In this episode of RadCentral, a radiology podcast, we discuss Breast Cancer Awareness, The Brem Foundation and The Find it Early Act with Rachel Brem, MD.

Dr. Brem is a passionate advocate for Breast Cancer Awareness and the Find It Early Act, the Director of Breast Imaging and Intervention at George Washington University Medical Center, Professor of Radiology at George Washington School of Medicine and Health Sciences and the Vice Chair of research and faculty development for the department of radiology.

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Audio Only Version:

Key excerpts:

“I decided that I was going to do something to make a difference and try to change the history and the narrative of other families like mine. So I went to medical school in New York at a time that was very exciting, when mammography was first being used.”

“In 2018, [The Brem Foundation] helped craft and unanimously pass, the DC breast density notification law, one of the a few that requires insurance coverage of what some people call adjunct, but we call essential screening in women with dense breasts.”

“The great news is that, 95% of women with early stage breast cancer survive and thrive. The death rate from breast cancer has gone down by 50% over the past two decades, but not so in all communities. Black women die at a 30% higher rate… Access to care is a very big deal. [The Brem Foundation focuses on education and access in all communities.”

“One thing everybody has to learn is that you can advocate for yourself. Generally no means no. But with the insurance company, ‘no’ does not mean ‘no’. You need to call. You need to advocate. You need to go to the Brem Foundation website and get the data.”

“Radiologists aren’t going to lose their job to AI. Radiologists who don’t use AI will lose their jobs to radiologists who use AI.”

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Transcript Episode 5: Breast Cancer Awareness & The Brem Foundation

The transcript has been edited from the video content: Repetitions and vocal disfluencies have been removed for reading clarity.

00;00;00;00 – 00;00;15;23
Dr. Brem
And the data is compelling and profound. That screening should begin at 40. So after much encouragement, they changed their recommendation to begin a 40. However, they only got it half right.

00;00;15;25 – 00;00;21;13
Laura
Welcome to RadCentral a radiology podcast hosted by Excalibur Healthcare. I’m Laura.

00;00;21;13 – 00;00;22;04
Betsy
I’m Betsy.

00;00;22;09 – 00;00;49;09
Laura
Today we are sitting down with Doctor Rachel Brem. She is the director of breast imaging and intervention at George Washington University Medical Center. Professor of radiology at George Washington University School of Medicine and Health Sciences, and the vice chair of research and faculty development for the Department of Radiology. She’s a passionate advocate for breast cancer awareness and the Find It Early Act. Welcome, doctor Rachel Brem.

00;00;49;11 – 00;00;51;15
Dr. Brem
Thank you so much. I’m delighted to be here.

00;00;51;18 – 00;01;05;20
Laura
Oh, we’re so happy to have you. So, Doctor Brem, your personal story is very compelling. It’s led you to become a very powerful voice in this fight against breast cancer. Could you share your story a bit with our listeners?

00;01;05;22 – 00;03;51;09
Dr. Brem
I would be delighted to. So at the age of 12, my mother sort of disappeared for a couple of weeks. She was 33 years old. We weren’t sure where she had gone. And only several months later, we learned that she was diagnosed with breast cancer. Had truly a mutilating radical mastectomy, which was done in the 70s and was told she had six months to live.

So there were many things about that. One is she actually lived 44 years, had ovarian cancer, multiple recurrences, but ultimately died cancer free. She got to raise us. All three of us. I have two brothers, and I guess it was the first time that I, without really knowing it, but definitely felt the enormous impact of earlier detection.

We really thought we were going to be raised by our father, but one of the things I learned after my mother told us, she had breast cancer is that my vivacious redhead, green eyed, sparkling mother sort of lost some of that spark. And I was, as I said, I was 12. We were all immigrants. I was born in Israel.

My mother is Israeli. And, you know, I just decided that I was going to do everything I could at that point to make sure that other 12 year olds were impacted by breast cancer as I was. And, you know, my parents thought it was kind of a crazy idea. They’d never seen a girl doctor before. But I was really committed.

And I had, you know, it wasn’t that I had any role models. I, you know, my role model was my local pediatrician, who was, of course, a man. And so I just decided that I was going to do something to make a difference and try to change the history and the narrative of other families like mine. So I did go to medical school at a in New York at a time that was very exciting, where for mammography was first being used.

The study was first published around the time that I was in medical school in the early 80s, and showed a substantial decrease in the death rate from breast cancer result of mammography. So that’s how I came to radiology. And then, you know, the story sort of continued as the director of breast imaging trying out ultrasound equipment in the 90s when ultrasound was only for diagnosis, we were taught not to use it for screening, trying out some ultrasound equipment.

