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Test Those Breasts ™️
This podcast by Jamie Vaughn is a deep-dive discussion on a myriad of breast cancer topics, such as early detection, the initial shock of diagnosis, testing/scans, treatment, loss of hair, caregiving, surgery, emotional support, and advocacy.
These episodes will include breast cancer survivors, thrivers, caregivers, surgeons, oncologists, therapists, and other specialists who can speak to many different topics.
Disclaimer: I am not a doctor and not all information in this podcast comes from qualified health care providers, therefore does not constitute medical advice. For personalized medical advice, you should reach out to one of the qualified healthcare providers interviewed on this podcast and/or seek medical advice from your own providers.
Test Those Breasts ™️
Ep. 31: Through the Lens of Radiologist, Dr. Bruce Kaplan
Have you ever wondered about the intricacies involved in diagnosing and treating breast cancer? I, Jamie Vaughn, invite you to join my conversation with my radiologist, Dr. Bruce Kaplan, as we journey through my battle with the disease. Dr. Kaplan, a specialist in breast imaging, played a vital role in my diagnosis and treatment, and his expert knowledge provides a unique insight into this prevalent disease.
Our discussion dives into the enormous flood of information that comes with a breast cancer diagnosis and the critical role of second opinions. Listen, as we take you through the often less discussed topic of male breast cancer, and the comparisons in treatment faced by male patients. We talk about mammogram confusion and the importance of self-advocacy in screenings, especially in our current era of AI-aided early detection.
Contact Dr. Kaplan:
BKaplan@renorad.com
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I am not a doctor and not all information in this podcast comes from qualified healthcare providers, therefore may not constitute medical advice. For personalized medical advice, you should reach out to one of the qualified healthcare providers interviewed on this podcast and/or seek medical advice from your own providers .
Welcome to Test those Breasts podcast. I'm your host, jamie Vaughan. I'm a retired teacher of 20 years and a recent breast cancer survivor. My life has been pretty nutso for over a year and many of you most likely know just how overwhelming this diagnosis is, and the more I can help empower women, the better. I launched my podcast on June 11, 2023, which was the one year anniversary of my diagnosis. It has a healing mechanism and have made it my mission to help shorten the learning curve for future diagnosed breast cancer patients and their caregivers. I want you to know that you are not alone. I was told from the very beginning that being diagnosed with breast cancer opens us up to the sisterhood of all sisterhoods, but some people need that extra help and encouragement and all of the confusing and many times, downright scary information they are being flooded with. I've been interviewing many survivors, caregivers, oncologists, surgeons, nurses, therapists, advocates and more in order to provide much needed holistic guidance for your journey. Breast cancer is such an epidemic, so the more empowered we are, the better. Now let's listen to this next episode of Test those Breasts. Well, welcome friends, back to this episode of Test those Breasts. I am your host, jamie Vaughan, and I am extra thrilled today to have my own personal radiologist. Well, I mean, he's a lot of people's radiologists, but he is Dr Bruce Kaplan and we have quite a story about Dr Kaplan. But first I want to let everyone know that Dr Kaplan did his medical education at the University of Vermont, new Mexico and Wisconsin and has been practicing diagnostic radiology in Reno, associated with Reno Radiological Associates and Renown Health, since 1999. He has really really strong ties to our community here in Reno, so strong that, well, we've become personal friends. I actually met Dr Kaplan at the Breast Center throughout the years when I've gotten my mammograms and I kind of knew who he was through my husband and a few other people. We have a really interesting story because Dr Kaplan essentially is the one who diagnosed me with breast cancer.
Speaker 1:Back in June of 2022, and I will be exact, on June 4th 2022, I had my retirement party at my house. Dr Kaplan was at our house at that time and a few days later, on the 7th of June, I had a mammogram my annual mammogram and they actually moved that mammogram up by three weeks because they asked me if I had felt anything or if I had noticed anything different. And I had. I had noticed a lump and some little burning sensations and stinging sensations every once in a while throughout that spring, and so they moved my mammogram up in light of that and on June 7th I went in and got the mammogram. I had a different radiologist at the time.
