Breast Health and Mammograms: A Deep Dive into Safety and Efficacy with Sarah Ham

In this episode, Mary is joined by Sarah Ham, a mammography supervisor, medical radiography technologist, and yoga teacher with over two decades of experience in women's breast health.

Originally from the Comox Valley, Sarah moved to Burnaby after high school to attend BCIT for the medical radiography technology program and graduated in 1999. She then gained extensive experience working at Burnaby Hospital, Brooke Radiology, and Mount St. Joseph Hospital, where she received her mammography training. After working in the lower mainland for two years, she returned to the Comox Valley in 2001. 

Sarah shares her extensive knowledge and personal insights to demystify the process of mammograms and breast imaging. The conversation covers the significance of early screening, the different modalities available, and addresses common fears and misconceptions surrounding mammograms. 

Additionally, Sarah opens up about her personal experiences with loss and healing, and how yoga has played a pivotal role in her life. 

Listeners are encouraged to take proactive steps in their healthcare by getting informed and overcoming fear through education and self-advocacy.

Resources:

• For the listeners residing in British Columbia, Canada, learn more about breast screening at https://www.bccancer.bc.ca/screening/breast
• Find Sarah and her yoga studio offerings on Instagram @HensDenYoga 

I would love it if you could support the show. Go into the show notes and click on the button where you read "support the show." You have the option to donate monthly, $3, 5, 8, 10. Be a loyal supporter for as long as you want with recurring fee as little of three as $3 a month, and opt out at any time. Each investment goes directly back into producing episodes with even better content, improved audio quality, and we'll go a long way in bringing great guests onto the show.

Transcript

 It is often that fear and the lack of knowledge around why we do it. The analogy which my supervisor back in the day told me is when you're looking at an ultrasound, picture yourself in a dark room and you're holding a flashlight and you're just shying that flashlight on the ceiling, that's what an ultrasound It is 

So you're only going to see the parts of the ceiling that are lit up. Lit up. Whereas when you do a mammogram, it's like turning the whole lights on. You're gonna see the whole ceiling because it's the whole picture. Right. So that's why it's important 'cause you might feel a lump over here.

If we only do an ultrasound in that one spot, we're missing the cancer that's on the inside of your breast.

Today's episode is one I've been genuinely looking forward to because we're stepping into a conversation that sits right at the intersection of medical expertise, women's health advocacy, and the kind of soulful healing that only movement and breath can offer. I'm joined today by Sarah Ham, a mammography supervisor and 

 medical radiography, technologist, and yoga teacher, who has spent more than two decades working directly in women's breast health. She's someone who has seen thousands of women walk into a screening room carrying fear, uncertainty, and sometimes lifetime of stories about their bodies.

She has made it her mission to help those women feel informed, supported, and seen. But what makes Sarah's perspective so powerful is that her career has unfolded alongside her own very real experiences of loss, grief, reinvention, and healing. After losing both her sister and her mother to lymphoma, she turned toward yoga.

As a way to study herself, regulate her nervous system, and rebuild from the inside out. That decision eventually grew into a second career teaching yoga, opening her own home studio and weaving movement, breath, and community into her everyday life. In our conversation today, we will explore the world of breast imaging in a way that feels accessible and empowering.

We talk about who should be getting mammograms. Different modalities available and the myths and fears that keeps so many women like myself from getting screened. We also look at midlife through the lens of prevention. breast density, self-advocacy, and how to navigate a medical system that sometimes feels intimidating or rushed, and then we move into the heart of it all.

How breath, yoga and fitness can help us process grief, regulator stress, and reconnect to a body we may have ignored or mistrusted for years.  Sarah's story is a beautiful example of. How a woman can hold two careers, one deeply clinical, and one deeply healing, and let both of them shape her in meaningful ways.

So settle in. This is a conversation about breast health, midlife shifts, emotional resilience, and the quiet power of coming home to your body again. And I think you're going to walk away feeling both informed and inspired. Please join me in welcoming Sarah Ham to the Menopause Disruptor Podcast.

Welcome back listeners today I'm joined all the way from my home studio Sarah, welcome to the Menopause Disruptor Podcast.

Thank you so much for having me. This is a very important topic we're gonna discuss, one that I have been avoiding mammograms and screening for my breast health.

I actually thought Sarah, about maybe we should just do this in the hospital. Wouldn't that be fun? But it takes too much time. I think the most important thing to address right now is

Why is it so important for women's health to get screened? 

because it's one of the few things that we can do for ourselves that doesn't necessarily require a doctor's referral if you're coming for a regular screening mammogram. so definitely. Women can, if they don't have any new breast concerns, if they're over the age of 40, if they don't have breast implants, they never had breast cancer, all those women can just bone and book their own screening mammogram through the BC cancer screening program.

They don't need a doctor's referral. So that's one thing that you can take into your own hands. Nice. There are, and I mean we might get into that later, but there's definitely a lot of mixed messages when it comes to when we should start screening and some doctors say, oh no, it's okay.

You can start at age 50. And that is the current recommendation. However, it is available starting at age 40. So I'm a big advocate of telling women to go ahead and start getting their screening mammograms as early age, age 40, because over my career I've seen. Multiple, multiple dozens, probably hundreds, thousands.

I've been doing this for a very long time of women diagnosed with breast cancer in their forties. I think it's really important to take advantage of that when it's available to us. And then, yeah mammograms are the gold standard for breast imaging. Okay. So basically they will detect a fair amount, most breast cancers.

Okay. And we can get into some of the limitations of mammography and the other supplemental modalities with ultrasound, MRI, those kind of things. But as far as your basic screen for mammogram or for breast, we're looking at mammograms. Oh, 

Wow. Personal story: I was recently married, moved to Goose Bay Labrador, the military base there.

So this would've been 1996. So I was only 27 and lo and behold, I still remember sitting on the front deck of our military housing. And I don't know why I was doing a press check then, but I don't know, maybe I just come back for a run or something and I was just whisking away sweat and I felt something very uncomfortable and I panicked.

'cause I remember a health class in grade six and they gave us an example of what a cancer could feel like. We had this little ball and there in there was the little bean like that could be cancer. And that's all I kept thinking, but it hurt like a son of a bitch to touch it. Fast forward after I finally got my screening a mammogram when I was sent away to, Newfoundland to get that done.

