Healthy Choices

Q&A: Longtime cancer surgeon Dr. Ernie Bodai on women’s breast health

Dr. Ernie Bodai, who helped create the U.S. breast cancer fundraising postage stamp in 1998, is director of Kaiser Permanente’s Breast Cancer Survivorship Institute.
Dr. Ernie Bodai, who helped create the U.S. breast cancer fundraising postage stamp in 1998, is director of Kaiser Permanente’s Breast Cancer Survivorship Institute. Sacramento Bee file

Last week’s news that women should wait longer to get regular mammograms rocked the breast cancer world.

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In Sacramento, the American Cancer Society’s recommendation to delay most mammograms until age 45 prompted calls to breast cancer surgeons such as Dr. Ernie Bodai, who has practiced for more than 30 years at Kaiser Permanente. Bodai, who has treated about 15,000 women, also pioneered the Breast Cancer Research Stamp, launched in 1998 as the country’s first fundraising postage stamp. That stamp has raised more than $80 million in research monies and is close to hitting the 1 billion mark in U.S. sales.

Today, Bodai no longer performs surgeries but is focused on post-cancer recovery as founder of Kaiser’s Breast Cancer Survivorship Institute.

In the wake of recent news developments on breast cancer, we talked this week with Dr. Bodai. Here’s an excerpt:

Q: The recent American Cancer Society recommendation stunned many breast cancer survivors, some of whom say they’d be dead if they had waited until age 45 to get a mammogram. What’s your take on the ACS’s change in policy?

A: The frenzy around the nation (when the new guidelines were announced) was incredible. It was kind of shocking to go from age 40 to 45. ... It’s a little bit disconcerting that every few years new recommendations are coming out. Now we have three large, well-respected groups with three different recommendations on when to start mammograms (American Academy of Obstetricians and Gynecologists at age 40; American Cancer Society at age 45; the U.S. Preventive Services Task Force at age 50). Even the medical community is confused about which guidelines to follow. ... The new recommendations (for starting at age 45) are related to “normal risk” women. But nobody really knows what a normal risk is. As far as I’m concerned, if you’re female, you’re at risk of getting breast cancer. The No. 1 risk factor is being female.

Q: What should women do?

A: Each individual patient should have a very detailed discussion with their primary care or ob/gyn physician about when to start screening. ... I’d have a discussion about risk factors. If they have extremely dense breasts, they might need mammograms (earlier). Or if they’re anxious about breast cancer, they should think about doing a mammogram sooner. It’s really an individual decision. ... My recommendation is a baseline mammogram at age 35, then annual mammograms starting at age 40. But if you have a sister diagnosed at age 37, for instance, you should have a baseline at 32 (five years before the age of diagnosis for a pre-menopausal, first-degree family member.)

Q: The Cancer Society’s recommendations are partly based on research looking at risks/benefits of early mammograms that can lead to false positives and overtreatments. Is this a case of research leaping ahead of people’s perceptions of mammograms?

A: A lot of the research is retrospective; not looking forward, but looking backward. Part of the reason there’s such a discrepancy between the three major cancer groups is because of the way they look at the data. With the advances in digital and 3-D mammograms, it could be comparing apples and oranges if they’re making recommendations based on studies conducted 10 years ago. ... The other thing that’s important is over the last 10 to 12 years, there’s been a radical change in radiologists. Some radiologists have developed a subspecialty dedicated and devoted solely to mammograms. You have to believe that people who are dedicated only to reading breast imaging are going to do a better job. ...

Mammograms are so sensitive now that you can pick up lesions that are less than a millimeter. We’re finding them and treating them. Are we overtreating these early cancers? These are questions I wish we had answers to, so we could separate out which ladies need aggressive treatment and which ladies don’t.

Q: Your breast cancer stamp is now 17 years old. What’s the status?

A: As of a couple months ago, we have sold about 993 million U.S. stamps. We’re trying to sell the 1 billionth by December. I’m planning on going to a post office in Washington, D.C., with Sen. (Dianne) Feinstein to buy the billionth stamp. It would be great to bring huge awareness to the stamp nationally. ... Many people have never heard of the stamp, but there’s also a very faithful following across the country (who buy them) because they’ve been touched by cancer. ...

