Franziska Haydanek: Over 50 % of young people get their health information from social media and most of them get it from TikTok. And there is so much misinformation and disinformation, which is misinformation for financial gain. And that's like the worst of the worst. We have to understand that the climate, this is what they're seeing online and those are the videos that are gonna go viral and this is what they're seeing in the office. So we have to understand what they're seeing, why they're requesting a QT imaging when no one's ever heard of this. Welcome to I Did My Own Research. I'm Dr. Fran, and today I'm joined by Dr. Robin Roth, who is an associate professor of radiology, specializing in breast and abdominal imaging. To you though, she's more likely known as the Boobies Docs, her popular breast health social media platform where she discusses breast cancer in a fun and educational way. Obviously a girl after my own heart. She is passionate about busting misinformation and helping people understand ways to find their breast cancer early. Dr. Roth is an author of her new children's book, Everyone Has Boobies. She hosts a podcast, The Girlfriend's Guide to Breast Cancer to help those navigating a breast cancer diagnosis or supporting a loved one. She also hosts an annual breast cancer fundraiser, The Boobie Bash. Welcome Dr. Roth. I did my own research. am so honored to be here. Thank you so much for having me. Dr. Roth, you do all the work that I just so admire. There is so much misinformation about our breasts, breast cancer screening, the modalities we have for breast cancer screening. and treatment options, like the misinformation online I see like rampant. And maybe part of that is because I'm an OB-GYN and the algorithm has learned that I am interested. So I'm just so thankful for the work that you are doing in a really, like you said, fun and educational way and making people feel engaged in their health. Tell us how you got to being the boobies doc. So it's the booby docks and thank you so much. It's a long story. And honestly, the feeling is mutual. You were one of the early creators that I really fell in love with. And I love how you stand up for against misinformation and we need more people like us. So thank you for inspiring me to do this. So how did I get here? Well, I'm a breast radiologist. So that means I'm the doctor that you see when you need a mammogram or if any of those tests were abnormal. And in many cases, I am the doctor who does I'm the doctor who does the biopsy almost always. And in many cases, I'm the first doctor that someone meets when they are diagnosed with breast cancer. And people don't usually meet a breast radiologist until there's a breast health problem. So I realized that there was this disconnect between like, nobody knows what I do as a breast radiologist. And, you know, I was really burnt out as my career. I love my career, but it really is exhausting diagnosing young women with breast cancer every single day. Okay. I was, you know, I, on paper, I had everything I wanted. I was, I was a mom of three kids that I worked my whole life for. I had this job that I loved. know, my husband is also a radiologist and we built our dream life together, but I still wasn't happy. And I felt like something was missing. And when I was young, I used to love creative writing. I would escape kind of because when I was young, I was bullied and I really was very shy. I would really express myself through creative writing. So there was a part of me that kind of lost that along the way as well. And I think a lot of people lose their spark or what they used to love when they were kids through the rigorous medical training. I was at this point in my career where was, I had everything I wanted on paper, but I wasn't happy. I was missing my spark. And I really, I have been talking to my therapist about wanting to start a blog. This was back in like 2018. Was I a doctor? Was I a mom? I was really struggling finding my voice. It's funny, I started my Instagram in 2018 as Dr. Robin Ross. And I did nothing with it. I couldn't figure out my voice. And I actually shared this this past weekend because I spoke to Northwestern Radiology residents about how I got here. And there is actually a screenshot from my notes at four in the morning in 2018. And it was like, the boob doc, your breast friend, the booby doc. You could see my wheels were spinning, but I didn't really have the confidence enough yet to do that to pull the plunge. But, you know, so I posted Sparrowling as ⁓ Dr. Robin Roth, and I really struggled to find my voice. But then something hit me. I was actually breastfeeding my third son during the COVID pandemic at this really low point. And I was like, I am surrounded by boobs all day. Like, just thinking about... Yeah, my own boobs, everyone else's boobs. My own... I was about to turn 40, and I was like, my own boobs, everyone else's boobs, and like... I, like you, I was opening on my Instagram, there was so much misinformation about mammograms, breast cancer. I was like, no, I'm a booby doc. I'm a booby doc. And it's called the booby docs because, so my best friend from med school, Adrienne, is also a breast radiologist and we worked together. And so when I had this epiphany, I was like, it's gonna be the booby docs. We're gonna make it plural. We'll be two best friends, right? You know, working together, navigating this stuff on our own. And it was, and that was... really how I found the voice. It was always me posting, but it was like under the guise of two people. I don't think I actually had the courage to do it by myself yet. And then we really picked up, we found our voice, we were on the news a lot. But then in 2021, she was never really into social media, it was always me driving the boat. And in 2020, she unfortunately lost her dad to melanoma, kind of a quick diagnosis and passing. And I made it my own. She left social media, like she was done. That was the tipping point for her. And I really took some time and reflected on like what I want to do with this. And I decided that the show must go on. It was always me anyways, but now I have the confidence to kind of do it as myself. That's why it is the booby docks plural. I always joke that maybe one day she'll be back, but she's like very happy being off social media. Because as you know, social media is not for everyone. No, it is not. It can be very toxic, both as a creator and as