And it turned out it was just cystic. Yeah, cystic in the breast, but scared me to death. And I did keep up with mammograms thereafter, but then I stopped. And I think many listeners can, can relate. I stopped because I started getting down that rabbit hole of it's bad for us and there's better imaging modalities, I guess you will, or other options out there.

But I was, I didn't keep up with the technology, the research, the science that tells us this is a good thing. But just how has mammograms advanced in, I know like even the last 30 years. 20 years. 

Yeah. I became an x-ray technologist in 1999, so I've spent. More than half of my life now. S Yeah. Taking x-rays and right away I as soon as I graduated from BCIT, I was trained to do mammograms in the lower mainland.

And so I've been doing mammograms since 1999. And of course when I first started it was all film technology. Cassettes, we go in the dark room, develop our images. Okay. Bring it out. Very, yeah, very early, early technology old. Yeah, old school. So since then, of course we came into the digital era and and actually that happened while I was working at St.

Joseph's here in, in Comox and mammography was actually the first modality in medical imaging to go digital as far as even x-ray, ct, all those things. Yeah. So we were the first one to go completely digital, which was really cool back then. So we got rid of those big processing machines. We were able to see our images almost immediately.

They also have algorithms so that they, rather than having to repeat an image because say one part of the breast is really re really dense and so the x-ray will penetrate through that as well as the fatty tissue. Oh, we might have to take an extra one or, or do two for one breast or that kind of thing.

Now there's algorithms built into the machine that will automatically fix that a little bit and manipulate the image that we can see everything clearly. 

That's, so those 

are just some early things and that's going back at least probably 15 years now or more that we've been digital.

No longer than that probably I. I would say it was probably around 2005 maybe that we went to. It's been a, it's been quite a while. Yeah. Okay. And then, yeah, there's been more, more advances as far as well, just to mention, we actually just did get a brand new machine here in the Comox Valley as well last month.

And we're, we were supposed to have this conversation last month for breast cancer awareness month, but it didn't quite work out for either of our schedule, so we're a month late. But but yeah, so with the new newer machines, we have the capability to do tomo so tomography, which is like a cross-sectional slice image similar in a way to like CT scan, which is computed to tomography or CAT scans.

Okay. It's taking the layers of imaging to create a 3D image. Okay. We'll be having that capability. Of course we're doing more biopsies under mammography guidance, whereas previously they would be only under ultrasound or, perhaps even just in a doctor's office, only by feel for palpable lumps, lumps that you can feel, not necessarily things that you could just see on a mammogram and not feel okay.

And then one of the latest differences new implementations is in for breast surgery. So when women have to come for their breast surgery, they've detected a small breast cancer mm-hmm. And going in to have like a lumpectomy. So they're previously. They would have to come to our department the day of their surgery and get a wire placed into their breast.

It's, we call it like a roadmap for the surgeon. So they'd have to come early in the morning. We'd under either ultrasound or mammogram, we'd place a fine wire localization, it's called into the breast, taking a lot of pictures and placing this wire. And then basically the patient goes to surgical daycare.

They have this wire sticking outta their breasts that we have to take down and they have to be mindful of until their surgery. Now there's new technologies it's called Molly Seed that we're using here. Okay. And it's basically like a magnetic seed that we implant in the breast. And we can, the, the good thing about it is we can implant it up to 30 days prior to the patient's surgery.

So they can come in anytime before their surgery date. Right. And have that implanted. And then the day of their surgery, they can just come in and go straight to surgery. They don't have to. Have to have the whole wire and, and all of that done on the day of. So it gives a bit more flexibility with booking, especially with patient in remote areas too.

So some places don't do like the localizations. They might do the breast surgery. Right. But not the localizations. So yeah, just lots of different new things. 

So this seed in itself, what, what exactly does that do that's implanted? 

So basically it's which is not to be confused with a breast marker or a breast clip.

So whenever a patient has a breast biopsy done under ultrasound or a mammogram, which is called a stereotactic biopsy, okay. We usually leave a little marker behind, and that's just to show where we took the biopsy from. I get it. So we leave a little bread, we call it the breadcrumb trail. Behind and that shows up on their future imaging.

So if it comes back benign, we just have a little marker showing up on their future mammograms to see where we took the biopsy from. It was proven benign. We're all good. So patients that it doesn't come back benign, it is maybe cancer or something that they wanna take a closer look at and actually remove surgically then the patient now needs to go for that.

Ne localization. So this is instead of putting the wire and they're putting an additional marker, but it's this time called a moly seed. It's a it's still very small, very small. Like the, the clip that we use during biopsies is like half the size of grain of rice. I'd say a moly seed is about the size of a grain of rice.

Okay. So very, very small. Yeah. So that goes in and then when the patient goes to the operating room, they actually have, it's almost basically like a metal detector where they place it on top of the patient breath. I haven't seen it in action in the operating room, but we did get a little like, rundown on it when we first implemented this.

So basically, yeah, it's just another machine where the surgeon will hold it over the breast and it will target and like give you a green light when you're right over that area of where the seed is and then they proceed with their surgery that way. And so 

going back to the biopsy then in itself.

When like either they've done, say the ultrasound, the tomography that you have. So 

ultrasound, biopsy or the mammogram. Biopsy mammogram, which is called the stereotactic biopsy. The stereotactic. 

So any one of those, if they detect something that could be worthy of the biopsy, then 

Yeah. So whenever the patient has a biopsy down under ultrasound or mammo, we leave a little marker in.

Okay. And then sometimes the patient doesn't need surgery, but if they do, then the patient has to again, have this localization, a different marker put in. Okay. Some, some surgeons are, and for some certain cases we still do, do have to use the wire. But for the most part now we're using the Molly suite as well.

Okay. Yeah, that's right. There's lots 

to I know. I know it. It sounds daunting. Yeah, it truly does. Yeah, because we're talking about breast tissue. Yeah. And just the idea of sliding them underneath that tray and going, squish. Squish. And those are some of the persistent fears that are attached to the idea of having to get a mammogram.

