1 00:00:03,200 --> 00:00:09,959 Speaker 1: Hey, everybody, welcome to a special episode of Amy and 2 00:00:10,119 --> 00:00:12,680 Speaker 1: TJ Robots. Sitting here next to me. A lot of 3 00:00:12,720 --> 00:00:15,040 Speaker 1: people have been following along with us the past. I 4 00:00:15,040 --> 00:00:17,320 Speaker 1: guess a couple of weeks we did a show talking 5 00:00:17,360 --> 00:00:20,480 Speaker 1: about on one of the episodes talking about you not 6 00:00:21,400 --> 00:00:24,880 Speaker 1: making an appointment and being over a year, a year, 7 00:00:25,160 --> 00:00:28,320 Speaker 1: a year and a half a half since you win 8 00:00:28,480 --> 00:00:30,360 Speaker 1: for blood work that you were supposed to have. Do 9 00:00:30,440 --> 00:00:32,319 Speaker 1: I have that right as a Breastkansas riber. 10 00:00:32,400 --> 00:00:35,080 Speaker 2: I have been doing it every six months or so 11 00:00:35,520 --> 00:00:37,600 Speaker 2: up until well, you know. 12 00:00:38,120 --> 00:00:42,120 Speaker 1: Yes, everything hit the fan. But we do update people 13 00:00:42,159 --> 00:00:45,440 Speaker 1: recently that you have made the appointment, are going to 14 00:00:45,440 --> 00:00:48,479 Speaker 1: get your blood work done very soon. And that appointment 15 00:00:48,600 --> 00:00:51,120 Speaker 1: is with someone you speak so highly up all the time, 16 00:00:51,159 --> 00:00:51,720 Speaker 1: Doctor Ritz. 17 00:00:51,920 --> 00:00:54,800 Speaker 2: Yes, doctor Ruth Ratz, and she is actually in the 18 00:00:54,880 --> 00:00:57,400 Speaker 2: studio with us. She is my oncologist. She has been 19 00:00:57,440 --> 00:01:01,760 Speaker 2: with me from the very beginning since I was oh yes, 20 00:01:01,840 --> 00:01:03,920 Speaker 2: a young pop of forty when I got my breast 21 00:01:03,960 --> 00:01:06,200 Speaker 2: cancer diagnosis. But doctor Ortz has been on the journey 22 00:01:06,240 --> 00:01:07,920 Speaker 2: with me every step of the way. And so first 23 00:01:07,920 --> 00:01:10,640 Speaker 2: of all, I'm just gonna apologize for having left so 24 00:01:10,720 --> 00:01:13,440 Speaker 2: much time and space between us over the past year 25 00:01:13,480 --> 00:01:15,840 Speaker 2: and a half. But it's so good to see you 26 00:01:15,880 --> 00:01:17,559 Speaker 2: and we're so happy to have you in the studio 27 00:01:17,680 --> 00:01:18,000 Speaker 2: with us. 28 00:01:18,000 --> 00:01:21,120 Speaker 3: So welcome. I'm happy to be here. I'm delighted to 29 00:01:21,120 --> 00:01:24,440 Speaker 3: be here with both of you and Amy. You know, 30 00:01:24,680 --> 00:01:28,399 Speaker 3: I stalk you, so even though I haven't seen you 31 00:01:28,440 --> 00:01:32,000 Speaker 3: in person, I know you've been okay. Oh, and I 32 00:01:32,040 --> 00:01:34,520 Speaker 3: see you training, I see you out there running. I 33 00:01:34,560 --> 00:01:37,640 Speaker 3: know you're healthy, and I know that you take really 34 00:01:37,680 --> 00:01:38,640 Speaker 3: good care of yourself. 35 00:01:38,959 --> 00:01:39,280 Speaker 2: Thank you. 36 00:01:39,319 --> 00:01:41,479 Speaker 3: So we'll update everything see you okay. 37 00:01:41,560 --> 00:01:43,800 Speaker 2: Yeah, and a couple and a couple of weeks, we've 38 00:01:43,840 --> 00:01:46,200 Speaker 2: got the appointment, but we asked you to come into 39 00:01:46,240 --> 00:01:49,480 Speaker 2: the studio because there's been a big headline this week 40 00:01:49,560 --> 00:01:53,200 Speaker 2: with actress Olivia Munn. She's forty three years old. She 41 00:01:53,680 --> 00:01:57,080 Speaker 2: let everyone know that she has just been through ten 42 00:01:57,120 --> 00:02:01,040 Speaker 2: months of treatment for breast cancer. That, of course, is 43 00:02:01,080 --> 00:02:03,960 Speaker 2: always a big announcement when there's someone famous who can 44 00:02:04,080 --> 00:02:08,040 Speaker 2: bring awareness to the cause. But it's a unique story 45 00:02:08,160 --> 00:02:11,280 Speaker 2: because she's talking about how she found her cancer. She 46 00:02:11,400 --> 00:02:14,760 Speaker 2: said she had a clearant mammogram. She said that she 47 00:02:15,639 --> 00:02:17,880 Speaker 2: didn't have any of the markers for genetic testing that 48 00:02:17,919 --> 00:02:21,080 Speaker 2: would make her a candidate for potentially having breast cancer, 49 00:02:21,120 --> 00:02:24,000 Speaker 2: but then she said her doctor two months later had 50 00:02:24,000 --> 00:02:27,560 Speaker 2: her do a breast cancer risk assessment test, and that 51 00:02:27,680 --> 00:02:31,040 Speaker 2: led to more tests, which led to her finding an 52 00:02:31,040 --> 00:02:35,960 Speaker 2: aggressive form of breast cancer in both breasts. And I 53 00:02:36,080 --> 00:02:38,440 Speaker 2: kind of thought I knew a lot about breast cancer 54 00:02:38,600 --> 00:02:40,919 Speaker 2: throughout my journey, but even I was scratching my hat. 55 00:02:41,080 --> 00:02:45,240 Speaker 2: A breast cancer risk assessment test. Please explain what that 56 00:02:45,560 --> 00:02:47,600 Speaker 2: is and just put this into perspective for us. 57 00:02:47,720 --> 00:02:50,600 Speaker 3: Yes, I think we were all very shocked to hear 58 00:02:50,639 --> 00:02:55,160 Speaker 3: this story and it raises an important issue, particularly for 59 00:02:55,240 --> 00:02:58,640 Speaker 3: young women who were diagnosed with breast cancer. Let me 60 00:02:58,720 --> 00:03:00,800 Speaker 3: just back up and talk about the man. You know, 61 00:03:00,840 --> 00:03:05,000 Speaker 3: we do want everyone to have mammogram screening, but as 62 00:03:05,040 --> 00:03:09,480 Speaker 3: I always say, it's not one size fits all, and 63 00:03:09,840 --> 00:03:13,880 Speaker 3: for many young women, the mammogram won't show early stage 64 00:03:13,880 --> 00:03:17,080 Speaker 3: breast cancer because the breast tissue is very dense in 65 00:03:17,200 --> 00:03:20,600 Speaker 3: young women and the mamogram doesn't show enough. So that's 66 00:03:20,600 --> 00:03:25,280 Speaker 3: why it's really important for each individual to speak with 67 00:03:25,400 --> 00:03:29,880 Speaker 3: her doctor about what are the other potential factors that 68 00:03:30,040 --> 00:03:34,120 Speaker 3: could be contributing to a risk of breast cancer and 69 00:03:34,440 --> 00:03:38,320 Speaker 3: do we need to change up or add something to 70 00:03:38,360 --> 00:03:42,960 Speaker 3: the screening and surveillance. Now, the Breast Cancer Risk Assessment 71 00:03:43,000 --> 00:03:49,120 Speaker 3: Tool could be helpful. It's a statistical model that was 72 00:03:49,240 --> 00:03:52,640 Speaker 3: developed many years ago. We've had this, you know, for 73 00:03:52,720 --> 00:03:57,280 Speaker 3: probably fifteen twenty years already, and it's a simple computer model. 74 00:03:57,320 --> 00:04:00,560 Speaker 3: It's free. It's available online. You can click on a 75 00:04:00,600 --> 00:04:03,720 Speaker 3: website and bring it up, and it asks a few 76 00:04:03,880 --> 00:04:09,200 Speaker 3: basic questions about a woman's personal history. It's really developed 77 00:04:09,200 --> 00:04:11,200 Speaker 3: for women. We know men can get breast cancer, we'll 78 00:04:11,200 --> 00:04:14,640 Speaker 3: come to that later, but focusing on women, it is 79 00:04:14,840 --> 00:04:19,359 Speaker 3: they ask about age, family history of breast cancer, focusing 80 00:04:19,440 --> 00:04:24,279 Speaker 3: on close relations we call those first degree relatives, mother, sister, daughter, 81 00:04:25,520 --> 00:04:28,640 Speaker 3: whether or not the person has had a prior biopsy 82 00:04:28,720 --> 00:04:32,520 Speaker 3: of the breast that showed any atypical cells. And then 83 00:04:32,560 --> 00:04:36,080 Speaker 3: some questions about reproductive history. How old you were when 84 00:04:36,120 --> 00:04:39,520 Speaker 3: you had your first menstrual period, how if you've had pregnancies, 85 00:04:39,520 --> 00:04:42,040 Speaker 3: how old you were at the time of that first pregnancy. 86 00:04:42,760 --> 00:04:47,160 Speaker 3: And then there's a calculation that's made that gives an estimate. 87 00:04:47,240 --> 00:04:49,920 Speaker 3: I mean it's not perfect, but an estimate. You know, 88 00:04:50,000 --> 00:04:52,320 Speaker 3: what's your risk of getting breast cancer in the next 89 00:04:52,360 --> 00:04:55,960 Speaker 3: five years? Or over your lifetime up to age ninety 90 00:04:56,720 --> 00:04:59,160 Speaker 3: and compares that to the general population. 