I found my own breast cancer when my oldest daughter was 12, and I was 37. So, history truly repeated itself, but it it’s been an interesting journey, but one that not only has had a lot of challenges, but has brought me a lot of passion and so definitely has had silver linings to some of the great clouds that have come this way.

00;03;51;11 – 00;03;57;18
Betsy
Yeah, that’s a wonderful story. How did it eventually lead to the foundation?

00;03;57;21 – 00;04;57;24
Dr. Brem
The foundation was started when I shortly after I came to GW in 2000. And what happened is, you know, if you would have told me 25 years ago that I’d be involved with the nonprofit, I would have said, not a chance, not possible. But what happened is, we were in DC. DC has the highest death rate from breast cancer in the country by a lot.

We saw a need and a bunch of really fabulous, impactful grassroots patients said, how can we make a difference? And so we began to identify unmet needs in our community. And that’s how the Brem Foundation started. So it was really started as a grassroots opportunity to identify and answer unmet needs in the breast cancer world. And from the start, we knew that we were going to be dedicated exclusively to early detection.

00;04;57;27 – 00;05;14;02
Betsy
Do you do you feel that the proximity to DC has been fortunate for the foundation? Do you have are there are there extra, benefits to being located? So close to Capitol Hill?

00;05;14;04 – 00;08;44;13
Dr. Brem
Oh, absolutely. First of all, you know, being in DC is being imbued in advocacy and policy, as our practice at GW is very close to the capital. So we have the privilege of being involved in the health care of people that we, you know, that help run our government. And, you know, it’s really part of the grain of the world in DC.

Plus our we’ve always been involved, with advocacy. You know, the Brem Foundation is really focused on three things. Education across all socioeconomic levels, certainly in the underserved community, there’s a need for a lot of, education. But even in the most privileged communities, you know, you ask someone to tell you about breast cancer and they say the pink ribbon.

And then not much after that, although that’s changing gratefully. So we were we’re committed to education across all socioeconomic levels were also committed to educating young breast imagers, radiologists. So we think this is the only breast imaging fellowship at GW that we run here that has a required committed community service component for our fellows, and they participate in the foundation.

They actually give many events, some of which are, you know, directed towards young people. We have an event every year called Check Out My Rack for young, people. Yep. I don’t do that. The fellows run that along with, you know, real keynote speakers and wonderful young breast cancer survivors and advocates. So we educate across all socioeconomic as well as our fellows and it’s been incredibly gratifying because many of them have gone on to their own communities, to their positions after their fellowship and been given the tools to start being the face of breast cancer in their communities for education as well.

We also do work in the underserved community. We do direct service. We have two programs, we have a number of programs, but one is called the Bee Fund, where we partner with federally funded health centers, identify patients who need funding for care for unregistered Americans, uninsured, whatever. We also have a really exciting program called wheels for women, where we partner with Lyft.

They are a front office to take underserved women to their free mammograms because screening mammography is now free. No co-pay, no deductible. And finally, advocacy has been an increasing part of our community and our mission at the foundation. Both at the local and national level. In 2018, we helped craft and unanimously pass, the DC breast density notification law, one of the a few that requires insurance coverage of what some people call adjunct, but we call essential screening.

in women with dense breasts and are involved with other states as well as very much on the national level. So personally through GW and mostly through the foundation, through the Brem Foundation, I, you know, we get involved with many congressional briefings, have close relationships with members of Congress that allows us to have a seat at the table for what is a very important piece of assuring that all women have the opportunity to get the proper screening. They need to find early, curable breast cancer.

00;08;44;15 – 00;10;12;01
Laura
Yes, it’s such important work. Thank you so much for everything that you do. You keep mentioning these underserved populations. Has there been challenges you’ve met along the way in trying to reach these communities?

Well, all of us in the health care community and certainly radiologists have these challenges, right? Breast cancer is not an equal opportunity disease. You know, the great news is that, 95% of women with early stage breast cancer survive and thrive, right? And that the death rate from breast cancer has gone down by 50% over the past two decades, but not so in all communities.

So black women die at a 30% higher rate. And so that’s probably very multifactorial. Genetics, Black women, Ashkenazi Jewish women get triple negative breast cancer more frequently, other populations as well. And the survival rate is lower. But, access to care is a very big deal. And we do focus on education and access in all communities. But those that need it the most, we focus on and those are many underserved communities.

And as many of the listeners here know, the American College of Radiology identified all black women in the United States as a high risk group and recommended that at the age of 25, they speak to their health care provider about how to optimally screen.

