Screening for Breast Cancer with Dr. Yvonne Karney

Welcome to the Wellness Sherpa Podcast, where we engage with passionate leaders, holistic thinkers, and disruptors who courageously share their personal journey, mission and wisdom with you. Together, we create a safe space to empower you to live your best, most vital life. Thanks for being here. Well, hello, everyone. I am thrilled to be here today with the lovely Dr. Yvonne Carney. And she is a traditionally trained gynecologist with over 25 years of experience in helping women. But she left her traditional practice and now has an integrative practice in the suburbs of Chicago where her whole focus has been on revolutionizing breast imaging. And I'm excited to, as somebody who's been through that process, to learn more and to share more with our audience. So I can tell that we both have a love of helping women. And I am thrilled to have you here.

So thank you so much. My pleasure. I'm so excited to be here and talk to your people.

Yeah, so. So, Dr. Carney, talk to us. You just shared this with me, but share with the audience what led you from transitioning out of a traditional practice into an integrative practice and then especially around the imaging. So share about that. That would be fabulous.

You know, it really was a journey for me and I want people to understand that it was, it was a big change for me, specifically because I actually was a US Air Force doctor. And so I was used to, that's how I started my career. So I spent eight years in the Air Force because they helped me through medical school, and then I was a Air Force doctor for them for eight years after. And so I was used to following algorithms and saying, yes, and, you know, don't deviate from the plan. Don't ask questions, just do what you're told. And we could quote all the studies because I did my residency through the, through the military. We were trained to quote all the studies as to, this is why we do it, and this is evidence based medicine and we're going to do it the right way. And that's how I started my practice. I really believed everything that I was taught. And then over time, though, I started really dealing with real people and real women and listening to them and hearing that their needs were not being met. Women confide easier in their ob GYN than their other doctor, typically, or maybe it was just me, but I think it's a, in general, a relationship that they feel like they can confide in them. And so, so many times at the end of my visit with a woman, you know, is there anything else I can help you with today? Yes. I don't know what's wrong, but I don't feel good. I have no energy or I have no sex drive or I have these other issues. And my. I already told my regular doctor and they said all my labs are fine, so. So it's gotta be my hormones, so please help me. And I would look then at their labs, and sometimes I would. Well, I would often check their hormones, you know, because I wanted to see if it was their hormones. And in those processes, I realized I did not have the tools to help women answer these questions. And I wasn't going to be so paternalistic to say, oh, you're just getting older or, oh, that's the way it is. You know, it's like something's wrong. These people are confiding in me that they don't feel good. I don't have the answers for them. And so that was. That really planted the seed. And then I had my own health struggles because I was an obstetrician. And, you know, obgyn babies come at crazy hours. So, you know, for multiple years, the. The first half of my medical practice, I was delivering babies and I started to get some significant stress. Fatigue issues landed me in the ER with vertigo. I thought I was having a stroke. I was like, this can't be healthy. And as I started to learn more about stress and sleep and health, and I actually started learning functional medicine, hoping that all the little tools I would use would help me withstand the rigors of my profession. And then over time, I realized, well, you can't out supplement lack of sleep. You can't out healthy diet lack of sleep. Maybe it's time to make sure that you sleep at night, not up all the time. So at that point, I had closed part of my practice and did gynecology only. And that's when it became very glaring to me that I didn't have the tools to really help women.

That's amazing. And I love what you said because I do think there's an intimate relationship with a gynecologist. Right. I mean, you're in that space. And I think you're right. When I look back on my own experience, that was a place I would go to for everything because I trusted my gynecologist. So I love that. So let's shift a little bit into informed consent. Tell me about that and what is happening in our world today with informed consent.

Heavy sigh. Heavy sigh.

Or not happening.