91 00:05:01,160 --> 00:05:05,560 Speaker 1: I think that the test is what's throwing everybody right now. Okay, 92 00:05:05,200 --> 00:05:08,159 Speaker 1: you tell people, tell women, go get a manogram, You 93 00:05:08,200 --> 00:05:09,800 Speaker 1: tell them what age to do it, how often to 94 00:05:09,839 --> 00:05:13,480 Speaker 1: do it, You go in, mamogram's clear and you should 95 00:05:13,480 --> 00:05:16,400 Speaker 1: be in the clear. Now, why would you take the 96 00:05:16,440 --> 00:05:20,120 Speaker 1: next step or why isn't everyone being told to take 97 00:05:20,279 --> 00:05:23,479 Speaker 1: do a mammogram and go online and everybody do this 98 00:05:23,600 --> 00:05:24,480 Speaker 1: risk assessment test. 99 00:05:24,640 --> 00:05:26,800 Speaker 3: Yeah, that's sort of actually a great question. We have 100 00:05:26,960 --> 00:05:30,919 Speaker 3: not made that recommendation. In this case, it did lead 101 00:05:31,120 --> 00:05:34,800 Speaker 3: to a diagnosis of breast cancer. I think maybe the 102 00:05:34,880 --> 00:05:37,280 Speaker 3: concern is that if everyone did it, there would be 103 00:05:37,400 --> 00:05:40,279 Speaker 3: kind of like mass panic because a lot of people 104 00:05:40,440 --> 00:05:43,960 Speaker 3: might have a slightly increased risk. I don't know how 105 00:05:44,080 --> 00:05:46,960 Speaker 3: hurt test actually, you know what the numbers were or 106 00:05:46,960 --> 00:05:47,680 Speaker 3: how it came out. 107 00:05:47,800 --> 00:05:49,279 Speaker 1: So thirty seven actually was it? 108 00:05:49,279 --> 00:05:52,880 Speaker 3: I have it right? Thirty seven lifetime risk. Yeah, so 109 00:05:52,960 --> 00:05:56,600 Speaker 3: that is higher than the average American woman who has 110 00:05:56,640 --> 00:06:00,279 Speaker 3: a twelve percent lifetime risk. So that was high enough 111 00:06:01,080 --> 00:06:04,520 Speaker 3: that it triggered the extra testing by her doctor. So 112 00:06:04,600 --> 00:06:06,279 Speaker 3: you know, as I was thinking about that. I mean, 113 00:06:06,360 --> 00:06:09,520 Speaker 3: maybe you're right, TJ. Maybe more people should go online 114 00:06:10,520 --> 00:06:13,280 Speaker 3: kind of get a rough idea where they fall out 115 00:06:13,320 --> 00:06:17,640 Speaker 3: on that. But remember it's just a rough idea. So 116 00:06:18,600 --> 00:06:20,799 Speaker 3: Olivia did the right thing. She took the next step 117 00:06:20,800 --> 00:06:22,640 Speaker 3: and went to her doctor and said, what does this mean. 118 00:06:24,120 --> 00:06:26,800 Speaker 2: This is also something that has been interesting to me 119 00:06:26,880 --> 00:06:29,520 Speaker 2: because yeah, I had never even heard of this test was. 120 00:06:29,680 --> 00:06:31,560 Speaker 2: We had to look it up and figure out what 121 00:06:31,640 --> 00:06:35,120 Speaker 2: it was. But I think most people know my history 122 00:06:35,200 --> 00:06:38,560 Speaker 2: that I had a mammogram at age forty because I 123 00:06:38,600 --> 00:06:40,680 Speaker 2: had a work assignment, not even because I was going 124 00:06:40,680 --> 00:06:43,479 Speaker 2: in there. Because at the time I was diagnosed, the 125 00:06:43,480 --> 00:06:46,880 Speaker 2: recommendation was fifty, then it went to forty five, and 126 00:06:46,920 --> 00:06:49,479 Speaker 2: now it's down to forty, which we're all applauding. I 127 00:06:49,520 --> 00:06:51,520 Speaker 2: know you are as well. Anyone who works with breast 128 00:06:51,560 --> 00:06:55,360 Speaker 2: cancer patients is saying, yes, forty years old. But I 129 00:06:55,480 --> 00:06:59,880 Speaker 2: ended up getting a sonogram after the mammogram showed abnormal. 130 00:07:01,320 --> 00:07:03,760 Speaker 2: If the sonogram is a better test than a mammogram, 131 00:07:03,839 --> 00:07:06,159 Speaker 2: or at least maybe a clearer test for younger women 132 00:07:06,200 --> 00:07:10,360 Speaker 2: who have potentially dense breast tissue, why wouldn't there always 133 00:07:10,360 --> 00:07:13,840 Speaker 2: be a sonogram or maybe even a sonogram versus a mammogram. 134 00:07:14,280 --> 00:07:18,560 Speaker 3: Well, I think you're right, Amy, And in my personal practice, 135 00:07:18,600 --> 00:07:21,760 Speaker 3: when I see young women at risk for breast cancer, 136 00:07:21,800 --> 00:07:25,000 Speaker 3: they haven't had breast cancer, but at risk, let's say, 137 00:07:25,040 --> 00:07:28,920 Speaker 3: because of family history, or they had a concern about 138 00:07:28,960 --> 00:07:32,000 Speaker 3: something and came in to be evaluated, we do always 139 00:07:32,040 --> 00:07:35,280 Speaker 3: add the sonogram. Some people who are very young, I 140 00:07:35,360 --> 00:07:38,080 Speaker 3: do the sonogram and I skip the mammogram because I 141 00:07:38,120 --> 00:07:40,000 Speaker 3: know that mammogram's not going to show me a whole 142 00:07:40,000 --> 00:07:43,160 Speaker 3: lot in someone who's very young, maybe in her thirties. 143 00:07:44,560 --> 00:07:51,160 Speaker 3: So again, you know, those screening recommendations are that everybody 144 00:07:51,160 --> 00:07:53,040 Speaker 3: should do the same thing, and I think we have 145 00:07:53,120 --> 00:07:57,920 Speaker 3: to tailor our recommendations to the individual person. And this 146 00:07:58,080 --> 00:08:01,400 Speaker 3: risk assessment test is some thing I run in the office. 147 00:08:01,840 --> 00:08:05,400 Speaker 3: I do it, and I might share that information with 148 00:08:05,440 --> 00:08:07,440 Speaker 3: my patient and say, look, your risk isn't as high 149 00:08:07,440 --> 00:08:10,600 Speaker 3: as we thought, or maybe it's higher than we expected, 150 00:08:11,480 --> 00:08:14,040 Speaker 3: or gee, we should do some genetic testing in you 151 00:08:14,160 --> 00:08:17,680 Speaker 3: because of your family history. So you know, there are 152 00:08:17,720 --> 00:08:20,200 Speaker 3: many factors we look at, and this should be one 153 00:08:20,200 --> 00:08:23,840 Speaker 3: of those things that gets incorporated into risk assessment. Lots 154 00:08:23,840 --> 00:08:27,160 Speaker 3: of gynecologists do it and I think that's what happened 155 00:08:27,160 --> 00:08:29,360 Speaker 3: in this instance. Or doctor said, let's just run this 156 00:08:29,440 --> 00:08:31,760 Speaker 3: on you and see how it comes out, like you 157 00:08:31,840 --> 00:08:32,720 Speaker 3: don't know what it triggered. 158 00:08:32,720 --> 00:08:35,640 Speaker 2: It's free, and why not Why wouldn't you do that? 159 00:08:35,679 --> 00:08:38,000 Speaker 2: There's no argument to not do it correct. 160 00:08:38,120 --> 00:08:40,920 Speaker 3: I mean, you know, I always say knowledge gives us power. 161 00:08:42,200 --> 00:08:45,600 Speaker 1: The sonogram versus mammogram does one? Is there a difference 162 00:08:45,640 --> 00:08:48,880 Speaker 1: in cost to the or or what insurance will cover, 163 00:08:49,400 --> 00:08:50,479 Speaker 1: so neither. 164 00:08:50,280 --> 00:08:54,200 Speaker 3: Of them are expensive tests. And but for whatever reason, 165 00:08:54,640 --> 00:08:59,680 Speaker 3: the insurance companies and Medicare and whatever has set up 166 00:08:59,720 --> 00:09:02,720 Speaker 3: this paradigm that you have to do the mammogram first. 167 00:09:03,080 --> 00:09:05,079 Speaker 3: Huh before you can order the sonogram. 168 00:09:05,160 --> 00:09:05,400 Speaker 2: Huh. 169 00:09:05,520 --> 00:09:09,720 Speaker 3: Yep, it's kind of a crazy thing. I cannot understand it. 170 00:09:10,160 --> 00:09:11,600 Speaker 1: Insurance generally cover both. 171 00:09:11,880 --> 00:09:14,200 Speaker 3: Yeah, it will eventually get covered, but sometimes you have 172 00:09:14,240 --> 00:09:16,760 Speaker 3: to go through the mammogram and then we can order 173 00:09:16,800 --> 00:09:21,880 Speaker 3: the ultrasound and for our older patients. Actually, just this 174 00:09:21,960 --> 00:09:31,000 Speaker 3: past year, Medicare changed their system so that we cannot 175 00:09:31,160 --> 00:09:33,440 Speaker 3: order the mammogram and ultrasound to be done on the 176 00:09:33,480 --> 00:09:37,360 Speaker 3: same day. The prus has to have the mammogram and 177 00:09:37,559 --> 00:09:40,200 Speaker 3: then if we think the sonogram is indicated we order 178 00:09:40,200 --> 00:09:41,880 Speaker 3: it and she has to go back a second time. 179 00:09:42,360 --> 00:09:46,200 Speaker 2: It's it's absurd and look, I have shared the story before, 180 00:09:46,240 --> 00:09:49,040 Speaker 2: but I haven't here on this podcast. I was outraged 181 00:09:49,080 --> 00:09:51,400 Speaker 2: when I had the first mammogram and the Mamma Van 182 00:09:51,640 --> 00:09:55,000 Speaker 2: in the middle of Times Square. They just saw something suspicious. 