00;10;12;04 – 00;10;19;00
Laura
And this partnership with Lyft, how could somebody find out more about this. What exactly is it. How does it work.

00;10;19;02 – 00;11;42;17
Dr. Brem
What happens is it turns out that in many communities underserved communities, the barrier to free mammograms is transportation. And we know that since the ACA, the Affordable Care Act, screening mammography is free, no co-pay, no deductible on January 1st. But yet, in many communities in the Latino community, they have to take a day off of work, take public transportation.

And so we really decided to face that challenge head on. And I have to say at the time, our CEO, who thought of this really creative, awesome program was, Andrea Wolf and who happens to be my daughter, who was 12 when I was diagnosed with breast cancer.

But a wonderful, creative, brilliant, zealot for women’s health. And it’s just been an incredible program. It’s actually, made it kind of stressful for the foundation because the need is multiples of what we anticipated. And although we used Lyft as the front office, we have to pay for those rides, which means we have to, fundraise for those rides.

But it’s really, it’s made a huge difference. And we have found many early breast cancers in women who have avail themselves of the wheels for women program. So that’s how the Lyft program works.

00;11;42;20 – 00;11;48;11
Laura
Now that’s great. Is this is that a national program or is it, just in D.C. right now?

00;11;48;13 – 00;13;49;12
Dr. Brem
Right now, it’s just local. A number of states have reached out to us to try to expand it. We are small but mighty.

you know, it’s interesting, the, when we first started the foundation, we did in person educational events and they were fantastic.

And then Covid hit and we, like so many others, pivoted to online. And it turned out to be a blessing again because we could reach so many more people, right? We reached people across the country, across the world, and at that point, again, trying to find ways of doing things better, we developed these really fun, very highly informative educational videos, and they’re on BremFoundation.org

So we started out with the initial one called Push Back. Now we have one on breast density. One what you should ask your doctor. And are you too young to have breast cancer? And we have developed this really creative partnership with web MD and as a result of that, over 10 million Americans have seen our videos. And they’re award winning.

We’ve been Webby finalists. So, you know, it just the foundation has just on a personal level, is just, you know, good begets good. And that’s really an example of it. Plus, again, very personally, it has expanded my horizon and, and opportunities in ways I never could have achieved. And that’s because it’s a real partnership with everybody together.

And, you know, the other thing is people asked us from other states, like you asked, can we do these educational events? And that’s how the education of fellows started, because we couldn’t scale up ourselves. But we figured, wow, what if we could scale up by teaching young physicians, young radiologists to become the face of breast cancer in their community as we have here in DC? You know, wouldn’t that be like a really great win-win? And so that’s how that happened.

00;13;49;14 – 00;13;56;22
Laura
It’s an excellent program to have a fellowship involved, too. How many fellows do you accept per year? Is that how it works per year.

00;13;56;28 – 00;14;08;24
Dr. Brem
Yeah, we have three a year. We had the unexpected opening this coming July. So, you know, shamelessly advertising if anybody wants to come to DC and do a breast imaging fellowship let us know.

00;14;08;26 – 00;14;32;27
Betsy
Okay. We will plug it for you. It’s a wonderful opportunity. And we can also we can also put in the show notes. We can put links to all of the videos that you just spoke of and of course a link to the website. I, I appreciated taking the quiz. I, I’m of the age where I should be getting regular mammograms. You have a little bit a little bit more to go, but she’s a little bit she’s a young.

00;14;32;27 – 00;14;37;19
Dr. Brem
It should be. I hope that is. I am.

00;14;37;21 – 00;14;40;09
Betsy
I am you are, yes. Yes.

00;14;40;11 – 00;14;43;07
Dr. Brem
Sorry, I can’t help myself.

00;14;43;09 – 00;14;48;03
Betsy
Thank you for embarrassing me on national television.

00;14;48;05 – 00;14;51;05
Dr. Brem
Never embarrassing!

00;14;51;08 – 00;15;26;23
Betsy
So I am, in fact, a dense breast person. And I have gotten the letters. I’ve gotten the extra ultrasounds, I’ve had procedures that I wouldn’t, without insurance, I would not have been able to, probably get them as easily. I appreciate that. I have insurance coverage, but I understand that that so many people don’t. And, I guess this is a segue into the find it early act. Let’s talk about that.

00;15;26;29 – 00;18;08;01
Dr. Brem
It’s been a very big legislation year for breast cancer. So first, you know, what happened in chronological order is the USPSTF the United States Preventive Services Task Force changed its recommendations for, screening mammography to begin at the age of 40, at the age of 50. And that’s a really good thing. You know, nearly a quarter of breast cancers occur in the 40s, and the cancers in younger women are more aggressive.

