Dorothy: [00:00:00] At a time in our lives when we often distrust those in authority, this is one physician who will give you hope for tomorrow. And he’s going to tell you very plainly what you need to know about your breast, about mammograms, and about what’s ahead of you as you become an older woman and are trying so hard to take care of yourself.
Listen to what this doctor says about something good coming out of COVID. According to him, women are asking better questions. They’re asking more questions. They are curious. They want to know what’s going on with their breast and you’re not just going to push them aside. Every one of those questions, he is ready to answer because an informed person is a healthier person and will do what they need to stay well,
Let’s Talk About Your Breast, a different kind of podcast presented to you by [00:01:00] The Rose 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. Join us as we hear another story and we answer those tough questions that you may have.
I’m Dorothy Gibbons and I’m the CEO and co founder of The Rose and we’re here today to talk about your breast. And our guest today is Dr. Sadruddin, who is better known as Dr. Raz. And certainly a man of many talents, but I think the most interesting thing that I’ve heard about him has how he went from being an engineer to a physician to a specialist in breast health. So thank you for being with us today.
Dr. Raz: Oh, pleasure’s all mine. Thank you for having me.
Dorothy: And Dr. Raz is our lead interpreting physician. Uh, he’s been with The Rose several years now, has [00:02:00] certainly brought some new protocols, raised the standards. We, we were able to get our breast imaging center of excellence due to his leadership.
So this is a man who has a very much an interest in breast cancer. And I want to go back though. You know, here you are with a degree from the University of Michigan. As an engineer.
Dr. Raz: Yes.
Dorothy: And then you go on to Chicago Medical School and for your Doctor of Medicine degree, and then of course go on into your fellowships. How the heck did you go from engineer, that to me is a very different way of thinking even.
Dr. Raz: It is.
Dorothy: To, to the medicine part.
Dr. Raz: Right. So, it’s a long story, but many people don’t know I actually immigrated to America. In fact, I did not even immigrate, I just visited in 2002 with family. And, uh, when I came here, I just, one day I went to high school, [00:03:00] and this was like sophomore year, um, just to see, hey, how is the American education system, and I liked it.
At that point, I told my parents, Hey guys, I, I like this. How can I stay in America? Right? So that was just a visit visa. Remember when you were just visiting a country, just got a six month visit visa. And my father had some business interests. So he converted the visa into what we call a business visa and that allowed me to stay and I was the only one here.
So all my family left and I was with my uncle and I finished my high school. Uh, at that point I converted to a student visa because I had to attend an American undergraduate institution and my counselor said, Hey, uh, Raz, why don’t you go to University of Michigan? She was from Travis city, Michigan. And she, she had a huge bias and I applied to engineering because I was always good with math, uh science, all these nerdy things.
Um, so I went to Michigan and there I [00:04:00] was In a branch of engineering called bioelectrical, it was a biomedical combination. So you did learn some biology, but your focus used to be an engineering side of things. And I did well, but while doing that, I got interested in volunteering. So I used to volunteer a lot, uh, at the Mott’s Hospital up at University of Michigan. It’s a children’s hospital. Um, and then also in geriatric care. Uh, and from there I met a surgeon, he’s an orthopedic surgeon, and there were a bunch of residents over there that were training to be orthopedic surgeons and they lacked a device how to get better at surgery. So that actually turned out to be my project for senior year where I came up with three four other engineering students came up with a nice device where these residents could practice, and that actually won a patent. And that got bought up by a private company.
Dorothy: Oh my goodness.
Dr. Raz: Right. So, that was one. But the other thing, [00:05:00] I actually ran into a radiologist who is a breast imager. And he was working up at the University of Michigan on a new biopsy device. And I actually helped him with that. That’s how I came into contact with breast imaging. Now, I did not take it seriously back then, but I knew, okay, there is a branch within radiology breast imaging, right? But I did help him with making this device. He also patented that. So, you know, when I graduated, again, this was 2007, 2008. Again, remember, 2007, 2008 United States was going through almost recession.
Remember the market crashed. I remember lots of jobs. So I had trouble with finding a job, not going to lie. But then because of my, you know, interest in medicine, I met all these doctors, did volunteering. Now I thought, you know, I’ve always had this bent towards volunteering. And I have this experience like making these devices, why don’t [00:06:00] I, you know, think about medical school.
And that’s where I really started thinking about medical school. I applied and I got in and that’s when I actually became a medical student is when I really started falling in love with, okay, the human body, the disease process. And yeah, the rest is sort of history as they say, uh, just went through medical school and radiology was a natural fit.
Why? Because it’s one of the most tech gizmo heavy, um, you know, field. And I was already attracted to that to begin with. And the only other field that would have been, was, would have been orthopedic surgery. But I just chose radiology because it had all the engineering nerdiness to it that, that, that I was attracted to.
And then I continued. Um, as to why breast imaging again, I had that experience, but in radiology, what you will quickly realize when you’re a resident or a physician that a lot of radiology is very passive. You’re reading images, you’re reading lots of images, [00:07:00] whether it be plain x rays, CT, MRI, um, but the patient contacts lacking a lot of radiologists don’t get to see lots of patients.
