Taking Healthcare by Storm: Industry Insights with Dr. Amy Kelly

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Amy Kelly, MD, Assistant Professor of Radiology at UPMC Magee-Womens Hospital in Pittsburgh, Pennsylvania, and a board-certified diagnostic radiologist with over 15 years of experience specializing in breast imaging. 

Dr. Amy Kelly discusses advancements in breast imaging, emphasizing the importance of annual screenings, early detection, and improving patient outcomes, with a focus on addressing disparities and leveraging social media for education.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website.

Publication number QI-080825-GK

Transcript

 Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

Subscribe now, and together, we can take healthcare by storm.

 Hello everyone, and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the medical Director of Quality Insights, and today we are joined by Dr. Amy Kelly. Assistant Professor of radiology at UPMC Magee Women's Hospital in Pittsburgh, Pennsylvania, with over 15 years of experience in breast imaging.

Dr. Kelly is a nationally respected expert whose research and evidence-based work have advanced breast imaging techniques and technology, something that is so very important in women's health. Her clinical focus lies in improving patient outcomes through innovation. And she's also deeply committed to radiology, education, mentoring, and using social media to make medical knowledge more accessible and meaningful.

And I am now following Dr. Kelly's Instagram account and I have learned so much and um, we'll let you know how you can follow her as well. I'm excited to talk. With Dr. Kelly about the future of breast screening, breast cancer screening, imaging innovations, and the role of education in patient care.

Dr. Amy Kelly, thank you so very much for joining us today. Thank you so much. I'm really excited to be here with you. Thank you for that kind introduction. And I'm just honored to be here. Thanks for allowing me this platform. Yes. So we are very happy to have you. So tell us how you came to do what you do now.

Okay, so starting way back in high school, I loved the sciences. I loved learning about the body how everything worked, understanding diseases, and so that is what really drove me to go into medicine. I will say I had a lot of great mentors along the way as well. A few family members, not many go into medicine, so they were really great as far as getting me exposure into the field.

And then once I was in medicine, I really grew towards radiology because I am a very visual learner. I love learning visually, teaching others visually. And I love the idea of using images to understand diseases in the body, how things are working, what's not working.  And then once I was in radiology, how I got into breast imaging.

 A couple different reasons. I love working with women.  I feel like. Breast imaging of radiology is a really meaningful specialty for me. I feel that I, I do make a difference in patients' lives through early detection. And it's just, it's a challenging specialty of radiology, but also very rewarding at the same time.

I can imagine. So you mentioned radiology. And you mentioned breast imaging, radiology. So for those individuals out there who maybe are not sure what is, a radiologist and what does it mean to be a breast imaging radiologist? Okay. That's a good question to start with. So radiologists are real doctors.

Some people don't think that but we did go to medical school. We actually went through a lot of training, even after medical school to become a radiologist.  After medical school, there's one year of internship. There's four years of general radiology training or residency. And then I actually did another year after that just focusing on breast imaging.

 And that was my fellowship. But in general. Radiologists  read or interpret various medical imaging technologies and modalities such as ct, MRI, ultrasound, and we interpret or read these images to help our colleagues, other doctors understand what's happening inside a patient's body if tumors are growing, infection, inflammation, that types of things too.

Help their referring doctors better take care of the patient and diagnose diseases and malignancies.  Radiologists also are able, one of the things that I love about my specialty is we do procedures as well. So there's an interventional or procedure aspect to what I do and what some other radiologists do.

So we also. Not only read a patient's breast imaging, but we also do the biopsies, the interventional procedures to diagnose cancers. Exciting work, I will say. All, all around.  breast cancer affects one in eight women in the United States  and we know that survival rates are the highest with early detection.

We actually, here at Quality Insights are involved in a state contract in Pennsylvania where we really are working with practices to try to develop that workflow for. Early intervention, really making sure that patients understand the importance of early intervention and  making sure the practices are implementing that.

So how do you emphasize the importance of annual screening and educating patients about the different stages of breast cancer and and the importance of early detection? Yeah this is a, great question. This is an important thing and, and a really important part of what we do.  So we know that breast cancer, the risk is definitely there.

It's one in eight women can develop breast cancer in the United States. And we also know that you know, the whole purpose of screening annually, starting at age 40 is to detect diagnosed breast cancer if it is there so that it can be treated at the earliest stage possible. And  we know through decades of research and the research that's been done globally and even in our institution at UPMC.

If screening is done at age 40 and starting annually, the stage of diagnosis is lower or earlier, and that results in better patient outcomes, better patient prognosis less intensive surgeries that's needed, less intensive. Treatments that's needed. So it's just  really beneficial to do the screen, to diagnose cancer if it's there early so that it can be treated more effectively and have better patient outcomes.

