Breast cancer is the most common type of cancer in women (excluding skin cancers) and second-leading cause of cancer-related death among women in the U.S. And while African American women are less likely to develop breast cancer, they're more likely to die from it – a lot more likely. Dr. Lashonda Soma, a breast imager for Midwest Radiology who serves as medical director of HealthPartners Mammography and Regions Breast Health Center, shares her personal and professional experiences with disparities in breast health.
Breast cancer is the most common type of cancer in women (excluding skin cancers) and second-leading cause of cancer-related death among women in the U.S. And while African American women are less likely to develop breast cancer, they're more likely to die from it – a lot more likely.
Dr. Lashonda Soma, a breast imager for Midwest Radiology who serves as medical director of HealthPartners Mammography and Regions Breast Health Center, shares her personal and professional experiences with disparities in breast health.
Relevant links:
Hosts: Kari Haley, MD, and Steven Jackson, MD
Guest: Lashonda Soma, MD
HealthPartners website: Off the Charts podcast
Got an idea? Have thoughts to share? We want to hear from you. Email us at offthecharts@healthpartners.com.
Kari Haley:
He is a rehab doctor from Chicago.
Steven Jackson:
She's an emergency medicine doctor from the Twin Cities.
Kari Haley:
Together we're examining the health equity emergency.
Steven Jackson:
Inviting voices for change without the cue cards.
Kari Haley:
I'm Dr. Kari Haley.
Steven Jackson:
I'm Dr. Steven Jackson.
Both, together:
And this is Off the Charts.
Steven Jackson:
Welcome to our show. We're very excited to be graced by the presence of Dr. Lashonda Soma. She's our medical director of the HealthPartners mammography and Regions Breast Health Center. Also, a breast imager for Midwest Radiology. Welcome, welcome, welcome.
Lashonda Soma:
Thank you.
Steven Jackson:
We're going to talk about a very important topic, disparities in breast health. So welcome to the show.
Lashonda Soma:
Thank you. Glad to be here.
Steven Jackson:
Right off the bat, tell us a little bit about yourself, maybe your journey and then how that kind of relates to just your passion for health disparities and health disparities in breast health.
Lashonda Soma:
Yeah, so I grew up in the south and grew up in Georgia, and I did most of my training in South Carolina, my internship and my residency and my fellowship. And originally I wanted to do some type of radiology that was related to emergency medicine trauma. It's a very niche thing, but I loved it. But along the way, during my training, we had some events in my family that kind of steered me down a different course. So my mom was diagnosed with breast cancer when I was early in residency and when she was diagnosed, she made this kind of off comment to me. She goes, "Wow, I'm the third one." And I said, "The third what?" She goes, "Well, my sister, Lynn, had breast cancer, and then my brother, Carlton, had breast cancer and now me." And I said, "Hold on. What?"
Steven Jackson:
Wow.
Kari Haley:
"Wait, Mom."
Lashonda Soma:
Yeah, why is this just coming up now? So she's fine. She has successful treatment. But along the way through that treatment, we got genetic testing for her to see if there was a genetic predisposition for breast cancer, particularly given that we had a male in our family that had breast cancer. And sure enough, there was a genetic mutation in the B-R-C-A 2 or the BRCA2 gene. After helping my mom through her treatment, then I myself got tested as well as my brother and I am also positive for the BRCA2 gene mutation. So then that was kind of a long journey of deciding what to do with that information. And ultimately, I did choose to do prophylactic mastectomies and reconstruction. So I have my own story and experiences that helped me to relate to patients as well as having family members with breast cancer.
So I decided that that was enough. Those were enough signs that maybe I should be doing something different, and I felt compelled. I feel like a lot of people know that when a decision is made for you, it's so much easier than when you have to make the decision. I felt like this decision was made for me, that it was what I was meant to do, and I'm so glad that those experiences brought me to what I do now, which is spend 100% of my time trying to bring women in to get screened and to also find breast cancers at an early stage to help save lives.