There are two subfields within radiology that get to do that. One is interventional radiology. Uh, where you’re doing lots of procedures, interventions, you know, uh, they’re vascular. You’re getting rid of clot, you’re figuring out, you know, giving tumors some medication, or figuring, you know, de clotting a clot in the brain for stroke patients.
And then the other one is breast imaging. Both are excellent fields. I was gravitated towards breast imaging for a couple of reasons. One again, my experience. And second is the instant gratification part. So interventional radiology has that, but not to the extent of breast imaging. The reason is very simple.
You can catch cancer early within breast imaging and you’ve completely changed the life of the patient. Now, again, unbeknownst to a lot of people [00:08:00] out there, maybe it’s not only the women that get breast cancer, men also get breast cancer. Um, but yeah, in a patient, if you can catch it’s that, and that brings me the most joy.
It completely changes the survivability and the, you know, You know, the lifespan of a patient if you catch it early and that’s instant gratification and you go from Finding the cancer on screening imaging all the way to the workup because you’re the one who is also biopsying that lesion mass calcification And then you get the diagnosis and you know, it’s early stage and you’ve completely saved the patient’s life It’s very rare to even get that in interventional radiology.
So I saw that when I was a resident. I was instantly attracted to that because it’s immediate impact. And there you have it. That’s how I turned out to be a breast imaging specialist.
Dorothy: That’s fascinating. Now, Dr. Raz, you may not realize this, but we have lots of patients that talk about how calming you [00:09:00] are when they’re going through their diagnostic workups and, uh, and, and they always talk about how you take the time to explain, to talk to them like regular people, you know, and, and—
Dr. Raz: Try to—
Dorothy: —and you do. Uh, so I, I’m so glad to hear you say that there’s something you’re doing that’s changing lives and changing the outcome that, that is so important. Women need to hear that over and over again. They, We’ve gotten a little lax about our, our awareness and, and COVID certainly put a hole in a lot of screening programs.
Dr. Raz: Right.
Dorothy: Of course, The Rose is still as busy as it always was, but, but still women did put it off. It, it could make a difference in their, in their survival. So I want to come back to that in just a minute and get your opinions on how that impacted women, but also how, or what you’ve seen since you’ve been in breast imaging.
That, [00:10:00] uh, is kind of an attitude or a way that women feel about mammograms. But I want to go back just a minute. So, When you talk about volunteering, you know, you haven’t stopped volunteering. I mean, you continue to volunteer. You’re the most, one of the most requested, uh, speakers during October. And so, and I, I know you were at the Avon walk, uh, you were, you’ve done work at Ibn Sina, you know, they’re just, just much of that community work.
Because The Rose is so community based, you know, we, we can’t do this without our community. You really are getting an insight into a very diverse population. And, um, I’ve always wondered, I, I know how skilled you are when you’re doing diagnostics. How does it feel for you, though, when You’re the one that tells the patient you have cancer.
Dr. Raz: Well, [00:11:00] there’s always a sense of, it’s, it’s difficult to put it into a single word. But, there’s a sense of relief a majority of the time if you catch the cancer early. Because I know what the survivability will be. So, if you catch node negative cancers or early DCIS or stage 0 cancer, which again I want to emphasize: majority of the screening cancers are early cancers.
If you do not do screen, screening mammogram, and you clinically find the cancer, it’s a later stage cancer. That’s the whole point.
Dorothy: Right.
Dr. Raz: You do screening, you catch it early, the survivability of majority of the patients, if it’s early enough, the cancer is. Like 95 percent plus almost 99 percent at five years post treatment.
Dorothy: Yes.
Dr. Raz: Relative to a healthy woman. That is outstanding. Few cancers have that kind of treatment. So I have that relief, but there’s also some part of sadness, um, [00:12:00] that because nobody wants to hear about cancer. I wish that was not the case, but the relief is immediate because I know, hey, it’s early and you’re going to be doing great. You’re in great hands. Um, And a sense of after the patient has completely understood what I’m trying to get to. And again, you mentioned I try to dumb it down and keep it layman’s term as much as possible. When the patient gets over their initial shock and is actually asking good questions, there is a sense of happiness too that comes with that.
Dorothy: Right.
Dr. Raz: And mostly the fact that hey, this patient followed through with her screening. She, you know, unfortunate that we found cancer, but we found it, we found it early.
Dorothy: Right.
Dr. Raz: And that realization is something that’s amazing. Um, because, again, one of the few cancers would be breast cancer where, where you can have tangible life changing thing.
Dorothy: And you can even find it early.
Dr. Raz: That is correct. So, So it’s a combination initially of, you know, some, [00:13:00] some sadness, but it’s immediately by relief and happiness is what a, how I would describe it.
Dorothy: And don’t you think a lot of women already feel like that’s what going to be, that’s going to be their diagnosis? I mean, haven’t you heard women say, well, at least now I know, or I was afraid of that. Or, you know, I think, I think there’s something in our body conversation that says, Yeah. Yes.