And we know that there's about four different stages of breast cancer. There can be stage zero. What we as radiologists know as ductal carcinoma in situ to, or cancer that has not invaded outside of the ductal structures of the breast. That's actually stage zero and the prognosis survival rate is approaching 100%.

If. Breast cancer is diagnosed at that. At that stage, it's treated. Patients do extraordinarily well. In contrast to that stage four or when cancer has spread not only through the ductal structures in the breast, but outside of the breast into the lymph nodes, the survival prognosis outcome is much lower.

So there's a great. You know, Not only survival benefit, but there's also a benefit for the patient as far as  I like to stress less intense treatment and surgery when it's diagnosed earlier. So, Screening mammography is, something that I think can be done pretty easily. It's free for the patient, it's available, and it's just a really important screening tool that can really help in so many ways.

 I think that's, I think maybe a lot of people don't understand that if it stayed zero and it's found a hundred percent survival rate, so like everyone. Yeah. That's a pretty per persuasive argument. Yes and I will say that there's a lot of talk about. Self-breast exams  and being aware of lumps and as a breast imager, a specialist when it is a lump, when it is a palpable area of concern.

That's almost, too late for us as breast imaging specialist, we wanted to detect a diagnose it before it becomes clinically evident or before it becomes a palpable area of concern for our patients. Yes. So given disparities in breast cancer outcomes that we know of among racial and ethnic groups, especially higher mortality rate among black women, what steps can the medical community take on the whole to improve early detection and outcomes in underserved populations?

This is a great question and, something that we are thinking about often these days. There have been a lot of research studies recently, which has shown significant disparities in minorities as far as breast cancer diagnosis. And their outcomes. And so I think the important thing is to improve access to screening.

screening mammography is number one. We do have a lot of mobile mammography units that are available and do go out to rural and underserved areas. I think it's important to keep Medicaid and insurance coverage available for patients of all socioeconomic areas to have access to screening.

Right now, screening mammography is, free. So that is a great thing. We wanna continue to have it be free. I think that it's, important to have our current patients who are a minority to go out and speak to their community. Currently we have,  a video that is going out in WTAE  that's one of our partnered news stations, and it is an African American woman who describes her experience with mammography and actually contrasted enhanced mammography and how that new technology helped to save her life.

So I think having,  women of similar backgrounds and ethnicities speak to their community to talk about their experience is really helpful. I think that's a really powerful to have patients share their stories, and sometimes it's easier for. Women to hear stories of other women like them versus a healthcare provider.

So sometimes it's easier for them to understand and listen. We are doing more education in our healthcare system about implicit bias and equity-based care.  So I think that there's a lot of improvement that's happening, but still more that can be done and should be done in the future.

Yeah, I think your education is so very important.  Most definitely.  And research has shown it works. So switching gears a little bit was something that I found really interesting. Can you tell us about the radio? Yeah. I thought this was so cool. Tell us about the radiographic social media. And digital innovation team.

What are some of the key ways the team uses social media which is  to increase engagement and visibility for the radiographics content. Yes. So Radiographics is a peer reviewed journal, which is amazing. It's been around for quite some time and it's targeted towards radiologists.

In all specialties. They have amazing articles and it the. The journal itself has evolved wildly over the last decade or so. It used to be a paid subscription to a paperback journal that you would get in the mail once a month, and now it is available online. And what the social media committee or a team.

Does is they help get these articles and information out there, not only to people who may not be able to afford the subscription for the articles, but in the United States, but globally.  There  and that's almost  like a underserved outreach, if you will.

 Because we are getting these articles out to people who normally would not have access to them  through I guess it's called X now, right? I keep wanting to see Twitter, but now it is X and so we're using primarily x that platform to take important articles, reduce them into a. Few slides of pertinent points or teaching points and then disperse it into social media.

So we're able to educate more radiologists around the world  make connections  teach it. It is really quite amazing.  And it has been helpful for me and I know a lot of other people around the world too. Grow our field and make connections with each other and learn at the same time.

It's really exciting. It's a good use of social media, I'll say. Yes. Yeah. Social media definitely has its pros and cons. I think that's one of the benefits of social media. So can you explain the UPMC breast Cancer Risk assessment process? How it works and I was looking at this  risk assessment.

It's very complex.  I know that there's some tools used like the Gale or Tyler ICK models, and I know they play a role. So can you just explain to us how that risk assessment process works?  So we are fortunate at Magee at UPMC to have a genetics and risk assessment program, which is a whole healthcare team that is.

