In this October 31, 2020 episode of the RxChill Pill podcast, host Dr. Juna Bobby (MD, EdM) welcomes Dr. Mansi Saxena, a breast imaging specialist at Massachusetts General Hospital and assistant professor at Harvard Medical School. The conversation, recorded for Breast Cancer Awareness Month, centers on the pervasive anxiety patients feel around breast cancer screening and biopsies, and how simple interventions can alleviate it. Dr. Saxena describes a randomized study of 157 women undergoing breast biopsies, where patients who listened to self‑selected music experienced a significantly greater reduction in State‑Trait Anxiety Inventory scores after the procedure compared to those without music. The hosts discuss practical aspects of offering music (patient‑chosen playlists via headphones, safety considerations for MRI, and ensuring communication with clinicians). They also share personal coping tools such as earphones, aromatherapy, and body‑scan meditation for dental and medical procedures. The episode then shifts to nutrition myths, summarizing large cohort studies that found no association between soy intake and breast cancer, while higher milk consumption (not yogurt or cheese) showed a modest increase in risk. Soy supplements, however, remain unstudied. Dr. Saxena outlines five evidence‑based lifestyle recommendations to lower breast cancer risk: maintain healthy weight, regular exercise, limit alcohol, breastfeed when possible, and avoid hormone replacement therapy. She emphasizes the importance of individualized risk assessment using models (e.g., Gail, Tyrer‑Cuzick) that incorporate personal and reproductive history, and how such assessments guide personalized screening strategies (age of start, frequency, supplemental MRI/ultrasound). A substantial portion of the interview is devoted to Dr. Saxena’s personal narrative: growing up in India, completing 18 years of training, navigating the challenges of being an international medical graduate, balancing family life, and transitioning from interventional radiology to breast imaging because it aligned with her patient‑interaction preferences. Her story illustrates resilience and dedication to medicine. The episode concludes with a reminder to schedule mammograms, bring preferred music, and a teaser for an upcoming three‑part mindfulness series with Laurie Cameron. Key takeaways: patient‑selected music is an effective, low‑cost method to reduce procedural anxiety; lifestyle factors and personalized risk assessment are central to breast cancer prevention; and personal resilience can shape a rewarding medical career.
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Hi!
So it's October 31st. Yes, it's Halloween, but it's also the 1-year anniversary of RxChill Pill, this podcast. So I'm excited that I made it this far, and I want to thank all of you who have been listening because I couldn't have made it this far without you and all of your amazing feedback. I started out this podcast as Chill Pill for Moms, but then a lot of my students didn't want to listen to it because it was called moms, and if you know me, you know that I teach a lot of teenagers and college students. And even grad students. And a good third of my listeners are male, so I changed the programming a little bit, but today is Breast Cancer Awareness Day. So if you have a mom or you know a mom, or even if you're not a mom, this is a pretty important topic. And some of you may know this, but I was a breast cancer specialist before I became a mind-body medicine specialist, so it has a special place in my heart. Today we get to talk to Dr. Manzi Saxena, a breast imaging specialist at Massachusetts General Hospital, Harvard Medical School. And she's going to talk to us about how to reduce anxiety around having a mammogram and even a procedure, or maybe even at the dentist. I have to be completely honest, and I was totally late for my mammogram this year. With COVID and everything, I kept delaying it, and I'm not proud to say it, but I was almost 18 months out. So I love going to get my mammogram usually because it's where I used to work, and I love seeing all of my fellow doctors and technologists that I used to work with, but it was still hard to get myself there. So if you get nervous like everybody else about getting your mammogram, I'm glad you're here because you're going to hear about a way to cut down that anxiety around getting any kind of medical tests or even procedures. You're also gonna hear about what the risk factors are for breast cancer and what your best practices are for preventing it. After this episode, if you haven't already done so, go back to episode number 2 with Dr. Nancy Gade, who talks about her journey as a physician and mom finding out that she was BRCA positive.
So I'm so excited to have Dr. Nancy Saxena. She's a specialist in breast imaging at the Massachusetts General Hospital in Boston. And she's an assistant professor at the Harvard Medical School. She's published numerous reviewed scientific papers and authored 6 book chapters in addition to making numerous scientific presentations at national and international meetings.
She's also researched the role of music during biopsies that can help reduce patients' anxiety.