It’s due to expire Dec. 31. Every four years, it has to be re-authorized. Right now, it’s passed (unanimously) in the U.S. Senate (co-sponsored by Feinstein), but is pending in the House (co-sponsored by Rep. Jackie Speier, D-Hillsborough).

It’s now 60 cents (per stamp) and 11 cents goes to research. We’ve raised $80.3 million, every single penny of which has gone to breast cancer research. About 30 percent goes to congressionally directed medical research through the Department of Defense directed at breast, ovarian, prostate and other cancers and 70 percent goes to the National Institutes of Health. Many of the studies have found things that are applicable to other cancers, like prostate, lung and colon. We’re really fighting cancer on all fronts.

Q: A new study shows the rate of African American women diagnosed with breast cancer is catching up to white women. At the same time, U.S. breast cancer death rates overall are declining, although black women still have the highest breast cancer mortality rates. Any thoughts on why that’s happening?

A: Death rates overall are going down because of earlier detection and more effective treatments. Many women are diagnosed with much earlier stage cancers. That leads to lower death rates.

African Americans usually are diagnosed with breast cancer at a more advanced stage, 2 and 3. A lot of people argue that’s because (in poorer communities) they don’t have as much access to health care, so they tend to not get regular screenings. That’s a huge factor. The diagnosis rates are going up because they are now getting more access to health care and getting more educated about the issues related to breast cancer symptoms.

Q: Why did you switch from surgery to start a breast cancer survivorship center?

A: There’s a real need for this. We see the ladies after they’re done with all their cancer treatments. It’s a time when they may feel abandoned by their oncologist. They had a security blanket of seeing a doctor every week that goes away. ...

One of the big problems is that there are more and more cancer survivors and fewer oncologists. It’s projected that by year 2020, there’ll be a lack of 3,800 oncologists nationwide, due to attrition and fewer doctors going into the field. They can’t follow these patients once they’re finished with their acute treatment. It’s going to fall in the lap of primary care physicians. We provide a plan going forward for the patient and their primary care doctor on here’s what they need to do: Annual mammograms, colonoscopy (depending on age), what labs to order (yearly checks for vitamin D, cholesterol, bone density, etc.), annual skin cancer check. ...

For the patient, it’s a 90-minute counseling session about the surgery and meeting with an oncology nutritionist. We provide a treatment summary and go over the long-term side effects of chemo, symptoms of recurrence and a lot of time counseling about a healthy lifestyle, mainly diet and exercise.

Q: What’s your prescription for a healthy lifestyle?

A: Avoid red meat and processed foods. ... We’ve been preaching that for years. Ladies can decrease their rate of breast cancer recurrence by up to 50 percent if they maintain a healthy BMI (body mass index) and avoid highly processed foods, red meat and dairy. The emphasis is on a whole-food (fruits, vegetables, nuts), plant-based diet ... anything that doesn’t have parents or eyes.

I invite their family members because all the (lifestyle) information applies to their spouse, mother, sister. It applies to everyone (male or female).

Part of the lifestyle recommendations we make for women are 1,200 milligrams a day of calcium and 2,000 units vitamin D3. About 75 percent of women who are diagnosed with breast cancer are vitamin D deficient. ... If they’re within (the normal range), their chance of cancer recurrence goes down. We also recommend 81 milligrams a day of generic baby aspirin, which decreases the chance of stroke, heart attack, blood clots, colon cancer, skin cancer and recurrence. Next to antibiotics, it’s a miracle drug.

They’ve just been through a very scary event in their life. It’s an intense visit. If they’re ever going to listen, it’s then. All I can do is give them the information. I can’t walk up the stairs with them instead of taking the elevator. I can’t make you eat a plant-based food, if you want to eat a hot dog. ... Cancer is a wake-up call to change your diet and exercise.

Claudia Buck: 916-321-1968, @Claudia_Buck