Dr. Raz: Yeah. Plenty of women. Plenty of women have that, um, and again, you know, it’s, um, it’s a thing and, and just to go back to the COVID thing you mentioned, and that’s what I’ve seen.
I’ve seen, obviously after COVID, what has happened is a lot of women have actually become more health conscious. Um, that’s what I’ve seen. I’m seeing, and I’m sure one of the other podcasters, Dr. Melillo may have, may or may not have mentioned this. Um, but that’s what I have seen. And with that drives this curiosity about screening, okay, so I’ve [00:14:00] noticed the past year, there are more women are actually curious and they’re more knowledgeable about screening when I talk to them.
Dorothy: Wow. That’s encouraging.
Dr. Raz: Yeah. So this gap that we had in COVID where they missed screening. Now they come back and like, Oh yes, I know this, this, this about screening, and I will be doing it every year. I read about this. So it’s sort of an unusual thing, but it’s true. This is what I’ve had many conversations with one regards to, which is very good, which is very encouraging because That means we’re going to catch more cancer early cancers, right? And we get to screen more women, which is, which is the whole point.
Dorothy: So I think you’ve kind of shown us how breast cancer and well, how the procedures for breast cancer differ from other procedures, right? You’re, you’re really right there with the patient. And, and it is, it is very different. So when you’re talking to women, besides telling them, we’re going to find this early, you’ve got a better chance.
What else do you want women to know about mammograms, their own health, their. I [00:15:00] love that you said they’re curious.
Dr. Raz: Yeah, um, a lot of women and this is true of my mom or many women that people may know, you know, close relatives, wife, um, is they tend to put family above even themselves. Um, and I’ve had women that it tend to ignore.
So plenty of women that we see, you know, from underserved community. Uh, women with no insurance— they know there’s something abnormal, but they tend to ignore it. Why? Because there’s some other priority out there. So, I would like women to know that that’s not how it should be. That, you know, your body, your mind, your soul should put yourself first.
And it’s difficult concept. Plenty of women are also very modest. Also, again, in breast imaging, majority of the patients I see are women. But they’re very good listeners. A lot of my patients are. So it’s all about accessibility. [00:16:00] So if we tell them they listen, and that’s what I want to tell them that put yourself first, get to screening when you can, and just take care of yourself. Take care of the health. I understand family comes first, but without you, there won’t be much of a family. And, you know, about screening again, if you can, you should be punctual in it if you can every year. And yes, it brings anxiety, you know, the unique thing about mammogram, you, you may know if you have had mammogram, it’s not very, uh, it’s not a very pleasant exam. It can hurt, there’s some compression of the breast, but again, keep the goal in mind while you’re doing it.
And, you know, regarding your health again, there are two things I would say, eat healthy, try to, try to, there is some studies that are going on there are correlating breast cancer with obesity. So it’s important, but eat healthy and try to screen, try to screen on your mammogram and then try to screen colon cancer. Those are the two cancers that we have in America, which. Which is very good cure for.
Dorothy: Right.
Dr. Raz: Um, so that’s what I [00:17:00] will say. Keep a chin up, be punctual, uh, and put yourself first.
Dorothy: Wow, that is so good to hear from, from you. About that understanding that women do not put themselves first. You know, it, it’s I’ve heard this for 36 years doing this place and, and to hear a physician talk about it.
I think, I think that’s, it’s a, it’s acknowledging what goes on with, in a woman’s life. It’s not criticizing, it’s not blaming. It’s saying you, you do have to take care of family. But you do need to take care of yourself first. Absolutely. Now this is a toughie and I realized that where you could get on some thin ice with this one, but do you really agree with the USPSTF, the United States Preventive Services Task Force, recommendations that women really don’t need to start screening until 50?
Dr. Raz: I do not. And there are studies that mention, and again, let’s be fair why they’re saying it. They’re saying it [00:18:00] because You know, mammogram can lead to what they say over diagnosis and biopsies that leads to it. And it’s true. We can do biopsy and it’s not cancer. It’s a false positive. Um, it’s true. However, if my mom and sister were involved or my wife, would I want them to start mammogram at 40? Yes. Why? Few studies have found that around 4,600 to 5,000 women get diagnosed with breast cancer extra. And I’m talking about if you were to start at 40 to 50 screening mammogram versus if you just wait until 50 and then start it. So that’s 5,000 women that would have just gone without diagnosis. Now you can imagine how, how many of them may have developed, if you wait until 50, aggressive cancer, or may have just, you know, not even made it till then.
Dorothy: Oh my goodness, that’s scary, yeah.
Dr. Raz: So there are a bunch of statistics, you know, um, largest like study out there found that mammography screening [00:19:00] cuts breast cancer deaths by roughly a third in women, all women ages 40 and over. Um, and again, there is this concept of life lost. In breast years, the best thing you can do is start in 40 because that’s where you get the best benefit.