Yeah. So how do you work with or can the medical system, but in particular you meet the patient, the client coming in where they're at to calm the fears and the anxiety associated with the mammogram. Be it just having to go through the procedure. And the fears that might be in their head that, oh my goodness, what if they find something?

Mm-hmm. Because it is one of the most fearful things, and you can speak to the statistics after about breast cancer. Mm-hmm. It was such a fearful, daunting, and admittedly Yeah. Probably 

one of my, yeah. My big fears too. Well first off, I forgot to say right at the beginning 'cause I didn't really get a chance, but I'm not a doctor.

I'm an x-ray technologist. And I am no way, like, representing any health authority or anything like that here today as well. Just wanna set that straight. This is all about my experience as a mammogram tech. Okay. I've been a mammal the mammal supervisor for 12 years, so I've worked only in mammography, not extra anymore for the last 12 years.

So this is where all my experience is coming from. But as, as far as getting into patient fears, yes, it's, it is it can be very heavy work. In general a lot of the modalities in the imaging department are dealing with cancer, right? Like ct, MRI, ultrasound, even x-ray, we're all, we're all di there to diagnose cancer.

Mostly just for, for mammography it is just cancer. That's all we're looking for. We're not looking for a broken breast, right? Like we're an x-ray, like a broken bone, right? So it's all about cancer really. Yeah. So of course there's gonna be increased fear and when it comes to something as personal as a woman's breast, then it, it even exaggerates that fear a little bit more.

The thought of perhaps losing a breast or being disfigured or anything like that. Right. And then a lot of it comes from family history. You've had these patients that come in and they've lost a mom or a sister or a daughter to breast cancer. Yes. It's, it's the fear is real.

And so I think it's just a matter of meeting people in a compassionate way and listening to them and, and just telling them as much information as you can. Being transparent. Obviously we're not allowed to say a lot during a patient's mammogram as far as the results go. But just educating on them on the steps as to what will be happening for their exam with their results, for their future mammograms.

All of that is very important, especially when it comes back to women that are getting called back for additional imaging. So Okay. Women that come in just for a regular screening mammogram. I would say that in general the anxiety is a little less than it is for women that are coming in for a diagnostic mammogram where they have a new lump or they've had previous breast cancer or they've been called back from for more images from the screening mammogram.

So those all now go into the diagnostic category and those women ob obviously can be a little more anxious. I'm not to say we certainly get a lot of women that are anxious just coming in for regular screening mammograms, maybe 'cause they have family history or maybe just because they're uncomfortable.

But in general personally, I wouldn't go into a screening mammogram worried that I have breast cancer. You're doing something proactive for your health, right? You're not there because you have a concern. Mm-hmm. You're just doing all the check marks, right? 

 So I try to say that to my women if they are feeling uncomfortable, like, look, you're doing all the right things.

You're here for your health. You don't have any concerns. You're getting regular screened, you are doing all the right stuff. So you know that itself is reassuring. And then yeah, for the women that have legitimate concerns or fears with getting the test done there are there are a lot of women that are just fearful of the actual exposure, the radiation.

There's a lot of unfortunate. Like false information out there regarding I'm not gonna get into all of that, but there is certainly a lot of things that circulate that are, from my perspective, my understanding is not true. So it, it leads into that bit of the fearmongering thing. Yeah, we're not we're not causing breast cancer by taking mammograms.

We're not spreading breast cancer. Putting compression on the breast during a normal mammogram is going to cause harm to your breast. We work with the patient to be sure that we check in with them when we're applying the compression. If a patient ever wants us to stop, we'll stop we, it is a, it's a two-way street, so we have that conversation.

We try to make our patients feels as comfortable as possible. I've learned over my career that I think working in public You're always gonna get a variety of people that walk through the door. Mm-hmm. Right. There's some people that are just never happy to be there, and that goes in any situation, but when you add that fear to it, then it can even be stronger.

Absolutely. And not everybody is pleasant, I can just say that, but but I find that killing them with kindness is the best medicine. Yeah. Because just turning around if someone comes in and is fearful or not fearful, but just maybe not super polite or anything, just being extra polite or that just seems to help the situation and it does help to calm them down a bit as well.

In particular if they're coming 

back on a second physical. Yeah. 

Yeah. And I wanna talk a little bit about that because some women when they, so when you have your regular screening mammogram done, we only do the standard four pictures. So we do two from the top one on each side. Okay. And then two sideways views.

And with this, this BC cancer screening program we're only allowed to do those four. Four of you. Okay. So if, if we see any extra thing that we wanna take a closer look at, we don't do that during that test. The patient is required to come back for additional imaging. However, we do check for image quality.

So if the patient's breathing, there's motion, we've clipped off an area, that kind of thing, we do repeat the images. 'cause we get a lot of patients come in, they, when they get called back and they say, what they didn't do it right the first time or, it's like, no, no, we check that.

It, the images were fine. It's the odd time maybe we didn't notice something and we get called back for, there's deodorant to, or something like that. Okay. But that doesn't really, really happen very often. the number one reason why patients get called back is because there's been a change in their mammogram and they need more images.

Okay. So radiologists always compare with previous images if there are some available, and anytime there's a change from your current mammogram to your previous, we will usually call you back. But we look back, so say you've had 10 mammograms and we always, they always look at the one that you had two years ago and then the one you had four years ago and six years ago, and they'll compare back quite a way.

So that's why it's so important for women to have regular mammograms and not just have question, not just come and have one. It's not a one and done situation. We haven't seen you since 1996, not a one. Are you done? Mammograms are all about comparison. So getting that first baseline and then coming regularly, so every two years, if you don't have family history or personal history of like chest radiation or you haven't been tested for the the gene, like genetic testing, some people have that done.

They're BRCA one or BRCA two positive, So high risk. So anyone that's not high risk is just every two years, age 40 and up. Everyone. See, I'm going off on a tangent now. I feel like I'm jumping around, but that's what we do. We disrupt conversations and then people with a first degree family history.

So mother, sister, daughter or father, brother, son with breast cancer are yearly and and then every two years for everybody else. But so having your mammogram coming every two years or every one year, whatever we compare. So good to know. Very good. So I do also tell patients that when it's their first mammogram, there's a higher chance they might get called that.