183 00:09:55,320 --> 00:09:58,640 Speaker 2: There was no nothing specific to cancer. They just said, 184 00:09:58,640 --> 00:10:01,160 Speaker 2: you know what, we'd like you to get another mammogram 185 00:10:01,200 --> 00:10:03,920 Speaker 2: because something looks a little off. And so when I 186 00:10:03,960 --> 00:10:07,320 Speaker 2: went to go make the follow up appointment at Nyu 187 00:10:07,400 --> 00:10:09,400 Speaker 2: Lang Gone, I got a call the night before from 188 00:10:09,400 --> 00:10:11,880 Speaker 2: my insurance company saying we are not going to cover this. 189 00:10:12,600 --> 00:10:15,000 Speaker 2: And so NYU called me and said, you're going to 190 00:10:15,040 --> 00:10:16,880 Speaker 2: have to give us your credit card if you want 191 00:10:16,880 --> 00:10:19,800 Speaker 2: to keep the appointment for tomorrow. And I almost did 192 00:10:19,840 --> 00:10:22,000 Speaker 2: not do it because I was annoyed A that I 193 00:10:22,080 --> 00:10:23,880 Speaker 2: was going back for a second one and B that 194 00:10:23,960 --> 00:10:25,520 Speaker 2: I was going to have to pay at least eight 195 00:10:25,640 --> 00:10:28,440 Speaker 2: hundred dollars out of pocket. Eight hundred dollars to a 196 00:10:28,440 --> 00:10:30,920 Speaker 2: lot of people is not even an option. That's their 197 00:10:30,960 --> 00:10:33,560 Speaker 2: rent payment, that's food on their table. I was lucky 198 00:10:33,640 --> 00:10:35,720 Speaker 2: enough to be able to afford it, but to think 199 00:10:35,760 --> 00:10:38,280 Speaker 2: that insurance companies get involved in a way where they 200 00:10:38,280 --> 00:10:41,800 Speaker 2: make life so much more difficult and potentially could could 201 00:10:41,840 --> 00:10:46,000 Speaker 2: be costing women lives, time, money, etc. I know you, 202 00:10:46,040 --> 00:10:48,040 Speaker 2: as a doctor have to be so frustrated by this. 203 00:10:48,400 --> 00:10:51,640 Speaker 3: We are very frustrated by it. And you know that 204 00:10:51,720 --> 00:10:56,199 Speaker 3: eight hundred dollars bill is probably including other costs than 205 00:10:56,440 --> 00:10:58,600 Speaker 3: just the cost of doing the X ray, because we 206 00:10:58,679 --> 00:11:03,319 Speaker 3: know that when we've done mass screening projects sending those 207 00:11:03,400 --> 00:11:07,439 Speaker 3: vans out, for example, we can bring the cost down 208 00:11:07,600 --> 00:11:10,760 Speaker 3: significantly and we don't want cost ever to be a 209 00:11:10,800 --> 00:11:14,079 Speaker 3: barrier for women to get the right screening that they need, 210 00:11:15,000 --> 00:11:20,360 Speaker 3: So that's really really important. It is very frustrating. And 211 00:11:20,400 --> 00:11:24,120 Speaker 3: again in our younger patients in particular, people say, oh, well, 212 00:11:24,120 --> 00:11:26,719 Speaker 3: breast cancer doesn't happen in people that age, but it 213 00:11:27,200 --> 00:11:30,360 Speaker 3: sure does, you know, and you know that too all 214 00:11:30,400 --> 00:11:30,800 Speaker 3: too well. 215 00:11:30,920 --> 00:11:32,760 Speaker 1: The doctor oris with a living mon here help me. 216 00:11:32,800 --> 00:11:35,840 Speaker 1: And again I'm familiar to a certain degree and to 217 00:11:35,840 --> 00:11:38,640 Speaker 1: feel maybe familiar little more because of who I'm in 218 00:11:38,679 --> 00:11:41,640 Speaker 1: love with here and the history of breast cancer. But 219 00:11:42,200 --> 00:11:46,040 Speaker 1: the order someone's told to go get a mammogram, you 220 00:11:46,080 --> 00:11:51,280 Speaker 1: get that mammogram. If it's clear, then there is no 221 00:11:51,480 --> 00:11:55,559 Speaker 1: next step necessarily right, You're done until your next scheduled appointment. 222 00:11:55,559 --> 00:11:58,480 Speaker 1: A living your month is saying the doctor. So the 223 00:11:58,520 --> 00:12:01,360 Speaker 1: clear mammogram, but still we went ahead and did the 224 00:12:02,240 --> 00:12:06,480 Speaker 1: risk the risk assessment, and if they hadn't done that, 225 00:12:06,520 --> 00:12:08,679 Speaker 1: then maybe they wouldn't have taken that. So I am 226 00:12:08,720 --> 00:12:11,240 Speaker 1: trying to find the order and trying to get women 227 00:12:11,280 --> 00:12:14,720 Speaker 1: to understand because I don't understand what the understand what 228 00:12:14,800 --> 00:12:17,480 Speaker 1: they should They run out and get online see their 229 00:12:17,520 --> 00:12:19,800 Speaker 1: risk assessment score and then immediately go talk to the 230 00:12:19,800 --> 00:12:22,240 Speaker 1: doctor about it. Is that what everybody should be doing. 231 00:12:22,880 --> 00:12:24,960 Speaker 3: I think everyone has to be aware of what's going 232 00:12:24,960 --> 00:12:29,080 Speaker 3: on in her own personal health and that family history story. 233 00:12:29,200 --> 00:12:32,839 Speaker 3: Every woman should see the doctor once a year or 234 00:12:33,040 --> 00:12:35,680 Speaker 3: you know, it could be a nurse practitioner or a PA, 235 00:12:35,760 --> 00:12:39,400 Speaker 3: whoever the person is who's providing your health care for 236 00:12:39,640 --> 00:12:44,480 Speaker 3: a GYN exam and a clinical breast exam, so sometimes 237 00:12:44,520 --> 00:12:47,240 Speaker 3: you can feel something that may not show up right 238 00:12:47,280 --> 00:12:50,080 Speaker 3: away on the X ray. Also, checking under the arms 239 00:12:50,080 --> 00:12:54,000 Speaker 3: for lumps is very important. So the clinical breast examination 240 00:12:54,920 --> 00:12:58,160 Speaker 3: and the mammogram is the way we start. I personally, 241 00:12:58,600 --> 00:13:02,280 Speaker 3: you know, as Amy knows, younger patients feel that ultrasound, 242 00:13:02,320 --> 00:13:05,800 Speaker 3: that sonogram should be part of that evaluation, and then 243 00:13:05,960 --> 00:13:10,320 Speaker 3: in discussing those results. It's not just when and done, 244 00:13:10,320 --> 00:13:13,360 Speaker 3: you're clear, it should be a discussion afterwards, well what 245 00:13:13,920 --> 00:13:17,880 Speaker 3: did my mammogram show? If there's very dense breast tissue there, 246 00:13:18,679 --> 00:13:22,079 Speaker 3: do I need a follow up test? If oh, yeah, 247 00:13:22,160 --> 00:13:25,640 Speaker 3: I didn't tell you my mom had breast cancer, or 248 00:13:25,679 --> 00:13:28,920 Speaker 3: my mom and her two sisters had breast cancer, or 249 00:13:29,800 --> 00:13:33,640 Speaker 3: in taking that reproductive history you find out that that 250 00:13:33,760 --> 00:13:37,439 Speaker 3: person had their first child over age thirty, and maybe 251 00:13:37,720 --> 00:13:41,120 Speaker 3: you know other issues in their personal health that might trigger. 252 00:13:41,840 --> 00:13:44,560 Speaker 3: In this case, it triggered you know, Olivia's doctor to 253 00:13:44,679 --> 00:13:48,720 Speaker 3: run that risk assessment score. It's not wrong for someone 254 00:13:48,800 --> 00:13:52,160 Speaker 3: to go online and do it herself. We just want 255 00:13:52,160 --> 00:13:57,360 Speaker 3: to be careful that people don't get misinterpreted. So once 256 00:13:57,400 --> 00:13:59,920 Speaker 3: you run it, go in and talk to an extra 257 00:14:00,360 --> 00:14:02,240 Speaker 3: about what that means and what you should do. 258 00:14:11,120 --> 00:14:11,160 Speaker 2: That. 259 00:14:11,280 --> 00:14:13,520 Speaker 1: I hear you right that a lot of women may 260 00:14:13,559 --> 00:14:17,200 Speaker 1: be getting the risk assessment and don't even know it 261 00:14:17,200 --> 00:14:19,160 Speaker 1: because they might be in there with their doctor. It 262 00:14:19,200 --> 00:14:21,000 Speaker 1: sounds like you were saying you were asking the questions 263 00:14:21,000 --> 00:14:23,000 Speaker 1: and doing the risk assessment even though the woman didn't 264 00:14:23,000 --> 00:14:24,080 Speaker 1: realize that. 265 00:14:24,160 --> 00:14:26,160 Speaker 3: Then I told her. They told her about Yeah, you 266 00:14:26,200 --> 00:14:28,360 Speaker 3: have to always tell them like right, what it is? 267 00:14:28,560 --> 00:14:32,520 Speaker 2: Right? And it's interesting because we've had this conversation. I 268 00:14:32,760 --> 00:14:35,880 Speaker 2: was among the more than eighty percent of breast cancer 269 00:14:36,040 --> 00:14:38,840 Speaker 2: patients who have no family history, so I would have 270 00:14:38,920 --> 00:14:41,720 Speaker 2: been considered average risk. I wouldn't have considered myself at 271 00:14:41,760 --> 00:14:45,560 Speaker 2: elevated risk. But you mentioned this to me way back 272 00:14:45,600 --> 00:14:48,000 Speaker 2: when my daughters were really young. Now, but now Avis 273 00:14:48,000 --> 00:14:51,360 Speaker 2: twenty one and Analyse is about to be eighteen, and 274 00:14:52,400 --> 00:14:55,280 Speaker 2: you had said, because of my history, their history is 275 00:14:55,320 --> 00:14:57,680 Speaker 2: now they are at an elevated risk. 276 00:14:57,720 --> 00:14:58,960 Speaker 3: Correct, So what. 277 00:14:59,720 --> 00:15:02,680 Speaker 2: Is the age because it's been so confusing for women 278 00:15:03,000 --> 00:15:05,520 Speaker 2: who are of average risk when they should have their 279 00:15:05,520 --> 00:15:09,160 Speaker 2: first mammogram. But what about people like my daughters whose 280 00:15:09,240 --> 00:15:12,440 Speaker 2: mom had breast cancer at a young age, When should 281 00:15:12,520 --> 00:15:13,640 Speaker 2: they have their first mammogram? 282 00:15:13,760 --> 00:15:16,760 Speaker 3: Is that clear? Yes? What we do is that we 283 00:15:16,920 --> 00:15:22,000 Speaker 3: recommend they start seeing an expert ten years before the 284 00:15:22,200 --> 00:15:28,040 Speaker 3: age at which their mom was diagnosed, so thirty round thirty. 