If you catch cancer within the 40s, then you have the largest amount of time to live, right? So the most lives saved, most living lives, years saved would be if you start mammogram at 40. Um, And there is definitely studies and very good studies that show that, um, you know, no negative cancers could be caught early and 40s have a larger benefit mortality benefit than if you actually just wait till 50 and do it after. So plenty of studies out there do not agree with the United States—
Dorothy: Well, and in your private practice, you’ve seen younger women.
Dr. Raz: Yeah. And this is again, observational. I have not done an observational study here at The Rose. We should. And I plan to. But yes, [00:20:00] plenty of breast cancers in late thirties and early forties I’ve seen. And again, I do not have the numbers and I have not performed observational study, but there may be increasing incidents you know of breast cancer in early forties. I do not know why that is now It’s a combination of good screening incidence increases. But there is something out there where there is an increased incidence outside of that of breast cancer and that just makes it even more important that you start at 40 instead of 50.
Dorothy: And you said something earlier about Be punctual. Why why why does it really matter if it’s 12 months 16 months? 18 months. I mean, does it, I know it could give the cancer more time to grow, but what else?
Dr. Raz: I mean, being a punctual, it’s a habit thing. Um, once you are punctual, let’s say if you’re punctual in your screening mammogram, it’s likely that you’re going to be punctual in your colon screening. It’s likely you’re going to be taking [00:21:00] care of yourself. It’s sort of like a trigger. Um, if you’re a good person, if you’re a person who walks every day, it becomes a second nature.
Dorothy: Right.
Dr. Raz: Um, so it has overall health benefits, but you’re right, um, there are interval cancers and again, majority of the cancers are not aggressive, but few are, and not every woman is low risk. Remember, um, around 20 or so percent or 25 percent of cancers are genetic based, family based. There are some risk factors.
Dorothy: Right.
Dr. Raz: And in those women, yes, for sure. However, if you are not punctual, if you do not do every year screening. There is an interval of cancer that can, in fact, there is an interval of cancer that they have anyways, around 11 to 12 percent they found for BRCA mutation, where even if you are doing yearly screening, it could develop in between screening.
Dorothy: Right.
Dr. Raz: But imagine if you’re just skipping a year. If you’re not punctual.
Dorothy: Right.
Dr. Raz: It’s even worse, so. For the total amount of cancers, we find around 20, 25 percent of the cancer [00:22:00] are the aggressive kind, which will develop in between screening. And so, it is important that you are punctual. For that subset, and in general, for majority of your health benefit. It’s better to be punctual. It becomes a habit forming thing.
Dorothy: Right. Right. That’s, that’s interesting concept. You know, it’s just, again, making it part of your style, your lifestyle.
Dr. Raz: That’s right.
Dorothy: Making it part of your year. When you went through your fellowship and let’s see, where did you do your fellowship? University of Texas Medical Branch at Galveston. So you, you’ve seen a lot of underserved patients.
Dr. Raz: Yes.
Dorothy: A lot of women who may not have even known about mammography or had no access to it. Is there any difference in caring for the insured and the uninsured?
Dr. Raz: There is no difference really. Um, I mean, my recommendations as the standard of care is the same for both.
Dorothy: Right.
Dr. Raz: If the difference really is, [00:23:00] and this is credit to you, Dorothy, that it’s, it’s a matter of access. Access and the Swiss cheese effect, if you will, following through the cracks. Um, so a lot of these women can come in for a mammogram once, but then they do not follow up. They don’t have a follow up.
Dorothy: Right.
Dr. Raz: And this is why this program that you have with the nurse practitioner, right? From getting to screening and then making sure they’re in the loop and not outside with a settlement with the primary care physician. It’s outstanding. And that’s the missing piece, really. You include that and a lot of these women will be punctual with their mammogram.
It’s it’s a matter of access. It’s a matter of education. Um—
Dorothy: And access is so important.
Dr. Raz: Very important.
Dorothy: I mean, I, I just go crazy with people going, Oh, we just want to raise awareness raise awareness. What are you going to do with those women after you raise all that awareness if you don’t have a place for them to go?
Dr. Raz: Implementation.
Dorothy: And you know and our our [00:24:00] younger black women I think it’s almost, um, it’s not very good that we’re telling them, Oh, well, you’re more susceptible, but then no one wants to do a screening mammogram on anyone under 40. And when you do have it, it’s going to cost some money because you’re going to do diagnostic. Talk to us a little bit about when, why do you do diagnostic? What’s involved?
Dr. Raz: Right. So diagnostic mammogram, we get special images, not the standard for views. Which is what screening mammography is, and diagnostic mammogram includes are, um, some extra images that are zoomed up, if you will, they’re magnified, or, um, what we use the word spot compression, where we compress a little bit more, yes, much to the disagreement of many, many women, but what we’re trying to do is get to the abnormality, whether it be you’re palpating something, or some calcifications that we see, when you’re not 40, when you fall outside of [00:25:00] that, It tends to be these extra images that we do because it is when a woman comes in with a complaint that we perform this examination.