Its purpose is to identify at-risk women for both breast and ovarian cancer, have them come in, talk about their potential risks  determine if they do use the, I think that they use the Gale model actually as a risk calculator in our particular clinic.  And they also determine if a patient may be eligible for, or if genetic testing is appropriate.

Genetic testing is not appropriate for everybody, but for some women it is. And what's great about the clinic is they sit down with the patient and talk about. Everything that the genetic testing entails as far as cost and what the results are and the implications of the results, not only for the patient but for her family members.

Sometimes that information is, missed in the setting outside of a professional genetics counselor. What we do as breast imaging radiologist is we try to identify patients when we're reading mammograms, reading images. We look at the patient's imaging and their particular history to see if they may benefit from being evaluated at our uh, UPMC Breast Cancer Risk Assessment Program.

So that's really exciting. Yeah some, things that trigger our referral for our patients to go to the clinic are patients with a family history of breast cancer, specifically multiple family members on the same side, or family members premenopausal who have a history of premenopausal breast cancer.

Any woman with a family history of ovarian cancer. Any woman who is at risk for a genetic mutation or who has a personal history of atypical breast lesions, those women are getting referred to the Breast Cancer Risk Assessment Program at our hospital. So those patients then I guess, are determined to be high risk.

Yes. It depends.  By definition, high risk is anyone who's calculated lifetime risk for breast cancer is at or over 20%. Other women who are considered to be high risk are women who have known. Genetic mutations such as the BRCA mutations that we hear a lot about other women who are considered to be high risk as anyone who's had chest radiation at an early age prior to age 30.

So those are just some of the many reasons why a patient may be considered high risk. Okay, so if, an individual is identified as high risk and in the program, how do you determine which prevention strategies like screening, enhanced screening, medication, surgery are the most appropriate for the individual?

So that is, a great question. I can speak about what we do as far as supplemental screening or screening for high risk women. I am not an expert as far as the medications such as tamoxifen or risk reduction surgeries that would be more reserved for the genetics. Providers and the surgeons, but what I can say from a breast imaging standpoint is a woman who is at high risk is recommended for supplemental screening in addition to mammography with breast MRI.

That is what we have really moved towards for supplemental screening  in addition to mammography over ultrasound, because breast MRI has a higher cancer detection rate and a lower false positive rate. Versus ultrasound and the women who we are recommending to have breast MRI for are those high risk women.

The patients who have a calculated lifetime risk over 20%. Anyone with a known genetic mutation. A patient who has a personal history of invasive lobular carcinoma, anyone with a history of chest radiation at a young age prior to age 30, those women we do recommend supplemental screening with breast.

Mr. That makes sense. So new research from UPMC highlights a clear survival benefit for women who have annual mammograms compared to those who are screened less frequently. And I'll say, I think it's a little bit challenging given the conflicting national screening guidelines. So how do findings like these influence your conversations with patients or maybe your conversations on social media?

Because I think we're moving away from annual mammography you mean like the US preventative task force recommendations? Is that what you're referring to as far as moving away from Yeah. Correct. Yeah. Moving away from, yes. Yes, there. So that, unfortunately there are different, depending on which organization you're looking to, there are different guidelines.

Unfortunately in, in our opinion as breast imaging experts, the US preventative task force I, I believe there. Recommending Biennial, which is every other year. And that is confusing because from our perspective, the Society of Breast Imaging and American College of Radiology and NCCN and American Cancer Society as well we all recommend.

Mammography starting at age 40 and annually thereafter. And you may be referring to a research that was done by my chair, Dr. Zuli, that was just published in 2024, so not too long ago. And they studied over 8,000 patients and they actually. Were able to look at the breast cancers and look at the stage of breast cancer that was diagnosed and go back and look at how often the woman in particular was being screened.

For example, if a woman was being screened annually. Every other year or intermittently. And we showed that there was a significant difference in the stage of diagnosis, depending on her interval of screening. For example, if a woman was being screened annually, late stage diagnosis was about 9%, versus a patient who was, screened intermittently. Their chance of getting a late stage diagnosis was 19%. So there is a big difference between how often a woman is being screened and then her, if she is diagnosed with breast cancer, the stage at her time of diagnosis. So, Unfortunately there is some conflicting guidelines out there and there is a lot of controversy on the.

Studies and the data that the US preventative Task force has used to come up with these guidelines we do not support them, is all that I can say.  And we do have quite a bit of, research  and data to show that release screening at age 40 and annually. Saves the most lives and life years and DI is diagnosing cancer at an earlier stage.

I would agree a hundred percent. And that's what I tell, you know anyone who asks me, so I think that's what, yeah. So the new Reg, FDA regulations are requiring breast density notifications for all mammogram patients starting in September  2024. I don't know if, you have seen this impacting patient understanding or follow up imaging decisions and any conversations between radiologists and referring providers.