Steven Jackson:
Wow.
Kari Haley:
That's quite the journey.
Steven Jackson:
That's quite the intro. I'm like, man.
Kari Haley:
Speechless at the intro.
Steven Jackson:
So, Dr. Soma, thank you for telling your story. And again, I'm a firm believer in just the concept of calling and purpose and personally speaking, I do what I do because maybe somewhat of a similar circumstance, and I think with that comes passion, that drive to really make things better for others. So thank you for sharing and thank you for doing what you do.
Lashonda Soma:
Yeah.
Kari Haley:
Can you tell us a little bit about what your practice looks like?
Lashonda Soma:
Yeah, so I am fortunate enough to work in a large group where we can practice as subspecialists. So many radiologists will read multiple different modalities, different body parts, but in our group, we are fortunate enough to be able to subspecialize such that many of us practice in one particular subspecialty every day, all day. And so I do breast imaging every day of my job. There's two components there. Mostly I'm in the breast center and usually you can find me here at the Regions Breast Center, but also out at Lakeview (Hospital in Stillwater, Minnesota). There are screening mammograms, which are mammograms that people get when they have no symptoms. So part of that work is sitting in front of the computer, reviewing the prior images and just interpreting those images and generating a report. The rest of my work involves more of a clinical component.
It's just patients that have either been called in from an abnormal screening or they have a symptom or they need to follow up, and those patients have appointments at our breast center and they will have some set of images taken. We will review them as a radiologist and then we go speak to the patient. We may also scan them ourselves, examine them, do biopsies, etc. So that's the part of my job I really love because I get to interact with people and particularly mostly women, which there are some wonderful things that come with working with women primarily. I love the fact that even in the hardest moments, which are moments when I may have to give people bad news, most women, their first reaction is how is someone else in their family going to cope with it? It's not about themselves, it's about their children or their husband. And that's what I absolutely love and that's why I love the clinical component of my job.
Steven Jackson:
I think about my own family, and I think about the concept of getting screened, whether it's a screening mammography or some sort of prostate evaluation, whether it's a DRE or a PSA or something. I know there's inherent fear. Sometimes there's mistrust or distrust to the point where things that should happen or should happen don't happen, which leads to maybe an outcome that could have been avoided. And just from your perspective and even in your practice, how do you overcome that challenge? Getting people in I would imagine would be something else sometimes.
Lashonda Soma:
Yes. That is the hard part. And I would say that my work in mammography is kind of twofold, so that most of the work that I do here from 7:30 to 5 involves people that have already come here. And then my passion outside of that is getting all the women who haven't even stepped into our doors to come in and to get a potentially lifesaving exam. You're absolutely right. There's so much fear in every single person when it comes to getting mammograms and many other screening tests.
For a lot of people, they feel like if they don't know, then it doesn't exist. And that can be particularly true in the Black community where some of the mistrust of the health systems is very well founded, and there's historical context for that, but also there's some additional layers to it that probably we need to break down. And the idea that when the doctor cuts you, that's when the cancer spreads everywhere. And there's also just not enough conversation I feel like amongst Black families about their medical history, for example, what I said about my mom and my aunt and my uncle, people just don't talk about that. You'll hear that somebody died. You never even know what they died of.
Steven Jackson:
You don't even know why. Yip. Very true.
Lashonda Soma:
And how powerful that information can be to save the lives of your family members if you just shared that. So really trying to get people one, to just have the conversations to encourage the people that you love and who are the ones... They trust you. So they're more likely to listen to their sister or their aunt saying, come get a mammogram than they are to even listen to me. So for every woman that I can't interact with to encourage them to say something to a woman that they love, I think that's where the power comes in and that's where we can break down the fear and get more people in. It has to be a horizontal growth through the community, build it and they will come does not work in the Black community. People just instantly think, what do they want me there for? You offer them money or gift cards, then they're like, really? Why do they want me there?
Steven Jackson:
What's the catch?