Usually, it is followed by an ultrasound. Uh, again, ultrasound is a complementary study. There are certain things we see on mammogram that we cannot see on ultrasound and vice versa. So, ultrasound is excellent at providing, uh, clarity in a dense breast. We may see a mass on mammogram, but it’s not a solid mass.
Well, then we’ll be able to tell on ultrasound. So all of that, when you combine those extra images and an ultrasound encompasses what we call diagnostic workup. Um, and it is needed for any complaint that a woman may have or a younger woman. Usually they come in because they have some complaint.
Dorothy: Right. And the other component of that is the physician has to be there to look at it.
Dr. Raz: That is correct. I perform—
Dorothy: And to talk to the woman, to perform the ultrasound. [00:26:00]
Dr. Raz: Yes.
Dorothy: And, and that’s a very different type of procedure when it’s the physicians in the room.
Dr. Raz: That’s right.
Dorothy: Doing it. And so many people think that I have a lump, I’ll go get on the mobile.
Dr. Raz: Right.
Dorothy: And, and have a mammogram. That’s all I need to do without realizing that’s just a part of it. Especially if you have a lump, you know, we, we don’t. We don’t let women have a screening on the mammogram, um, coaches if we know they have a problem and make sure that they do get on in for diagnostic. It’s, it’s so important.
Dr. Raz: It is rare, but occasionally we do not see certain types of cancer on mammogram and ultrasound. And this is why, you know, as you mentioned, when I’m in the room. You can sometimes just feel it, and again, it comes from experience. There have been a few cases where lobular cancer, which likes to hide from us on imaging, we have just found based on palpation and then gone back to imaging and be like, okay, there may be subtle [00:27:00] things here and they’ve turned out to be cancer. So that’s, that’s why it’s important. That’s really the difference when the physician’s in the room with the diagnostic.
Dorothy: And you don’t have a problem saying, well, we may have to do a biopsy.
Dr. Raz: That’s right.
Dorothy: She doesn’t have to leave here going, Oh, I wonder what’s going to be next.
Dr. Raz: Right.
Dorothy: You say we may have to have you back or I, I don’t see, you know, it’s a system. I’m comfortable with it. Whatever.
Dr. Raz: Right.
Dorothy: I think that just gives a woman a sense of reassurance.
Dr. Raz: Yes.
Dorothy: And, and once again, she’s being treated and, uh, told that it’s important.
Dr. Raz: Right.
Dorothy: I wouldn’t be in the room, I the doctor, if this wasn’t important enough for me to look at.
Dr. Raz: Right.
Dorothy: I think it sends an incredible message, besides being necessary, but It does send a different message to women.
Dr. Raz: You’re right. Um, majority of the time when, let’s say if it’s calcification follow up, when I, I tend to show it to the [00:28:00] women too.
Dorothy: Mm-Hmm.
Dr. Raz: I open up the screen, I showing, look, some other radiologists call these are calcifications. This is how it looks. Plenty of women appreciate that. Remember, if you go do your CT chest or anything, brain MR, you just get a report.
Dorothy: Right.
Dr. Raz: But nobody’s really showing you, Hey, what are these words? What do they mean? I tend to show a lot of women on the screen, what I’m seeing and what it means. I mean, at least that’s my style. So it’s important from that perspective as well.
Dorothy: True. And calcifications are normally found through mammogram?
Dr. Raz: Yes.
Dorothy: Don’t always see those on ultrasound.
Dr. Raz: No, you do not. But again, it will be a diagnostic mammogram, where I tend to go, I go in and see the patient, and then show it to them. So yeah. Understand what’s even in the report.
Dorothy: Right.
Dr. Raz: Plenty don’t even know what calcification is, but you know.
Dorothy: Right, right, well, and there’s no reason for him to I mean when you get down to it’s not something they’re going to encounter right in regular day to [00:29:00] day life. And so If a woman finds a lump in her breast, what would you say to her?
Dr. Raz: Well. Majority of the lumps tend not to be real masses. However, if it is a mass that’s hard, that’s solid, um, and it persists, and especially if it’s growing, right? Within a month you felt it, next month it’s bigger. Absolutely something you need to come in for and get imaging on. So any of those things happen, I encourage all the women to come in, and so we could take a look under imaging.
Again, remember, The negative predictive value, what that means is if I don’t see anything on mammogram, don’t see anything on ultrasound, well then we’re 99 percent sure there isn’t anything there.
Dorothy: Right.
Dr. Raz: So that’s a pretty good sure insurance right there. So if you have those things that I just mentioned, you know, mass that you feel, it’s growing, it’s hard, feels unlike any of the rest of the breast tissue. Most likely is a bonafide mass. [00:30:00]
Dorothy: Right. And that’s so important because breast tissue can have a lot of different characteristics, but if you know your breast, you know, that wasn’t there last month or, you know, I think, I think that’s, we’ve unfortunately in the, at the breast cancer world, we don’t talk enough about self exam and it’s still one of the main tools for women to use.