285 00:15:28,080 --> 00:15:30,800 Speaker 3: That doesn't mean they have to go into a whole 286 00:15:30,920 --> 00:15:34,400 Speaker 3: intensive thing, but they have to talk to someone who 287 00:15:34,440 --> 00:15:38,920 Speaker 3: is an expert and go through their personal history, maybe 288 00:15:39,000 --> 00:15:42,160 Speaker 3: run a risk assessment score, and then figure out, okay, 289 00:15:42,160 --> 00:15:45,320 Speaker 3: what's going to be the best way of keeping track 290 00:15:45,360 --> 00:15:47,960 Speaker 3: of them and getting started a little bit early or 291 00:15:48,040 --> 00:15:51,280 Speaker 3: so we're ahead of the curve and watching closely. 292 00:15:51,560 --> 00:15:54,520 Speaker 2: I mean, obviously I had access to the best doctors 293 00:15:54,560 --> 00:15:58,120 Speaker 2: in the world, you doctor Ratz and the incredible surgeons 294 00:15:58,120 --> 00:15:59,880 Speaker 2: and everyone there at NYU Langona, and I had a 295 00:16:00,040 --> 00:16:04,600 Speaker 2: credible insurance. For women who don't have those means or 296 00:16:04,640 --> 00:16:07,400 Speaker 2: have access to healthcare like that, are they going to 297 00:16:07,560 --> 00:16:10,440 Speaker 2: find it hard? Say they go online and they take 298 00:16:10,440 --> 00:16:12,440 Speaker 2: this breast cancer risk assessment test and they see it's 299 00:16:12,440 --> 00:16:17,200 Speaker 2: elevated significantly above that twelve percent average. What are their options? 300 00:16:17,280 --> 00:16:21,080 Speaker 2: Will they What could you suggest to them? What is 301 00:16:21,120 --> 00:16:22,000 Speaker 2: your advice to them? 302 00:16:22,600 --> 00:16:25,960 Speaker 3: Well, first of all, we have an amazing network of 303 00:16:26,560 --> 00:16:33,360 Speaker 3: National Cancer Institute designated cancer centers in every state of 304 00:16:33,400 --> 00:16:36,800 Speaker 3: the Union, all fifty states. Now we have you know, 305 00:16:36,840 --> 00:16:38,920 Speaker 3: four or five of them right here in New York City, 306 00:16:39,280 --> 00:16:42,760 Speaker 3: So we have a lot of density of population and 307 00:16:42,840 --> 00:16:46,520 Speaker 3: a lot of healthcare providers. In other parts of the country, 308 00:16:46,600 --> 00:16:50,400 Speaker 3: it could be a big geographic distance for someone to 309 00:16:50,440 --> 00:16:54,840 Speaker 3: travel to, but at least if you end up at 310 00:16:55,000 --> 00:17:00,200 Speaker 3: a cancer center or a university medical center, or or 311 00:17:00,240 --> 00:17:04,360 Speaker 3: a medical center affiliated with a medical school. So we're 312 00:17:04,400 --> 00:17:08,320 Speaker 3: talking about places that are a little more academic. You'll 313 00:17:08,320 --> 00:17:12,560 Speaker 3: get access to someone who's an expert. There are some 314 00:17:12,760 --> 00:17:17,320 Speaker 3: other organizations that are out there that provide amazing information 315 00:17:17,400 --> 00:17:20,720 Speaker 3: and screening for women. Planned Parenthood is one of them. 316 00:17:21,480 --> 00:17:24,320 Speaker 3: People think Planned Parenthood was only out there to provide 317 00:17:24,359 --> 00:17:28,440 Speaker 3: contraception and help women if they needed to terminate a pregnancy, 318 00:17:29,000 --> 00:17:33,199 Speaker 3: but actually they also provide the entry point into the 319 00:17:33,200 --> 00:17:38,639 Speaker 3: healthcare system for breast health as well. And other organizations 320 00:17:38,680 --> 00:17:41,680 Speaker 3: that are out there with who can provide services at 321 00:17:41,720 --> 00:17:47,200 Speaker 3: low cost or accepting insurances that are like Medicaid or 322 00:17:47,320 --> 00:17:50,640 Speaker 3: public health insurance, but all the major medical centers will 323 00:17:50,960 --> 00:17:54,600 Speaker 3: accept other insurances. And here in New York City, for example, 324 00:17:54,640 --> 00:17:58,640 Speaker 3: in our public hospital system, Health and Hospitals Corporation HC 325 00:17:58,720 --> 00:18:02,120 Speaker 3: hospitals can go in even without insurance and be seen 326 00:18:02,160 --> 00:18:04,120 Speaker 3: in our breast clinic and be evaluated. 327 00:18:04,840 --> 00:18:07,280 Speaker 1: Can you give some perspective to this Olivia mun story 328 00:18:07,280 --> 00:18:09,320 Speaker 1: that it's getting a lot of attention. She's a famous person. 329 00:18:09,359 --> 00:18:11,520 Speaker 1: She put it out there, and that's great to bring 330 00:18:11,560 --> 00:18:16,000 Speaker 1: attention to. But just how rare is a case like hers, 331 00:18:16,000 --> 00:18:19,200 Speaker 1: and that a mammogram didn't catch something, you'd then take 332 00:18:19,240 --> 00:18:22,040 Speaker 1: a risk assessment, and the mammogram missed that she has 333 00:18:22,080 --> 00:18:25,280 Speaker 1: this aggressive form of breast cancer in both breasts. Is 334 00:18:25,320 --> 00:18:27,720 Speaker 1: this that kind of an anomaly of a case here. 335 00:18:27,600 --> 00:18:29,960 Speaker 3: Well, I think it's not so unusual in our young 336 00:18:30,040 --> 00:18:33,440 Speaker 3: patients where the mammogram is not necessarily the best test 337 00:18:33,920 --> 00:18:36,719 Speaker 3: because of that dense breast tissue. And maybe she had 338 00:18:36,720 --> 00:18:39,880 Speaker 3: an ultrasound or an MRI or something. She had both, 339 00:18:39,920 --> 00:18:44,520 Speaker 3: she had both after the risk assessment test. I know 340 00:18:44,560 --> 00:18:47,200 Speaker 3: they keep saying this is an aggressive form of breast cancer, 341 00:18:47,760 --> 00:18:51,560 Speaker 3: but I think that's a strong word. She chose that word. 342 00:18:53,080 --> 00:18:56,359 Speaker 3: And I'll give you a little biology lesson here. Breast 343 00:18:56,359 --> 00:19:00,600 Speaker 3: cancer is not just one disease. There are many types 344 00:19:00,720 --> 00:19:05,280 Speaker 3: of breast cancer. She really has an intermediate form. I 345 00:19:05,320 --> 00:19:08,320 Speaker 3: think that luminole B I've I've never even heard of it. 346 00:19:08,560 --> 00:19:14,320 Speaker 3: So we have four molecular subtypes of breast cancer. Luminal 347 00:19:14,560 --> 00:19:20,080 Speaker 3: A B and then the her too enriched or her 348 00:19:20,080 --> 00:19:24,560 Speaker 3: too new positive breast cancer, and then the basoloid breast cancer, 349 00:19:24,600 --> 00:19:29,240 Speaker 3: which is unfortunately called triple negative, which is kind of 350 00:19:29,280 --> 00:19:32,720 Speaker 3: not a great name, But what that's referring to are 351 00:19:32,760 --> 00:19:35,840 Speaker 3: the three receptors that we look at that give us 352 00:19:35,880 --> 00:19:39,200 Speaker 3: a lot of information about the biologic behavior of that cancer, 353 00:19:39,240 --> 00:19:43,440 Speaker 3: and that's the estrogen and progesterone receptors, the hormone receptors. 354 00:19:43,920 --> 00:19:47,760 Speaker 3: Those are the luminal A and B cancers. And then 355 00:19:47,800 --> 00:19:50,800 Speaker 3: there's the her too positive that's her too new positive 356 00:19:51,080 --> 00:19:55,560 Speaker 3: and triple negative means there's no receptors present for estrogen, 357 00:19:55,600 --> 00:19:58,240 Speaker 3: progester on her too new. All three of those are absent, 358 00:19:59,040 --> 00:20:01,840 Speaker 3: and that helps us to determine what treatments to use 359 00:20:02,080 --> 00:20:05,879 Speaker 3: in targeting the cancer and making sure we're treating that 360 00:20:05,960 --> 00:20:10,480 Speaker 3: individual with the right kind of treatment. So, the estrogen 361 00:20:10,560 --> 00:20:15,639 Speaker 3: positive breast cancers are all luminal and we subdivide them 362 00:20:15,680 --> 00:20:18,600 Speaker 3: into A and B, and there are tests that we 363 00:20:18,680 --> 00:20:22,720 Speaker 3: can use that help us figure out which subtype it 364 00:20:22,880 --> 00:20:25,720 Speaker 3: is and that helps us determine if we should add 365 00:20:25,800 --> 00:20:31,520 Speaker 3: chemotherapy to just the anti estrogen endocrine therapy. And Amy 366 00:20:31,560 --> 00:20:34,880 Speaker 3: knows about that. Yes, I do do genomic assays. One 367 00:20:34,880 --> 00:20:38,439 Speaker 3: of them is called the acotype test. There's also a 368 00:20:38,560 --> 00:20:41,879 Speaker 3: mamma print test. There are several tests we can run 369 00:20:42,080 --> 00:20:46,000 Speaker 3: on the tumor tissue that tells us Okay, we know 370 00:20:46,080 --> 00:20:50,760 Speaker 3: it's estrogen receptor positive, but are there other factors at 371 00:20:50,760 --> 00:20:53,520 Speaker 3: play here which tell us, well, maybe we need to 372 00:20:53,560 --> 00:20:55,000 Speaker 3: add a little something else to the treatment. 373 00:20:55,560 --> 00:20:56,520 Speaker 1: And I'm sorry, just a quick thing. 374 00:20:56,600 --> 00:20:59,000 Speaker 3: So it's not super super aggressive, but it's a little 375 00:20:59,000 --> 00:20:59,840 Speaker 3: more aggressive than. 376 00:20:59,800 --> 00:21:02,719 Speaker 1: The you said, not super aggressive and not necessarily an 377 00:21:02,720 --> 00:21:06,080 Speaker 1: anomaly because a mammogram isn't the best test for a 378 00:21:06,119 --> 00:21:08,959 Speaker 1: younger woman. When you say young in your world, when 379 00:21:08,960 --> 00:21:10,840 Speaker 1: you talk in breast cancer and women young, what is 380 00:21:10,880 --> 00:21:12,920 Speaker 1: the age we're talking about when you're thinking. 