'cause we have nothing to compare with. And that does, that is true. 'cause we have to make sure that their tissue, that's normal for them. Oh, 

okay. 

So anyways, when patients get called back we usually go through some additional images, what are called spot compression views or magnification views.

So those are the typical views that we do. We would also be doing like tomography, this new machine we got, we'll be doing that. We're not quite there yet, but we will be. So those are kind of things that we'll be doing in replacement of these spot images. It's still a mammogram, it's still gonna put you in compression.

Unfortunately still have to hold your breath. So usually patients come back and they have these spot compression views. So we're focusing in on one area of the breast tissue that the radiologist circled for us on an image, and we're spreading that tissue out much better in that one spot. That's why the compression is necessary to spread out the tissue.

That's right. So we want to, a lot, breast has a lot of stuff going on in there. It's not just fatty tissue. There's glands. Mm-hmm. There's ducts, there's Cooper's Ligaments. So all that glandular tissue that's in there, which tends to, as we age, be fatty, replaced, but as we're younger, it's more dense.

More glandular. 

Okay. 

Though all these structures that are in the breast oftentimes stack up on one another and then it shows up like this little white patch, which is dense tissue and that. Could be something else hiding in there. So we have to have a focused look, spread the tissue out and see it better.

So usually patients that have something that shows up they'll come for that. Sometimes they're also booked for an ultrasound, if we can't make it go away, is what we say on mammograms. So sometimes we do those spot compression views or just even a repeat view and it, it totally goes away.

So we know it was just a summation. We call it a summation of breast tissue. So it's just overlapping breast tissue. Now we really focus the compression on that one area. It's spread away. We can see that there's nothing hiding under their patient's. Good to go. 

Okay. 

Some patients obviously if it persists there could be a small mass.

It doesn't mean that it's breast cancer. It could be a fibro adenoma, it could be a cyst, it could be something benign. Could just be glandular tissue that is dense. And but the patient would go for an ultrasound and then the ultrasound will determine what the tissue is made of it. Okay. So is it solid?

Is it a solid mass, which could be a fibro adenoma or a cancer or is it or a papilloma or is it a cyst which is fluid filled? Okay. Or is it just that glandular tissue? So those are sort of some examples of probably not all the examples of what. And then from there it's determined where the patient either needs to proceed to biopsy.

So they would be booked for likely a ultrasound guided biopsy. Most things are done under ultrasound for biopsies. Okay. Because if it's a mass that we can see under ultrasound, we biopsy it under ultrasound. Okay. Excuse me. The only time we do biopsies under mammograms are usually for little calcifications of the breast that don't show up on ultrasound.

Ah, so interesting. And those are things that are found really early, like early. And when we talk about breast screening, catch this early detection. We're looking for the early, early stages of breast cancer. So it's before you would ever be able to feel it develop into a lot. Is that right? So little tiny calcifications or usually end up being what's called DCIS ductal carcinoma in situ.

So that's like the very first stages of breast cancer and they show up like little grains of sand that show up in the image and you can't feel it, you can't even see it under ultrasound. So that's when we do those biopsies under a stereotactic biopsy using the mammogram machine. Okay. So 

really that was a lot but informative.

 Very informative. And I'm running a lot, I don't even know if I answered the original question, but. I can't remember what it was, but as long as I'm feeling better about a potential or my future mammogram. Which obviously will be booking with you, Sarah, but, and that's exactly what happened in my situation, is that I had been called back.

For the ultrasound. Yeah. And fortunately my case, they realized it was a cyst. Yeah. And and that sucker stuck around for a long time. Yep. And then eventually it just 

dissipated, disappeared. Yep. Disappeared. And cysts are usually, they're often cyclical, so they'll come with women's cycle. they'll flare out.

That's why you get tender breasts right before your period. They're usually hormone related so yeah. They can they can come up and we're not usually too concerned about painful lumps. It's more about non-painful lumps. Okay. That are hard and fixed. They don't move, they don't fluctuate, they don't go away.

They don't move around. They're hard. They're fixed and they don't hurt 

like that little bead that we used to feel in that beanbag when we were kids in health class. Interesting thing that you mentioned also about family history. And now we're gonna switch gears here. Yeah, sure.

And shift to the other side of Sarah. But the two, there's a bridge, there's a beautiful bridge. Yeah. Between those two sides of you. And that is family history. Now you had lost your mother and your sister to lymphoma. And so now you're very much aware of health history 

In your life. Before we go into that, how did you, Sarah, find your way through it and continue to show up at your job? A very important job too for other women. Tell us a little bit about that. 

Yes. Well, it definitely has been a journey. I lost my sister. She was age 33. I was 27 to non-Hodgkin's lymphoma.

That was back in 2002. And so that was right after I moved back to the valley here. it was definitely hard navigating everything. And then. 2019 lost my mom to the same two types of non-Hodgkin's lymphoma, and she battled for a very long time. My sister, it was more aggressive. She was younger.

They didn't have one of the chemo treatments. The CHOP R they had chop but not the R there, rituximab, I think it's called. At the time. So she was diagnosed in 2000 and passed away in 2002. My mom had a much longer battle. I think she was battling for eight years. it was, it's definitely was life changing.

And as far as lymphoma goes, there is no I don't believe there's any direct co correlation on family history. Okay. Originally when my mom was diagnosed, I did contact my doctor, like advocated for me to contact sort of the cancer research and I did this whole screening thing, but I actually never did hear back about that.

But I, I don't know if they've No news. I don't know if they've ever proven any link to that. Okay. Yeah as far as, did you want me to talk about family history for breast cancer as well? Or just move more into my story? Can you take it in the way that you feel fit? All right. I'm getting a little choked.

There definitely are. Yeah. I'll just quickly touch on the breast imaging or the breast cancer family history thing, because it isn't it is, does play a role in risk, it's not actually the number one risk for developing breast cancer. The top risk for developing breast cancer are being a woman and being 50 or over, And then there's the breast, the previous breast cancer history in very close family relatives. A lot of, oh, my grandma or my aunt or whatever. we don't actually record those statistics unless there's like multiple family members and usually diagnosed under H 50 is where we're mostly interesting concerned.