It’s free, you know, do your self exam. How many women find it before they ever get here? So that’s, that’s important. So for young mothers, now, this is one of the saddest things I’ve seen ever since I’ve been here. We have diagnosed so many young women who have a child that’s two or young younger, you know, they they developed this right after they were pregnant.
Dr. Raz: Yes.
Dorothy: And went to their doctor Invariably were told it’s milk ducks. It’s not anything to worry about and I know it’s difficult to image someone when they are nursing, but they still need to get it checked, [00:31:00] right?
Dr. Raz: Yes, and it does not matter. Um, your breasts on mammogram are dense, but at least on ultrasound, if it is an abnormal mass, we will see it.
Dorothy: Right.
Dr. Raz: Um, and yes, you can have galactoceles, and you know, milk cysts, and these other benign entities that you can get when you’re lactating. But no, if it’s cancer, I’ll see it and that’s, that’s the, that’s the problem because when you’re pregnant, let’s say, and you’ve developed a mass, well, I mean, naturally your breasts are responding to a surge in estrogen, but that’s exactly when cancer responds as well. Remember, cancer loves to eat estrogen.
It grows on it. It thrives on it. And it’s very easy to confuse that with a, Hey, it’s just a piece of breast tissue or just a cyst. We don’t know. And if it’s unlike anything you have had the feeling for, then it’s better to check it out.
Dorothy: And the same kind of applies, and we haven’t really spent any time talking about the different types [00:32:00] of breast cancer in, uh, our programs, but I do think it’s important for women to know a change in the appearance or if they see a, an inflamed looking area.
Dr. Raz: Yes.
Dorothy: We have so many, so many patients that have gone to perhaps family doctor, dermatologist, and actually it’s inflammatory breast cancer. So, describe what that looks like or—
Dr. Raz: That’s right, um, Inflammatory breast cancer involves, you know, involvement of breast cancer within the lymphatics, within the skin. And essentially your breast, you know, as the word says, will look inflamed. It will look, you know, there is a sign called Peau d’orange, and all that means, it’s in French, it looks like orange. It’s super engorged, big, really inflamed, it will look red, angry, and heavy. Can cellulitis and infection do this? Yes. But usually the way these things go is if a woman goes to a primary care, they give [00:33:00] antibiotics and it does not resolve. And that should be sending alarms. Immediately that needs to be worked up on imaging, on ultrasound. And, you know, most of the time, inflammatory breast cancer is associated with the mass.
We see a mass underneath, we biopsy, and we get the diagnosis. Sometimes it’s not. Sometimes we have to do something called skin punch biopsy because it’s in the skin by the lymphatics, and we diagnose it that way. But basically, bottom line, if you have infection of the breast, it better resolve from antibiotic course. If it does not, there may be a chance that that may be inflammatory breast cancer.
Dorothy: Right. So, how the breast looks, how it feels.
Dr. Raz: Self breast exam.
Dorothy: Yes, yes. A lot of women don’t look at their bodies. You know, we were told you’re not supposed to. And I’m sure in many cultures that’s very prevalent still that it’s not right for you to look at your body. Yeah. [00:34:00] So that’s, that’s a big thing for women to get used to. And besides when we’re looking at our bodies, we’re going, Oh, that’s too fat. Let’s do this. That’s too that, you know, but Yeah. That, it’s good to know that’s a big part of, of finding this too. So where do you think mammography is going to go?
Dr. Raz: I think there are, so interestingly, there are some protocols being worked on in Europe specifically. It’s, Europe’s tends to be ahead of us and clearance of FDA, FDA is a little bit difficult to get clearance from, but point being fast MRI sequences. So screening for breast cancer using fast MRI. So just to give you context, current MRI will take, if you were to do breast MRI, it would be like 20, 30 minutes.
That’s significant amount of time. You know, you can imagine it’s this noisy machine that’s just constantly going like, right. And you’re getting your MRI 30 minutes in there. Claustrophobia. I mean, you know, I got an MRI. I didn’t feel great. Now I’m a [00:35:00] radiologist. So, but fast MRI would be five minutes. Barely even ten minutes. The advantage is it’s highly accurate. It’s even more accurate, sensitive to catch breast cancer than Mammogram, ultrasound, and mammogram and ultrasound combined. So that will be a, an excellent screening tool. So that’s where I think, so it’s that or something called contrast enhanced mammography, where you inject contrast.
Um, so new studies have been done to see the efficacy of that, the sensitivity of that, is it better than our current modalities. But that’s where I see this going. I do see within the 10 years that a lot of screening will be done with these fast MRI protocols as MRI machine improves, as the technology improves.
Dorothy: Right.
Dr. Raz: And if she can get the timing down to five to 10 minutes, yes, I think it’s viable. And I think that’s where we will be going. The main advantage being. While you have compression, some compression when you do breast [00:36:00] MRI, it’s not like mammography. I’m sure plenty of women would love that.
Dorothy: Right, right.