Lashonda Soma:
What's the catch? It doesn't work. It has to be amongst people who have already established a trust relationship.
Kari Haley:
I know this episode will be airing in October likely, which is Breast Cancer Awareness Month.
Lashonda Soma:
Correct.
Kari Haley:
So just for our listeners, I think it'd be great if we'd be able to talk a little bit about what screening is, maybe when people should be getting screened, and then secondarily, I think after we maybe talk about that, thinking a little bit about those gaps in screening between Black and white women and what we can do to start to close that gap.
Lashonda Soma:
Yeah, so for most women, screening mammography will start at age 40. That is for average risk patients, but now we recommend that everyone have a conversation with their provider about what their risk is. A lot of that is based on family history, but some additional things as well, that you have that conversation by age 30. That way we know if you should start screening early. Otherwise, age 40 is the perfect age for most women.
And with a screening mammogram, for most women, it will be two pictures of each breast. The breast is put into compression and the exposure is roughly six seconds. And then the compression releases. Most people find that once they get a mammogram, it wasn't as bad as what they were imagining. And we do encourage that if you tend to have tender breasts that you just take some Tylenol ahead of your exam, but that's it. Then you leave. Usually you can be in and out in just a few minutes. We have over 30 clinics where you can get your mammogram and then you get the results either through MyChart or through a letter in the mail. And we usually generate those within one business day.
Kari Haley:
That's fast turnaround.
Lashonda Soma:
Yeah.
Steven Jackson:
That's good information too.
Lashonda Soma:
As for disparities, the statistics are quite striking. So Black women are less likely than white women to develop breast cancer, but they're 40% more likely to die of it, which is staggering. Black women have a higher incidence of hormone receptor negative breast cancers, which are the more aggressive breast cancers or what we call triple negative breast cancers. And if you're a woman under 50 and you are Black, you are twice as likely to die of your breast cancer than a white woman who's diagnosed under 50.
A little of that is biology, but a lot of it is access to screening and utilization, and that's what we have to make huge strides in as far as Black women go because it is unacceptable that you're more likely to die from something even though you're less likely to get it than another group. And the other thing is that even though they have all of these risk factors and these higher mortalities and they're more likely to have family members that have had breast and ovarian cancer, Black women are still less likely to be referred to genetic counselors to talk about getting tested than white women are. So there's multiple layers that we need to work on. We as physicians as well as in the community.
Steven Jackson:
Yeah. I love going back to the purpose of our podcast. We want to inform, we want to also empower, and I think a lot of people, including myself short from looking it up or reading about it, I've always thought, I'm going to expose my own ignorance. I thought it was 50 years old and I don't know if the guidelines have changed, but now it's 40 and even have a conversation as early as 30. Didn't know that. And if I didn't know it, how many people out there that's listening didn't know it? So thank you for that information.
The other thing, I mean, we're really highlighting not only jarring statistics, but also the need to get educated. I mean, again, it doesn't make sense that I'm less likely to get something, but I'm more likely to die from it. I mean, that should open somebody's ears. That shouldn't be something you just go into the next part of the podcast, that should make you hit pause and say, dang, what's up with that? What do we do? How do we begin? As part of your question, Dr. Haley, how do we begin to close these gaps because they're wide and we definitely don't want to do anything to perpetuate the problem? How do we make it better? What are some of the things? What are your thoughts?
Lashonda Soma:
They are. I mean, as health care providers, I think that sometimes even stepping out of your lane a little bit because we know there's a problem. So if you're an emergency physician and you're treating someone, if you say, oh, and hey, by the way, get your mammogram. If people hear over and over again from their diabetes doctors, the cardiologist, whoever they are encountering, if you hear it enough, you may actually maybe just get so annoyed that you go and do it.
Steven Jackson:
Dang it. I'll get it.
Lashonda Soma:
Right. But I think we've gotten into so much subspecialty care in health care that no one looks at the whole patient anymore. It's like, "Oh, I'm your cardiologist. I'm here to talk to you about your heart." And it's amazing that we piecemeal things together, but we miss things that could easily be treatable and save the patient.