a consumer. Well, thank you so much for, mean, that is a, you know, the story is one that many women in medicine particular can relate to, right? We are children who had a lot of interests and did a lot of different things and, you know, I, it's a... story old as time, we love to read or we love to write or we love to craft. And then we, you know, went into this really hardcore process of going through medical school and training. And by the end of the day, you know, you worked your 16 hours, the last thing I want to go do is like now pick up a pen and paper or like start crocheting. And I think many of us lost those parts of ourselves that were really important to us as, you know, younger adults and children. And once you get to the other side of your training, you kind of are like... Well, now who am I? Because I was a trainee for so long. You really built your whole life around your identity as a physician. And you, and then at the same time, many of us are like becoming parents at the same time. And so now you're a parent, you're taking care of small children and everything revolves around them. And your job is very demanding and you, who are you at the end of the day? Like who what's left for you? You lose your identity in some way, you know, going through this process of becoming a mom, becoming a doctor that you always wanted to be. But then you get there and like you said, you know, Once I was in attending and a few years out of my career and I felt comfortable, like my kids, I had my three kids. I was like, what the hell did I just go through? The trauma of that, I did a lot of meditating. I did a lot of like really soul searching. I did inner child work. I was really a dark place. And I think that happens a lot. But then the thing that happens also when you're in your 40s or your mid-career is like, you don't have to prove yourself to anybody anymore. That is a very valuable thing, because now I'm like, I'm not trying to get into a residency program. I'm not trying to get into a fellowship program. I have my job, I have my career. I know I'm, you know, I've proved myself already, and I don't care as much what people think. And I think that's the hardest part about social media, is putting yourself out there to the judgment of others, and it's uncomfortable. And like, when you're starting something new... It's very uncomfortable. Like it makes other people uncomfortable. They're like, what is Fran doing? Or what is Robin doing? What, like, I remember even having the conversation with my husband. was like, I'm going to change the name to the booby docks and I'm going to really kind of go forward with this. And he's like, what? He like had no idea. was even thinking about this. Yeah, I think it's almost, I feel like I feel more vulnerable about my social media presence with the people I know in real life than online. Like I can talk to the millions of people who see my videos and no problem. But if my husband's like, I'm gonna listen to this video, I'm like, I would rather you not. I like block my husband from my stories. don't need him to see. Thank God my husband doesn't even do any, not a single social media. So he can't actually, he probably listens to the podcast. He said he wouldn't even, then I'm like, please don't. It is very hard to put yourself out there because one, you are trying something new, you're being different than most people. And at the same time, when we go on as physicians on social media, we have a duty to the people who are seeing our content to really put forward that evidence-based medicine. And I find that very hard to balance when you are trying to fight the algorithm about, The algorithm loves a little bit more feelings. It loves a little bit more controversial things. It loves a really solid hook that usually isn't based on reality, but we have to balance that with being the person who's actually supposed to be combating that. Have you found that trying to find that balance is hard for you, or is it just so natural at this point that you're used to having to say things in a way that people understand without having to make it like a scary gotcha kind of thing? I think I've gotten so good at like explaining... know, complicated breast topics to the general public. But like you said, the controversial stuff is what gets the clickbait. And that's the problem with the social media algorithm, because it's pushing this misinformation. Like there are doctors, you know... I do, everyone who's listening gets in quotations. Right, that's a quotation. So there are doctors out there that will try, you know, tell you that mammograms cause cancer. And that's gonna get your attention, right? And why are they telling you this? Because they're usually trying to push a thermogram or QT imaging or whatever new fad that they have discovered that they're trying to prey on you, on your fear of getting breast cancer and try to sell it you as an alternative when really it's not that. And it is a very scary climate out there because when I speak up about these things, like if I want to combat a video that says mammograms cause cancer, I put myself at risk. Like I have had, there's this one case in particular, there's a doctor, I... You know, who it's usually the chiropractors or the functional doctors, in my experience. They were making a video. So this doctor has made a whole platform about trying to, know, mammograms have radiation, therefore they cause cancer. So mammograms cause cancer and trying to, but meanwhile, opening, trying to sell you something called QT imaging, which if you asked 100 radiologists, none of them have ever heard of it except me, because I have to deal with it. She lives in my backyard. So you pay $600 out of pocket to have this radiation-free ultrasound, which we've been using for decades. We use all the time in certain scenarios. It doesn't replace a mammogram because it can detect microcalcifications of early breast cancer or some of the early signs. But then she's going to tell you that DCIS is not cancer, so you don't have to worry about it. Because her imaging doesn't detect DCIS. But she's now trying to tell you that DCIS is actually not cancer. Yeah. Well, if you can't detect it, doesn't exist. So, you Yeah, right. And so she goes on social media and makes this post about DCIS is not cancer, has no potential to ever harm or kill you. That's terrifying. It's terrifying. So I go on to make a video about, like DCIS is in