Dr. Raz: Um, and in general you just have higher sensitivity. That’s where I think it’s gonna go.
Dorothy: And of course that access to that type of service is going to be, again, another challenge for our anybody probably. But also there may not be enough places offering it.
Dr. Raz: Right.
Dorothy: Certainly not going to care for the uninsured.
Dr. Raz: Right.
Dorothy: And it could become a diagnostic cost instead of a screener.
Dr. Raz: Right. No, you’re right. I mean, it’s, in the near future, I do not see mammogram going anywhere. Um. But that’s just the future glimpse. I’m showing you where our screening methodologies may evolve.
Dorothy: And that’s encouraging. That is so—
Dr. Raz: It will catch more cancer. I can tell you that.
Dorothy: Something like twice as much as—
Dr. Raz: Correct. If I were to just do screening mammogram. In a thousand women, I would catch [00:37:00] cancer off of that screening three to four women. With MRI, it’s more like eight to ten.
Dorothy: Right.
Dr. Raz: So it’s just a more sensitive study. It’s a better study.
Dorothy: All right, so now we want to know a little bit about Dr. Raz. Again, you told us a wonderful story how you, how you got into all this and, and I do want to emphasize what you said about this is one of the few radiology, uh, areas that you actually get to talk to the patient.
Dr. Raz: Right.
Dorothy: You actually have contact with the patient and not all radiologists can handle that for one thing. That’s true. I’ve seen my share.
Dr. Raz: Yeah.
Dorothy: But, but that’s part of the job you love.
Dr. Raz: Yes.
Dorothy: So, in our world today, what is it in the healthcare particularly that, you hope to see for your children, for your daughter, for your son. And let’s see, she’s what? Nine- ish?
Dr. Raz: She is going to be eight.
Dorothy: Going to be eight.
Dr. Raz: Yes. Her birthday is coming up. Um, [00:38:00] well, where I could tell you where medicine will be heading.
Dorothy: Okay.
Dr. Raz: Um, increasingly we’re going to see precision medicine, um, and also outcomes based medicine. And people talk about this, insurance companies talk about this, where If you were to perform a procedure, let’s say, well then what is the outcome of it?
Dorothy: Right.
Dr. Raz: Uh, did you actually benefit the patient or not? There will be trackers to it. Like people would track it and say, Hey, did that actually tangibly change the patient’s life? Tangibly brought benefit to the health or not?
Dorothy: Right.
Dr. Raz: It’s again, it’s very intangible at this point, but there will be criteria is now associated with, associated with it, which I think is excellent because that will be bringing the medical costs down.
Dorothy: Yes.
Dr. Raz: That would get rid of a lot of unnecessary procedures or things that we may do in medicine. And again, precision medicine, think of it as a technological improvement. For [00:39:00] example, we did not have cell phones, iPhones, all these things that have made communications way fast. Now we don’t use mail or these things that we consume everything.
The cost is down, let’s say. So you just pay your phone bill, cost is down. Same thing with precision medicine. If we could, and what that means is basically a lot of genetics will be involved. Let’s say if you have cancer, you just precisely target that one tumor or mass and you do not hurt the rest of the body like chemotherapy may. Or you do, you know, genetic testing where you figure out, okay, well, then 10 years from now, you’re susceptible to develop diabetes, this and that with high accuracy.
And if you have that kind of tool, which we’re beginning to have in biotechnology, then you can prevent lots of diseases. You can change your lifestyle. And this will be very tangible. It would not be like a shotgun approach. Hey, eat healthy, don’t eat [00:40:00] sugar and you’ll be healthy. Yes, there is general benefit to it.
But specifically, let’s say like Dr. Raz, your chance of developing cardiac disease in 10 years is like 100%. You can get an MI 12 years. So, our studies show this, your data shows this, time to lower your cholesterol, time to work out. And then being able to objectively measure using technology, you know, there’s an iPhone on these watches. And then the physician actually updates you over the air. So basically that’s how I seem. Yeah.
Dorothy: Wow. That’ll be a big change. I thought 3D mammography was a big change.
Dr. Raz: But this will basically change a lot of medicine. It will become very personal. So personal medicine and precision medicine. This is where I see medicine going. Um, and this will be immense benefit. Cost wise, also health improvement wise.
Dorothy: Right, right. But you really don’t [00:41:00] see that cancer will be eliminated by the time your daughter’s a young woman.
Dr. Raz: Cancer is such a heterogeneous disease. Um, it’s—
Dorothy: Explain that, explain that word for us.
Dr. Raz: It means it’s, there is no one cancer. I mean, there is no one breast cancer.
Dorothy: That’s true.
Dr. Raz: There’s so many breast cancers and each of them has dependent on the receptors. There are on the tumor mass and, and imagine all these different cancers. They all are different, subcategory. It is difficult. Uh, it’s difficult because what is cancer? It’s just uninhibited growth of cells in our body that body has no control over. That’s what cancer is, really. If we can somehow genetically alter cells in the future, there is hope we can eliminate cancer. But we are not there yet. That would be Star Trek level medicine, where the, you know, where the doctor just goes beep beep beep beep beep beep.