Yes. You know, informed consent is a keystone of good medicine. And it what has at the core that the acknowledgement that the. The woman. I'm just going to use women. But we mean all patients. The person is in charge of their health, and if we give them information to help them make decisions, then they're the ones that make the decisions about their health. And that's informed consent. And it's missing in a lot of medicine, but it's especially missing in breast imaging and breast cancer screening. That became painfully aware to me over the last few years in the back of my head once I started learning about functional medicine and true cause of illness. And it's not just the tumor that's the problem. It's inflammation that's the problem. And I. And I was. I was still practicing gynecology, but this little voice in the back of my head was like, mammograms, you know, isn't radiation at risk for breast cancer? And yet here we are doing these imaging studies is, you know, at what point is the radiation bad versus the study good? But in my. I was a good soldier, right? I was like, okay, no, the risks, you know, the benefits outweigh the risk. Early detection far supersedes the teeny, tiny risk of radiation. But over time, it still bothered me that women weren't told about any of the risks. Right? And then in the last couple years, I became aware of a newer technology. And then I was like, holy cow. Now we really. Because if that's all there is no screening versus these risks or no other imaging options, then. Then it changes the conversation. But if there's alternatives now I think it's really time to have that conversation. And so I'm really starting to get the word out about, let's talk about informed consent. So that means we talk about the benefits, the limitations, and the risks. And then once we know those things and we talk about. What do we not know, right? We can't say that we know everything. And honest conversation means I don't know the answer. We're doing the best we can with the information that we have. So if we have those conversations with women and then let them make their decision, that's good medicine.

Yeah, that's. That's brilliant. So what is the standard today? So I know, you know, I'm in my late 50s. I was told because my grandmother had had breast cancer, that at age 40, I needed to start getting my annual mammogram. And like a soldier, I did it right every year. Every year, Every year. And I had originally dcis, which is the calcified. And so what is the standard today? Because I, you know, I haven't had a mammogram in years now. And we'll talk about why and we'll talk about what some other options are. So I did the thermography, which was the only other tool available to me at the time, you know, nine years ago, and have continued to do that every year. But I'm excited we're going to talk about the new technology that you're offering. So going back to what is the standard today? So in the normal practice, where are women being driven as far as mammograms?

The standard breast imaging and screening for cancer hasn't changed much in the last 50 years. Mammogram came around in the 70s, President Nixon's war on cancer, it became more well known. There was a small change to mammography in 2011 when digital tomosynthesis was invented, which means they can stack the images and get a 3D approximation. It's not true 3D imaging, but it's a bunch of stacked 2D images and they can get an approximation of a three dimensional image. So that's. And that was still 13 years ago. That was the last real change in the technology. And then all these recommendations for screening are set by the United States Preventative Task Force. So they updated their recommendations this year to be average risk. Women are recommended to be screened every other year between ages 40 and 74, and that's average risk. So that's no family history of breast cancer, no known genetic mutations, and there's actually online risk assessment tools that a primary care doctor or a gynecologist can answer questions from a woman to determine if she has an increased lifetime risk of breast cancer. And then she's not considered average risk. And then if you're not average risk, the recommendations are not set. Most people are doing mammograms at least once a year. If you're higher risk, some are doing twice a year and some are doing alternating mammogram with MRI at six month intervals. So, you know, in January they have their mammogram, in July they have an mri, in January they have a mammogram. And so that is what is done most often for women that are considered to be higher risk.

And I would imagine, and you know, I haven't been, you know, in tune with studies lately, but the accumulation of that in the body over time is probably what creates an issue. Right. So for me, because I was high risk, I was getting it every year. Right. So I'm just curious about that. What's your take on that?