Speaker 1:Dr McDonald called me in and my audience does know about Dr McDonald because I have told that story and he told me that he was really concerned about some groupings of calcifications and an associated mass, and so I immediately made an appointment to get a biopsy and I asked them to share my results with Dr Kaplan.
Speaker 1:And Dr Kaplan actually looked at them that day, that night and I was on my way to a concert with my husband and my dad and a few friends and he called me that night when we were in line to go into this concert and let me know that it was a 95% chance or more that it was breast cancer.
Speaker 1:So I essentially found out that day, but then I got a biopsy that Friday, which was the 10th of June, and then I got a phone call from Dr Kaplan about 24 hours later when I was camping with some friends and my husband, and that is when we found out that it in fact was breast cancer and from there Dr Kaplan was able to sort of navigate me into finding with my breast surgeon and my oncologist, and he's been very, very helpful this whole entire time. So, dr Kaplan Bruce, I call you because you're a friend of mine, but, dr Kaplan, welcome to the show. I just really appreciate your taking the time to join us and share with my audience your expertise and thoughts on the issue of breast cancer, not only in women but also in men. So how are you doing today?
Speaker 2:I'm doing great. Thank you for having me.
Speaker 1:Well, I just think we have quite a bit to talk about. You know, you know my whole entire story. You and I have been in touch this whole entire time and I have reached out to you for advice. I've let you know every step of the way what has been going on with me, all of my fears and concerns and all the things. So I just want to really kind of start out with asking you to share a little bit about how you even got involved in radiology. Like, what is it that drew you to radiology and, in particular, working with breast imaging?
Speaker 2:Well, radiology back when I started in the mid 90s was was really still an evolving field. Technology had not really affected it too much and it was regular x-rays, a tiny bit of CAT scans. Mammography at that time was still on films, but I knew that as technology evolved, radiology was going to involve with it and become a central part of diagnosis and even treatment in medicine.
Speaker 1:So how long have you been working specifically with breast imaging?
Speaker 2:I would say I started when I arrived in Reno in 1999, but really have gone full in probably around 2012 or so. Okay, before that I was doing a little more hospital work and some other different specialties, but I really went full in at about 2012.
Speaker 1:Would you say that that is about the time that you recognize I mean, I know that one in eight women is what I'm hearing statistically that women get breast cancer. Would you say that you really got involved in that when the number started really picking up? Because I talked to a lot of doctors, surgeons and oncologists who were like general surgeons and then, like Dr Chu, like I know that she was a general surgeon and then she really got into breast surgery at a certain time, probably recognizing the need for specialized breast surgeons, same with oncology. Would you say that is about the time when you're like, yeah, you know what this is like big, we need to have someone that can be in there specifically for breast imaging.
Speaker 2:I think that's a great point, especially as you get into your 40s and maybe 50s. It really hits home because you start having friends that get diagnosed with it and so you really look at it in a different way, that it's not just something out there. You're gonna know lots of people that have or had breast cancer. Okay, you're circle of friends, just in a small circle of friends.
Speaker 1:Yeah, yeah, that must be really, really difficult. So delivering that kind of news must be sometimes kind of difficult, depending on who you're delivering it to. But can you walk us through kind of what goes through your mind and in your heart when you have to pick up the phone and call somebody to tell them that they have breast cancer?
Speaker 2:So a couple of things. First, the initial part telling them their diagnosis. You want to be very straightforward and not beat around the bush. Tell them the diagnosis in a compassionate way, but then quickly shift to this is a treatable disease. The treatments have gone so much better with like biological treatments, improved surgery, improved radiation therapy, chemotherapy if needed. They are so much better than they are, I should say, more effective than they were even five years ago, absolutely 10 or 20 years ago. Much more less side effects and more effective at the same time.
Speaker 1:So what I?
Speaker 2:would say to someone if they got newly diagnosed is try to not let your mind go too far. It's a one day at a time and again the treatments are much better than they used to be and it is a manageable disease.