She lives in New Hampshire with her husband, daughters, and the naughtiest Labradoodle in the world.
We also talk about Mansi's extraordinary grit, not only in becoming a doctor, but also being a foreign grad, raising children, and finally choosing a specialty that she loves. You might hear some jingling noises, and those are Mansi's beautiful bracelets.
Hi, Mansi, how are you? Thank you so much for joining me here today.
Well, thank you for having me. I'm really excited for this opportunity to talk about this important topic.
October is Breast Cancer Awareness Month, and there's so many people out there getting their mammograms this month and having their screening exams. So I used to work with high-risk patients, so I know how much anxiety that an exam like this can cause. And I was so interested in the research that you had done on music.
So, you know, anxiety is— there's actually a really high prevalence of anxiety in our patients who come into the breast imaging section. You know, there is the looming diagnosis, always this fear that they might have breast cancer. The annual screening mammogram is actually a really anxious time for a lot of women. Sometimes they have to wait a couple of days for their results, and those days can be very harrowing. Anxiety is also important in the context of breast cancer screening because that has been flagged why we shouldn't do breast cancer screening. They consider the anxiety that is caused by the screening mammogram, the anxiety that is caused by any resultant diagnostic imaging or biopsy as one of its biggest harms.
Well, there is the— there is the issue of radiation. But you're saying the biggest harm is anxiety.
Yes, absolutely. That is what is called— what is counted as one of its harmful effects. So we— I was very, very curious to see because if we can reduce the anxiety that is associated with breast cancer screening or any biopsy that is caused, we can then increase the benefit. You know, you're always asking for the harm— looking at the harm versus benefit ratio.
So you're going to increase the amount of time that people come in to get screening if you decrease their anxiety?
Absolutely. And, you know, anything we can do to bring women in for screening is a win, right?
Yes.
You know, we just want them to come in. Screening is, you know, has been shown to reduce breast cancer mortality, shown to reduce breast cancer morbidity. So we did this study with 157 women who were all scheduled to come in for a breast biopsy to our division. So either an ultrasound-guided biopsy or a stereotactic biopsy. And we randomized them into women who would listen to music during their biopsy and women who wouldn't listen to music during their biopsy. And then we used a standard score. It's a State-Trait Anxiety Inventory to assess their anxiety level both before the biopsy and the level after the biopsy. And we were really, you know, it was a really interesting finding that before the biopsy, everybody was anxious, right? Everybody's anxiety levels were high. But after the biopsy, there was a much greater reduction in anxiety in women who listened to music than women who didn't listen to music.
So fascinating.
I mean, I'm not surprised, but I think that's so powerful to look at 157 women.
Yeah.
And I thought it was great. And I think what was unique to our study was that we allowed women to choose their own music. Oh, okay.
I was gonna ask you, what were they listening to?
Yeah, so they were listening to all kinds of stuff. Some people wanted classical music, pop music, some people wanted to listen to even hard rock. And, you know, we just, we played it in the room. We used Pandora so they could access whatever single, whatever song they wanted. And I think that made a huge difference. If they were able to listen to music they were familiar with, I think that really made a difference to them. There have been a few studies which have sort of forced people to just listen to classical music. And, you know, I think if you're not familiar with the music, it doesn't really help you relax.
So I love that because I was going to say, was it relaxing jazz or like slow classical elevator music? But I can see, like, if somebody doesn't like it, it's not going to help them relax.
I know. And sometimes classical music can have those chords or those bars. It's almost like, oh my God. That's true. I know.
And the cymbals.
Exactly. We used to have— we had a CD that we used to play at another site, not as a part of the study. And it was so terrible because every time I would tell the patient, okay, now I'm going to do the biopsy, it had this crescendo, which is the da da da. And you're like, oh my God. So I think letting them choose their music is definitely helpful.
That's fantastic. So it was statistically significant decrease in anxiety when they're listening to the music of their choice.
Yes.
So did you tell them ahead of time before they came that you were gonna do this or they, it was a surprise when they came in?
No. So it They were all told to bring in their headphones, but then they got randomized into music or no music.
Okay, so that is a fantastic study. I love it. Was there anything else in that study we should know about?
No, just that, you know, we've started recommending people bring their music. And now, you know, access to music because of smartphones is so easy that I think everybody should be given the option. Obviously, you cannot use it in MRs because you can't take the phone in.