I am honestly, as a patient, really as a patient and a provider really curious about this subject. Yes. No, this is a great thing to talk about. And I think, I personally think it is a great improvement in communication between the radiologist referring provider and the patient herself.  Yes, so in.

September 10th, 2024, the FDA passed a federal national law that requires that any mammogram report have a communication of the patient's breast tissue density to her in plain language. And an in some sort of information on what that means. So the FDA required mammograms to state the breast tissue density.

I think of it as, as kind of a , two parted task. The first part is for patients to become aware of their breast tissue density. So we kind of, tackled that first goal with the FDA law and the papers that are sent to every patient with information about their breast tissue density. The second.

Bigger and almost arguably more important part of that task is to provide education for the patients on what to do next. So she knows she has breast tissue, dense breast tissue, what to do next and. This is a really important conversation because breast tissue density is common. It's almost half.

About 40% of women, depending on their age, have dense breast tissue. And it is important because we know as mammographers that having dense breast tissue makes the mammogram a little bit less sensitive. It makes it harder to diagnose breast cancer, so that's also an important part of communication education that we're trying to get out to our patients, is that yes, you have dense breast tissue and it does make it harder for us to read your mammogram, and sometimes breast cancers can be missed in the setting of dense breast tissue.

So I really encourage patients to have a conversation with their referring provider and or radiologist about the implications of their breast tissue density and primarily if supplemental screening is right or indicated for them. And this is a little bit nuanced and we recommend supplemental screening kind of on a spectrum, and we consider a patients.

Breast tissue density and their risk factors when making that decision. I will say that for women who have extremely dense breast tissue or category D, when we're determining a patient's breast tissue density, we break it up into four different categories. So a woman with the most extreme, tissue, extremely dense breast tissue. We do recommend supplemental screening for all of those women in addition to mammography. And as I mentioned earlier, we do supplemental mr. I had no idea. 40 to 50% of women have dense breasts on mammography. Yes. Yeah. So the kind of statistics that are commonly thrown out there by breast imaging experts are  we know that about 40% of women have dense breast tissue, and in the setting of dense breast tissue.

40% of breast cancers can be missed. So that is, a significant number and something that  we need to be aware of the limitations of mammography and recommending supplemental screening in addition to mammography, if it's indicated. Yeah. Really important.  Last question. As technology continues to evolve as.

  What do you see as the most promising advancements on the horizon for breast cancer screening and imaging, and how might they change the way we detect and diagnose breast cancer in the next decade? Oh, this is a great question. I love this question.

So I think probably at the forefront of everyone's mind is ai. So I think that we will be using AI more, not necessarily to read the images alone by themselves, but to kind of improve workflow efficiency, help eliminate. False positives help improve our cancer detection rates.  New imaging technologies such as contrast enhanced mammography, which we're really excited about at Mickey.

I think  that is gonna be more centralized to. Helping to screen patients, and I think that there might be a possibility of using that as a standalone  screening modality in the future. Contrast enhanced mammography supplemental screening with breast MRI and, abbreviated breast MRI or ultra fast breast MRI is something that we're doing more at Magee, which is.

Cheaper, quicker, faster screening tool um, that's gonna become more popular in the future. And then I did just wanna bring up this really interesting, exciting thing that I just learned about. I don't know if you've heard, if you've heard about the Pizo electric ultrasound that was used in space when the women just went up into space recently.

Oh, that's cool. But yeah, it's this. Pizo Pizo, I don't even know if I'm pronouncing it correctly. Pizo Electric Ultrasound, which is this portable ultrasound that the women were wearing when they went up to space and it, it actually is able to detect breast tumors and they're thinking that down the road and the future, this might be something that a woman could.

Wear or take home. It's really portable and efficient and lightweights and used to help diagnose or detect breast cancers or fast-growing tumors in the interval between when she's coming in for screening. So,  I think that there's a lot of room for technology advanced. Demands and it's a really exciting time.

I know in radiology in particularly, it is fast growing and fast evolving with new technologies.   Look forward to some of those things in the future. Yeah, I do as well. Dr. Amy Kelly, thank you so very much for joining us. I know you have an Instagram because I follow it and I get lots of great information.

So can you tell everyone  how they can find you on Instagram? Sure. Thank you. So my Instagram is Amy Kelly, md and I'd love to have you guys. Follow. Um, and if you have any questions or anything like that, just DM me. I'm happy to respond and help you guys with your breast imaging journey.

 Dr. Amy Kelly, again, thank you so very much for joining us. It's been a really interesting and enlightening conversation. Thank you so much. Have a wonderful day.

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.