Outside of that, I am involved in a group called the Minnesota Gaps Project, and that is a group that was put together by two women in the community, and it has what's called community co-design. So they tapped women from the community, most of us Black women, to talk about what are the barriers, find out what the barriers are, and then to develop organically grown solutions to it, not, "Oh, this is what I think we should do. Let's have a screening event." Great. And that has been an amazing experience.
On September 30th, we're hosting an event called "Live, Laugh, Learn," and it's basically going to be a party, 250 women, at least 90% of them will be African American. I will be speaking there, and we are just going to try to normalize speaking about breast health, and we're going to teach people a few things and have a good time and just try to start getting into the community and starting there instead of starting from here and hoping people show up.
Kari Haley:
I think that's huge.
Steven Jackson:
That's awesome.
Kari Haley:
I think that is so huge, especially because I think so much of medicine happens outside the walls of a clinic or a hospital and that as physicians, we often expect people to come to us when they're in need, but we're never out there necessarily in the community being part of the community and participating in the community to build the trust. Why would... It'd be like a stranger being like, "Yeah, come to my house. Just come over. Don't worry. I'll take care of you. Don't worry. It'll be fine."
Steven Jackson:
"You're safe."
Kari Haley:
"But you're safe here." But then why would you have... If you think about that, why would you ever do that?
Lashonda Soma:
It's true. And one thing that I thought about is that particularly, I know a lot of my family members have this kind of, I will call it a misconception that providers don't care about them, that the healthcare system doesn't care about them. I know a lot of doctors, and almost every single one cares deeply for every patient that they see. Sometimes we're not the best at showing it either because we're under different constraints or you just don't know how to develop that personal relationship. The problem with that is that as an African American, if you go to a doctor or a provider and you have a negative experience, it just validates what you already thought and you're more likely to just withdraw versus if you didn't already have that kind of idea, you just say, that was a terrible doctor, I'm going to a different one.
Steven Jackson:
That's right. That's a good point.
Lashonda Soma:
And how can we make sure that we are showing people, all people that we care? Because that may be the one opportunity we're getting for a long time to care for that person.
Steven Jackson:
We had a similar podcast episode related to this principle, and that's changing mindsets, which obviously doesn't happen overnight. But for me, I don't automatically assume that patients trust me because I'm a nice guy or I have credentials or I've been here X amount of time, all these different things. I look at each individual patient and family as a person or group of people that I have to earn their trust because if I'm in that mindset, then I'm not walking in making assumptions. I'm making sure that I'm present. I'm not thinking about my next appointment, but I'm thinking about everything that you're saying and your concerns, and I think that takes practice. I'm not saying I've mastered it. If I'm stressed or I have personal things going on, or if I'm late, I'm 30 minutes late for clinic or 30 minutes behind in clinic. So there are a lot of external factors, but I think the sense of I need to earn this person's trust and just having that mindset might be a consideration, maybe.
Lashonda Soma:
It's true. And trust goes a long way. I mean, a lot of times when a patient's interrogating you, they're actually trying to figure out... They're scared and they want to know that you feel you're making the right decision, but the only way they know how to do that is to ask you what they think are some medical questions or what would it be, or what's this test show? I feel like when a patient trusts you, they usually don't ask you those kinds of questions. They just say, this person caress about me and is trying to do the right thing, and they don't need to try to then stretch their minds to try to make sure you're doing your job right, because they now trust that you are doing your job right.
Steven Jackson:
Have you noticed being African American, have you notice... Because I've said this in different arenas, sometimes I have been granted trust that I didn't earn because I'm Black and it's like, I'll get the, you're making us proud or you're representing, which I mean I appreciate that. I still try to earn the trust, although I may already have it. Have you seen that also in your arena being who you are?