Speaker 1:Yeah, my mind went to a lot of different places when I was first diagnosed and I only wish that I would have known about some of the resources out there. You were very, very instrumental in connecting me to the right people as far as doctors. I wish I would have had more insight on some support, like even. I know there's breast cancer coaches out there and they're not all created equal. I mean, you have to be really careful about who you're talking to when you're getting coaching like that or podcasts, and one of the reasons I started this podcast is because when I was diagnosed, it was just a overwhelming amount of information and opinions. You know, I had people reaching out to me saying why can't they just get in there and cut that sucker out, you know right now, and come to find out? It really truly depends on, first of all, the kind of breast cancer you have, and also I think that one of the reasons sometimes they do chemo first and then surgery is that I think they want to know what the efficacy is and if that chemo is in fact treatable through that for your breast cancer, will it shrink that so that in case you get it the next time, if you do they know what worked on you? And that's one of the things that I did not understand until later on. But I just wish that I would have had someone guide me, but I just wasn't in that space at that time. I was looking for information.
Speaker 1:So it's really hard not to freak out and think the worst. And I remember the first thing I was thinking to myself oh my God, I'm going to lose my hair. You know things like that and that was really hard, and a lot of people are like, hey, you know, it's just hair, it'll grow back. But it's one of the most tough things to actually wrap your mind around, because we women really truly are. You know, a lot of us are really wrapped up with our image and our hair and eyebrows and eyelashes and things like that. So when you're going to lose it all, that's really freaky. You know what I mean.
Speaker 2:A couple of things I think to remember also is that breast cancer is not one disease. It's multiple diseases, depending on the receptors, how early it is when it's caught, has it spread to places. So it's really multiple diseases and you're absolutely right and the thought that surgery is just going to fix it is really old thinking. It's certainly an integral part to the treatment, but really the biologic treatments are what's changing outcomes for the better? That's relatively new and again, it's not one disease. It depends on all the different receptors and there's classifications for those. It depends how early it's found. Has it gone to lymph nodes, has it gone to other places? All those are extremely important. It's not just one disease, it's multiple diseases and I think most women and I guess men sometimes, but most women very quickly become educated on the differences in those and the expected outcomes.
Speaker 1:Right. Right, you know, throughout my journey I've really become quite an advocate for second opinions. I've talked to doctors who actually encourage patients to get second opinions, mainly because they want to make sure that the patient is comfortable, less anxious and are more what some call more compliant, right when you go into these treatments. And there is a philosophy about shared decision making. Because you know, back in the day and sometimes doctors still have this mentality there's this sort of patriarchal type mentality where I'm the doctor, you know, I diagnose you or whatever it is, and here's what you have to do this, this and this and the patients like, yes, okay, we'll do that. And now there's more of a mentality of shared decision making. I really like that philosophy because it does make me feel a lot better when I know that I am being included in on the decisions of what I'm going to. And I didn't even learn about that philosophy until later on, after I was even finished with my treatment. But what are your thoughts about second opinions?
Speaker 2:I think they're great, even if the second opinion person says the exact same thing, that will then reinforce what the treatment plan is, and if it's different, then that puts it in the woman's hands, with the doctors both to then, because things aren't as black and white as a lot of people think in medicine. Sometimes there are gray areas and that there may be a gray area, and then the more information, the better for the woman, and then they can make their own decision based on what they think is best for them in their personal situation. Everyone's situation's gonna be slightly different.
Speaker 1:Yeah, because I can't tell you how many people reached out to me and said don't do chemotherapy, it's gonna kill you, and or you know you need to go to this doctor or this doctor, and at the time it was a little overwhelming. It was very overwhelming actually to have all of those, because that just kind of fueled the fire of fear in me that I was going into something that you know was not gonna be good for my body and all the things. And so I do think it's really important for people to reach out to certain you know hospitals, if people recommend it, even just to get that second opinion. I finally did do that. As you know, they found a thymoma tumor in my thoracic cavity, in my up against my heart, and I actually did go get a second opinion, really a third opinion. As far as the med they wanted to put me on because it was causing a rare anemia and I was kind of baffling a lot of people here in Reno about this rare anemia. So I ended up reaching out to not only UC Davis but also Indiana University, which made it easier for me to make the decision of whether I was gonna get on that med or not, because they actually did agree with each other, so that's a really good point that you made. And then also my breast surgery. I ended up really using my voice and my intuition to make the decision to not have breast surgery here in Reno, just because they didn't have the kind of surgery that I ended up having. They don't do that here in the area, so I needed to go out of the area to do that.