Okay. And then also breast density plays a bit of a role in, in that, which we can touch on a bit later too. But yeah, as far as my journey going through the losses I've had and and that has definitely opened me up to realizing life is short and working. I do remember after my sister passed away, obviously I had a bit of time off and then I tried to come back to work.

'cause at the time I think I actually didn't, I might not have had an actual permanent position yet 'cause I was still pretty new. I think I was casual, I wasn't getting paid any sick days or anything like that. Okay. Back then. So I was struggling to come back fairly quickly so that I could pay my rent.

And I remember just walking into the hospital and. Had to walk right back out because just that fear, like the feeling of Yeah. Just being in the hospital with her and everything. And then I just walked in and I was like, I can't do this yet. And I just had to turn around and walk right back out.

But, got it. And it was even, it was part with my mountain too, because she was local and, 'cause at the time when my sister passed away, well, I shouldn't say that. I was living in Vancouver and I moved back here because of her actually, 'cause she was sick. But but yeah, anyways, and then with my mom I can let you know and I'm.

I'm proud of her 'cause she chose Maid and so that happened in our hospital and so I was there for her for, through all that. And and yeah. So it was definitely hard to go back and and face, face that and be in a, in that environment of so many times where I have patients like, tell me how they're there for their mammogram, they don't have cancer or didn't have breast cancer they've just lost their daughter or their husband or their their sister to different types of cancer.

And a lot of times it is lymphoma and and so we just have that little moment together and Yeah. And that certainly happens a lot. it did shift me into my other passion, which is the yoga and wellness. Yeah, shortly after my mom passed away, I.

 before that I was really getting into yoga and and then after she passed away, I was just thinking like I was, felt like that soul searching, feeling like where I just needed something to fill my cup. And it literally was like the day after her birthday was September 28th which was her first birthday that she wasn't here for.

And then the next day I woke up and there was like an advertisement on social media about a teacher training here in town. And so it was just like, I was like, oh, it's meant to be. And so I just inquired about it. Hadn't even been to the studio, just signed up 

And then at the time, I really didn't think that I was going to be teaching either, which I know a lot of yoga teachers say when they sign up for their first yoga teacher training. Yeah. But yeah, I just wanted to do it to deepen my own practice. 

And then as I proceeded with that, of course it ended up being during COVID.

So we, I started that in, in January, 2020, and then by March we were shut down. And so we had to pivot and do things online and then we had to do things outside. But anyways, we managed to get it all done. And and throughout that I was starting to teach a little bit to some of my friends and coworkers online.

And so I'd set up, I had my own little bedroom and I'd set up my camera. Nice. I had this little group and started teaching them, and then I started teaching 'em outside. and then as things went, they're just like, you should just. Start teaching. Start teaching, and then it just, yeah, it totally led into this.

Well, we had to get the perimeter drain done at our house and let's just redo this other part of the house and yeah so, then, yeah, it just went from there and then did another 500 hours and Good for you. 

So same studio? No. That's when you went 

and met? No, yeah. Yeah. That was through Halle in Costa Rica yes.

Yeah. So it's exciting. Yeah, it's great. And it is a great balance because I still, I love my work with women at the hospital. I feel like it's really important and is valuable and it's just even though we're not always appreciated because there's people, oh, you're just inflicting pain, but it's like for a good purpose, right?

 and so yeah. So there's that. And then but also rewarding and a totally shift of like making feel people feel really good in a yoga class, yeah. And and yeah. But I, both jobs, I'm, I am. Telling patients how or people how to move their body bodies. I'm positioning them sometimes hands, hands-on, giving lots of instructions.

So that's very similar. 

Yes, of course. 

Yeah. I think that part just came naturally to me, which is why I progressed into actually being a teacher and opening the studio because I'm just used to basically telling people what to do all the time. That's right. So, that part was pretty, pretty seamless.

Oh, seamless, yeah. And it's a nice balance of things in healthcare of course can be very stressful during COD. All of that is especially of course it can certainly be challenging. And so this is just a nice balance of just a little inner calm and and yeah, I think it's just so important.

I know you had asked before about that crossover of like health and fitness, into like breast health as well. going back to risk factors. Of course obviously for everything our health is so important so, really diet and exercise. Limiting alcohol, not smoking, all those things that play risk factor in breast cancer as well.

 BMI, that's why unfortunately sometimes we still collect patient's weight and height for BMI, which is not super reliable, but it gives paints a bit of a picture usually of Patients where they're at and whether they're at higher risk for developing breast cancer, based on of a higher BMI 

of course.

 Because as we know, we move into the menopause transition, and I've spoken about this a lot myself on my soul podcasts as well as many guests. We increase inflammation, cortisol levels, stress levels. and these inflammation markers increase, which is a precursor for many diseases, including type two diabetes and some cancers as well.

So yes, our nutrition movement and even the mindfulness and restorative practices such as the yoga that allow us to really get into our bodies. And and so you're really taking care of women's breasts in many different ways, Sarah, and we commend you for that. But now you are moving into the menopause transition, and I bet you, you were having a different let's say, perspective or empathy for some of the women that are coming in.

Yes, certainly funny enough, because when I first started doing mammograms, I guess it probably would've been about 24 ish. And you get the women that are like, have you had this done before? Because they're looking at you and you're young and no, I haven't, but it's not because I don't want to.

It's just 'cause I'm not eligible yet. Oh my gosh. I could not wait until I turned 40. I, I swear I got my first mammogram on my 40 just so I could say I've had a mammogram, I'm part of the club and I like to see what my breasts looked like. Like how dense were they? I have no idea. Is a good point.

Speaking of density, so that's not anything that you can feel or look at. It's all density, all is about how you're. Breast appears on a mammogram. Ah. So sometimes patients say, oh, my breasts are really dense, but actually we take the picture and they're completely fatty. 

 And then in the last couple years, I just turned 50 this year, so I definitely, I am feeling the full pen perimenopausal. Effects fun, that's for sure. We get women that come in and they're of course we have them undressed.

We offer a gown if they want. A lot of women don't bother with a gown, 'cause they're just gonna be, we're gonna be touching everything anyway, so they come on over, it takes five minutes, they're in, they're out. At the beginning they're, ooh, it's cold, right? And by the end they're just having a hot flash and they're sweating everywhere.

