Participants: Dr. James Marcum (Host), Dr. Brent Barrow
Series Code: BRX
Program Code: BRX00020B
00:01 Welcome back to Bible Rx, we are talking about making the
00:04 diagnosis of breast cancer.
00:06 Joining me is Brent Barrow of radiology and
00:10 I was chuckling as we got started today.
00:12 Let me tell you what I was chuckling about Brent.
00:13 It is sort of funny, you know we are talking about a
00:16 serious subject here. - absolutely!
00:17 We are talking about when you wanted to become a doctor.
00:20 I had one fellow that was doing a rotation with me
00:24 in the office and I said when did you decide
00:26 you wanted to be a doctor?
00:27 Well I think when I was a baby and wanted to be a doctor.
00:31 I just thought that was funny when he was a baby
00:35 he would want to be a Dr. but I ended up that I never
00:37 wanted to be a doctor, I ended up doing other things.
00:40 Being a doctor wasn't on my mind until I was well through
00:45 with another career.
00:47 Let's get back to talking about breast cancer.
00:49 The reason this is so important is that a lot of women
00:53 die from breast cancer, Tell us is early detection important?
00:56 What if we miss it for 3-4-5-6 months,
00:59 does that make a difference in survival?
01:00 Early detection is preeminently important.
01:03 The difference between having a stage zero or stage one
01:08 breast cancer verses having disseminated breast cancer,
01:12 survival rates for those early detection is
01:16 100% in five years verses 20% in five years.
01:20 So early detection is absolutely paramount.
01:24 When you think of the number one killer, we have
01:26 cardiovascular disease which starts in our youth,
01:29 and we want to prevent that from happening.
01:31 Then we have the malignancies, and I guess breast cancer
01:34 is right out with, - yes lung cancer is number one.
01:36 For women breast cancer is number two and there will be,
01:42 I guess the latest statistics from 2004 a little over
01:47 180,000 new breast cancers in women.
01:50 Over 1800 breast cancers in men, same year.
01:56 Wow, has the numbers been going up or are
01:57 they leveling off?
01:59 The numbers are fairly flat unfortunately there has
02:02 a slight reduction, public health, education
02:06 the more educated the society is a higher rate of getting
02:11 mammograms, surveillance and breast examines
02:14 and things like that.
02:15 So our overall breast cancer rates have slightly drops
02:19 to statistically they are thinking there might be a
02:21 slight rise of one to 2% over the next couple years,
02:23 but by enlarge flat is slightly decreasing.
02:27 180,000- 186,000 women with a new diagnosis
02:32 it's a big number.
02:35 It sounds like the technology has really gotten much
02:37 better through the years, what happened to those women
02:39 in the 50s that had breast cancer?
02:40 They died. - wow, so this is where technology is very
02:44 helpful, now before we leave the subject of breast cancer
02:46 is there any other fact that you think this lady should
02:48 be aware of before we move on to something else?
02:50 Well, unfortunately there are things that she can control
02:55 and unfortunately there are things she can't control.
02:58 Risk factors for breast cancer, one being a woman.
03:02 She cannot control that.
03:03 When she starts have a menstrual periods it is very
03:06 difficult for her to control that.
03:08 Never conceiving, having or carrying a child increases
03:14 your risk of breast cancer. - if you never had a child?
03:16 Your risk is higher.
03:18 If you have a child later in life the risk is higher.
03:20 Being overweight, being inactive and drinking alcohol.
03:28 More than a drink a day all increase your risk of
03:32 developing breast cancers.
03:34 So some of those things we can control very aggressively.
03:37 So to control the risk factors, early detection and maybe
03:41 some genetic testing.
03:42 In her case, she probably needs to go to a breast cancer
03:48 Center, or a cancer center in her area that would have
03:53 counselors, and those counselors will be able to, based
03:58 upon, some of the things they need to know is the age of
04:01 when cancers are detected, the tissue type that cancer was,
04:05 all those things go into determining whether or not she
04:09 is at a higher risk or a not very high risk of having
04:14 BRC 1 or BRC A2 gene.
