Studying medicine, Lashonda Soma originally wanted to be in the emergency room as a radiologist specializing in trauma. But early in her residency, one comment from her mom would change everything. Shortly after receiving a diagnosis of breast cancer, her mom responded by saying “wow, I’m the third one.”
“The third what?” Lashonda responded.
“Well, my sister Lynn had breast cancer, and then my brother Carlton had breast cancer, and now me.”
It was something that the now Dr. Soma had never heard discussed before: Her family’s history of breast cancer. Today, Dr. Soma’s mother is healthy, having received successful treatment. But as Dr. Soma tells it, “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.
“Sure enough, there was a genetic mutation in the BRCA2 gene. After helping my mom through her treatment, I then got myself tested as well as my brother. I am also positive for the BRCA2 gene mutation . . . ultimately, I chose to have 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.”
Deciding that there were enough signs compelling her to do something different, Dr. Soma was called to “spend 100% of my time trying to bring women in to get screened and also find breast cancers at an early stage to help save lives.” As medical director of HealthPartners Mammography and Regions Breast Health Center, as well as a breast imager for Midwest Radiology, Dr. Soma is doing exactly that.
In today’s Off the Charts, Dr. Soma talks more about her practice, what goes into a screening, how traditional fear of health care professionals contributes to disparities in breast health and what can be done to build trust and save lives. Listen to the episode or read the transcript.
Screening mammograms and follow-up imaging
Dr. Soma does breast imaging every day – mostly at the Regions Breast Center in St. Paul, but also at Lakeview Hospital in Stillwater. There are two main parts to her job: “There are screening 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 getting a report.”
Most women at an average risk for breast cancer should start having their screening mammography regularly at age 40. However, everyone should talk with their health care provider about what their risk is by age 30 – based on family history and other factors – to know if they should start screening early.
“Most people find that, once they get a mammogram, it wasn’t as bad as what they were imagining ... usually, you can be in and out in just a few minutes ... and we usually generate [the results] within one business day.” For most, a screening mammogram includes two pictures of each breast, put into compression for an exposure of six seconds. As far as pain, if you have tender breasts, it’s recommended to take Tylenol ahead of the exam, but that’s it.
The other part of Dr. Soma’s work “involves more of a clinical component ... patients that have either been called in from an abnormal screening, have a symptom or need to follow up. Those patients have appointments at our breast center.” There, she takes and reviews images before discussing them with the patient.
As Dr. Soma says, “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’s 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.”
Fear, disparities and the power of family
When she isn’t helping people inside of her practice, Dr. Soma’s passion “is getting all the women who haven’t even stepped into our doors to come in and get a potentially lifesaving exam.” However, “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.”
That fear is particularly strong in the Black community where mistrust of health systems runs deep due to a combination of historical context, misinformation and a lack of conversation among Black families about their medical history.
As a result, the disparities in breast health are alarming. “Black women are less likely than white women to develop breast cancer, but they’re 40% more likely to die of it. Black women have a higher incidence of hormone negative breast cancers, which are the most aggressive breast cancers – what we call triple negative breast cancers. And if you’re a Black woman under 50, you’re twice as likely to die of breast cancer than a white woman under 50.”
Some of these outcomes are due to biology, but the much larger cause is disparities in access and screening. In addition, “even though they have all of these risk factors and higher mortalities, and are 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.”
As Dr. Soma says, all of this is “why we have to make huge strides 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.”
The first step in breaking through those disparities starts at home – with families talking about their health histories and encouraging each other to get screened. As Dr. Soma knows well, that information is powerful and can save lives when shared. Which is why it’s important to encourage the people you love and who trust you to have these conversations
“(People are) 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.”
Closing the gaps by connecting with communities
It’s also crucial for health care professionals to actively reach out to communities, not just to close gaps in breast health but to narrow health disparities overall. As the three doctors discuss in this week’s episode, so much of medicine happens outside of clinic and hospital walls. In health care, there’s a general assumption that people will come to doctors when they’re in need. But, doctors and health care professionals aren’t necessarily participating in the community and building trust. Consequently, if there aren’t established trust relationships, people in the community won’t get the care they need until it’s too late.
“I know a lot of my family members have this kind of misconception that providers (and the health care 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, 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.’”
That’s why each health care interaction is crucial in establishing trust. By seeing each visit as an opportunity to earn trust, go beyond assumptions and be present in the moment, it can go a long way to building relationships that grow and involve other family members in the community.
It's also important for health care professionals to be more open in the community and share their own personal experiences. By seeing barriers and developing organically grown solutions that reach people in the places where they are – like Dr. Soma does with her involvement in the Minnesota Breast Cancer Gaps Project – professionals can build relationships vital to saving lives.
To hear more from Dr. Soma about her work with the Minnesota Breast Cancer Gaps Project, as well as the importance for health care providers to take opportunities and make important recommendations, listen to this episode of Off the Charts.