Speaker 1:Yeah, thank you for your thoughts on second opinions. So what can women do? Let's talk about self exams, the importance of self exams, because I know that leading up to finding out that I had breast cancer, I did feel lump. When you have dense breast tissue, you have lumpy breasts sometimes and some people at younger ages who are still menstruating and your breasts get kind of lumpy. What are we looking for? Why is it important for women to do self breast exams and really to listen to their bodies? In my experience.
Speaker 2:the women doing a self breast exam tend to actually pick things out more accurately than a doctor do any exam on them, because they know where they're normally lumpy. They'll see if something's different. They tend to be much more accurate and it is an important adjunct to getting mammography to do a self breast exam. A good way to do it is just pick a day of the month and do it in the shower and just takes a few minutes. If there's a small change, have it worked up. If you notice something or have a small change, have it worked up, especially women with more dense breast tissue, because for them the imaging is not as accurate. Especially mammography is not as accurate.
Speaker 1:One of the breast cancer coaches that I spoke to recently said that if you are doing a breast exam say, for example, you're over on your left breast near your armpit and you feel something she says to go to the other side and feel it over there too and see if there's something similar over there. So she was giving some techniques and things like that. What about men? Have you ever diagnosed somebody, a man, with breast cancer?
Speaker 2:If you had asked me, that a year ago my answer would have been no, but just this last year I diagnosed a man and actually did his biopsy, and it can occur what's the?
Speaker 1:difference Like what do they have to do? Is it very similar to women? The type of breast cancer, what kind of treatment and things like that. The type is similar.
Speaker 2:If there's going to be chemotherapy, that's similar. The receptors are different. Men tend not to have esters and receptors. The surgery is different. The surgery is always a mastectomy for a man. Oh, okay. At least that recommendation. And again, it's not common but it's something to watch out for. And, as we were talking earlier, in a perfect world, once a month a man should probably do a skin check and do a self breast exam. Yeah, at least those two Okay.
Speaker 1:Yeah, we got to talk about the men. I was kind of blown away. I mean it makes sense that men can get breast cancer. I mean I guess I just didn't think about that before, and now you hear a lot of people, like on social media. I'm on some groups where people are saying we need to talk about men too, because they get it too, and so I'm just so glad that I know about that now and I'm able to speak about it and ask questions and recognize and things like that. So one person though you have diagnosed, very interesting.
Speaker 2:Yeah.
Speaker 1:There is a question I was going to ask you that I didn't discuss with you before, but I think that you can talk to it. There are different kinds of mammograms and sometimes it gets a little bit confusing about what women should do. So for me, when I found out that I had dense breast tissue number one, all women should know if they have dense breast tissue and ever since I've had two lumpectomies before, I always have asked every year to make sure that my mammogram included like a diagnostics, with the. What do you call it? What am I calling it? What are all of the different kinds that you can get? What is the most effective way to get a mammogram? You know whether it be 3D or what does that look like?
Speaker 2:And it's almost gone 100% in the direction where Everyone is doing the 3D mammograms, so called Tomosynthesis, and they should have what's called CAD, which is computer aided diagnosis. Most systems have that and actually a big change that's coming now, especially for denser breast, is AI artificial intelligence where that helps stratify the risk just based on density and what the breast looked like. It can help us find early cancers and also let us know that it's a very low risk mammogram.
Speaker 1:Okay, that's really cool.
Speaker 2:That's just started. In the last year or so or maybe two. It's going to change things. We're using AI in a lot of different areas of radiology now and it's very effective as an adjunct.
Speaker 1:What do women have to do? So I know that there are some women whose insurance don't cover certain things. This is a real problem because it's not equal out there and women need to be able to have these mammograms. The word I was looking for, bruce, was ultrasound.
Speaker 2:It's really not that hard of a.