381 00:21:12,640 --> 00:21:15,840 Speaker 3: Young, less than forty five? 382 00:21:16,000 --> 00:21:17,920 Speaker 1: Okay, yeah, she's forty three. 383 00:21:18,040 --> 00:21:18,920 Speaker 3: Yeah she's forty three. 384 00:21:19,080 --> 00:21:21,320 Speaker 2: And you know, it is remarkable hearing you talk about 385 00:21:21,600 --> 00:21:23,720 Speaker 2: there have been so many advances. I mean even when 386 00:21:23,720 --> 00:21:27,480 Speaker 2: I was diagnosed ten years ago, I got the ANCA 387 00:21:27,640 --> 00:21:30,280 Speaker 2: score and you were able. That was I remember you 388 00:21:30,320 --> 00:21:34,080 Speaker 2: sat me down and you said, sorry, you got chemotherapy 389 00:21:34,119 --> 00:21:37,560 Speaker 2: ahead of you because my AUNCA score was I believe intermediate. 390 00:21:37,720 --> 00:21:40,880 Speaker 2: And you can actually predict or at least say whether 391 00:21:40,960 --> 00:21:42,760 Speaker 2: or not what your chances are of having it recur 392 00:21:42,800 --> 00:21:45,080 Speaker 2: and become metastatic. So I think mine's intermediate. 393 00:21:45,160 --> 00:21:48,720 Speaker 3: It was, And it's not just that score. We also 394 00:21:48,760 --> 00:21:52,359 Speaker 3: look at the clinical factors, age, size of the tumor, 395 00:21:52,760 --> 00:21:55,040 Speaker 3: did any cells get into the lymph node? And we 396 00:21:55,200 --> 00:21:58,199 Speaker 3: put all of that together. So you know, nothing in 397 00:21:58,200 --> 00:22:00,479 Speaker 3: medicine is just like an on off switch. It's not 398 00:22:00,640 --> 00:22:03,240 Speaker 3: just one thing that determines what we do. It's kind 399 00:22:03,280 --> 00:22:08,360 Speaker 3: of all of the information and then that soft thing 400 00:22:08,400 --> 00:22:11,480 Speaker 3: we call clinical judgment. That's why you can't replace me 401 00:22:11,560 --> 00:22:16,600 Speaker 3: with a robot just yet. Isn't she great? 402 00:22:16,840 --> 00:22:19,159 Speaker 2: Isn't she great? I love doctor writ You know. I 403 00:22:19,160 --> 00:22:20,639 Speaker 2: can't believe I let a year and a half go 404 00:22:20,760 --> 00:22:27,040 Speaker 2: without coming into see But when stories like this hit 405 00:22:27,119 --> 00:22:29,600 Speaker 2: the news, I know a lot of women go into 406 00:22:29,640 --> 00:22:32,439 Speaker 2: panic mode, and you don't want people to overreact. But 407 00:22:32,480 --> 00:22:35,359 Speaker 2: also it's not a bad thing because this type of 408 00:22:35,400 --> 00:22:38,680 Speaker 2: story brings awareness where women suddenly start to take their 409 00:22:38,680 --> 00:22:41,440 Speaker 2: health a little bit more seriously and think, oh wow, 410 00:22:41,800 --> 00:22:43,679 Speaker 2: it could happen to me. What is your reaction when 411 00:22:43,720 --> 00:22:47,000 Speaker 2: you see celebrities come out and explain what happened. I mean, 412 00:22:47,040 --> 00:22:48,879 Speaker 2: they might not get all the facts exactly right, but 413 00:22:48,960 --> 00:22:53,080 Speaker 2: the general idea is to warn and make women aware. 414 00:22:53,480 --> 00:22:58,119 Speaker 3: I'm always proud when someone steps forward to share something 415 00:22:58,160 --> 00:23:03,720 Speaker 3: that's deeply personal, deeply intimate, and be able to open 416 00:23:03,800 --> 00:23:08,680 Speaker 3: up to the public and say, learn from my story. 417 00:23:08,800 --> 00:23:13,640 Speaker 3: I'm sharing this with you to help you. And that's 418 00:23:13,640 --> 00:23:17,159 Speaker 3: a tremendous gift and I think that for people to 419 00:23:17,240 --> 00:23:19,600 Speaker 3: do that is very, very courageous. 420 00:23:20,080 --> 00:23:22,520 Speaker 1: This obviously raises awareness, but this is living a month 421 00:23:22,600 --> 00:23:24,440 Speaker 1: story and all of the back and forth about this 422 00:23:24,680 --> 00:23:27,600 Speaker 1: breast cancer or risk assessment test. Where would you caution 423 00:23:27,800 --> 00:23:30,119 Speaker 1: us in this story? You want the word out there, 424 00:23:30,240 --> 00:23:32,960 Speaker 1: but where do you caution everybody in listening to the story. 425 00:23:33,000 --> 00:23:36,040 Speaker 3: Well, I always caution people not to panic, but I 426 00:23:36,080 --> 00:23:39,720 Speaker 3: would say the test is available. And I think Amy's right. 427 00:23:39,840 --> 00:23:42,679 Speaker 3: I think the more that people are aware of their health, 428 00:23:42,880 --> 00:23:45,360 Speaker 3: the better they're going to be able to take care 429 00:23:45,359 --> 00:23:47,800 Speaker 3: of themselves. So if a woman says, gee, I'm a 430 00:23:47,840 --> 00:23:50,000 Speaker 3: little concerned about this, I'm going to go online and 431 00:23:50,080 --> 00:23:52,560 Speaker 3: run that essay on myself, you know, see where my 432 00:23:52,640 --> 00:23:56,960 Speaker 3: number comes out. Then make sure though that we have 433 00:23:57,040 --> 00:24:00,600 Speaker 3: the support system for her so she can follow up, 434 00:24:01,240 --> 00:24:03,840 Speaker 3: maybe even make that appointment with your doctor first, or 435 00:24:03,880 --> 00:24:06,560 Speaker 3: go into your healthcare provider and say i'd like to 436 00:24:06,600 --> 00:24:08,359 Speaker 3: do this, maybe we can do it. Together. I mean 437 00:24:08,400 --> 00:24:10,800 Speaker 3: it takes about three minutes to punch the numbers in 438 00:24:10,840 --> 00:24:14,560 Speaker 3: on the computer, so then you're not just sitting there 439 00:24:14,600 --> 00:24:16,720 Speaker 3: and then can't get an appointment to see your doctor 440 00:24:16,720 --> 00:24:18,600 Speaker 3: for two months and you're all in a panic about it. 441 00:24:18,840 --> 00:24:22,000 Speaker 3: So maybe schedule that appointment and say this is something 442 00:24:22,080 --> 00:24:24,360 Speaker 3: I'd like to discuss with you, and go over all 443 00:24:24,400 --> 00:24:28,400 Speaker 3: the other factors. Other risk factors for developing breast cancer are, 444 00:24:28,520 --> 00:24:33,520 Speaker 3: for example, alcohol, use too much drinking no good, don't 445 00:24:33,600 --> 00:24:36,840 Speaker 3: drink every day, don't drink more than two drinks if 446 00:24:36,840 --> 00:24:39,159 Speaker 3: you're going out to a party. You know, alcohol can 447 00:24:39,200 --> 00:24:42,440 Speaker 3: be a big risk factor. Keep a healthy body weight. 448 00:24:42,800 --> 00:24:45,280 Speaker 3: You don't have to be super skinny, but a healthy 449 00:24:45,280 --> 00:24:49,919 Speaker 3: body weight. Physical exercise is important. Amy knows that. I 450 00:24:49,960 --> 00:24:53,280 Speaker 3: think it's been a big factor in really keeping you 451 00:24:53,359 --> 00:24:56,720 Speaker 3: healthy and getting you through the side effects of treatment. 452 00:24:56,840 --> 00:25:00,280 Speaker 2: Oh yeah, to even be able to tolerate tomoxifen as 453 00:25:00,320 --> 00:25:02,879 Speaker 2: long as I did. You know, I think staying active 454 00:25:02,960 --> 00:25:06,399 Speaker 2: kept my joints working, because that's a big complaint. You know, 455 00:25:06,480 --> 00:25:09,120 Speaker 2: some of the meds that they put you on makes 456 00:25:09,160 --> 00:25:11,240 Speaker 2: you not want to exercise. But if you can push 457 00:25:11,280 --> 00:25:13,120 Speaker 2: through it, then you can get to the other side 458 00:25:13,119 --> 00:25:14,720 Speaker 2: of it, and you can make it work and stay 459 00:25:14,760 --> 00:25:17,640 Speaker 2: on it for as long as possible, which obviously reduces 460 00:25:17,640 --> 00:25:20,360 Speaker 2: your risk of recurrence, which is what we're all looking for. 461 00:25:21,000 --> 00:25:23,879 Speaker 2: I have a question if can you, as a woman, 462 00:25:24,000 --> 00:25:27,679 Speaker 2: go into your doctor and say I just want a 463 00:25:27,720 --> 00:25:31,720 Speaker 2: sonogram and could you insist on it? Can you pay 464 00:25:31,720 --> 00:25:33,639 Speaker 2: for it yourself if your insurance won't pay for it? 465 00:25:33,680 --> 00:25:36,040 Speaker 2: If you have the means, what are your rights or 466 00:25:36,080 --> 00:25:38,520 Speaker 2: options as a patient if you think you want something. 467 00:25:39,880 --> 00:25:42,159 Speaker 3: I think you should have that discussion with your doctor, 468 00:25:43,280 --> 00:25:46,320 Speaker 3: and I think most doctors would agree to, you know, 469 00:25:46,359 --> 00:25:48,760 Speaker 3: work with you in getting the right test done for you. 470 00:25:49,560 --> 00:25:52,560 Speaker 3: Sometimes we have to finesse the order in which we 471 00:25:52,640 --> 00:25:55,960 Speaker 3: do things. Sometimes, even at the cancer center, I have 472 00:25:56,040 --> 00:25:58,280 Speaker 3: to call the radiologist and say, you know, I'm not 473 00:25:58,560 --> 00:26:01,000 Speaker 3: doing that mammogram on this thirty two year old. It's 474 00:26:01,040 --> 00:26:05,399 Speaker 3: not happening. Just do the ultrasound, pick up the phone 475 00:26:05,400 --> 00:26:07,840 Speaker 3: and you know, make that phone call. But we can 476 00:26:07,960 --> 00:26:12,840 Speaker 3: usually get things done in the right sequence and appropriately 477 00:26:12,880 --> 00:26:13,600 Speaker 3: for each patient. 