Lashonda Soma:
Absolutely. On the one hand, it's a beautiful thing because I walk in the door and there's a Black patient and their eyes light up. They're like, "OK, she's going to take care of me." And I do try to take care of all people equally, but I have to say in my own heart, there is a higher level of pressure for me because I know that person has immediately trusted me.
Steven Jackson:
You don't want to mess that up.
Lashonda Soma:
I don't want to mess it up. But you're right, absolutely. I definitely get that quite a bit.
Kari Haley:
What other pieces do you feel going back into working in the community and everything, what other things can we do? You mentioned stepping outside our lanes. One thing I try to do, even if I don't necessarily mention getting your mammogram, getting young people who have no primary doctor, let's get you a primary doctor. Let's try to get you a... I want you to follow up for this. Even if it's in two weeks, like get a primary doctor. We can help you get a primary doctor. What other things can people, both in medicine and then even people outside of medicine, maybe even do to try to help bring people and gain that trust in our system so that they are getting the screening care that they need because screening care saves lives?
Lashonda Soma:
Absolutely. I think that's a difficult question. I think if I had the answer, I might be up here in the C-suite, but I do think we have to take opportunities when they come. If someone's scheduling their colonoscopy, but they're not up on their mammogram. Hey, can I schedule you for your mammogram, too? Sometimes people just don't know what they're supposed to be getting. I see that all the time. Oh, I thought I was supposed to come every five years. Oh, I thought I was supposed to stop at 70. People just don't know. And so if we just take opportunities when we are interacting with them. The other thing is to just be more open in the community about what you've been through. I feel like a lot of women who are not Black wear their breast cancer survivorship like a flag that's waving. They got on the pink.
They want to tell you all about, oh, what? "Hello, nice to meet you. I survived breast cancer," and Black women don't say anything about it. It's like a secret. And so how can we have those conversations be more prevalent? And then even the Gaps Project, what we've done. We recorded some videos, some were done in the breast center about dispelling myths and to help people know what to expect. And then we link those with QR codes and we put them in beauty salons and community centers.
Steven Jackson:
Nice.
Kari Haley:
Really cool.
Steven Jackson:
We got to meet people where they are. And I personally, just to wrap up, would love to see mammography stretch beyond the idea of that it has to be in a health center. There are a lot of places where you find minorities that is in a health care place, but you could have a mammogram machine, for example, in community centers, in the social security office. I mean, how much time do people spend there? All kinds of places that we could reach them. And this idea that it has to be in a clinic, I would love to one day see that not be, to put it into a box like that.
Well, I think sometimes you have to do something different if you want different results, and we've already talked about the results. We've talked about some of the jarring statistics, and it's going to take that type of forward-thinking and out of the box thinking to really move the needle in a different way because it's a need. But I mean, listen, thank you so much. I mean, again, I've been educated. I've been taking a few notes over here and I wrote down, get your mammography or get your mammograms, so I might have to add that in some of my take home talks with my patients. And I'm in the rehab space, which is a lot different than radiology and emergency medicine, but nevertheless, that's something that I'm committed to just trying to incorporate in my practice.
Lashonda Soma:
Glad to hear that.
Kari Haley:
Thank you so much for being on the podcast. I think that one, we've all been educated on when we should be getting our mammograms. And then two, also just the ideas and the surrounding thoughts about how we can bring what we're doing inside the walls, outside the walls. And really, that's probably where we should be meeting a lot of our patients, especially when it comes to screenings and preventative care.
Lashonda Soma:
Perfect. Well, thank you guys for giving me the opportunity to come here, and anytime I have a platform to get one more woman to get a mammogram, then it's time well spent. So thank you.
Steven Jackson:
Yeah, thanks.
Off the Charts is a production of HealthPartners and Park Nicollet.
Kari Haley:
It is recorded by Jimmy Bellamy, with creative by Peggy Arnson, Tina Long, Tim Myers and Jeff Jondahl.
Steven Jackson:
Production services provided by Matriarch Digital Media.
Kari Haley:
Our theme music is by Ryan Ike.