And so you know that that's getting into a risk of mammography. So a mammogram is a compression of the breast down to about 1cm in thickness. And it's done in two dimensions, top to bottom and side to side. And then the breast is radiated. An X ray is obtained because it's looking for abnormal calcifications that could be cancerous. And so the reason that these calcifications show up is that cancer is not normal. It doesn't grow normally. It's all, like, bent over on each other, and it's not normal tissue. So the little capillaries that are forming inside that tumor are all on top of each other. And so it shows up as calcifications on a mammogram, and that's what is done. So the theory is, my goodness, we can pick these up when they're less than a centimeter in size, several millimeters in size, and there's no way a woman is going to feel a lump that's, you know, 1.5 millimeters. So, goodness gracious, yay. We're detecting cancer significantly earlier than would be found if we waited until that tumor grew to be the size that she felt a lump in her breast. And so the goal is, okay, we catch it earlier, then treatment's easier. Right. Instead of a mastectomy, maybe she only needs a lumpectomy. The ultimate goal, you would think, would be to decrease death from breast cancer, but it hasn't really panned out that the death rate used to be. Right.

Haven't changed.

No. And it happens.

Important to know.

But it's still a consideration that if you catch something early and you are going to do surgery, that it's easier to get a lumpectomy. The. For recovery time and, you know, the emotional aspects of disfigurement. Right. That's all. It's so, yeah. So easier to get a lumpectomy than a mastectomy. So that's still a reason, I think, to do some sort of screening to catch things early.

Right.

But you're right, it doesn't really. It hasn't panned out to prolong the life. That hasn't changed much.

Right. And that's really important to take note of.

So. So when we look at the benefit and then you look at the risk. Right. So there is radiation. It's not a lot. It's only about 0.4 millisieverts per mammogram, which isn't very much. But what we think is that the lifetime risk accumulates. It's not just one and done. It's like over your lifetime, how much radiation have you gotten? And that, that could increase over time. So that could become significant. Right. We start mammograms in your 20s or 30s because of a family history. And you're doing it every single year because of a family history. That's a lot of radiation by the time you're in your 60s. And, and that, that was that little bug in the back of my head going, okay, so breast cancer becomes more common for women in their 60s. That's often when it's diagnosed. Unless it's, you know, more, more of a genetic issue. Is there any possibility that we could be causing some of these cancers because of the radiation? And the answer is absolutely yes. Now go ahead. There was a study that extrapolated data from atomic bomb survivors and looked at their cancer rate. And this came out saying that for every 100,000 women screened, there are 88 radiation induced cancers and 11 cancer deaths.

Wow.

Now that's a low number. But why aren't we told that? Right, right. I was never. This is embarrassing, Jen. I didn't know that. And I was recommending this study for women.

You weren't taught that.

Right?

I know that's part of the challenge. And I think that's, you know, one of the beautiful things that you're here to change is to have the conversation that hasn't been had for women along the way and to give them a better tool. So let's talk about the, the tool, the new way of screening and how that came about for you and why you love it.

So first of all, the, there's a new technology and it's called QT imaging and that stands for quantitative transmission. And it is a breast imaging modality that has no radiation, there's no compression required, there's no IV contrast required. It's true 3D imaging. It's not an approximation of 3D with slices and then a computer is filling in the gaps. It's true 3D imaging and it's affordable. It's not super expensive. The, you know, mammograms, screening mammograms are covered by insurance, but the vast majority of insurances do not cover the callbacks. Or if, if they say you need additional views or an ultrasound because you have dense breasts. And those studies range from like 7 to $1200 and those aren't covered. So if there was a modality that could decrease the need for those additional studies, it would be a worthwhile endeavor. We need to be careful with the words that we use. So I want to use, I want to make sure I use the right words. And so QT imaging is not intended right now by the company to be for screening. That's what they're saying. We're not. Because they're not going to war against mammograms. Right. They're saying it's an all, it's an additional modality and it's available on demand. And if women decide on their own, based on informed consent, that they decide not to have a mammogram, now there's an alternative. And you know what's, this is significant because the CDC estimates that 30 to 40% of women of mammogram age don't get mammograms. Wow. And so I don't really, I'm not telling people, don't get a mammogram. I know there are some doctors who are saying that. I'm saying let's learn about risks, benefits, limitations and alternatives and then let the, let the woman make her decision.