People do have music in MRI machines now.
Yeah, there are some, some people sort of have some sort of access to some music, but in ultrasound and stereotactic biopsies you can really use it and it's really helpful.
But not all facilities have the ability to play music for you if you're doing an MRI.
Exactly.
Okay, but some places do.
Yeah, and you know, I must, there is a little criticism that you have to be sure that the patient can still hear the operators, can still hear the physicians, the communication shouldn't get impeded. So what I have been doing is I have them put in the headphone in one ear and leave the other ear open.
Awesome. I love it. And you keep doing this now, right?
Yeah.
That's awesome. And you know, I have to tell you, I always bring my earphones and I bring a pair of sunglasses and I bring some aromatherapy when I go to the dentist.
I know. You know, I take my headphones too. And once I forgot and I stopped at CVS and bought headphones before I went to the dentist. Yeah. Because that makes the whole, makes all the difference. And it also, you know, it's, my dentist has this habit of asking you questions while He's working on your teeth and I'm—
they don't really want to hear your answer.
Oh, so once that's funny, he doesn't—
I know when you're trying to talk with the things in your mouth. Yeah. I always bring that trio to the dentist office and then I also do a body scan and I kind of relax the muscles in my neck and shoulders. And when I do that and I do a meditation where I, you know, put my trust in the clinician to be able to relax actually helps the clinician too, or the dentist. I mean, if I'm like nervous and anxious and gagging and my dentist is trying to do something, that stresses him out. So same thing with medical procedures. You know, I used to always think about that when I used to do procedures on patients or take care of all of that. Yeah.
You know, I completely agree. And sometimes I've noticed that, you know, sometimes if the patient is very anxious or very on edge, they sort of set the tone in the room and they make everybody a little, you know, edgy. And if the patient is relaxed Everyone's relaxed. The procedure goes really well.
When you're tense and scared, you tend to clench up your muscles. So the pain is even worse.
Yes.
For the remainder of the podcast, I want to talk to you about the myth of soy and lifestyle issues around breast cancer risk, because there was all this talk about, you know, don't drink or eat soy. And now I think it's reversed. I think it's It's fine.
Yeah. Soy, the way this all originated is because soy has isoflavones, which are sort of considered the plant estrogens. And so there was this concern and, you know, there's estrogen-positive cancers and there was this big concern that estrogen in soy could be causing breast cancer. Now, there have been two large, large studies. One of them is came out from Loma Linda University in California, where they took 52,000 North American women and then followed them for almost 8 years. And they did multiple food frequency questionnaires, and they looked at both dairy intake and soy intake. And they found that there was no association between breast cancer and the consumption of soy.
But dairy—
dairy is— exactly. But they did see that people who had a higher— got a higher percentage of their calorie intake from dairy, and that's milk. It doesn't include yogurt and cheese, just milk.
I was going to say yogurt, right? Yogurt is great for you.
Yogurt is great, cheese is great, but if you were having actual milk, there was a slightly higher incidence of breast cancer.
Did it matter if it was like skim milk or fat?
No, so it didn't matter, right? The amount of fat in dairy didn't matter. The food soy, the soy in tofu, soy milk, edamame, that doesn't have enough isoflavones to cause breast cancer. But soy supplements, right? If people are taking actual soy supplements, those might have a much higher level of isoflavones and those haven't been, you know, studied. So all these studies are looking at food soy.
Wait, can I just say, reeling back, how much is a large dose of soy supplements and why are people taking soy supplements anyway?
So You know, I don't know why people are taking soy sauce.
For protein? You mean for protein?
It's a good source of plant protein, fiber. It has vitamins, potassium, sodium. I'm sorry, not sodium.
Is there like a level?
I don't know the actual numbers of where, of how much soy is in supplements and how much soy is in food, but I just wanted to clarify that it's food soy that all of these studies—
Okay, yes, of course. And like Japanese women They've studied and they eat tons of soy and they have a lower risk of breast cancer. So— and they're actually saying that this might even help.