Speaker 1:I know that mammograms and ultrasounds they work together and so I always have both. I always know when I'm laying on that table and they're doing an ultrasound. I look at the nurses' face number one and I look at the screen. So I always know when they see something. So that day when Dr McDonald called me back, I was not surprised at all and I just want women to be as aware and educated as possible to know what kind of mammogram, even what, to ask what kind of equipment people have. So, like you know, every October there's like these mobile mammograms. What do they have? Is it just a screening? I guess I'm just really concerned about women going in and getting a screening and it's not enough.
Speaker 2:Yeah, it is going to help A couple things. So, first of all, screening is for someone with no symptoms. It's just your routine yearly and I'll backtrack down a little. There's different recommendations out there about how often people should get a mammogram. There was a recommendation put out in about 2014 that was kind of wishy-washy. There's a federal recommendation that said start at 40 or 50 and do it every year or other year. All the medical societies believe that it should start at 40, screening mammograms, and every year. And some people should start getting them earlier, mainly people that have a strong family history of breast cancer and if they have a genetic risk like the broccogene cancer. That's really important and they would start earlier.
Speaker 2:The other part of this puzzle here is should you do supplemental ultrasound? So we have two kinds of ultrasound. One is called diagnostic ultrasound and that's when someone has either an abnormal mammogram or a lump and that we just do it goes right with the mammogram. Both of those two give us information and then we come up with one answer. The screening breast ultrasound is moving forward very quickly.
Speaker 2:It's not yet FDA approved, which is holding it back a little. There's still need a little more data, but there is a lot of good data out there that you can find cancers in dense breast tissue that you might not see on mammogram and that's so-called whole breast ultrasound. You might hear an acronym ABUS, that's automated breast ultrasound, and so that can be a supplement to mammogram. You should not do ultrasound only because there's lots of things on mammogram that will not be seen on ultrasound At this time. I kind of suggest yearly mammogram and if they have denser breast tissue, either in the category three or four, they could consider whole breast screening, maybe every year or other year, and again, there's not great scientific data for that and that should, I bet, be arriving in the next couple of years where we're gonna have really good data on that end.
Speaker 1:Do we have like this AI in-?
Speaker 2:We do. We do, okay, we have it in other areas like CAT scan and MRI for breast. Actually, in conjunction with Renown, are looking at it very closely and will probably have an AI system in place by the end of this year, if not sooner, I would think.
Speaker 1:Cool yeah, so AI can be used for good or bad, and I'm kind of liking this one for the good.
Speaker 2:Yeah, it's like any tool it can help you and it can hurt you.
Speaker 1:Yes, yes, yes. So to wrap up, I know that you talked a little bit about some advice, about not going into the dark place when you get diagnosed, and that's really, really hard to do, and I would highly recommend, highly recommend seeking out a therapist who has experience with people who have had, or like they've had, experience with people who've had breast cancer. I actually was very, very lucky. I was connected to a therapist very, very early on and she wasn't taking any new patients, but she took me and we have actually been together ever since. I still go to her and she has been incredibly helpful. So I just highly recommend people, at least for their sanity and I know that friends are really helpful and your whole tribe of people who are supporting you can be very helpful. But sometimes, talking to someone who is unbiased they don't know you, you are just you know and even seeking out a breast cancer coach that might have been referred to you or whatever very, very helpful.
Speaker 1:I literally just found out about two people today, one person's I know her. Her mother was just diagnosed just recently and she reached out to me today asking for recommendations for oncologists here in the area. And also I had someone tag me on social media just this morning. Her friend just was diagnosed earlier this month, like on this, I think. She had a biopsy on the 6th of October and she is posting on Facebook.
Speaker 1:She's very open, just like I was, about this horrifying fear of losing her hair and I did comment on there saying, hey, you know, I was in that place in June of 2022. I get that feeling and I know you know there's people on there saying, oh, you know, don't worry about it, it'll grow back. But I'm kind of in the camp of let's let people feel the feels. It's okay to feel the feels, just don't stay in the dangerous fear. I went there for a minute and I got myself out of there by seeking out a therapist and things like that. What is another big piece of advice that you would give to someone who has been newly diagnosed with breast cancer?