fact very early cancer. If left untreated, in many cases, it will progress to invasive cancer and continue to grow. That's how cancers, you know, and it's important to know about DCIS because it's like the most... If you're not going to call it cancer, you have to call it pre-cancer. But it is an early cancer. And I have seen DCIS missed, and six months later, it blows up. Not all DCIS is equal, and it's not treated equally. So I got in there and to say that, you know, it's not all... that all DCIS is not treated equal, and some of them will go on. It's... We're still trying to figure out who are the people that will go into invasive cancer. I get, After this video, I get a cease and desist from her lawyer. Wow. And I get reported to my medical board from this woman in a Facebook group that DCIS is not cancer because she thinks I'm unprofessional and I'm like gaslighting all these people into thinking they have cancer. I am so, that is terrible. It's terrible. Like this is what I have to deal with to speak up these days. So it is just showing you. Like, you know, on social media, you get to see all, like, the videos. But, like, there is a lot that goes on behind the scenes, and I'm sure you have your own stories of, like, how you have felt threatened or, like, you know, tried to be scared into not speaking up. And it's really challenging. I am so sorry that happened, because what you're trying to do is give people actual information. I think, you know, I've talked about where the origins of my name of the podcast came from, like, I did my own research, is because... People will go online, they're looking for information. There's someone out there who's purposely putting out false information, like saying, like, you know, that mammograms cause cancer and DCIS is not cancer and you should just get this ultrasound. Now they did their research and are making information on some, a decision on what they think is an informed, like, choice, but is actually very misinformed. And these people who are making that content are really not doing it with the best of intentions. I don't always know if they even recognize that it's that... what they're doing, but you know, it does come down to they're trying to sell their courses, their like, their non-evidence based things. And there's a girl that I made a video about who has also, she makes a video that says, I'm a doctor and I won't get pap smears. And then talks about like what she would do instead. And she would do thermography or of the, I don't know, the pelvis and whatever. And then she's made videos where she like sitting next to a toy and goes, I'm a doctor and I won't get a colonoscopy because it causes cancer. And then she has also made videos. I'm a doctor and I won't get a mammogram and here's what I'll do instead. And so. They all push this thermography stuff as someone who does not work in this space, and many of the listeners probably don't also. Can you explain what thermography is and why they think this is a better option? Thermography is like going through airport security and hoping that they're going to find your mammogram. Stop. It's looking at inflammation in the body. Like, it is so nonspecific. favorite. And it is so... Right. inflammation is your root cause, right? That's they're going to try to have you explain. So, you know, you're going to find... you're probably going to find a cavity before you find a breast cancer. I've seen many women for two reasons come to me because when there is an abnormality on the thermogram, they are going to send you for a mammogram. 100%. I get that all the time because that's really the only way that we're going to detect. It is so nonspecific, a thermogram. Again, it... I've seen people come in because their thermogram was abnormal and now they have to get their standard mammogram. And we're a little stuck of like, what do we do with this? Do we give her a BiREDS 3 or call it probably benign and follow it in six months? Because what, you know, now we're stuck with this non-good tests that found something that we have to now work up the traditional way. And then I've seen the alternative of women getting a thermograms, showing up with a large cancer. How could this be? I've been getting thermograms. Well, the thermogram, the same alert to the pap smear, right? It's not gonna catch those microcalcifications. They're not gonna find those abnormal cells of a pap smear. They're gonna find big, bulky, raging tumors. If you're lucky, like, yeah. It's like too late when we could have caught it three years ago and not been here at all. I'm actually surprised to hear that for you because I was gonna say, I assume that most patients who get come to you are people who are... informed about what the importance of mammogram is, and they're not coming in there with that misinformation, but I guess I never thought of it that way, that actually, you are gonna eventually have to see those patients who fell for that misinformation. And now, how do you address that with them in real life? How do you say, well, thermography is not helpful? Do you find that they're receptive to that? So, a lot of times, they come in because, A, there was an abnormality, so now they're forced to come in. or they're willing to get a whole breast ultrasound because that doesn't have radiation, but they won't get that mammogram. So then it's really an opportunity to teach, right? It's a teachable moment. So if they're in the office, then I come in and I explain that your ultrasound looks fine, but I can't see everything with ultrasound. Mammograms help us find microcalcifications that we're just unable to see with a ultrasound. What is your concern with the mammogram? So usually it's the fear of the radiation. They've been tricked into believing that it's a high amount of radiation. When in actuality, a mammogram is such a low dose of radiation, it's equivalent to a cross-country flight or seven weeks of background radiation. We're exposed to background radiation all the time, from radon in our home, from the sun, from the moon, from the stars. So... We are exposed to a small amount of level of radiation. That's what it's equivalent to. But because it's an X-ray of the breast, that's again, X-rays detect calcifications. That's why you get X-rays of your bones because they can detect calcifications. With that information, we are able to, know, when we find breast cancer, when it's localized to the breast, when we