Actually helps with breast cancer. So they have these 300,000 Chinese women that they followed for about 8 years and they found there's a 3% decrease in breast cancer for every 10 milligram per day increase in soy uptake. Now, so, you know, high intake might be protecting, but again, this, you know, breast cancer also has a strong genetic predilection. It's different in different races. So this is a Chinese study. So, but the other study was in North American women. It was pretty diverse and they did not find any association either. The 5 main things that basically they talk about lifestyle-wise that you can do to reduce your risk of breast cancer is maintain a healthy weight, exercise regularly, decrease your alcohol intake, You know, obviously breastfeed if you can. Don't take hormone replacement therapy. And one thing that I try to tell all my patients is that you try to get an individual risk assessment. What is your individual risk, right? Because breast cancer now increasingly and breast cancer screening is not a one-size-fits-all thing anymore, right? So based on your personal history, in fact, when you started your period, when you had your menopause, when you had your first pregnancy, All of that plays into your breast cancer risk. There is even concern now that if when you were a baby, if your mother had preeclampsia or if you had a high birth weight, that might increase your breast— risk of breast cancer. So, you know, I tell all my patients, especially the young patients, that you should talk to your primary care physician or talk to your gynecologist and get an individualized risk assessment. And once you have— so, you know, they take all your history in and they put it in these computer models, right? Tyler-Cusey, Gail, any kind of model. And it gives you a number. It gives you a lifetime risk number. And then once you know that, you can then see what kind of screening you should be getting. Is just, you know, should you be starting earlier than 40 or, you know, whatever age? Should you be starting earlier? Should we be doing it annual? Should you be adding supplemental screening like MRI, ultrasound, anything to it? So I think those 5 things would be really helpful if you wanted to reduce your risk of breast cancer.
Okay, so that's great advice. And if you're a young woman listening, then you should always find out about your breast cancer history, your family history, right? That's really important.
Absolutely.
And even in young women, if they find something palpable or there's like some sort sort of symptoms, even a teenager, they need to bring that to their doctor or tell their parents.
Yes. And, you know, obviously the biggest risk factor for breast cancer is age, right? You know, obviously as you get older, your breast cancer risk rises.
But if you get really old, then your risk of aggressive breast cancer decreases. So, yeah.
Absolutely. The older you get— When you get really old.
Yeah, that's true.
You're absolutely right. Yeah, well, you know, only the lucky get to get to grow old.
That's true.
Beats the alternative.
Absolutely.
But, you know, 11% of breast cancers are in women younger than 45.
Wow.
And that is like sort of at the edge of where women start to get screened. So you should obviously know your personal risk and then get to know your breasts almost. You know, I know it sounds really weird, but a lot of people don't actually You know, what's normal for them or not.
I mean, they used to tell them to do a breast exam, self-breast exam all the time. And then they took that away because everybody was feeling all kinds of lumps. And then it was just like causing all these false positives and unnecessary biopsies. So then they told— the recommendation was not to do a regular breast exam. So it's kind of confusing, but just know what's normal for you, right? If you see any changes or feel anything different.
Right. You know, like you're in the shower, you feel a lump. Don't assume it's a cyst. Come in, we'll take a look.
Yeah.
You know, if you see some dimpling, if your breast starts to decrease in size, you feel— even if you see nipple changes, right, redness in your nipple, any thickness, any discharge, come in and we can definitely take a look and see what's going on.
Yeah.
Okay.
Those are all excellent recommendations. And now we have like a preventative plan, right, to stay healthy. And the normal healthy weight is because of the estrogen, right?
Yes.
So, okay, because fat cells make estrogen.
Exactly. Stimulates more adipose tissue you have, the more estrogen converts. And, um, and that's why healthy weight and exercise.
Mansi, I know you went to medical school in India, and could you just tell us a little bit about the amount of resilience you had to have to come in as a foreign grad and to be able to pass the board exams here? That's pretty tough. And so you kind of went through a lot of everything twice, right? At least.
I did. So I have, I have this thing I tell all the residents, right? I'm the most trained doctor you can find in the hospital because I was in training for 18 years. Oh my goodness. When I started. So from the day I started my medical school to the day I started my first actual attending job was 18 years.
Wow. Now that's grit. How did you talk yourself into staying with it and sticking with it and staying optimistic through that?