Right. So the training, you get the 3D image and what information does that give to the patient, to the woman who's coming in?

It actually looks like a breast mri as far as the images that come out. It actually has 200,000 times more data points than a breast MRI. It's super sensitive. A breast MRI operates in the same planes every 2 millimeters. It does a section of the breast, so there's a 2 millimeter gap. And if there's a 1 millimeter lesion, it could potentially be missed. Right. Because there's, there's a gap there that a computer program is generating image like, oh, it looks like this above and it looks like this below. So it's probably like this in between in that 2 millimeter gap. But in this device it's actually true 3D image. There's not loss.

You're not trying to make any assumptions.

Right? Right.

Okay.

So what happens is the scan is read by a radiologist, a board certified radiologist that's trained in breast mri and then it does some additional training on how to, how the QT scan differs from an MRI and how to look at the images and evaluate it. So then they're given a report of either normal, recommended short term interval follow up or there's something suspicious. You should see a breast surgeon. It's super important to know that the only way to know if you have cancer is with a biopsy. You have to have a tissue diagnosis. You cannot have an ultrasound, an mri, a mammogram, or Anything and know for sure that you have cancer. Okay.

And that's really helpful. And how long has this technology been out, and what is your role in bringing it out into your area and across the United States?

So this technology was invented by a brilliant doctor named Dr. Clock, and he was actually hired and given a grant by the FDA and the National Institutes of Health of over $20 million back in the early 2010s, 2010, somewhere between 2011 and, like, 2015 or so. And he developed this. His goal was something that was safe, effective, accessible, and, you know, without the. To decrease the callback rate, because the FDA considers the 15% callback rate for mammograms to be an adverse event. Right. So his goal was to decrease the adverse events, and he developed the machine, and by 2016, they started doing studies. Okay. By the end of 2018, early 2019, it got FDA clearance as a breakthrough medical device. And then they started offering it to women on demand. And that was five years ago.

Right. So we heard about it.

Exactly. Exactly. Now, Covid probably had something to do with it, right? Because nobody was doing anything for almost two years, unfortunately. But when I heard about the. The technology from a colle of mine and then she introduced me to the inventor, me and a few other Doctors were like, Dr. Clark, this needs to be known. You know, women. And he's like, well, yeah, we're working on it, but the hospitals aren't really interested.

Right.

And we're like, okay, well, we're going to bring it out. And so we started to figure out how to get it to women. And so it's a grassroots effort. The radiology centers and the hospitals are not, at this point interested. Within 15 years, I don't think they'll have a choice. But I don't want to wait 15 years. Right. And so I brought it to.

My cancer rates are increasing. Right. Our cancer rates are going up. And so it's a really important tool for women to have available.

Yes.

So, wow, five years. That's a long time. Yeah, I. I just heard about it late last year, actually, at Mindshare.

Yeah, I was the one. One of the ones on the stage, if you were there.

Yeah, that's perfect.

So it's taken in this.

Pardon me.

Go ahead. It's taken this long to find, you know, to get access to the machine, to line up a radiologist that is trained and ready to interpret, you know, the studies. But I have the only machine. I just brought it in last week. It was installed, and we started scanning this week. So we're super excited to be able to offer it to women. We don't. We're offering it without a referral. Just if someone wants it, they can get it, because we know that women deserve to have options, and we want to give them options. And so that is. That's the mission of what I. What I'm doing is just to, you know, number one, educate on the. On the importance of informed consent so that. And if someone wants to get a mammogram, I'll support you. You know, but make sure it's your decision and not just that you're lining up to be a good patient because some doctor told you that you needed to get it or you were foolish. Right. When, when mammography first started, and as I started reading the data and the studies, they. They used the terminology in the early. In the late 70s and early 80s that women were invited to screen, okay? Because it was a rollout of a new program, and so they were inviting women to screen. We don't invite women to screen anymore. We give them an order and say, go get your mammogram. And if they don't, we're like, why didn't you get your mammogram? Don't you know that the. The breast cancer rate is this? And if you don't get it detected earlier, it's a, you know, it's a death sentence. We're not giving them invitations with information. We're just saying, go do this and that. That needs to stop, because that's very paternalistic and, like, not allowing the. The intelligence of the individual to determine what's most important to them. Right. And is it more important for you to prove that you don't have cancer, or are you one that is concerned about anxiety and stress, of unnecessary procedures? There's a difference, right? Absolutely. And only the person knows that for themselves. I cannot make that decision for you, but I can give you information and you can weigh your own personal value system on it.