So that and the data is compelling and profound, that screening should begin at 40. So after much encouragement, they changed their recommendation to begin a 40. However, they only got it half right because they continue to recommend every other year screening. And I mentioned to you that the death rate from breast cancer has gone down by 50%. And if we go to every other biennial screening, we’ll be able to maintain 81% of the, mortality reduction we’ve achieved.

But what’s the corollary to that? Right? More women are going to die of breast cancer. And that’s unacceptable. So and the USPSTF I think it’s really important to particularly, for radiologists and health care professionals and anybody to listen to this, they need to know a little bit more about the USPSTF So that started in the 70s. It’s for prevention.

So it’s not for people with disease. And it is, a panel of experts in primary care. And it’s very important to remember and to realize that there are no cancer experts. There’s no cancer physician, no radiologist, no cancer medical oncologist, surgical. That is considered a conflict of interest. Okay, so there are no experts on cancer on the USPSTF right.

And the other thing about that, you know, it is a arbitrary metric of what’s an acceptable, threshold for mortality reduction. So what the USPSTF does is it gives a grade of a D or I for insufficient information for, a, health exams, that are for prevention. And the data is very compelling that the death rate will go up if we stop screening every year.

And they and maybe the worst thing about it is that their argument for not screening every year is the harms of mammography, of which guess what? The number one harm of mammography, according to the USPSTF is. What do you what do you thing?

00;18;08;04 – 00;18;08;27
Laura
I don’t know, but.

00;18;09;03 – 00;18;10;02
Dr. Brem
What is it.

00;18;10;05 – 00;18;12;20
Laura
Pain? I don’t know.

00;18;12;22 – 00;21;29;05
Dr. Brem
I’ll tell you. It’s the harm. It’s the stress o anxiety that women are going to feel if they have a false positive mammograms. And all radiologists know, you know, your callback, you’re going to call that 10%. And only a small percentage of those are really going to have cancer. But first of all, I mean, don’t we live in a world where people are empowered, women are empowered and should be able to make that decision themselves.

Second of all, studies have shown that that anxiety’s transient and third of all, as someone who’s been taking care of women with breast cancer for decades, if you tell someone they have end stage metastatic disease, they are going to be far more anxious than if you tell them they have to come back for another mammogram, ultrasound, or even a biopsy to find out if they indeed have breast cancer.

So that’s what the USPSTF does. So that happened last, September 10th. In 2024, the FDA mandate that all women in the United States be told what their breast density went into effect, went into law. That, too, is a wonderful thing, sadly, only half right, because what they say is every woman has to be told that she has.

If she has dense breast, and if she does that, she should speak to her health care provider about steps forward. But we know that because of dense breast tissue, right. Cancers are masked, are hidden. And if we use ultrasound, MRI for that, we can find 25% more cancers. And they’re really important cancers. And you know, you might say every cancer is important, but these are really important because they are small, invasive, largely no negative cancers hidden in in the dense breast tissue because cancers are white and breast tissue is white.

And so, you know, we know that we can find most of these cancers early, that there are less interval cancers, that there are more low grade cancers. If we use MRI and ultrasound to find additional cancers. And so, you know, we wish I personally and the Brem Foundation and many others, the American College of Radiology, we wish that the FDA had gone a little bit further and said, you need additional testing.

Before the FDA mandate went into effect, there were 39 states and proudly the District of Columbia that had some density notification law, and they varied. Some said you have dense breast, some said you have dense breast, and you need more testing. Some said you have dense breast, talk to your health care provider. And some like DC said you have.

And Pennsylvania and Illinois said you have dense breasts. You need more testing and insurance is required to cover it, but not without a co-pay or deductible. So co-pay and deductibles do matter and hence the Find It Early Act. So the Find It Early Act is an act that will remove copay and deductibles for all breast examinations so that women can have these truly lifesaving exams without having to worry about whether they have to pick dinner on the table for their families or, these saving exams. So it will remove the copay and the deductible for examinations for the detection of breast cancer. But that is not yet not past.

00;21;29;07 – 00;21;42;28
Betsy
Okay. What’s can you make any predictions on the, the progress of it or what, what will be a year from now.

00;21;43;01 – 00;22;28;18
Dr. Brem
So the hope is that it will be enacted. We have wonderful partners in Congress. The House side, Rosa DeLauro on the Democratic side, and Brian Fitzpatrick on the Republican side have sponsored this bill. Congresswoman Debbie Wasserman Schultz, a very close friend of the foundation, has been really a wonderful partner with the Breast Foundation, is very supportive.

