Breast Cancer Surveillance: Knowing Your Risk and Your Options with Dr. Rachel Brem

The Positive Gene Podcast | Hereditary Breast Cancer Series, Episode 2 Knowing you have an increased breast cancer risk brings important decisions. If you choose continued surveillance, what does “watching closely” actually look like? In the second episode of our 10-part hereditary breast cancer series, host Sara Kavanaugh welcomes Dr. Rachel Brem, a breast imaging radiologist, breast cancer survivor, BRCA1 carrier, and co-founder and chief medical officer of the Brem Foundation. Dr. Brem shares how her mother’s breast cancer diagnosis at age 33 shaped her career, and how she discovered her own breast cancer while testing ultrasound equipment shortly before a planned risk-reducing mastectomy. Together, Sara and Dr. Brem explore the considerations behind surveillance and risk-reducing surgery, how different imaging tools contribute to early detection, and why screening conversations should account for your individual risk. Drawing on her own experience living with a CHEK2 variant and extremely dense breasts, Sara shares the questions that come with choosing surveillance and revisiting decisions as research and personal circumstances evolve. In this episode, we discuss • How Dr. Brem’s experiences as a daughter, physician, and patient shaped her approach to breast care • The personal considerations behind surveillance and risk-reducing mastectomy • The roles of mammography, breast MRI, ultrasound, and contrast-enhanced mammography • Automated breast ultrasound (ABUS) and its role in supplemental imaging • Why breast density matters and what to ask your healthcare team • Understanding screening callbacks, false positives, and biopsies • Why a negative BRCA result doesn’t necessarily mean average breast cancer risk • Financial and transportation barriers to breast care • Emerging applications of artificial intelligence in breast imaging • Speaking up when you have questions or concerns about your breast health About our guest Dr. Rachel Brem is a breast imaging radiologist, professor and vice chair of radiology, and director of breast imaging and intervention at George Washington University. A breast cancer survivor and BRCA1 carrier, she brings both professional expertise and personal experience to her work in early detection and patient advocacy. She is co-founder and chief medical officer of the Brem Foundation to Defeat Breast Cancer and co-author, with breast surgeon Dr. Christy Teal, of No Longer Radical: Understanding Mastectomies and Choosing the Breast Cancer Care That’s Right for You. Connect with Dr. Brem and the Foundation: • Brem Foundation: https://www.bremfoundation.org/ • About Dr. Brem: https://www.bremfoundation.org/dr-brem Resources mentioned in this episode Breast health education and risk awareness • Brem Foundation: Education, resources, and information about breast cancer early detection. https://www.bremfoundation.org/ • CheckMate: The Brem Foundation’s breast health quiz, available through its website, can help you identify questions to discuss with your healthcare provider. Breast imaging technology • Automated breast ultrasound (ABUS): An imaging approach that captures a broad set of breast ultrasound images for a radiologist to review. It uses sound waves without ionizing radiation or injected contrast and may be used as supplemental screening for people with dense breasts. • BeSound: Dr. Brem discusses this company’s approach to expanding access to automated breast ultrasound. Visit its website for information about services and availability. https://www.besoundbreast.com/ Supplemental ultrasound does not replace recommended mammography or a personalized high-risk screening plan. Ask your healthcare team which imaging options are appropriate for you. Access to breast care • B-Fund and Wheels for Women: Learn about the Brem Foundation’s programs addressing financial barriers to diagnostic testing and transportation barriers to breast care. https://www.bremfoundation.org/accessforwomeninneed Reading and screening guidance • No Longer Radical, by Dr. Rachel Brem and Dr. Christy Teal: https://www.simonandschuster.com/books/No-Longer-Radical/Rachel-Brem/9781668001134 • National Comprehensive Cancer Network (NCCN) patient resources: https://www.nccn.org/patientresources/patient-resources About this series This episode is part of a 10-part series exploring the medical and personal experiences of living with hereditary breast cancer risk. Through conversations with genetic counselors, physicians, advocates, previvors, and survivors, we explore risk assessment, high-risk screening, preventive surgery, decision-making, and the emotional realities of living with increased risk. Our goal is to help you better understand your options, ask informed questions, and work with your healthcare team to make decisions that are right for you. Start with Episode 1, Understanding Hereditary Breast Cancer Risk with Genetic Counselor, Dena Goldberg, and follow The Positive Gene Podcast so you don’t miss the next conversation. Medical disclaimer This podcast is intended for education and awareness only and does not provide individualized medical advice. Genetic risk, screening recommendations, and preventive options vary by individual. Please consult a qualified healthcare professional or genetic counselor about your personal and family history. Host: Sara Kavanaugh | The Positive Gene Podcast Website: https://www.sarakavanaugh.com Instagram: https://www.instagram.com/positivegenepodcast/