Right?

So I never would chastise women. Once I learned this stuff about not getting a mammogram, I'd be like, okay, as long as you realize this, and if it's your decision that you don't want to have it, I will honor that. I'm not getting. There's doctors that kick patients out of their practice if they don't, you know, keep up with all the recommended tests and screens and stuff.

Well, and again, you know, it's a system, right? So the recommendations, it's kind of, you know, I was in change Management for a long time in my career. Career. And getting people to change their thought processes.

Right.

Is.

It takes a long time.

It takes a long time. And I remember a boss telling me it's a third. A third, a third. So the first third will say, heck, yes, I want to try it. I want to be the trailblazer. The next third will say, I'm going to see how those third do. And then the. The last third will say, no, I'm not interested. I'm doing what my doctor is telling me. Right. And so, you know, how are you getting the word out? How is this grassroots working? So you just got your equipment.

It started this week, so. Okay.

And so how are you getting the word out? I mean, this is awesome that you're here. I hope every woman that's listening that is in the area will go visit you and have the screening and have the experience.

If it.

If it resonates right.

If it resonates right. So I'm, you know, I'm just trying to get the word out by being on other people's platforms, podcasts. So thank you so much for giving me the opportunity to share this information, because it's people like you who have the platform and women interested. Right. Because your audience is interested in taking control of their health. Not everyone is. So as I speak to more people on different podcasts, then I know that the word will get out. And the word's going to get out. As women in this area, they'll go, holy cow, did you know, I just went and had the study done and it didn't, you know, they didn't have to squish my breast between two hard plates. And I laid there for, you know, 20 minutes and had the scan done, and I fell asleep during it. It was very relaxing. And, you know, that's going to be like, wow. I think the word of mouth is going to be very important for that. But, yeah, we just need. We need more people to become aware. Last night, I just did a dinner lecture for the local integrative doctors in the Chicagoland area. So I was able to give them the full presentation that I have on informed consent and then the technology of the device. So I'm expecting that there will be some excitement in the area generated by that. Right now, a lot of our people calling us are from out of state because there's no. There's only six centers in the country right now.

Yeah, that's.

And so I have the only one in the Midwest.

Yes.

And.

And is this technology in other countries? And are There any in Singapore right now. In Singapore. Okay.

And. And Dr. Clock has been trying to work with like academic centers to do studies. And so that's where it's available in Singapore. Okay. They just sold to Canon and so can't. A division of Canon has taken over or is going to be taking over the manufacturer of the machines because prior to that it took eight months to build a machine.

Wow.

And so now in order to increase the availability, they need to have the ability to make machines at a better rate. But right now, like I said, because the hospitals and the radiology centers are, are not interested, I think that it's going to be people finding little centers like mine. I partnered up with a doctor in California and the name of our company is Clarity Breast Imaging. So she has a center in Northern California, I have a center in the Chicago suburbs. And then our vision is, over time, potentially we might open more centers, but we want to get things settled and running smoothly in our current. Yeah, right.

And so are there any risks at all with this new technology?