478 00:26:13,920 --> 00:26:17,280 Speaker 1: The test is available on the National Cancer Institute website 479 00:26:17,280 --> 00:26:21,240 Speaker 1: and they say they've had a huge spike. Please caution, 480 00:26:22,320 --> 00:26:25,840 Speaker 1: as women of color, black women, in particular, I think 481 00:26:25,840 --> 00:26:28,480 Speaker 1: here that I think they've tried to update the tool 482 00:26:28,480 --> 00:26:30,959 Speaker 1: over time, but it might not be as accurate. For 483 00:26:31,040 --> 00:26:31,800 Speaker 1: women of COLT. 484 00:26:31,760 --> 00:26:35,360 Speaker 3: May actually underestimate the risk and we're not sure why 485 00:26:35,400 --> 00:26:37,879 Speaker 3: that is. And it's not even because when we do 486 00:26:38,000 --> 00:26:41,040 Speaker 3: genetic testing we can find a particular gene. We haven't 487 00:26:41,040 --> 00:26:45,399 Speaker 3: identified that yet. They also caution that for Asian women 488 00:26:45,440 --> 00:26:50,080 Speaker 3: born outside of the United States, the test and Hispanic 489 00:26:50,119 --> 00:26:52,679 Speaker 3: women born outside of the United States it may not 490 00:26:52,800 --> 00:26:55,959 Speaker 3: be accurate. And that's because when the test was developed 491 00:26:56,320 --> 00:26:59,800 Speaker 3: decades ago, it was validated on a population of pre 492 00:27:00,119 --> 00:27:04,080 Speaker 3: dominantly Caucasian women, so there could be some caveats there. 493 00:27:04,640 --> 00:27:09,400 Speaker 3: If a woman has a history of what we call 494 00:27:09,560 --> 00:27:15,000 Speaker 3: non invasive breast cancer DCIS or LCIs, the tool is 495 00:27:15,040 --> 00:27:20,200 Speaker 3: not accurate. If the person knows she has a genetic 496 00:27:20,280 --> 00:27:23,280 Speaker 3: mutation like BRCA one or b r c A two 497 00:27:24,000 --> 00:27:28,400 Speaker 3: or another genetic mutation that could increase the risk of cancer, 498 00:27:28,800 --> 00:27:31,920 Speaker 3: the test is not accurate. So all of those kind 499 00:27:31,920 --> 00:27:35,639 Speaker 3: of disclaimers are the in the small print there. You 500 00:27:35,680 --> 00:27:39,160 Speaker 3: know when you open up the click on the internet 501 00:27:39,200 --> 00:27:40,080 Speaker 3: to open up the test. 502 00:27:49,280 --> 00:27:51,800 Speaker 2: I have a question for any woman who is listening 503 00:27:51,880 --> 00:27:55,560 Speaker 2: right now. What you mentioned the things you can be 504 00:27:55,600 --> 00:27:58,119 Speaker 2: doing to prevent cancer or to lower your risk of cancer, 505 00:27:58,359 --> 00:28:02,840 Speaker 2: But what in terms of monitoring and making those appointments, 506 00:28:02,880 --> 00:28:05,800 Speaker 2: what should women be doing at what age? Can you 507 00:28:05,800 --> 00:28:08,280 Speaker 2: give us kind of that rundown, So anyone who's listening knows, Okay, 508 00:28:08,280 --> 00:28:10,280 Speaker 2: if I'm this age, I should be doing this. If 509 00:28:10,280 --> 00:28:12,480 Speaker 2: I'm that age, I should be doing this. How often 510 00:28:12,520 --> 00:28:13,360 Speaker 2: should I be doing it? 511 00:28:15,600 --> 00:28:18,760 Speaker 3: I'm going to start really young. I think any young 512 00:28:18,800 --> 00:28:23,040 Speaker 3: woman who is sexually active should have an exam with 513 00:28:23,400 --> 00:28:27,880 Speaker 3: a gynecologist or a gyn healthcare provider once a year. 514 00:28:29,640 --> 00:28:33,639 Speaker 3: Make sure everything's okay, and that's also checking for infections 515 00:28:33,760 --> 00:28:39,600 Speaker 3: or other conditions, and be sure it includes a breast exam. 516 00:28:41,200 --> 00:28:45,320 Speaker 3: I think that all women from early age eighteen on 517 00:28:46,040 --> 00:28:50,880 Speaker 3: check yourself every month. The best time to do a 518 00:28:50,960 --> 00:28:55,240 Speaker 3: self breast examination is right after your period is finished. 519 00:28:55,560 --> 00:28:57,640 Speaker 3: That's when the breast is going to be the softest 520 00:28:58,080 --> 00:29:00,200 Speaker 3: and the least tender. As a lot of women know, 521 00:29:00,240 --> 00:29:04,000 Speaker 3: they feel fluctuations during the month with that monthly cycle, 522 00:29:04,400 --> 00:29:08,360 Speaker 3: So once things have quieted down, check yourself, poke around 523 00:29:08,400 --> 00:29:10,760 Speaker 3: under the arms, make sure there are no lumps or bumps. 524 00:29:12,040 --> 00:29:16,440 Speaker 3: If someone has a concern, any concern at all. Something 525 00:29:16,480 --> 00:29:20,960 Speaker 3: feels weird, this looks odd, my skin color changed, there's 526 00:29:21,000 --> 00:29:25,840 Speaker 3: a discharge from the nipple, something's painful. Go in and 527 00:29:25,920 --> 00:29:30,000 Speaker 3: get it checked out. May turn out to be nothing, 528 00:29:30,360 --> 00:29:33,480 Speaker 3: but check it out. So that's for all women. I 529 00:29:33,480 --> 00:29:36,760 Speaker 3: would say from late teenage years on, go in at 530 00:29:36,840 --> 00:29:40,960 Speaker 3: least once a year for checkup, and check yourself every month. 531 00:29:41,760 --> 00:29:44,960 Speaker 3: In terms of when to start breast imaging, that's that 532 00:29:45,120 --> 00:29:49,840 Speaker 3: ultrasound or the mammogram or if necessary, an MRI, that's 533 00:29:49,920 --> 00:29:53,480 Speaker 3: where tools like this risk assessment tool might really help 534 00:29:53,560 --> 00:29:57,520 Speaker 3: us figure out. Okay, we have a general guideline that 535 00:29:57,600 --> 00:30:00,720 Speaker 3: says start in your forties, but maybe someone needs to 536 00:30:00,760 --> 00:30:05,040 Speaker 3: start earlier because of a family history or some other 537 00:30:05,080 --> 00:30:08,560 Speaker 3: factor in her health. So that's where we should maybe 538 00:30:08,600 --> 00:30:12,040 Speaker 3: have our healthcare providers run that risk assessment tool when 539 00:30:12,040 --> 00:30:15,720 Speaker 3: someone's coming in. Really, it literally takes three minutes. Now, 540 00:30:15,720 --> 00:30:17,880 Speaker 3: I don't think every eighteen year old needs it, but 541 00:30:17,920 --> 00:30:20,400 Speaker 3: maybe when we're starting to get into those early thirties, 542 00:30:20,960 --> 00:30:24,560 Speaker 3: that will trigger the provider, whether that's a nurse or 543 00:30:24,640 --> 00:30:27,200 Speaker 3: a doctor or who's ever seen that woman, say yeah, 544 00:30:27,240 --> 00:30:29,920 Speaker 3: did anyone in your family ever have breast cancer? You 545 00:30:29,960 --> 00:30:33,200 Speaker 3: know or did you have? You had any pregnancies? How 546 00:30:33,200 --> 00:30:35,479 Speaker 3: old were you when that first baby was born? And 547 00:30:35,480 --> 00:30:38,360 Speaker 3: that then we can plug those numbers into the tool 548 00:30:38,400 --> 00:30:39,200 Speaker 3: and see where we're. 549 00:30:39,080 --> 00:30:41,880 Speaker 1: At to that question. I'm so bad. I keep going 550 00:30:41,920 --> 00:30:45,520 Speaker 1: back to this test this tool here, but there might 551 00:30:45,520 --> 00:30:48,560 Speaker 1: be a breakdown that lets people know if your number 552 00:30:48,640 --> 00:30:50,560 Speaker 1: is this, if your numbers this, But can you tell 553 00:30:50,600 --> 00:30:52,400 Speaker 1: people here because a lot are going to go on 554 00:30:52,720 --> 00:30:54,560 Speaker 1: and fill this out. So a living you moone's number 555 00:30:54,600 --> 00:30:57,280 Speaker 1: was a thirty seven percent, and that's way, way, way high. 556 00:30:57,440 --> 00:31:00,880 Speaker 1: But where do you start seeing numbers you and someone 557 00:31:00,920 --> 00:31:03,719 Speaker 1: else doing it online to where you should be a lot? 558 00:31:03,880 --> 00:31:05,960 Speaker 3: That's a great question, TJ. Because people are going to 559 00:31:05,960 --> 00:31:09,880 Speaker 3: be doing this right. So we say that the average 560 00:31:10,880 --> 00:31:14,680 Speaker 3: lifetime risk of breast cancer for an American woman is 561 00:31:14,720 --> 00:31:17,640 Speaker 3: about twelve percent. So if you punch it in and 562 00:31:17,680 --> 00:31:22,040 Speaker 3: your lifetime risk that's going to age ninety is fourteen percent, 563 00:31:23,360 --> 00:31:26,400 Speaker 3: I wouldn't get too too worried about it. But if 564 00:31:26,440 --> 00:31:28,640 Speaker 3: you if you're coming up, you know, let's say, and 565 00:31:28,680 --> 00:31:33,320 Speaker 3: I'm kind of just making this up honestly, but you know, 566 00:31:33,640 --> 00:31:36,440 Speaker 3: twelve percent, So if you're starting to hit closer to 567 00:31:36,520 --> 00:31:40,760 Speaker 3: twenty percent, twenty five percent. She was above thirty percent. 