So I totally know about that. And, the biggest one that I have dealt with in my little perimenopause journey is the brain fog. Oh, you tell, it's been quite, quite a thing. So I'm usually very type a, very organized don't really make too many mistakes really on the ball.

I'm supervisor of course certainly have been noticing few little slips here and there. And it's come, there was a few instances, this is going back probably a year over a year ago for sure before I started any HRT, which I have started now. But I was talking to my patients and it's a lot of, it's pretty repetitive, right?

We're always asking the same questions and so I had a lady come in and I asked her birthdate and. And and it happened to be that day, a lot of people come in on their birthday for their mammograms. So I was I was like, oh, it's your birthday, happy your birthday, whatever. And so she comes over and I start to ask her my spiel, my usual questions.

 and my first question is, any new concerns or issues with your breasts? And said, I said, is there any new concerns or changes to your birthdate?

Yes. It's 50 years so far into the future just looked at me and we both just broke out laughing. And then and then I think it was the same day, I swear I had another lady, same thing, came over, asked her birthday.

She comes over and ask her the questions. I said, is there any changes or new concerns to your breath?

That's because we're always telling patients to hold their breath when we take a picture. Of course. So yeah, just like silly things like that. And that crosses over into the yoga thing too.

'cause I've been instructing yoga. And when I first got into yoga and I sometimes go to yoga classes I always used to get annoyed by the teachers that would get their right and lefts mixed up or Or do something on one side but then not do the exact same thing on the other side

And what is this woman doing? She's totally out of it. Well, likely she was perimenopausal. 'cause there's been times where things have come out of my mouth and I'm like, why did I just say that? I don't even know why that came out of my mouth. Oh goodness. So definitely feeling that for sure.

Yeah know and these are all real and relatable stories and I think that the more that we can approach something from a position of empathy, relatability. Relatability. Yeah. it makes the experience less daunting. Yeah. And, but it also helps women realize, you know what, we really are in this together.

 And it is being in this together as community that we're gonna help each other get through it. the fun times, the hard times mammograms, and unfortunately losing our loved ones to what screwing up your left and right. And your down dog from your, up dog from your cobra to, but I can relate to that too.

And brain fog that's a real thing. I've spoken about that, and you mentioned it too, having a career and knowing that you have to show up and perform. I think that you're probably one of those environments where it is. Very understandable 'cause of the nature of your work that you're doing.

A lot of women have struggle with this terribly to show up their very best 

Yes. 

 those little just go 

up here, Mary. 'cause I was worried that I wouldn't be able to form words together in a sentence. Doing quite well, I wanted to talk just a few minutes if I can interject.

Absolutely. I had talked about who is eligible for screening mammograms. I wanted to touch a little bit on the diagnostic mammograms as well Because, there's a little misconception on some women that might not get mammograms 'cause they don't think they need to.

And those women often are women with breast implants or women that has small breasts or whatever. Women with breast implants still get mammograms. It's still the regular recommendations every two years if you don't have family history. Okay. The only difference is that they have to get referred by their doctor.

They have to get a requisition sent in just for implant screening or mammogram with because of implants. Okay. The screening program just doesn't allow for those extra pictures. We take eight pictures with implants instead of four. So we do four where we put the whole breast in, but we just don't really use any compression at all, so we're never gonna pop an implant.

Okay. And then we do another set of four where we push back the implant and then we get some compression on the tissue that's in front of the implant. Okay. So they're breast tissue and so we take eight pictures instead of four. So yeah, that is one common. Misconception that we're gonna pop implants or that we don't do them at all.

And we do them all the time. So you just have to have a doctor's referral for those. And then women that, yeah, have a new lump, new concern, nipple discharge. As far as nipple discharge, excuse me, we're not really worried about anything milky or yellow or even brown green. Those colors we're not too worried about.

Okay. It's more so if it's bloody or clear. Those are the two more concerning colors of discharge. And it's more if it's spontaneous and just out of one side. So if it just happens on its own and you're not squeezing it out right, per se then that's a bit more concerning. You should definitely go see your doctor.

And with those ones we do a mammogram and an ultrasound. Women that have other types of discharge, we'll still do a mammogram, but usually we don't have to do an ultrasound for those unless we see something on a mammogram. And would that be more related to an infection? It could be or could be a little papillo.

So the papilloma's inside the duct, Inside the nipple there, those often and they can be cancerous, papilloma. So that's why they have to get checked. Okay. Yeah so, that is for that, and then women that have had breast cancer, they are usually followed by a doctor and followed by, even depending on when their breast cancer was, maybe still the cancer clinic or a surgeon.

Those patients are yearly for their mammograms. And they do need to become through the diagnostic. They need to get a referral each time. So I always tell patients 'cause there's been a few that have been lost in the shuffle, because what happens, people come for their regular screening mammograms, and with the screening program you get your reminder letters, right?

So you, once you're in the screening program, you'll get a reminder letter every two years saying it's time for you to book your screening mammogram again. So people do that. Then you find a breast cancer during your screening mammogram. So then the patient has their breast surgery, all that. Now they're not part of the screening program anymore.

Okay. So now they have to come in through their doctor. unfortunately there has been lapses and maybe. I don't know all the extent of the reason why, but all of a sudden, four years goes by and the patient comes back for a mammogram and says, well, I didn't know that I wasn't gonna be getting a reminder notice.

So it's really important for women to educate themselves to not rely solely on their primary care provider. 

Yeah, of 

course. Which I'll get into those last three questions was like, advocate for yourself and be responsible for your own health and really be persistent as well.

If you have like a, a concern is your intuition. but yeah, just, so just being on top of it, not waiting for if you, if you keep track, like if you think you're supposed to have a mammogram in a year, write it on your calendar and then if it's not happening, inquire about it. So those are all just an important things.

'cause unfortunately things do fall through the cracks. Things get lost, whatever of course happens. So just keeping a medical record for yourself is important. So yeah, breast cancer, implants new concerns, lumps those patients obviously will come in, they'll get the ultrasound as well.

What else was I gonna say about that? There was something else. So just to recap 

quickly. Yeah. Stay educated. 

Yeah. 

