. Parizi: Thank you.
Post-Credits: Thank you for joining us today on Let’s Talk About Your Breasts. This podcast is produced by Speke Podcasting and brought to you by The Rose. Visit therose.org to learn more about our organization. Subscribe to our podcast, share episodes with friends, and join the conversation on social media using #LetsTalkAboutYourBreasts. We welcome your feedback and suggestions. Consider supporting The Rose. Your gift can make the difference to a person in need. And remember, self care is not selfish. It’s [00:31:00] essential.