568 00:31:40,800 --> 00:31:43,280 Speaker 3: That's a higher risk. It also gives you a number 569 00:31:43,280 --> 00:31:48,080 Speaker 3: within the next five years on that risk assessment tool. 570 00:31:48,360 --> 00:31:51,320 Speaker 3: So the lifetime risk my hers was thirty seven percent, 571 00:31:51,760 --> 00:31:54,040 Speaker 3: but I don't know what the number came out, because 572 00:31:54,080 --> 00:31:56,960 Speaker 3: it gives you both within the next five years. If 573 00:31:56,960 --> 00:32:00,560 Speaker 3: that number is significantly higher, you may want to go 574 00:32:00,640 --> 00:32:04,320 Speaker 3: in sooner. So, for example, We're going to calculate a 575 00:32:04,400 --> 00:32:06,280 Speaker 3: patient risk, and I'm going to make up the answers 576 00:32:06,320 --> 00:32:09,479 Speaker 3: to the question. Let's see how it comes out. So 577 00:32:09,600 --> 00:32:12,760 Speaker 3: the first question is does the woman have a medical 578 00:32:12,880 --> 00:32:17,120 Speaker 3: history of DCIS or LCIs. The other thing it asks, 579 00:32:17,160 --> 00:32:20,080 Speaker 3: by the way, is has she had radiation treatment to 580 00:32:20,120 --> 00:32:23,560 Speaker 3: the chest area because that increases the risk of breast 581 00:32:23,600 --> 00:32:27,320 Speaker 3: cancer significantly, and sometimes we give that radiation treatment to 582 00:32:27,400 --> 00:32:30,200 Speaker 3: young women who have lymphoma. We don't do it so 583 00:32:30,280 --> 00:32:32,840 Speaker 3: much anymore, but we used to. So I'm gonna say no, 584 00:32:32,840 --> 00:32:36,000 Speaker 3: no history of those things. Is there a mutation in 585 00:32:36,040 --> 00:32:40,240 Speaker 3: BRCA one, BRCA two, any genetic mutations, I'm gonna say no. 586 00:32:43,000 --> 00:32:44,760 Speaker 3: What age patients you want is to look at. 587 00:32:46,240 --> 00:32:48,320 Speaker 1: Let's do let's do forty five. 588 00:32:48,400 --> 00:32:51,560 Speaker 3: Forty five? Okay, forty five, so I'm gonna put that in. 589 00:32:51,840 --> 00:32:55,280 Speaker 3: By the way, the essay starts at age thirty five, 590 00:32:56,000 --> 00:32:58,120 Speaker 3: so a twenty eight year old can't use this. It's 591 00:32:58,120 --> 00:33:00,720 Speaker 3: not valid. Oh okay, so it starts at age thirty five, 592 00:33:00,760 --> 00:33:03,880 Speaker 3: So I'm going to pick forty five. What is the 593 00:33:03,880 --> 00:33:07,800 Speaker 3: patient's race or ethnicity, and the choices here are white, 594 00:33:08,080 --> 00:33:14,280 Speaker 3: African American, Latina, Asian, American, Native American, or Alaskan Native 595 00:33:14,480 --> 00:33:22,000 Speaker 3: or unknown let's go black, okay, And has the patient 596 00:33:22,080 --> 00:33:25,800 Speaker 3: ever had a breast biopsy with a benign meaning a 597 00:33:25,880 --> 00:33:29,480 Speaker 3: non cancerous diagnosis. I'm going to say no, right, most 598 00:33:29,520 --> 00:33:30,160 Speaker 3: women haven't had that. 599 00:33:31,000 --> 00:33:34,320 Speaker 1: And as we feel this out, can you depending on 600 00:33:34,400 --> 00:33:36,680 Speaker 1: what you do in your life year to year, your 601 00:33:36,760 --> 00:33:39,160 Speaker 1: number can change. How do you take the test year 602 00:33:39,200 --> 00:33:39,520 Speaker 1: to year? 603 00:33:39,640 --> 00:33:43,479 Speaker 3: All right, that's right exactly, because things right, things are 604 00:33:43,480 --> 00:33:46,760 Speaker 3: going to happen. Then we get into those questions about 605 00:33:46,800 --> 00:33:49,960 Speaker 3: your reproductive history. What was the woman's age at the 606 00:33:50,000 --> 00:33:53,400 Speaker 3: time of her first menstrual period. They give us three choices. 607 00:33:53,800 --> 00:33:57,560 Speaker 3: A very young age which would be before age eleven, 608 00:33:58,160 --> 00:34:00,920 Speaker 3: then kind of twelve to thirteen, which sort of average, 609 00:34:01,440 --> 00:34:03,880 Speaker 3: and the third choice would be fourteen or older. 610 00:34:04,000 --> 00:34:04,640 Speaker 1: To the average. 611 00:34:04,720 --> 00:34:07,400 Speaker 3: Let's give her the average twelve to thirteen, and the 612 00:34:07,440 --> 00:34:11,560 Speaker 3: age of the of her first child, so either no 613 00:34:11,760 --> 00:34:15,440 Speaker 3: births or what age she was when she had a baby. 614 00:34:15,760 --> 00:34:19,759 Speaker 3: Let's say twenty nine. So then okay, you're right on 615 00:34:19,800 --> 00:34:21,879 Speaker 3: the edge because it goes twenty five to twenty nine. 616 00:34:22,080 --> 00:34:24,040 Speaker 3: A's thirty or older. Let's give her twenty nine. 617 00:34:24,080 --> 00:34:25,920 Speaker 2: Yeah, I just use my birth age. I mean my 618 00:34:26,360 --> 00:34:29,759 Speaker 2: age when I gave birth. That's like, yeah, that's great. 619 00:34:31,040 --> 00:34:31,839 Speaker 3: I wish. 620 00:34:33,640 --> 00:34:35,720 Speaker 2: I was born in nineteen twenty nine. 621 00:34:35,760 --> 00:34:39,680 Speaker 3: No, and what about that family history? Does she have 622 00:34:39,800 --> 00:34:44,920 Speaker 3: a mother, sister, or daughter who had breast cancer? I 623 00:34:44,920 --> 00:34:45,239 Speaker 3: don't know. 624 00:34:45,280 --> 00:34:46,480 Speaker 2: What do we say? Say one? 625 00:34:46,760 --> 00:34:49,799 Speaker 3: Okay, let's say her mom had braains. Okay, okay. So 626 00:34:49,920 --> 00:34:53,560 Speaker 3: this is now for this individual person, and I'm calculating 627 00:34:53,600 --> 00:34:57,399 Speaker 3: her risk. The risk of her developing cancer within the 628 00:34:57,440 --> 00:35:03,760 Speaker 3: next five years eight fifty is only one point four percent. Wow, 629 00:35:04,360 --> 00:35:06,960 Speaker 3: that's a little higher than the average risk, which is 630 00:35:07,040 --> 00:35:10,360 Speaker 3: zero point nine percent for the general population. So she's 631 00:35:10,400 --> 00:35:14,920 Speaker 3: not in major big trouble this year. Over the course 632 00:35:14,960 --> 00:35:18,160 Speaker 3: of her lifetime, her risk is a little bit higher 633 00:35:18,719 --> 00:35:23,640 Speaker 3: fourteen point four percent. Compared to nine point five percent. 634 00:35:23,800 --> 00:35:27,360 Speaker 2: I'm actually surprised because with a mother who had cancer, 635 00:35:27,440 --> 00:35:31,719 Speaker 2: being African American, that's actually a surprisingly low number to me, 636 00:35:32,400 --> 00:35:33,640 Speaker 2: is it to you? 637 00:35:33,760 --> 00:35:37,920 Speaker 3: Well a little bit? Yeah, wow, but. 638 00:35:38,000 --> 00:35:40,520 Speaker 1: You get that number. That woman just filled that out. 639 00:35:40,560 --> 00:35:42,880 Speaker 1: She sees fourteen point four. Now what do I do? 640 00:35:43,160 --> 00:35:46,440 Speaker 3: She says, Okay, what she really should see is in 641 00:35:46,480 --> 00:35:50,440 Speaker 3: the next five years it's one percent. So don't panic, 642 00:35:51,480 --> 00:35:54,480 Speaker 3: but pick up the phone. Make sure you have that 643 00:35:54,520 --> 00:35:57,880 Speaker 3: appointment to see your doctor. Check in your calendar. Did 644 00:35:57,920 --> 00:35:59,960 Speaker 3: I do a mammogram last year? Am I up to date? 645 00:36:00,080 --> 00:36:03,120 Speaker 3: If not, go in to see your doctor. Bring this 646 00:36:03,239 --> 00:36:06,719 Speaker 3: information and say I want to review this with you. 647 00:36:07,400 --> 00:36:10,600 Speaker 3: Am I doing enough screening? Is there something we should 648 00:36:10,600 --> 00:36:13,360 Speaker 3: add to this? Gee, my mom had breast cancer, but 649 00:36:13,640 --> 00:36:16,439 Speaker 3: we never did that genetic testing thing. Should I speak 650 00:36:16,480 --> 00:36:19,200 Speaker 3: to the genetic counselor so, you know, follow up on 651 00:36:19,320 --> 00:36:22,120 Speaker 3: all of those issues, Doctor Ratz. 652 00:36:22,160 --> 00:36:24,600 Speaker 2: I just thought of something because as you plug those 653 00:36:25,280 --> 00:36:28,160 Speaker 2: numbers and that information in, that would have been me 654 00:36:28,719 --> 00:36:32,400 Speaker 2: except for that I didn't have a family history, I 655 00:36:32,400 --> 00:36:34,879 Speaker 2: didn't have a close relative who had breast cancer, and 656 00:36:35,760 --> 00:36:39,040 Speaker 2: I was forty not forty five. So my number would 657 00:36:39,080 --> 00:36:41,920 Speaker 2: have been probably even lower than that because I. 658 00:36:41,920 --> 00:36:44,759 Speaker 3: Might as well yes and no, I mean I don't know. 659 00:36:44,800 --> 00:36:46,520 Speaker 3: We'd have to put it in and see. 660 00:36:46,239 --> 00:36:49,520 Speaker 2: But by those questions, I'm fairly certain I would not 661 00:36:49,600 --> 00:36:54,200 Speaker 2: have had a high percentage. And yet and yet I 662 00:36:54,280 --> 00:36:56,719 Speaker 2: had I had, I had stage two breast cancer. It 663 00:36:56,760 --> 00:36:59,319 Speaker 2: had spread to my lip notes. So you know, I 664 00:36:59,360 --> 00:37:01,560 Speaker 2: wouldn't want people, and I know you wouldn't want people 665 00:37:01,600 --> 00:37:04,200 Speaker 2: to go on take this test and think I'm good, 666 00:37:04,600 --> 00:37:07,000 Speaker 2: I don't have to get a mammogram. I'm good, I 667 00:37:07,040 --> 00:37:08,760 Speaker 2: don't have to go in every year and get tested, 668 00:37:09,160 --> 00:37:10,120 Speaker 2: and that could happen. 