Be proactive and advocate. 

Mm-hmm. 

Which are three key areas and. Almost all women's health. Yeah, 

all women's 

health. 

 I can't tell you how many times I've had women come in. One, one personal story that I know was a woman comes in, she was like 49 maybe, or something like that.

And actually she was probably like 47. And she came in because she thought she felt a lump on one of her breasts. It was her first mammogram. She hadn't had a mammogram before. Okay. And so she comes in, I do her mammogram. And I mentioned to her that she could have, 'cause she's like, I've been asking my doctor to have a mammogram since I was 40.

But he said, no, that you didn't need to have one until you're 50 I said, well, just so you know, you could have just came in anyways. You don't need a referral if you don't have a concern. So turns out the lump she was feeling there was nothing there. She was glad you tell you, but we found a cancer on her other side.

Oh my goodness. So things like that happen all the time, which is why I always tell women's unfortunately doctors all have different perspectives on when women should get screened and. I can tell you from my personal experience, get in there when you're 40, start going and you're gonna catch something that you won't feel.

And the whole key is the early detection to save lives, right? to get that treatment earlier. Usually if it's caught early, all you need is a little lumpectomy and maybe some radiation. That's it. It hasn't spread to any lymph nodes. You're not eating chemo, you're not eating a mastectomy it's just it's just just such a big difference.

 That's what I 

have to say about that. Sarah, the information that you shared today is so critical. Just breaking the. The myths and the fears, and then addressing it from a point of view of empowerment for women. 

Education, like we said, proactive advocacy. being empowered with that knowledge to know that you have in your hands the ability to make wise choices early 40 and your early in your perimenopause phase as well, to really make some nice changes.

Some important changes and detect as well mm-hmm. Early detection. I am so pleased that the conversation just 

came up haphazardly. I was gonna say, I, that's one other thing I didn't say yet, which I wanted to just quickly say. Not going over. A lot of women want to just have an ultrasound done and not a mammogram and ultrasound's really big right now because of breast density.

That's. All everywhere. Right? So it's really important to know why ultrasound does not replace mammography, and that is because number one in BC you can only qualify for that breast creating ultrasound. If you've had a recent mammogram that shows your density score. So there's A, B, c, D for breast density, a being the least dense DD being the most dense.

So women that are in the cd, so denser breast tissue do have limits to sensitivity of me mammography. So we're not able to detect breast cancers as well as we can in someone with A and b density breast, where there's more fatty breasts. We can pick out those white spots that show up as cancers easier in the fatty breasts.

So some women a lot of women don't like having mammograms. A lot of them don't like having them, but have never had ones, but some of them have and just don't like to come. So there are women that try to get around the system and try to have their just ultrasound only. And unfortunately it's not possible.

For the most part, unless you have a targeted, like palpable lump or something like that. Then there's ways around things. But as far as a screening goes, I'm talking about not no clinical concern. You just wanna have your breast look at so those patients do have to have a regular routine mammogram done within, I think two years to show their density score and then they could be eligible for the supplementary breast ultrasound screening.

And as far as a targeted breast ultrasound. So say even a patient comes in, they have a lump, they wanna just have an ultrasound, they don't wanna have a mammogram. We really do try to work with a patient to educate them as to why a mammogram is so important. And sometimes we'll ask the booking clerk to just please tell 'em to come anyways for their mammogram, which they could talk to the tech.

We can explain why. And then I swear, nine times outta 10 we're doing the mammogram. But it is often that fear and, just the lack of knowledge around why we do it. The analogy that I told you that day, which my supervisor back in the day told me is when you're looking at an ultrasound, picture yourself in a dark room and you're holding a flashlight and you're just shying that flashlight on the ceiling, that's what an ultrasound It is interesting.

So you're only going to see the parts of the ceiling that are lit up. Lit up. Whereas when you do a mammogram, it's like turning the whole lights on. You're gonna see the whole ceiling because it's the whole picture. Right. That's a great analogy. Yeah. So that's why it's important 'cause you might feel a lump over here.

If we only do an ultrasound in that one spot, we're missing the cancer that's on the inside of your breast. Right? that's important. 

That is such clarity in your description. Thank you for that. Now my listeners up here in British Columbia. Sarah, you brought some literature over here.

I did, 

 basically this just goes through The categories of, okay, who should get screened and when? Age 40 to 74 for average risk, it's every two years. They put a cap on the 74, but it actually doesn't end then.

They send reminder letters out to age 74, but women over age 74 can still come from mammogram. They just won't get the reminder letter and we get a lot of questions as to why that is. I think a lot comes down to, well, we're not gonna send reminder letters out forever for one thing, of course.

And also everybody's health obviously is different at that age. And so women that are healthy and wanna be proactive and wanna keep screening and know that if they were fine, something they would do something about it, then absolutely keep coming. But not everybody is in that situation. Okay. There might be other health issues that are that are more important.

Yeah. Also typically it's my understanding that breast cancers that are found later in life, like in their seventies, eighties, or are usually not going to be what necessarily ends that person's life. They might be able to live with it throughout the rest of their life, whereas breast cancer is earlier in life, forties, thirties, even fifties are more aggressive and we really wanna get on top of screening and treating those women is an important message right there.

Yeah. Okay and then as far as the high risk I had mentioned higher than average or, so the women with the first degree relative with breast cancer are known diagnosis of a DH, which is atypical ductal hyperplasia. So some patients that have biopsy that come back with that, and it's just an atypical cell, so it's something that they're gonna watch.

So they're at a higher risk. They're, it's not actually breast cancer yet, but they're gonna come yearly just to be sure it's okay. And then other women also, it is not on here, but it's women that have had chest radiation. So say they've had like lung cancer or some other kind of cancer and they've had direct radiation to your chest, that's a higher risk obviously, of developing breast cancer.

And women that have had their genetic testing done in their BRCA one, BRCA two, which is also related to ovarian cancer. There's all those links there. So they're yearly. So that's what this form says. And on the back, there's all the clinics in the province with phone numbers. So there's that.

And then it talks a little bit about this is just what we give to patients sometimes when it's their first mammogram. What happens next? So basically after the patient leaves for their screening mammogram, they go home, they'll get their letter in the mail, they get their own report in the mail actually.