find the breast cancer early, then we are able, you will benefit from the 99 % survival rate over five years. and probably going out further to 10 years, which is ridiculous. Breast cancer mortality has gone down by 40 % over the last four decades. And a lot of that is because of early detection. I like to say early detection is the breast protection. It's very treatable. Breast cancer is very treatable when we catch it early. But then we have these complicated things of people trying to now confuse you because they see breast cancer as a money-making machine. And they always like to say, big pharma wants you to get a mammogram. That's not how big pharma works. Like, I don't get paid. That's not, I will get paid. I get paid to read whatever breast imaging is appropriate for my patient. I don't get paid per mammogram the way that these people are getting paid per thermogram, per KETU imaging. They're not only like recommending this and then they're gonna read it and then they're gonna tell you to get a mammogram in the end when something's abnormal. Well, that's like the insulting thing, right? They like talk about like big pharma or big radiology. I don't know if that's a big talking point, but the reality is that big wellness... is much more of a bigger money-making scheme. It's not regulated. There are no guidelines. It's not like there's an academy of thermography that's evidence-based and everyone's following it. And like, anyone can just be like, ⁓ I'm doing thermography, or I'm like, I'm going to be a coach, or I'm going to be a breast cancer coach, or whatever. You can do whatever you want. When the reality is, is those of us who practice evidence-based medicine really have to follow standards of care that are compiled by experts and through... decades of research, and of course, people deserve to be paid for that, but I think it's really important for people to hear how we are paid, and then it's not just like, I'm pushing a mammogram on you because I want $60 for the read, right? Like, that's not the reality. And I wish it stopped there. It doesn't even just stop there. Because now the same doctor who's going to tell you to knock on a mammogram to get the QT imaging scan, if you get a diagnosis of breast cancer, they're gonna say, you don't need... You don't need radiation. You could treat this naturally. We're gonna get you on this... Juiced fast. Yep. And I'm gonna be your coach. I'm gonna be your health coach. We're gonna eliminate the toxins. It is so dangerous. Like, they're now doubling down on this, right? Like, how long until this is complete malpractice? Unfortunately, there's no... They don't have a license. There's no board. So it's not like you can report them. They're just like grifters who, like... I wish there was some counsel of people who held people responsible for being terrible people, but that doesn't exist. So if you don't have a medical license, there's no medical board, you can just do whatever you want. And what does she do? She blocks me so that I don't have to see her videos, I can't talk about them and call out how dangerous that is and send me a cease and desist and try to silence me. And it's like, what the... ⁓ You know, like, what are we doing? That's terrible. That's why I would go on my burner account and still see the videos. Yeah. I do hop in my husband's account every so often. Don't tell her. Don't tell her. It's a secret. I'm sure she's blocked me too, so she'll never see this. It's really bad out there. And I don't think people understand how really bad it is and how dangerous it is. And usually when I have these conversations with people in the office, they come around to getting a mammogram, you know, or like every other year, something, something just so that we can look, you know, make sure that there's nothing that we're missing. Like I'm open to people being their own advocates and like, you know, if you're comfortable with radiation, then let's make a plan. Like I'd say, get an ultrasound and then an MRI every six months or do something. I'm not willing to not find your breast cancer. I just want you to understand what we're looking for and what you're missing by not getting a mammogram. Yeah. And I will say, I feel like I've become a better doctor because I see what patients see online and the conversations that are had there. And I feel like I can now approach those conversations. in a much more patient-centered way than I might have if I was just saying, these are the guidelines, you must do this. I understand that patients should be making their own decisions. I feel as physicians, it's kind of like I make recommendations and you decide what's best for you. The best I can do is tell you what the evidence is and then I will work with you in a way that you feel comfortable. For me, that happens a lot, like unlabor and delivery, where we have to very much... I want to, like, I could say, you are going to do this, this, and this because I'm the doctor, when the reality is, is we have to be able to, like, listen to our patients, hear their concerns, ask them. I mean, you brought that up earlier, is like, just asking the patient, what is your concern with this? So that I can give you the real information so that you can make a true informed decision is like a big difference between the paternalistic style of like, you will do this because I am the doctor. And I think there's, I think that's the most positive thing that we can do as physicians who consume social media and then make that content is that you have to hear what your patients are saying so that you can learn how to be a more patient-centered clinician rather than that paternalistic style because our patients are getting this information and we have to be able to work with it. That is so true. you know, on that note, I've done a lot of ⁓ writing and talking about all the misinformation and why more people, why more evidence-based doctors need to be on social media. Over 50 % of young people get their health information from social media and most of them get it from TikTok. And there is so much misinformation and disinformation. So disinformation is what I'm talking about and what you're talking about, which is misinformation for financial gain. And that's like the worst of the worst. So, you know, we have to understand that the climate, this is what they're seeing online and those are the videos that are gonna go viral. And this is what they're seeing