04:16 She may eventually, based on all that information,
04:20 she may get tested and find out if she is a carrier and
04:24 then there is some changes and choices she will have
04:27 to make because of that.
04:28 You know it must be rewarding as a part of the team
04:31 to help make a diagnosis early on and perhaps
04:34 save someone's life, we were talking about this today to
04:37 educate people and that is why we spend so much time on
04:40 breast cancer because it is prevalent, it is something
04:43 we can help save someone's life with early detection.
04:45 And something that goes along with that, you know it is
04:49 very routine for me to see with specific mammograms
04:53 which is our screening test, the diagnostic test.
04:55 You have the self breast exam, you have your clinical
04:58 breast exam, and you have a mammography, these three
05:01 things we used as a screening for breast cancer.
05:04 It is very common for a lot of women to say I had a
05:08 mammogram last year, or maybe two years ago and it
05:11 was fine and I've had no problems.
05:14 The reason why cancer detection has gone up and cancer
05:18 survivability has gone up is because of early detection.
05:24 It's those every year or other year mammogram when you see
05:28 a mammogram look normal and you see a mammogram the following
05:32 year and you start to see something a little bit subtle,
05:35 it's those subtle changes that is the early cancer.
05:39 It is not a half-inch size really ugly looking lesion in
05:43 the breast, we want to find it when it is really subtle,
05:47 not when it is obvious.
05:48 To do that we have to go through those three major steps.
05:52 Maybe I should've been a radiologist, it sounds so
05:55 interesting about detecting cancer, I like it when
05:58 you scanned this a can actually help someone figure out
06:00 what is wrong with the body and intervene,
06:03 that is very fascinating.
06:04 Let's move on to another question.
06:05 This is from a gentleman Iowa and it also is related to
06:09 malignancy. He says I'm scared to death of developing
06:14 cancer, what are the screening test I should do?
06:18 So this is a 58-year-old and it sounds like he might
06:22 not have been to his doctor because I'm sure his doctor
06:25 would have addressed this.
06:26 What are some of the things the 58-year-old gentleman
06:29 should do from an imaging perspective to help lower
06:32 the risk, or early detection of cancer?
06:35 Sure, there is a number of things that are done routinely
06:39 now, a male at that age range needs a PSA done.
06:43 He probably needs a prostate exam done.
06:46 So PSA done detects prostrate cancer.
06:48 A prostate specific antigen, it's a blood test,
06:52 I just went to my internist recently and
06:54 you have all those kind of labs done.
06:57 Because he is over 50, he probably needs to have a
07:00 prostate exam, he's over 50 he probably needs to
07:03 have a colonoscopy, that is the current guidelines.
07:07 Now that screens for colon cancer?
07:08 It's screens for colon cancer and in men that is the
07:10 second-leading cause of cancer after lung cancer.
07:13 Lung cancer is a tough one because there is not a good
07:17 screening exam, we used to use chest x-rays and sputum
07:21 or something like that and chest x-rays were notoriously
07:26 low sensitive rate for detecting a small cancer and of
07:30 course we want to find cancers when they are small.
07:34 We use CT scans or cat scan images every day in radiology.
07:39 So one of the thoughts was why don't we just start screening
07:44 people with CT scans?
07:46 There is a national study going on right now trying to
07:52 determine what populations would benefit from screening
07:56 CT scans and some of those populations will be people
08:00 who have certain work related exposures whether it be
08:04 asbestos, dust, smokers, former smokers, secondhand smoke,
08:09 so that information is ongoing and we don't have that yet.
08:13 To screen the entire population unfortunately would be
08:17 something that would be cost prohibitive.
08:20 The other side of every screening exam is that there are
08:25 things that we find that we have to then work up that may
08:31 be normal, that non-calcified granuloma in the lung.
08:35 That in a guy who is a smoker and has a history in what
08:39 ever and you have this little 4 mm lesion in his lung,
08:43 we are going to watch it closely and make biopsies.