669 00:37:10,239 --> 00:37:12,600 Speaker 3: That could happen. And that's what I was getting back 670 00:37:12,640 --> 00:37:16,920 Speaker 3: to before, where it's not just one thing. This is helpful, 671 00:37:17,120 --> 00:37:20,680 Speaker 3: but remember check yourself. Go every year to see the 672 00:37:20,719 --> 00:37:23,920 Speaker 3: doctor and have a clinical breast exam, and make sure 673 00:37:24,280 --> 00:37:27,880 Speaker 3: that starting at age forty there's some kind of screening, 674 00:37:28,640 --> 00:37:31,480 Speaker 3: and if you're at higher risk, start at a younger age. 675 00:37:31,600 --> 00:37:33,719 Speaker 3: Doctor RATZ, do you have anything else? Babe? 676 00:37:33,719 --> 00:37:34,759 Speaker 2: I didn't want to just s well. 677 00:37:34,640 --> 00:37:36,200 Speaker 1: I was trying to put in your numbers and at 678 00:37:36,239 --> 00:37:38,640 Speaker 1: your risk it does come out very very low. 679 00:37:38,800 --> 00:37:41,440 Speaker 2: Yeah, And I wouldn't want someone to have a false 680 00:37:41,440 --> 00:37:44,440 Speaker 2: impression that somehow they're not going to get breast cancer 681 00:37:44,480 --> 00:37:46,480 Speaker 2: because this test told them their number was low. 682 00:37:46,560 --> 00:37:49,799 Speaker 3: It doesn't substitute for all those other things we need 683 00:37:49,840 --> 00:37:51,120 Speaker 3: to do to take care of ourselves. 684 00:37:51,200 --> 00:37:54,400 Speaker 2: I remember sitting, Oh, I could get emotional hair sitting 685 00:37:54,880 --> 00:37:57,520 Speaker 2: at NYU, I was about to probably see you in 686 00:37:57,520 --> 00:37:59,440 Speaker 2: a few hours, and didn't realize going in for my 687 00:37:59,480 --> 00:38:01,960 Speaker 2: follow up man and kind of getting nervous because they 688 00:38:02,000 --> 00:38:04,440 Speaker 2: kept asking me to come back and get new images 689 00:38:04,440 --> 00:38:08,040 Speaker 2: and new images, and I was trying not to get scared. 690 00:38:08,080 --> 00:38:10,600 Speaker 2: So I started looking up my chances as a forty 691 00:38:10,680 --> 00:38:14,279 Speaker 2: year old, otherwise healthy woman, and I said, oh, I 692 00:38:14,320 --> 00:38:16,120 Speaker 2: got a one percent. I got less than a one 693 00:38:16,160 --> 00:38:19,720 Speaker 2: percent chance of having breast cancer. And I put myself 694 00:38:19,760 --> 00:38:21,799 Speaker 2: at ease, and I told myself to stop freaking out 695 00:38:21,920 --> 00:38:24,600 Speaker 2: that I almost certainly didn't have it. And even when 696 00:38:24,640 --> 00:38:27,040 Speaker 2: they found something when I had to have a biopsy, 697 00:38:27,080 --> 00:38:29,640 Speaker 2: I was like, it's gonna be benign. So when I 698 00:38:29,760 --> 00:38:31,920 Speaker 2: was told I had breast cancer and I saw you, 699 00:38:32,000 --> 00:38:34,919 Speaker 2: I believe about an hour later, I couldn't have been 700 00:38:34,920 --> 00:38:37,759 Speaker 2: more shocked. I didn't think it could happen to me. 701 00:38:37,880 --> 00:38:39,560 Speaker 1: What did you get that said it was one percent? 702 00:38:39,560 --> 00:38:40,160 Speaker 1: Where'd you get that? 703 00:38:40,560 --> 00:38:41,480 Speaker 3: It's just the average. 704 00:38:41,480 --> 00:38:43,160 Speaker 2: I mean, if you are of, if you have no 705 00:38:43,239 --> 00:38:46,160 Speaker 2: family history, if you're relatively healthy. I knew I was thin. 706 00:38:46,239 --> 00:38:50,040 Speaker 2: I knew I exercised, I knew I ate well. I 707 00:38:50,080 --> 00:38:52,400 Speaker 2: found an average risk. A woman in my age had 708 00:38:52,400 --> 00:38:54,560 Speaker 2: a less than one percent chance of developing. 709 00:38:54,160 --> 00:38:56,359 Speaker 1: An I said, because I just feeled her answers out 710 00:38:56,400 --> 00:38:58,120 Speaker 1: on this assessment. It came point six percent. 711 00:38:58,200 --> 00:38:59,640 Speaker 3: See that chance less than one percent? 712 00:39:00,120 --> 00:39:02,520 Speaker 2: Yet and yet I had breast cancer. So I just 713 00:39:02,560 --> 00:39:05,239 Speaker 2: want to I wanted to point that out right. So 714 00:39:05,320 --> 00:39:09,239 Speaker 2: none of these tools are fool proof. They're helpful, but 715 00:39:09,320 --> 00:39:11,040 Speaker 2: I think you're writing Amy, we want to make sure 716 00:39:11,080 --> 00:39:13,399 Speaker 2: that people still follow up and do all the other 717 00:39:13,440 --> 00:39:15,200 Speaker 2: things they need to do to stay healthy. 718 00:39:15,080 --> 00:39:18,719 Speaker 1: And look our best to Olivia mon and congratulations and 719 00:39:18,760 --> 00:39:21,440 Speaker 1: thank you really for putting this out there and sparking 720 00:39:21,440 --> 00:39:25,360 Speaker 1: these discussions. And I bet you the fact that she 721 00:39:25,560 --> 00:39:27,920 Speaker 1: has done this is going to save lives that we 722 00:39:27,920 --> 00:39:31,359 Speaker 1: don't even realize. But doctor writes, before you go, can 723 00:39:31,400 --> 00:39:33,960 Speaker 1: you please talk to this one for me? And you 724 00:39:34,000 --> 00:39:37,000 Speaker 1: know I've stayed on her about it, but if you 725 00:39:37,040 --> 00:39:39,360 Speaker 1: can give her a little reminder of just how important 726 00:39:39,360 --> 00:39:42,440 Speaker 1: it is for her to keep up with those appointments. 727 00:39:42,760 --> 00:39:47,160 Speaker 3: It is important. And what I love the most about 728 00:39:47,160 --> 00:39:49,719 Speaker 3: my practice is all the people who come in for 729 00:39:49,760 --> 00:39:53,640 Speaker 3: their once a year check up twenty years later and 730 00:39:53,680 --> 00:39:56,320 Speaker 3: they're fine. And even for some of my young patients 731 00:39:56,360 --> 00:39:58,400 Speaker 3: who come in and tell me that they've had a 732 00:39:58,400 --> 00:40:02,719 Speaker 3: baby since they were diagnosed, see those babies or you know, 733 00:40:02,800 --> 00:40:06,920 Speaker 3: celebrating other life events and it is just fantastic. So 734 00:40:07,000 --> 00:40:09,920 Speaker 3: it makes me happy, and then I know you're healthy. 735 00:40:10,360 --> 00:40:13,560 Speaker 3: So I think the other thing that happens is once 736 00:40:13,640 --> 00:40:17,400 Speaker 3: someone does have a cancer diagnosis, anything else that comes 737 00:40:17,480 --> 00:40:22,359 Speaker 3: up we want to know about. Not because it means 738 00:40:22,360 --> 00:40:25,399 Speaker 3: the cancer is coming back, but you know, we sort 739 00:40:25,440 --> 00:40:29,000 Speaker 3: of have a lot of ownership around our cancer patients, 740 00:40:29,040 --> 00:40:31,960 Speaker 3: and I think as oncologists, we like to know that 741 00:40:32,000 --> 00:40:34,279 Speaker 3: you're well, and we also want to make sure that 742 00:40:34,320 --> 00:40:36,480 Speaker 3: you're doing all the other screening tests you need to do. 743 00:40:36,560 --> 00:40:39,279 Speaker 3: You know, that colonoscopy, No one wants to talk about it, right, 744 00:40:39,400 --> 00:40:44,279 Speaker 3: Who's going to remind you about that? You know? So 745 00:40:45,040 --> 00:40:47,520 Speaker 3: there are other things that we like to just check 746 00:40:47,560 --> 00:40:50,640 Speaker 3: our boxes and make sure everybody's healthy and come in 747 00:40:50,680 --> 00:40:53,120 Speaker 3: for your checkos well, doctor Ortz. 748 00:40:53,239 --> 00:40:57,120 Speaker 2: I am so so happy you came in and you 749 00:40:57,160 --> 00:40:58,520 Speaker 2: came to see me before I came. 750 00:40:58,360 --> 00:40:58,879 Speaker 1: To see you. 751 00:40:59,000 --> 00:41:02,040 Speaker 2: But I am going to be there on March twenty six, 752 00:41:02,120 --> 00:41:04,399 Speaker 2: so we can catch up then, and I will have 753 00:41:04,440 --> 00:41:07,440 Speaker 2: my girls get their baseline mammogram at the age of 754 00:41:07,480 --> 00:41:11,040 Speaker 2: thirty after everything I just heard you say, and with 755 00:41:11,120 --> 00:41:13,560 Speaker 2: a sonogram, with the sonogram, you're right with the sonogram, 756 00:41:13,560 --> 00:41:15,280 Speaker 2: and that was part of what we were talking about. 757 00:41:15,320 --> 00:41:18,319 Speaker 2: So I think so many women are going to be 758 00:41:18,360 --> 00:41:22,040 Speaker 2: so grateful for your perspective and your information and thank you, 759 00:41:22,080 --> 00:41:24,120 Speaker 2: thank you just for being you, and thank you for 760 00:41:24,160 --> 00:41:27,399 Speaker 2: helping me over this past decade and for the decades to. 761 00:41:27,360 --> 00:41:30,120 Speaker 3: Come, for the decades to come, and to everyone out there, 762 00:41:30,160 --> 00:41:44,600 Speaker 3: don't panic. You're going to be fine.