in the office, you know, before they come to our office. So we have to understand what they're seeing, why they're... requesting a QT imaging when no one's ever heard of this, this is why. Because it's on social media, it goes viral for all the wrong reasons. And now, like, nothing that you say, like, they think I'm evil, you know? Like, they have been brainwashed into thinking that we are the enemy when we're actually, it's like we're just trying to help and give factual evidence, base information. Like, I didn't go through all this schooling, all this training to, like, lie to you. Like, I really, I find the... the creation of this divisiveness, feel, because so much of it is like, radiologists don't want you to know this about mammograms. OB-GYNs don't want you to know this about cervical cancer screening, right? And it's like, yeah, they don't tell you that because that's not real. That's not based on anything. But that very fearful hook that you just did for your video sure is going to get three million views. And then my creation of a video that combats that gets like 20 views. And you're like... Awesome. Right. So now everyone saw this like ridiculous video and you have no way of addressing it. Yeah. And it was so bad that actually the Surgeon General in 2021 issued a public health guidebook for how to combat public health misinformation and has really interesting points about how it's a public misinformation is a public health crisis. It causes confusion and so is mistrust in the medical community. And we really have to combat it head on. And the way to do that is by rewarding creators that do this evidence-based information and helping promote people. And I don't think that's really the climate. Well, mean, look to see who we're currently nominating for Surgeon General. I think Alan Rubin needs to be this Attorney General. Can we nominate him for Attorney General? Or you. Would you ever do it? No, I would never. Because you know what? I think once you get to the certain part of the Donner Kruggen you realize that you are actually not the right person. Like, you know so much that you know that you're not the right person. Like, people have commented that the last couple days, they're like, ⁓ you should be surgeon. I'm like, no, I should not. Like, I am purely a clinician who makes TikTok videos. I have no experience in health policy and all those kinds of things, right? There's so many, like, people who should do that job and are not up for nomination. And that is, like, the infuriating part of, like, when it comes to, disinformation and the government at this point, because now we are elevating the highest positions in healthcare to these people who absolutely should not be there. When you said you have no public health policy, neither does she. That's the point. Exactly. I know I shouldn't do that job. It's not imposter syndrome. She should probably have some imposter syndrome because let the people who are true experts and have done this work for years do that job, not just someone who wrote a good book and makes good Instagram videos. as someone who actually is not a practicing physician and has no experience in the actual job. Like just because you have some connections in wellness grifting doesn't mean you should be doing this job in the highest points in government. It's like infuriating. It sets the tone for our public health. Like we know that we're gonna be dealing with more misinformation. Like I don't wanna hear what she has to say about mammograms, because I know it's not gonna be good. No, it's not gonna be good. It's the same, you know, it's the same thing. I want you to tell me a little bit because I see this conversation a lot in real life and in online about dense breasts. I feel the concept of dense breasts has really picked up over the last years as someone who orders a lot of screening mammograms. I have been seeing a lot more results of dense breasts. Can you just like, this is like you teaching me really, but also our listeners about what does it mean to have dense breasts? What are people telling you online that it means? And in reality, what should we be doing about it? That's a great question. And about 50 % of women have dense breasts. And basically that means, you know, our breasts are composed of fat and fibro glandular or dense breast tissue. And dense breast tissue and the fibro glandular tissue is where all the stuff happens. That's where, you know, it's where we have breast tissue. It's really the hormonally active breast tissue. The thing about dense breast tissue, well, it's not abnormal to have greater than 50, your breasts composed of greater than 50%. dense breast tissue. that just means that having dense breast tissue just means that you're more dense than you're not. And about 50 % of women will have dense breast tissue. And really the only way to know it for real is on your mammogram. We could tell your breast density because we could see the fat, which is black, and the dense tissue, which is white. And the problem with the dense tissue being white is that breast cancers are also white. it obscures dense breast tissue has the possibility to obscure. breast cancer is on a mammogram. So I think of it like finding a snowflake in a blizzard. You know, the snow is white and the breast cancers are white. So finding a single breast cancer in a pile of snow becomes harder. So same thing with dense breast tissue. That's the problem on mammogram. and not only that, dense breast tissue is an independent risk factor for developing breast cancer. So having dense breast tissue or having more hormonally active tissue We now know that that also increases your risk. And the more dense you are, the greater the risk. Because this is where the breast cancers are developing. So it's a double-edged sword. It makes it harder to find the breast cancers in this patch of dense tissue. And it increases your risk, because you have more of it. Yeah, and I'm sure that's really scary for people to hear, right? And we're only hearing about it now because of advocacy and legislation. Because before this, women weren't informed that they had dense breast tissue. So women with dense breast tissue, mammograms becomes less sensitive. They're not insensitive. They can detect calcifications really well, areas of architectural distortion well, but sometimes they obscure a mass, especially if you're extremely dense. Okay, but knowledge is power, right? So now