And now we, are working with others to have Senate sponsors, and I can’t I don’t think I can say anything yet, but this morning I had a phone call that I think we are getting there, that we may very well have a sponsor both on the Democrat and the Republican side.

00;22;28;18 – 00;22;29;28
Laura
In the Senate. Wonderful.

00;22;30;01 – 00;22;36;19
Dr. Brem
Yes, in the Senate. So we’ll see. Do I can I predict. No. Can I hope? Yes.

00;22;36;21 – 00;22;52;17
Laura
So it seems like the challenge so far in the Senate is this broader philosophical debate about the federal versus the state mandates and just spending more federal dollars. Is that do you see any other challenges that are standing in the way of getting this enacted?

00;22;52;19 – 00;23;29;27
Dr. Brem
You know, I think it will cost more. And it is another governmental sort of mandate requiring coverage, as you can imagine, probably don’t have full buy in from the insurance companies. So I think there are a lot of forces working together. But look, we have passed other bills. Bills have passed that require coverage of genetic testing and preventive exams for our military. You know, the FDA mandate passed, mQSA has passed. So we you know, it steps forward and the hope is that we’ll get there.

00;23;29;29 – 00;23;47;28
Laura
Right, so, you say it’ll cost more, but there are I mean, preventative care does reduce overall cost. Correct. And the health care system and inevitably saves lives. So if we can just advocate for this preventative care, women get their screenings, we catch it early. We save lives. You know, I don’t what’s stopping this.

00;23;48;00 – 00;23;52;17
Betsy
What someone in insurance has to know that this that’s how it is.

00;23;52;20 – 00;24;50;02
Dr. Brem
For me. It’s a no brainer, right. And if you do, the economic modeling added cost three times more to care for late stage breast cancer than in early stage breast cancer. And the other thing that it’s really important to remember is we talk about mortality right from breast cancer. And that’s an important metric. But we have to talk about and at the Brem Foundation, we talk a lot about something called the intensity of care.

And that is what does a woman have to go to achieve survival. So, you know, we have great improved and ever changing therapies. Right. We have immunotherapy. We have targeted therapy. We have so many things. But what does a woman have to go to get to a cure, and it’s not the same. It’s more intensive therapy.

It’s more intensive surgery more intensive chemotherapy for later stage disease. And we can’t forget about that as well. So.

00;24;50;04 – 00;25;10;20
Laura
Can you share do you have any firsthand anecdotes of women who, you know, they’ve gotten their breast density notification and don’t have the funding to go for a follow up MRI or a follow up ultrasound? Have you seen that in your practice personally?

00;25;10;22 – 00;25;51;22
Dr. Brem
You know, one is that we recommend additional screening that’s for us and it’s denied by the insurance. Right. And one thing everybody has to learn is that you can advocate for yourself. No, generally no means no. But with the insurance company, no does not mean no. You need to call. You need to advocate. You need to go to the Brem Foundation website and get the data.

And I can’t tell you how many times we have an educational that’s at the Brem Foundation. And someone says, you know, thank you for encouraging me to call my insurance company. I had an MRI. Finally it was approved and they found a small, highly aggressive breast cancer.

00;25;51;25 – 00;25;52;29
Laura
Wow. Yeah.

00;25;53;02 – 00;28;42;27
Dr. Brem
And sometimes, you know, women have to save up for their deductible, right? So even if it’s approved by insurance, the deductible comes into play. And, you know, I have to say personally I feel so fortunate for many reasons. You know, very few people have the 360 degree view that I have of breast cancer. Right. Started as a daughter, a physician, an expert, a patient, a survivor, right.

And a mother of three daughters and now ten grandchildren, of whom six are women or girls. So, you know, one of the things that really speaks to this is that knowledge is power. And because of that, I don’t know if you can see it, but, okay. It’s by Christy Teal and myself, and it’s published by Simon and Schuster, and it’s basically, very practical, compassionate information about breast cancer screening, diagnosis, treatment.

There’s a chapter about, for the life partner of someone with breast cancer. There are questions to ask your doctor, but it’s really all about knowledge is power. And that kind of knowledge, and therefore power will, help you advocate for yourself, for insurance companies, help you advocate for yourself with physicians. And I don’t know how your, you know, radiology group works.

But for us as radiologists, adjunct screening or imaging in women with dense breasts is really hard from a workflow perspective. Right? You come in, you don’t know how many women with dense breast you’re going to have that day. You have limited time on the magnet on more. So, even though we know that if you screen women with Ma with extremely dense breast, from the dense breast study, you will find 16 more cancers per thousand women screened.