08:45 He may have it taken out and it turns out it is a non-
08:49 calcified granuloma that was cured but it was going to do
08:53 anything to him anyway.
08:54 As you know anyway you can do anything to a patient,
08:58 instrumental, a procedure there is always a risk of
09:03 a complication, so that the untorted effect of some of
09:08 the things, having multiple CT exams particularly is what
09:12 we use as a primary, there is radiation dose, there is
09:15 radiation exposure and having an occasional scan is not
09:18 a big deal, but repeated imaging is something that
09:24 you are going to have accumulated effect.
09:26 Right, well sounds like there's ways to image for colon
09:30 cancer? - there are.
09:32 Of course colonoscopy is currently the gold standard.
09:35 With the colonoscopy you have to take that prep and
09:38 clean everything out and then they put the scope in
09:41 and they look around.
09:42 There is another test that is being done and is being
09:46 looked at and there is some conflicting data as to
09:49 whether it is as good as colonoscopy or it is at least
09:52 close to colonoscopy and that's something called
09:54 virtual colonoscopy. - okay.
09:57 Another CT exam where you go through the same prep.
09:59 Now when they say prep that something where you get
10:02 all the poop out. - yeah yet have to drink that stuff
10:04 and get all that stuff out of you.
10:06 - I would not like that.
10:07 No nobody likes that, but we want to get all that debris
10:11 out of the colon so there's nothing along the
10:13 wall of the colon.
10:14 With the virtual colonoscopy we actually also give
10:17 patients a little tablet for several days ahead of
10:20 time and it has a small amount of Barium in it.
10:23 Barium is very highly dense, and we can see
10:26 that on the CT scans so we know that little bit of
10:29 debris that is they are on the wall the colon is
10:31 just a little bit of barium.
10:33 The problem with virtual colonoscopy is that it is not
10:37 100%, like you said there's some conflicting data.
10:41 He had to go through the same prep, it is not the most
10:44 comfortable exam, when you have your colonoscopy they
10:46 pretty much make you, they don't put you to sleep but
10:50 they give you the I don't care medicine so you, and with
10:53 the colonoscopy if there is a polyp there they
10:58 will take it out.
10:59 That's a precancerous? -It's precancerous I mean that is
11:02 were a lot of colon cancer is developed from those
11:05 polyps and as the polyps get bigger the likelihood of
11:09 cancer in that polyp gets higher so surveillance is important.
11:12 Whatever test your doctor thinks based upon his
11:15 consultation with you, a Gastrologist, a radiologist
11:18 an institution, those things are important for
11:21 those who are age 50 and he needs to be getting
11:23 screened for that.
11:25 It sounds like our friend should get maximal screening
11:26 and see his doctor and get a prostate, a PSA,
11:29 a colonoscopy depending on his risk, a chest x-ray,
11:33 for sure a physical exam to look for skin cancers,
11:36 testicular cancers and all those others.
11:39 This fascinating Brent, and correct me if I'm wrong,
11:43 that radiologist can detect malignancies, they find
11:48 infections in the body, and their imaging does structural
11:51 damage, right that is what you really look for.
11:53 Of course for malignancies we need to treat that
11:55 aggressively, either remove it or chemotherapy.
11:58 Infections we need to treat that with antibiotics or
12:01 remove the infections.
12:02 For structural problems we might need to fix it and
12:05 anatomically, an imaging and technology has brought us
12:08 to this day and that is very interesting.
12:10 I want to thank you for joining us today on Bible Rx.
12:13 If you might have a question that you would like us to
12:17 address please get a hold of us at heartWiseMinistry. org
12:20 or you can mail us a letter and Heart Wise Ministries
12:24 P.O. Box 8, Ooltewah TN 37363.
12:28 Remember God has given us many technologies to heal
12:31 the body but at the heart of health is love and
12:34 we want ultimate healing and by having love in your life
12:37 this can be accomplished.
12:38 Thank you for joining us today on Bible Rx.