And in about two to three weeks, copy of that goes digitally to their doctor or care provider. Oh, one other thing I should mention is that women that don't have a family doctor, which happens a lot around here. 

you can still book yourself for a screening mammogram on your own without a family doctor. So that's not an excuse to not have a screening mammogram 

 if we need you to come back for additional pictures, like I mentioned, coming back for those additional views. Then the office, like our department calls, the patient has them come back. Usually it's within a week. You're coming back, having those additional images done, and then that now is a diagnostic report that will be sent to your doctor.

Great. Yeah. And then once you're in the screening program, you get reminder letters either every year or every two years. One thing I'll mention is that if you ever move, make sure you update your address with the actual screening program. Okay. They're not linked to the hospital. So if you update when you check in at the hospital, it's a different computer system than the screening program.

So what happens is people get lost in the shuffle too, because they move, they forward their mail for six months, but they don't get the reminder for two years. And then next thing you know, 10 years folds by and the patient's like, well, I swear it was three years ago.

Of course it about 10 years ago. 

 Now we understand that with the medical system that we're seeing, there's a lot of backup to get in, but mammograms different. You're not backed up in this 

huge wait list. Actually, we are pretty backed up right now. It's been quite busy.

We had a bit of d downtime with our machine install. Okay. 'cause we were down for about three weeks and even before that it's just been, it's been busy. I think that a wait list right now for a screening mammogram is probably about two and a half months. Okay. So if if you're yearly for sure, get ahead of that.

Queue. when the reminder notices go up from the screening program. It's from the head office and they don't necessarily pay attention to Every site's waiting list. So they just send it out. I think it's two, two months in advance 

And so by the time you actually make that phone call, next thing you know, you're all of a sudden two months behind of when you should be getting done. let's put it this way, if you're due in February of next year, you should be phoning right now.

'cause that's what we're booking into right now. 

Excellent message. a nice little reminder. Can I tie you my funny Yeah. Mammogram. Okay. this wasn't an actual mammogram. we did a mock mammogram. I had a contract with celebrate the a hundred years of St.

Joseph's Hospital, 2013. And I had hired a beautiful videographer and he created this lovely montage of stories of care with Compassion. That was the line I was involved with that. Were you involved with that? Yeah. At the, at St. Joe's. At St. Joe's, yes. Oh, yes, I was. So we brought, yep. Mm-hmm.

Okay. Yeah. Well, they needed a model for the mammogram, And the foundation who was in charge of overseeing these projects for celebration, said to me, Mary why don't you just throw on 

The Cape, yeah. And we're gonna be filming from the backside and our videographer, Zach with male. A funny guy. Great guy. I know that. 

Exactly. Yes. I went to the VCIT with him. We 

lived in residence together. Very small worlds we live in. So I, they just film it, pretending that I am just placing my breast onto the squishy.

Squishy. And and then they pan over to the machine and they use somebody else's pictures. Okay. But she had massive, massive breasts. Yeah. Well, didn't we just lose our shit in there? Because I'm looking down my little gro, it doesn't add up. It's not me. Is it on magnification? It took a couple of tapes.

But what is that ever? Just an icebreaker for the whole situation. That's hilarious. And I'm gonna put the link to that video if it's still up here too. You should. Because 

actually I think that I do remember because 2013 was the year I became the supervisor in there. Oh yeah. And incredible. Yeah. So I think I do remember that 

I don't think it was me that was actually there on that filming day, but, 

 I 

remember Zach and everybody coming around with video cameras. We did photo shoots and everything. We did photo shoots. We 

did a scene in Emerge, which ended up being I thought this take took a long time.

It took several takes when they were doing a merge. 'cause it just turned into a gong show. Everybody was being silly and Yeah. That care with compassion. Yep. Speaking about care with compassion, I segue to our nice. Closure, Sarah, honestly, your care, your compassionate and lived experience, not only just as there to help women through their fears of a mammogram, but lived experience for understanding the journey of healthcare and what it is to lose someone love dearly and find a way to heal for yourself 

So thank you for sharing. You're welcome. And enlightening us with such powerful knowledge on mammograms and why it's so important for screening during forties and onward It's all comes down to quality of life. 

and empowering. And the fact that we can actually do something for ourselves.

We can take control of our health. Yeah. In that way. Beautifully said. 

Thank you for joining us today. 

Thank you so much for having me.

 I wanna close this conversation with a real moment of humility going into this conversation with Sarah. I'll be honest, I carried some fear, some skepticism . And a lot of unanswered questions about mammograms and breast screening. And this interview was for me, a big dose of a humble pie, but in the best way being properly educated about the safety standards, the technology, and the care that goes into breast screening here in British Columbia shifted something in me.

It didn't quite erase. Every feeling I had, but it certainly replaced fear with context and that's what matters. and then in one of those perfectly timed life moments. Sarah called me shortly after a conversation to say there'd been a cancellation.

Do I wanna come in for a mammogram? sure enough, I went in and yes, like many women, I was called back for more imaging. And all I want to say about that is this, A callback is not automatically bad news. It's information, it's clarity, it's the system doing exactly what it's designed to do. Sometimes a reason for additional tests might include 

Either the diagnostic needs specific x-rays of an area concern or an ultrasound is necessary to use sound waves to produce an image in a specific area, or sometimes it's For a biopsy to take a sample of tissue from the area of concern.

But this does not necessarily mean cancer was found. according to the research, over 95% of women called for additional tests, do not have cancer. Right now, I don't have the results to share with you for my second round. I'm going in this week. But what I do have is a deeper trust in the process and enormous respect for the professionals like Sarah who do this work day in and day out with such precision and care.

And I have a renewed commitment to making decisions from a place of informed choice, not fear, which is exactly what this platform is all about. To inspire women to make informed decisions about their healthcare needs 

So if this episode stirred something in you. Be it fear, resistance, curiosity, or even relief. My hope is that you take the feeling and turn it into conversations with your care provider. You deserve clarity and support, and you also deserve to feel empowered in your healthcare decisions. 

And if you live here in British Columbia, you can visit the screening website online@screeningbc.ca slash breast. Thank you for tuning in here today, andfor listening with an open heart.