No, [00:42:00] no, no, you know, and he fixes you. No syringes, or X ray. But can we get there? Yes, I think we can.
Dorothy: Wow.
Dr. Raz: Because already we do gene editing. And we do it in organisms. I’m sure maybe some listeners know, like if you go shop in the mall, there are already biologically generated shampoos and lotions that you’re using. And that comes from a yeast. So for example, there is a product called BioSense, I believe. It’s very popular. The, there’s a, there’s an element in there called squalene. It’s like a, like a moisturizer. That used to come from liver of the sharks, you’d have to kill the shark to get this product. But now guess what? Yeasts are making it. We grow yeasts and they produce this element for us. And you just put it in the creamer, moisturizer and then you use it.
Dorothy: Wow.
Dr. Raz: So yeah, so by gene [00:43:00] editing. So, and again, we already have, you know, genetic testing that we do in breast cancer, right? So now it’s just a matter of, and there are technologies out there that can go in and change the DNA of the cell. So when we get to that level, yes, I think precision medicine combined with gene editing can get rid of cancer.
Dorothy: We’ve covered the importance of annual. We’ve covered the importance of starting at 40. We’ve covered if you feel anything, get it checked.
Dr. Raz: Yes.
Dorothy: We’ve covered even if your regular doctor tells you it’s nothing.
Dr. Raz: Yes.
Dorothy: Get a second opinion.
Dr. Raz: Yes.
Dorothy: Get it checked. Um, we’ve covered as our theme for this program is take care of yourself.
Dr. Raz: Yes.
Dorothy: Okay. So this is just an imaginary question. You’ve already imagined what cancer is going to be like in the future.
Dr. Raz: Yes.
Dorothy: I want you to imagine that you could be anyone in history, male or female, for 24 hours, who would you pick?[00:44:00]
Dr. Raz: Well, knowing that I’m a nerd, then I would like to, I would like to be Einstein. And the reason is I wanted to know, and again, it’s very nerdy, but, but I, I believe Einstein was working on like the theory of everything, so you can figure out how the world works. So I like to be in his shoes, be in his brain and figure out how far he got for 24 hours.
Dorothy: Yeah.
Dr. Raz: So it’s sort of seeing the truth about the world from the person who was pretty close— see what he saw, which we may never be privy to know, um, regarding the universe. So that’s what I would like to be. But again, I’m a nerd. So.
Dorothy: That gives me chills. I mean, really that that’s, I don’t, I’ve asked that question many times, but I’ve never had that one.
Dr. Raz: I’m sure somebody would pick like a rock star. You know, I mean, that’s more fun. This is not fun, but I would like to know the truth. I mean, in the end, we’re all here on earth. What are we trying to do, right? I mean, trying to find our [00:45:00] way, trying to figure out what the universal truth is. I’d like to know that, but it’s more of a spiritual thing.
Dorothy: Well, yeah, but you, you believe in that spiritual side of, of health of people of, yeah, I think it’s very, very important that we, we understand that’s another part of our health profile.
Dr. Raz: Yes.
Dorothy: You know, if we’re, if we’re connected there, we have a little extra edge.
Dr. Raz: Yeah.
Dorothy: And if we’re looking in that way, we do also.
Dr. Raz: Yes.
Dorothy: Anything else you want to share?
Dr. Raz: No, I think, you know, you mentioned this in COVID, I’m seeing curious patients, patients who are now more health conscious.
Dorothy: That’s so positive. I mean, that’s really good.
Dr. Raz: It’s true. It’s like when patients got COVID, all of a sudden they became more health conscious. That’s how I’m seeing it now in my practice. And So, I like that to continue. I like patients to be curious and ask their doctors tough questions. I like it when a patient comes in like, hey, can you explain this to me? Awesome. Great. [00:46:00] Do not just take whatever for granted if a physician is telling you, hey, you have calcifications.
But what does that mean? You should ask them. Be curious and just positive attitude. After COVID, you know, we’re going through this, you know, in generally speaking economy, inflation, this and that. And one thing is a lot of us are very resilient. Keep that up, keep the positive attitude going and then just translate that into your health.
Dorothy: Oh, great advice. That is so good. Yes. That resilience has been really what got us through.
Dr. Raz: Yes. So keep that up.
Dorothy: All right. Well, thank you so much for being with us today and online. For everyone who’s been listening, you can always send your questions for Dr. Raz to therose.org and we’ll get them to him. And as you heard, he’s, he’s liking that you’re curious. He wants to answer your questions. So we’re going to wrap it up for today and. Reminder, take care of yourself.
Post-Credits: Thank you for [00:47:00] joining us today on Let’s Talk About Your Breasts. This podcast is produced by Freddie Cruz Creative Works 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 #Let’sTalkAboutYourBreasts. We welcome your feedback and suggestions. Consider supporting The Rose. Your gift can make the difference to a person in need. Remember, self care is not selfish, it’s essential.