Speaker 2:Probably the first thing is there are very good treatments out there. They'll have a full team of people to support them. Again, like you're saying, it's very easy to go your brain to take you in the wrong way and get in a real dark place, but for the majority of people it's a very treatable disease.
Speaker 2:Okay, okay, it's a process like you talked to earlier. A lot of people want to think, okay, I get this diagnosis, you do surgery, you take it out and Get things going quickly. But it's a process where chemotherapy now plays an integral role before surgery and in almost everyone. And, yeah, it's considered a systemic disease, probably very early and by Using kind of the scientific data to Understand that it's not just the one area, could be in other places and the chemotherapy is really important and making sure those Don't you know pop up or come back or anything like that.
Speaker 2:Okay and it's gonna be a process I mean for almost everyone. It's gonna rule your life for a solid six months to a year.
Speaker 1:Yeah, yes, and it does. But I will say that I received a couple really good pieces of advice, one being one of my friends said what are you fearing? And I said I'm fearing that a big monster is coming into my body and I'm gonna be really, really sick. She says I totally understand that. She says when you get through your first treatment, you'll be okay, you'll be better, because then you'll know what to expect. It's no picnic whatsoever, but you'll at least know what to expect. And that's the advice I gave to one of my friends who's going through chemo right now, because she was very fearful and I said when you get through that first one, you'll have an understanding of what's it gonna be like and then you'll be a lot better, because it's mostly the fear of the unknown and you know how sick is this gonna make me, what's this gonna do to me? And most people who think about chemo sometimes think death right, oh, my god, I have to go in chemo, but it is really going in there and taking care of the problem.
Speaker 1:A really good piece of advice the doctor to gave to me. This was fabulous. She talked me off the ledge a couple of times. She said that when you are open to people and you let them know, which is totally good. That was me. That was the way I was able to process. She says you have a lot of comments that come at you that are not helpful and we have to learn how to filter that out. Like, filter that out. I had a few people who said things to me that are like I was like this is not helpful at all. She says you've got to learn how to filter it out. Well, that was really, really helpful to me.
Speaker 2:So they're gonna remember the worst stories and kind of share those a lot of time and it may may or may not be accurate in your own situation.
Speaker 1:Right, right, exactly like a lot of people think they know what sometimes they don't know and then they kind of throw that on you and you're just like you know, you're scared because you're not sure what's gonna happen. But I had to really learn how to filter all of that stuff out and be very honest about it, and that is again one of the reasons I started the podcast was to shorten the learning curve for future diagnosed breast cancer patients, shorten the learning curve number one and also really have that real talk about comments from the gallery that don't help, it's like in hopes to sort of educate those people as well. And sometimes they just don't know what they don't know, like they've never been Diagnosed or they don't know anybody who has, or maybe they do know somebody oh, I have one of my best friends, mom's cousins aunt had it and this is what they did and you should do so anyway. Okay, well, I really appreciate your time, and do you have anything else to say before we wrap up?
Speaker 2:All I want to say is I'm proud of you, jamie, the way you've worked through this. It's amazing.
Speaker 1:Well, thank you. Sometimes I didn't feel like I was doing such a great job, but here I am, my hair is growing back and, who knew, I would probably keep my hair short from now on and I'm cancer-free and I've had my breast surgery and I'm hoping that just by interviewing people like you Will help other people, and so I just really appreciate you're being part of that conversation.
Speaker 2:Thank you very much of any time.
Speaker 1:All right. Thanks, bruce, and to my audience, thank you so much for joining us on this episode of test those breasts and we will see you next time, on the next episode. Bye for now, friends. Thank you so much for listening to this episode of test those breasts. I hope you got some great much needed information that will help you with your journey. As always, I am open for guests to add value to my show, and I'm also open to being a guest on other Podcasts where I can add value, so please reach out if you'd like to collaborate. My contact information is in the show notes. I rely on people like you to listen, raid, review and share this podcast with your loved ones, so please enjoy my trailer and any other episodes. I'd love to hear your thoughts. I'm on Apple, spotify and other platforms. I look forward to sharing my next episode of test those breasts.
