Dr. Baltrusch (00:00):
My name is Kyle Baltrusch. I am a plastic surgeon at Portland Plastic Surgery Group in Portland, Oregon.

Eva Sheie (00:05):
Dr. Baltrusch, why do breast cancer cases always spike in October?

Dr. Baltrusch (00:09):
Diagnosis actually doesn't increase in the month of October, but mammograms do increase by about 30%, and that's because it's breast cancer awareness a month. And so the American Cancer Society put this initiative out in the eighties to hopefully increase awareness and get people to schedule and undergo their annual mammograms. And so we do see a spike in mammograms in October, November, and into December, but diagnoses actually pretty much stable.

Eva Sheie (00:38):
Does all that awareness actually work to get people to come in?

Dr. Baltrusch (00:41):
I think it does. I mean, breast cancer reconstruction is about 30 to 40% of my practice, and I would say it's pretty stable throughout the year, but I would say that a PCPs being a little bit more aware to schedule mammograms and people to reach out to their PCPs to schedule their mammograms, we do see that increase during these months.

Eva Sheie (01:01):
The guidelines change a lot, don't they? I think it went from every year to every two years. Do you know what they are right now?

Dr. Baltrusch (01:07):
They do change a lot, and I know now we're having patients start their annual mammograms when they're 40, potentially even younger if they have a very strong family history, as well as even getting MRIs instead of mammograms. And we are seeing a lot more young patients being diagnosed with breast cancer. So I'm seeing a lot of more 30, 40 year olds coming in to see me to talk about reconstructive options.

Eva Sheie (01:29):
How's the MRI better than a mammogram?

Dr. Baltrusch (01:32):
Say women who have dense breasts mammograms are able to detect breast cancer more easily than mammograms.

Eva Sheie (01:38):
Better view.

Dr. Baltrusch (01:40):
Better view.

Eva Sheie (01:40):
What about ultrasound? Does ultrasound ever play a role in diagnosis?

Dr. Baltrusch (01:44):
I would say ultrasounds are more useful when we're actually undergoing biopsies. So when there's something concerning on imaging with mammogram or MRI, then they'll do an ultrasound guided biopsy to establish a diagnosis.

Eva Sheie (01:57):
As the plastic surgeon, this stuff is not happening in your world. It's before they reach you, right?

Dr. Baltrusch (02:04):
Certainly, yes.

Eva Sheie (02:05):
So is all this imaging passed along to you at some point so you can see what's in there?

Dr. Baltrusch (02:10):
Yeah. I have access to all the imaging, so I work with practice at Legacy as well as St. Vincent, and so I have access to their Epic systems where I can see the discussions that my patients have had with their surgical oncologists and medical radiation oncologists, et cetera, and so I can have those images as well.

Eva Sheie (02:29):
This is a great time for me to ask you. You're part of a bigger team here. When someone's going through breast cancer treatment or even from before diagnosis, what does that whole team look like and what does that timeline look like? Where do you fit in?

Dr. Baltrusch (02:44):
Yeah. It all happens pretty quickly, and so I always have to remind myself that the patients that are coming to see me have had a lot of information thrown at them very quickly because we want to take care of these patients quickly. So with diagnosis, then they see a surgical oncologist as well as a medical oncologist. The surgical oncologist discusses the options, the indications for different procedures with that patient. And then ultimately, if the patient wants reconstruction or is a good candidate for reconstruction, then the surgical oncologists refer them over to my office.

Eva Sheie (03:18):
On this podcast, we bring you directly to the doctors who are where before meets after. Links to our guest's website and contact info are in your show notes. Follow us on Instagram @wherebeforemeetsafter. Where Before Meets After is a production of The Axis, the podcast agency for aesthetics, theaxis.io.