Many times we don’t as radiologists. We do here, but, it’s very difficult from a workflow perspective to offer this to everybody that has dense breasts. And that’s why it’s really important for women to advocate for themselves and also as radiologists, to understand how profoundly important it is to, find these early curable breast cancers. And that’s, you know, why Christy and I wrote the book.

Because, we really wanted to share our unique 360 degree view. She’s the head of breast surgery here and did not have breast cancer, but her mother died of breast cancer, and she’s had prophylactic mastectomies. So we wanted to share our insights, knowledge and power, with others. And that’s why we wrote this book.

00;28;42;29 – 00;28;47;15
Laura
We’ll definitely share a link to the book in the descriptions for our podcast.

00;28;47;15 – 00;30;01;23
Betsy
Yes, it’ll be featured. I want to tell you how impressed I am with the entire website in general, but I also did take the quiz and if I can just on the podcast, recommend it to any woman who would just like to know a little bit more about herself and breast cancer awareness and screening. I can I can say right now that I it was an enjoyable experience and that’s hard to say about medical anything medical.

So I enjoyed taking the quiz. I learned a little bit about, some of the, some of the risks. And I also found it very interesting that on the website, it mentions that the number one risk for breast cancer is being a woman. And I thought that was a very clever way of saying to, to the public, everyone should be concerned about it. It’s something that, that doesn’t it doesn’t ignore any demographic and it affects it can affect anyone at any time.

00;30;01;25 – 00;35;34;00
Dr. Brem
And even though the disease, only a only 1% of breast cancer occurred in men. So this year they’ll bet they’ll be about to, 225,000 new cases of breast cancer and about 45,000 women will die of their disease in the U.S., about 2250 men, 1% will develop breast cancer. But there isn’t anybody in the United States that isn’t impacted by breast cancer, right?

Every man, every woman, every child, whether it’s a neighbor or a colleague, you know, a mother, a sister, and even sometimes, sadly, a daughter. Right? Everybody is impacted with 1 in 8 women, 12% of the of women will develop breast cancer in their lifetime. And so even though the disease doesn’t impact men frequently, directly, it doesn’t affect them.

In fact, you know, I’ll share a story with you, which is while I was in the midst of writing the book, my husband and I were on vacation and we were in this beautiful Caribbean resort, and I was feverishly writing, and he came up to me and he said, and this is years after I had breast cancer. We had three young daughters.

When I was diagnosed. And he may not have had breast cancer, but he absolutely was profoundly impacted by breast cancer. And he came up to me and he said, are you going to have a chapter on the life partner of somebody with breast cancer? And I sort of looked up at him and I said, you know, we will now because it didn’t even cross my mind.

But it’s really important. So everybody is impacted by breast cancer. And, you know, it’s been so extraordinary that the most educated people need more information about, you know, risk factors, which is what, you know, the Brem Foundation does, you know, risk factors and screen and risk based screening. That and how often does someone say, you know, I cannot believe that someone can have breast cancer with a normal mammogram, but that, you know, as a radiologist, we see that all the time.

And that’s why we need these additional screening modalities, that mammography is very effective and very important in the incredible reduction in the death rate from breast cancer. But having a normal mammogram is no guarantee that you don’t have breast cancer. And that’s not a widely known fact. And that’s why this whole knowledge is power situation. And then, you know, for me, if I would have shared with you that if you would have said I’d be involved with a nonprofit 25 years ago, I wouldn’t have believed it.

And even until Claire Daugherty, our CEO, took over as the CEO several years ago, now, I didn’t understand the incredible impact of advocacy. And without that, without partnering with media, with, social media, with advocacy, we really won’t be able to have nearly as much impact, no matter how significant or important your work is. And Claire Daugherty has taught me so much about advocacy.

She’s really an expert, comes to the Brem Foundation with an enormous amount of experience on advocacy work on the Hill. And I have to say, you know, it’s really been her vision that we’ve increasingly had a seat at the table. So, you know, the one thing I’d say to radiologists, if I could or whoever listens to this is, you know, think outside of the box.

There’s so much we could do beyond, you know, fantastic clinical work, whether it’s the opportunity to not only practice great medicine but advance it with new technologies. You know, I’ve been involved with this, you know, a number of very exciting new technologies, including ultrasound tomography, a technology that’s recently FDA cleared that sort of helps us both improve the detection of breast cancer and improve the specificity.

But just to understand, for me how life enhancing all these tributaries of radiology have been for me, whether it’s the foundation or work on the hill being involved with companies to bring new technology to the clinic. So I think, you know, just for anybody, but especially for radiologists, if you look around, there are opportunities to make the world a better place in a very real way.