we're telling, now the legislation is such that you will be informed if you have dense breast tissue, you will be informed that dense breast tissue makes it harder to find small breast tumors on a mammogram, that... it increases your risk. If you have dense breast tissue, if you add an ultrasound or an MRI to your annual mammogram, then we're able to find smaller node-negative cancers at an earlier stage. So you might need something called supplemental imaging, such as an ultrasound or an MRI if you're high risk. So that's where, know, I think breast cancer screening needs to be a personalized approach. And that's what we're going to see in the future of breast cancer imaging. using a mammogram, not only are we going to be able to tell if your breast cancer is present, but we also have new AI software coming down the road that will tell you your five-year risk of developing breast cancer. So we're gonna know the people that we need to screen more diligently, like, you know, maybe every six months we're alternating, you know, versus the people that maybe you're, like, not likely to get breast cancer, and maybe you can be the person that can come in every two years. So I think that's where we're gonna go with this breast density, this knowledge that... you know, your breast composition is a really important part of your breast cancer risk. And it's also, you know, will help us personalize a breast cancer screening that was right for you, because it shouldn't be one size fits all. We know there are people that are getting breast cancer younger than 40. We need to catch those people earlier. And then there are people that might never develop breast cancer. So maybe we can back off those people. So that's where we're going. That is so interesting that the legislation really changed a lot of that. I had no idea. Thank you for explaining that. Yeah, it wasn't even until 2015 that people were informed about breast density because there was like this Dr. Nancy Capello who was diagnosed with stage three breast cancer. And what she found out was that like she called it breast density, the best kept secret from the patient that all this information was in her report, but it was never translated to her. in a way that made sense. So she really advocated for legislation and bills to cover supplemental imaging if you have dense breast tissue. So it's really fascinating and it's really opening up all these conversations that we should be having. Yeah, I think that's a great example of a patient ⁓ and a physician at that point really changing the game for a lot of things and taking their own experiences and trying to improve something. And I think that's something that you have done. You've shared a lot about your own breast imaging. You have recorded your own mammograms. you, I believe went through a little bit of a scare early, like a year, six months ago and really shared your experience with that. And I just, like, I really applaud you for that because it's very hard to put your own medical conditions out there. Going through something like a mammogram, which is very, you know, intimate can feel very, to put yourself out there like that is very hard. And I, you know, I recorded my own IUD insertion because I wanted to kind of like demystify it a little bit. What are, like, is it a similar motivation for you to be like, look, I am getting a mammogram. Yes, I don't love this, but here's the importance. Is that kind of like where you're coming from? 100%. I want to be the best role model that I can. you know, going through the experience, maybe I get, when I share my, you know, I've shared my mammogram, I've shared my colonopathy, I had an abnormality and I took people through that. And I decided I was going to do it in real time because whatever happened, I was going to tell people. So even if I was diagnosed with breast cancer tomorrow, God forbid... I know that I would do all the steps. know what the steps are. I'm such an educated patient. I would know that I need, like, so just to take you through what happened is that I had a new focal asymmetry. I knew I was going to need a biopsy. The next day we did the stereotactic biopsy. I towed people along through that. It came back as something benign called PASH, but it... was we called it discordant because it looked kind of suspicious on imaging. So I walk people through what is discordant me. Like what an incredible learning opportunity to take people through. And I really see the value in that. So I decided to become an oversharer because every time I post something like that, the amount of people are like, it wasn't as bad as I thought it was gonna be for you. Like even the stereo, like I was getting a stereotactic biopsy while filming my mammogram. I would like to show more, but my hospital would really like me not to show any of it. That's where I struggle a little bit because I know how valuable this really is to take people through, especially doing it live in real time and not after the fact. So I think we can all lead by example and like you said, demystify, make it less scary, you know, hopefully convince someone to get their mammogram, get their colonoscopy because it's not as bad as they thought it was gonna be. Yeah, well, thank you so much for your vulnerability because in the end, that can save someone's life. Someone can see that and say, okay, I understand now and I understand the importance and now I'm gonna do that. So... I really applaud you for just making yourself vulnerable like that. I'd like to get into just a couple quick rapid fire questions. So it's a little, medical, some personal. Okay, self breast exams, where do we stand? Do it every month, get to know how your breasts normally look and feel. know, knowing you're the only one who's gonna notice a change, especially if you're not getting screened regularly. You know, if you're under, like we are seeing a rise in young breast cancer. The greatest risk was actually women in their 20s were seeing the biggest spark. And that's not meant to scare you, but it's meant to inform you and empower you to learn how your breasts normally look and feel so you could recognize when there is a change. Because 80 % of young people who are diagnosed with breast cancer find the abnormality themselves. And an important reminder to clinicians that there's no patient right now who's too young for breast cancer, colon cancer, right? Yeah. And what's self-infuriating to me is