None. Okay. It's a woman lays on her belly, one breast is scanned at a time. There's a, there's a hole in the table and the table shaped nice and ergonomic. So even for people with low back issues, it's usually not hard. And the breast is bathed in a warm water bath. It's the temperature of body. And so then the, the scanner rotates around the breast and the length of the scan depends on the volume of breast tissue. So it's usually somewhere between eight. The longest I've seen is 18 minutes per breast, which is not short, I'll grant you that. It, it, it's. But you know, it's not uncomfortable either. Right. There's nothing compressing. And you know, when a woman gets an mri, usually they give IV contrast. And that's gadolinium, which is a heavy metal, so that's a toxin. And I understand that they're saying the benefits outweigh the risk, but, you know, let's have that conversation about the risk at least. Right.

So where can the audience find you? Your website, if you can share that and we'll include that in the show notes.

Absolutely. So I made a, I made a URL that will be easy for people to remember for the breast imaging. And it's chicagobreastimaging.com and that will take anyone to the page on my website, which is for the breast imaging. And if they're interested in the rest of my practice, YvonCarneyMD.com takes them to the homepage of my practice. And from there, there's a page on breast imaging, but I also just created a URL specifically for that page.

Fabulous. And so any words of wisdom before we complete here for women?

I just want to encourage women to use their voice. You know, we. So many women, and I'm speaking to myself also, you know, we. We take care of everyone else, and we don't want to be complainers, so we, you know, we keep things quiet, and we don't want to be seen as, you know, a bad person. So we kind of look at authority. Right. The doctor said, do this, and I'm afraid to ask a question because they sighed when I asked a question or I could tell they were in a hurry. Well, it's really time to use your voice and, and make sure that you understand what is being recommended for you and ask questions. And if your doctor doesn't answer your questions, then get a new doctor. There's choices, and you deserve to feel comfortable with your health care and your health plan, because traditional medicine is really a disease plan. It's not a health plan. Right. So take control of your health, Ask your questions, find a doctor who's your ally and your advocate and your guide, and not just handing you prescriptions, and I think you'll do very well.

Well, we see the world so similarly, and I, you know, I love how you ended that because it's so true. You know, we are the advocates of our own health. We are the caregivers of these bodies, and we have relinquished a lot of our, you know, our power, whatever you want to call it, to authorities. And I know, you know, I grew up in a Catholic military family, so everything was follow the rules. And my dad was in the Navy, similar to the Air Force.

And.

And so using my voice has been part of my healing. And I think it is for a lot of women is being able to speak up and say, wait a minute, I want to take the time to review this and make my own decision.

Yes. And you know that fairly new in.

The last 10 years where women have said, wait a minute, take this back and really make my own decision.

There's a misconception out there that, well, if it were really good, insurance would cover it. Right. Well, okay, so get back to me when this is covered by insurance. Okay, good luck. Wait 10 or 15 years. Right. Because insurance doesn't care if you're healthy. Healthy.

Right.

They care about meeting minimum standards and making a profit. And so that, you know, that is, we. We have to take advantage and take control of our health and say, you know, yes, it's important to try to use insurance when it's available. But when there's people who want to go the extra mile, most of them realize that they have to do that whether or not insurance says yes. Because insurances, their first answer is usually no. And that is sad. But they realize that 25% of the population, when they're told no, won't ask why not? And so right off the bat, they're saving 25% by saying no to everyone.

And then they actually say no twice. They actually. That's how they're trained, is twice to decline coverage. And I'm guessing by the second decline, probably it's more like who say, okay, I give up, you know, because I.

Must not be worthwhile because it's not covered, so I can't do it.

Right.

Yep.

So that's where we get to keep using our voice and we get to keep speaking up. And, you know, grassroots, I think, is the time that we're in right now.

Is it's up to us.

You know, we are the ones we've been waiting for. It's up to us.

Yes.

Not waiting for somebody to come in and say, you know, do it this way.

So.

Well, thank you. I appreciate your wisdom and your knowledge and your trailblazing to bring this new technology. And again, I hope the audience, if this resonates with you, that you reach out to Dr. Carney here, because she is amazing. So thank you so much for being here.

My pleasure. Thank you.