So, you know, I think one thing, one thing that I definitely wanted to do was that I wanted to practice. I wanted to be a doctor anywhere I was. I love what I do. So I started off with medical school in India and, you know, getting into medical school is hard anywhere, but it is so hard in India. Super hard in India because it's so competitive. Yeah, I bet. So I had to spend a year just studying for my entrance exam, and then we got in, finished, then I did a radiology residency in India, and then I got married and my husband wanted to come here. So I was like, all right. So we came here and then I spent another year giving the exams and then slowly, you know, did research for a couple of years and then started my residency and then stayed on as an attending at Mass General Hospital. There was a time, and I had, you know how it is with women, right? You, you sort of have to have your babies at some point in that whole process. So we had our daughter when I was an interventional radiology fellow. I did interventional radiology before breast imaging.
Wow. So interventional radiology is another specialty in radiology for those people who don't know. But so you went from interventional, which is a hyper-specialized field, to breast imaging.
I did. And, you know, just talking personally, I remember we had my baby, we had our daughter, and my husband is a cardiologist. So he was a cardiology fellow and I was an interventional radiology fellow. And I used to literally pick up the baby and drop her at 6:00 with our daycare lady and then pick her up at 6:00 or 7:00 in the evening and just wash her and put her in bed. Those were crazy times, but I did. I used to love— I loved interventional radiology, but I just couldn't— I just didn't like the long, long hours that it had. That was very hard for me to keep up those hours and pay attention to my family. So breast imaging for me was a great mix because I like interventions, I like talking to patients. You know how in radiology you sometimes are in a little dark room and you don't talk to anyone, so So breast imaging was perfect. When I found breast imaging, I was like, oh my God, this is exactly what I've been looking for all along.
How did you know that you wanted to be a doctor so badly through 18 years of training?
There was nothing else I ever wanted to be. Really? Ever since I— yes, there's— I don't have any doctors in my family, but— and I— this is now family, sort of family folklore. Ever since I was 3 or 4, I was like, I want to be a doctor., and my parents were really, you know, happy. Who doesn't want their kid to be a doctor? And then I just went through just wanting to be a doctor. I never considered anything else. My mother is a teacher, and when I was in school, I also dabbled a lot in theater. Like, I used to love to act, and I always said, you know, if I wasn't a doctor, I would have been an actor or a teacher. And then our town— I live in a small town in New Hampshire, and the town turned 350 years, and they wanted to put up a play, and they asked town folks to volunteer. And I was like, oh my God, I want to be an actor, I'm going to act in this play. And it was so curious, I got cast as a teacher. So I got to be a teacher, act as a teacher, and I hated it.
I absolutely hated it.
After the first performance, I was like, oh my God, thank God I didn't become an actor. I would have hated it. And then obviously I also got to be a teacher, and I didn't like it. I mean, It's a great noble profession, but being a doctor is the only thing I could ever be, I think.
But for 18 years, that's amazing.
I know, it was a long journey, but it's been worth it. My dad was a naval officer. I think growing up in the military sort of gives you a lot of resilience. I was always moving. I attended maybe almost 8 schools by the time I was done with high school. Wow. Always living in a new place. My dad and I were counting the other day. I think I lived in almost 30 apartments by the time I was done. We were always moving, always making, you know, you had to make new friends, you had to get through things. So, but I never thought of giving it up. I always, it was always something I was going to do.
Amazing. Okay, well, thank you so much for spending time with us today and giving us all your awesome tips.
Yeah, thank you. It's great.
Thank you so much for listening, and remember that October is Breast Cancer Awareness Month, but that doesn't mean that we shouldn't think about it the rest of the year. So if you haven't already gotten your mammogram, go ahead and make that appointment. Don't be afraid. It doesn't matter if you're late, and remember to bring your favorite music with you. So tune in tomorrow because I have a special 3-part series with author and mindfulness leadership teacher, Laurie Cameron. She is CEO of Purpose Blue, a mindfulness coaching company that works with corporations and schools. Laurie is the real deal. I met her at Search Inside Yourself, Google. She's funny and warm and smart, and I love spending time with her. I know you're going to love listening to her and learning about her best practices and all the wisdom she has to share. So join me tomorrow, Monday, and Tuesday. And Tuesday she will lead us through a special 15-minute guided meditation on uncertainty, and we can all use that on Tuesday. Don't forget to email me at podcast@mindbodyspace.com if you have any suggestions for guests or topics, or if you have any questions for me or any of my guests. This is Dr. Juna signing off, wishing you and your family wellness.
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