Being in DC makes advocacy easier, but there’s enormous on the state level, as well. And in fact, last week, the day before the FDA mandate came into effect, Peter Eby from University of Pennsylvania and Sally Friedewald from Northwestern were on the hill lobbying extensively for the funded early act. So you don’t have to be in DC.

You know, the Society of Breast Imaging, the American College of Radiology is very involved in advocacy for many different aspects of health care and radiology. And, you know, I’d love to just share my own experience of, you know, being impacted. So, you know, sort of being exposed to the difficulties of breast cancer from a very young age, but also seeing, you know, the gift of the passion that that’s brought into my life to try to see things and make it better. It’s just been, you know, a gift.

00;35;34;03 – 00;37;18;17
Betsy
I’ve been I’ve been reading about AI and radiology in general. But I understand that mammography has been very affected by developments in AI. Is that anything? You can tell us a little bit more about? How do you have experience. Does the Foundation have any experience with the with the use of AI for detection?

00;35;58;15 – 00;36;21;15
Dr. Brem
So the, the foundation doesn’t practice medicine. But here at GW we are very strong proponents of AI. Every single one of our mammogram has been evaluated with AI for 15 months now. We use, what we think is unequivocally the most effective AI called Transpera by a company called Screen Point, a Dutch company. We use it on every mammogram.

And the data is compelling that not only does it make reading mammograms faster and makes us more confident, you know, I used to be reticent of reading screens late in the afternoon when I was tired, but with AI, I’m not ever. I’m not worried that I’m going to miss something, but the data is compelling, that it finds breast cancer is up to four years earlier, and that it sees things through the deep learning algorithms that humans can’t.

And in fact, you know, you can sort of think of it as short term risk. So I think, you know, people say aren’t you as a radiology afraid that you’re going to lose your job because of AI. Right? So I always like to say radiologists aren’t going to lose their job to AI. Radiologists who don’t use AI will lose their jobs to radiologists who use AI.

00;37;18;19 – 00;37;20;26
Laura
Sure. It’s an extra tool in your tool belt.

00;37;20;28 – 00;39;35;26
Dr. Brem
It is an extra tool. At the end of the day, you’re the final decider. Studies have shown large, well-defined studies have shown that the function of AI is as good as radiologists. And, you know, two things I want to say. One is with healthcare disparities, AI is going to be such an important tool to help us break down these disparities, because in many underserved community, we don’t have subspecialized radiologists.

But AI can make general radiologists read mammograms with the expertise of subspecialized radiologist. Right. And so, you know, my dream would be not only that it states, but like places like Africa, where the death rate is very close to the incidence of breast cancer, wouldn’t it be great if we could just use AI to find those women that need additional screening and have sort of a spoken wheel system that they can go to a central place?

You know, because the dearest resource is human resource. So AI can make general radiologists function as well as some specialized radiologists. It can make technology available more available because it results in reading faster. And, you know, a very small percentage of mammography practices use AI widely now and in mammography. But if you go to the RSNA, the exhibit floor is full of AI companies and they’re available now for pulmonary embolism and brain bleeds and lung cancer.

And so many other things. And I you know, of course, we have to be careful to use it properly. In Europe, where every screening mammogram has to be read by law by two radiologist in the countries. AI is so good that Transpera AI is used in four countries in Europe as the second reader. So it allows more mammograms to be read.

So AI I think it’s very exciting. It has to be appropriately used, but I think it’s just going to make radiologists better and it’s going to save lives. We use it on every case.

00;39;35;28 – 00;39;44;05
Betsy
RSNA 2024 I believe the theme is AI. The entire theme of RSNA 2024.

00;39;44;07 – 00;39;52;05
Dr. Brem
Yeah. I mean, that’s I mean, the exhibit floor was largely filled with AI companies last year as well.

00;39;52;07 – 00;39;53;16
Betsy
Are you going?

00;39;53;19 – 00;39;54;21
Dr. Brem
Yes, absolutely.

00;39;54;22 – 00;40;02;01
Betsy
I am I’m headed there with leadership here. So maybe I’ll run into you. Maybe we should get coffee together.

00;40;02;03 – 00;40;03;10
Dr. Brem
Have you ever been?

00;40;03;13 – 00;40;04;24
Betsy
I’ve never been.

00;40;04;27 – 00;40;05;25
Dr. Brem
To the experience.

00;40;05;25 – 00;40;06;04
Betsy
Yeah.

00;40;06;04 – 00;40;10;10
Dr. Brem
It’s my it’s my 34th RSNA or something, like that.