actually the American Cancer Society doesn't technically support the self-breast exam. But they encourage... learning how your breasts normally look and feel. Well, how are you going to do that if you're not teaching people how to touch your breasts? I do think it's a very paternalistic approach to like, look, but don't touch, you know, like, we know that there's a problem. We're not screening you, but like, you know, you will deal with it when we get to that. And it's really not the case. So I try to do a monthly, I always on my, on the booby docks, I always post to feel it on the first, teaching people how to do a self-breast exam and how to advocate for yourself when you find something abnormal. and you want to push for the appropriate imaging. Because I feel like a lot of young women are told it's just a cyst, it's just a clogged duct, you're too young for breast cancer, and we know that's not true. So I always try to give the people, my followers, like another next step, like, how do you know that it's just a cyst? Is there any imaging test that we can do to make sure it's not anything more serious? Just so I could sleep better at night. Yeah, an ultrasound. Yeah, if you're under 30, we start with an ultrasound. And that is so easy and has no radiation, so. Yeah, have to have these conversations. lot of patients come to their gynecologist, even though I'm like, am a pelvis doctor, your top part, I'm just somehow, I get involved, right? But if anyone comes with a breast concern, 100 % of the time, they are getting imaging. One, because like clinically indicated blah, blah, blah, blah, two, but actually on a medical legal side, obstetricians are most oftenly sued for breast problems. So I'm not just, first of all, I'm not that extremely trained in the breast. I got some a little bit in residency. did like a month of breast rotation, but really, breast is not my forte. So I'm going to send them to the experts and be like, you tell me what is going on here. It's such a good point. You're not taught this in OB-GYN residency. You're not taught breast health. Everybody is all women out there are falsely walking around thinking that their doctor, their OBGYN is in charge of their breast health and they're not. Like no one is in charge of your breast health except you, which is why you have to be empowered. And that's like really the heart of my mission is that like, you know, you're not getting to me until there's a problem, but I'm trying to get you on social media before, you know, to hopefully teach you the tools that you need. So if there is a breast problem, you know how to recognize it and then speak up for yourself. Yeah, exactly. Okay, which social media platform seems to have the most misinformation when it comes to the breasts? TikTok, 100%. It's so easy. What has been one of your most rewarding patient interactions? I have, well, number one, I get stopped regularly on the streets by people going, the booby docks, I got my mammogram. You know, like, I'm like, yes, girl. That's so fun. And then also I have had several people reach out to me through social media and say that something that they learned on my page... help them find their breast cancer early. And they're usually young women who wouldn't have seen, you know, gotten, wouldn't have gotten their first baseline mammogram for another few years. And I get scared to know what would have happened to them. So that is why I do it. That is why I do what I do. I always say that, like, in my real job, I can, like, you know, touch 20 patients per day, but on social media, you can touch... millions. I hope anyone hearing that story sees the value in physician, like, not only like other doctors, but like leadership in hospitals. I understand they don't want to still always film in their spaces, and I understand that. But anyone who is in leadership, please support your physicians who are trying to do this work. Because, sure, they're maybe not like catching that one of your actual patients, but they are catching patients, and it's really important. And patients want to be on social media. Like, all the people that I've ever filmed, they're like, let's make a video, you know, like, because I see the value in what I do, because it makes it less scary for somebody else. I, as a gynecologist, received quite a few interesting DMs. Pictures, stories. Do you get pictures in your DMs? ⁓ yeah. I get lots of tidpicks in my DMs. Yes. I know. Tidpicks are hilarious. I know. No, it's usually people wanting me to help them interpret their mammogram, which also brings me to my point that, as a breast radiologist, we overestimate what people understand about the reports. Like, we're giving these really detailed reports using all this fancy lexicon, but our patients don't know what any of it means. And so that's where, like, we have to be better, and that's what social media is so beautiful at, is explaining these things that they don't have the opportunity to ask a radiologist. They're never, you know, so... I find it so like, it's just opened up such a world of like, wow, my patients know nothing from my experience. So like social media really allows me to have these conversations with them in a more meaningful way. So it's really cool. Your top three favorite creators that you're following doesn't have to be medical. Okay. I will say you, I do think you do a really fabulous job. And I'm not just saying that because we're talking right now. Lady Spine Doc, I like... yearn to have her level of like confidence and just this brand building that she has really done. And I'm gonna put in a newbie here and I love what this guy is doing. Dr. Brandon Axelrod, he's that oral maxillofacial resident who's trying to make pay off his student loans by doing balloon art. ⁓ I did see this. I did see that. He is so fascinating. And I think that's the perfect example of how to do social media. to find something that you loved as a kid, whether it be writing, whether it be creating, really using that to combine what you're passionate about now, like you being a doctor. They don't have to be, even make sense. They don't even have to be in line and really running with that. And I think what he's doing is so cool and he's done it in a pretty short amount of time. So I would put him in there as my current top three right now. I love that. OK, what was your question for me? I'm excited. OK, you shared recently that you made more money on social media. than