00;40;10;10 – 00;40;17;00
Betsy
Okay, it’s my first time, and I, I’m looking forward to diving in and trying to learn as much as I possibly can.

00;40;17;04 – 00;40;21;00
Dr. Brem
You will learn so much. My biggest advice to you is wear comfortable shoes.

00;40;21;02 – 00;40;23;05
Betsy
Okay. All right, I will.

00;40;23;07 – 00;40;24;04
Laura
It’s a large.

00;40;24;07 – 00;40;29;05
Dr. Brem
You will get your steps. You will get your steps.

00;40;29;08 – 00;40;53;05
Laura
All right, Doctor Brem, this has been a really great conversation. Thank you for your time and for sharing all of your insights on breast cancer awareness. The find It early act. It was super interesting to learn about how the Brem Foundation is making a difference in people’s lives. You’re a partnership with Lyft is just everything. Thank you, thank you, thank you.

00;40;53;12 – 00;41;09;21
Dr. Brem
It. Is it is, you know, it is an extraordinary group of very committed people who run the Brem Foundation day to day, which I don’t, and for whom I’m incredibly grateful and from whom I learn every single day.

00;41;10;25 – 00;41;19;24
Betsy
This will air in October. It will be breast cancer awareness month. Do you have an uptick in activity during.

00;41;19;24 – 00;41;45;09
Dr. Brem
Oh, God. Yeah. Okay. October is a very busy month. It’s a very exciting month. But, there’s always all sorts of things. And, you know, we, Claire, the CEO and I will be traveling a good bit. We’re giving, you know, some conferences in Chicago and other places in the country. We were supposed to be at the New York Times doing an event book signing.

But the somehow the small election that’s going on has. Distracting for news media. So we’ll do it again later in the year. But yes, October is very exciting and it’s an opportunity to teach and educate visibility. You know, it’s got many good things. So we are very busy in October.

00;42;07;07 – 00;42;09;00
Betsy
And we love hearing this.

00;42;09;02 – 00;42;28;29
Dr. Brem
Thank you. You know the foundation we have our big annual event. We had one this past week called Brem Bash. We had a country music sort of hoedown as a fundraiser. And then we have our big annual event called empower. Our last year, we were very fortunate to have the head of the NIH, Doctor Monica Bertinelli, speak as our keynote speaker.

00;42;28;29 – 00;42;36;20
Dr. Brem
We’ve had members of Congress in the past and other real leaders. So, that’ll be on April 25th this year. Come, come.

00;42;36;22 – 00;42;38;01
Betsy
Yeah. Send us information.

00;42;38;01 – 00;42;39;07
Dr. Brem
We should. Okay.

00;42;39;09 – 00;42;54;05
Laura
And if any of our listeners are interested in learning more about the foundation, about, donating or getting involved volunteering, visit bremfoundation.org. We will link it in the show notes as well. Thank you, Doctor Brem again for coming.

00;42;54;05 – 00;42;55;25
Dr. Brem
Thank you for your. This is great.

00;42;55;27 – 00;42;57;20
Laura
It really was really nice to talk.

00;42;57;21 – 00;43;03;05
Dr. Brem
Thank you. Thank you so much for all you do. I look forward to meeting you at RSNA in person.

00;43;03;07 – 00;43;07;18
Betsy
Thank you. I will I will, reach out. We have your email, and I’ll be in touch.

00;43;07;20 – 00;43;10;02
Dr. Brem
Awesome. Thank you so much.

00;43;10;05 – 00;43;13;29
Betsy
I was very excited to speak to her today, and she delivered.

00;43;14;04 – 00;43;23;06
Laura
She sure did. And I’m really excited to see what happens with the Find It Early Act. I hope that it ends up getting passed. Yes. All right. You ready to wrap this up?

00;43;23;06 – 00;43;24;18
Betsy
Let’s wrap this up.

00;43;24;20 – 00;43;46;00
Laura
If you have anything you would like to share or add to our conversation, or if you would like to be a guest on RadCentral, please visit RadCentralPodcast.com. Thank you for listening. RadCentral, a radiology podcast, is a production of Excalibur Healthcare. Be sure to like and subscribe wherever you get your podcasts. From all of us here at Excalibur. Have a great week!

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** The views, opinions, and statements expressed by guests on this RadCentral are solely their own and do not necessarily reflect the views, opinions, or positions of the RadCentral podcast, Excalibur Healthcare, or its hosts. Excalibur Healthcare does not endorse or guarantee the accuracy, completeness, or reliability of any information shared by guests during the episodes. *

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