your OBGYN job. How does that happen? Tell us more about that and how did you get there? Yeah, so a lot of it is just consistently posting in all the places because everyone plays a little bit differently. So TikTok pays you per view, Instagram pays you not very well, YouTube, if you're monetized, will pay you for views. And then Facebook actually is the best place for, I think, content creators because it's a low threshold to get paid and you can just automate your posting and you can post 10 videos a day. And that is where I make the most consistent money. I also work with brands. So I have sponsorships where I, that's where the larger percentage of my money has come from in the last couple of years. I will, I've said this a hundred times, but I have turned down hundreds of thousands of dollars of sponsorship because people do really try to take advantage of that doctor title. And so I accept way less than I get offered, but I, you know, there's something to be said for asking a doctor to put their name on something. So I, ⁓ charge like a premium for that. And then I have my, like apparel line where I make, you know, funny t-shirts and whatever. And so that actually has been also another consistent point of income. The money part is great because for me, you know, I am I graduated from residency in 2021, so I'm still in the catching up part of finances. My husband and I still have a combined $600,000 in our student loans that we're waiting for, PSLF in a year and a half. We have three young children. We haven't had those last 10 years of building an emergency fund, putting money into retirement. So the money has allowed me to be more caught up a little bit than I think I would have otherwise, but... And like, I'm a bougie girl. Like, I could be going crazy, but I'm really trying to be like a smart financial person and like just prepare for the future, really think about longevity, think about like how hard do I want to work in my job? I'll never stop working clinically, but do I have the option of like having a little bit more balance in that? So it's been an interesting ride and I kind of take it day by day and I try to be very thoughtful about the work that I do in that space, but it's a learning experience for sure. I think it's so great that you've made money and it's so important because again, it does take a lot of time and energy to make videos and to, you know, to get where you've gotten. It's not overnight, it's not easy. A lot of hard work went into that and you should be getting paid for it because again, we're putting out quality content. And it takes away, like we'd make more money, but like I would make more money by spending an hour reading X-rays, but I'd rather educate. And so for me, it's really like, this is the first year I'm actually making money through it. And again, it's through brand deals mainly because, but like I'm doing it for companies like Hologic that make namograms and they want me to myth-bust. Like this is stuff I'm gonna do anyways. And I need to make money because I spend a lot of money on this stuff. Like I wanna pay for an assistant. so that I could make more content and be the best version of myself as a mom, as a breast radiologist. So I always worry that the general public thinks it's a bad thing that we monetize on social media, but I think it's a necessary step in order to take this like a serious business. And it is, and we have the potential to do so much, but like we need to pay for the travel, know, self publishing a book, like I spent thousands of dollars. to self-publish my book, which you should definitely buy. Everyone has movies.com. You should everyone buy it. Yeah. You know, I like make $4 per book. Like I'm not gonna get rich. This is not a get rich quick theme. It's because I think that kids need this book. Yeah, I need that book. You do need that book. I'll send you a copy for your office. I would love to send you a copy for your office. And for your kids, they're gonna love this book. Wait, I have to show you a part of my book. Can I read you like three pages of my book? I would love that. Last week in class, our teacher said we have a special guest. The door swung wide into our surprise. Who walked in abreast? The class began to chuckle, followed by blank stares. Hey kids, I'm just the booby. There's no need to be scared. Everyone has boobies. It's pretty plain to see. Everyone has boobies, just like you and me. Hey, you can't say those words, the ones that start with B. Breast and boobies aren't bad words. It's just anatomy. Okay. And then let me just show you one other thing. My kids are in the book. Like that's my niece. But then, you know, I talk about breastfeeding, how boobs are really magical. how animals have boobies, mammals do. But then there's this page when it said, the boobies can get boo-boos and have a scar or two. My mommy boobies have a scar, my daddy has one too. That's me by the way. But if boobies get a boo-boo, there are things that doctors can do. They could bind it, they could shrink it, they could fry it, they could freeze it. They can cut it, they can care it and make that booby boo boo go bye bye bye. Everyone needs a book. Everyone needs a book because everyone has boobies and we got to start talking about them young. because we all grow up, like we currently don't talk about breast with our children. And that's where we're getting it wrong. We're like, we are growing up feeling shameful and feeling like censored without ever having a conversation about it. So I'm really trying to open up the conversation in a funny, silly, playful way that's age appropriate for your kids. And honestly, like parents love it. It opens up these more serious conversations that we need to be having with our children about boundaries. about puberty, all these things that we need to be talking about. Yeah, I definitely can't wait to read that with my children. I would love to send you a copy. And for everyone, can buy a copy on Amazon, obviously, but you could also buy a signed hardcover on my website, theboobydocs.com. So go check it out. Dr. Roth, you're doing incredible work between your book, your social media, and your real life, right? Like you are doing it all. Thank you so much for being here, for helping Myth. best things for me as a clinician, for our listeners, and to really continue to encourage the best breast health. Thank you so much for being here. Thank you so much for having me.