Speaker 1: Hey, everybody, welcome to a special episode of Amy and
Speaker 1: TJ Robots. Sitting here next to me. A lot of
Speaker 1: people have been following along with us the past. I
Speaker 1: guess a couple of weeks we did a show talking
Speaker 1: about on one of the episodes talking about you not
Speaker 1: making an appointment and being over a year, a year,
Speaker 1: a year and a half a half since you win
Speaker 1: for blood work that you were supposed to have. Do
Speaker 1: I have that right as a Breastkansas riber.
Speaker 2: I have been doing it every six months or so
Speaker 2: up until well, you know.
Speaker 1: Yes, everything hit the fan. But we do update people
Speaker 1: recently that you have made the appointment, are going to
Speaker 1: get your blood work done very soon. And that appointment
Speaker 1: is with someone you speak so highly up all the time,
Speaker 1: Doctor Ritz.
Speaker 2: Yes, doctor Ruth Ratz, and she is actually in the
Speaker 2: studio with us. She is my oncologist. She has been
Speaker 2: with me from the very beginning since I was oh yes,
Speaker 2: a young pop of forty when I got my breast
Speaker 2: cancer diagnosis. But doctor Ortz has been on the journey
Speaker 2: with me every step of the way. And so first
Speaker 2: of all, I'm just gonna apologize for having left so
Speaker 2: much time and space between us over the past year
Speaker 2: and a half. But it's so good to see you
Speaker 2: and we're so happy to have you in the studio
Speaker 2: with us.
Speaker 3: So welcome. I'm happy to be here. I'm delighted to
Speaker 3: be here with both of you and Amy. You know,
Speaker 3: I stalk you, so even though I haven't seen you
Speaker 3: in person, I know you've been okay. Oh, and I
Speaker 3: see you training, I see you out there running. I
Speaker 3: know you're healthy, and I know that you take really
Speaker 3: good care of yourself.
Speaker 2: Thank you.
Speaker 3: So we'll update everything see you okay.
Speaker 2: Yeah, and a couple and a couple of weeks, we've
Speaker 2: got the appointment, but we asked you to come into
Speaker 2: the studio because there's been a big headline this week
Speaker 2: with actress Olivia Munn. She's forty three years old. She
Speaker 2: let everyone know that she has just been through ten
Speaker 2: months of treatment for breast cancer. That, of course, is
Speaker 2: always a big announcement when there's someone famous who can
Speaker 2: bring awareness to the cause. But it's a unique story
Speaker 2: because she's talking about how she found her cancer. She
Speaker 2: said she had a clearant mammogram. She said that she
Speaker 2: didn't have any of the markers for genetic testing that
Speaker 2: would make her a candidate for potentially having breast cancer,
Speaker 2: but then she said her doctor two months later had
Speaker 2: her do a breast cancer risk assessment test, and that
Speaker 2: led to more tests, which led to her finding an
Speaker 2: aggressive form of breast cancer in both breasts. And I
Speaker 2: kind of thought I knew a lot about breast cancer
Speaker 2: throughout my journey, but even I was scratching my hat.
Speaker 2: A breast cancer risk assessment test. Please explain what that
Speaker 2: is and just put this into perspective for us.
Speaker 3: Yes, I think we were all very shocked to hear
Speaker 3: this story and it raises an important issue, particularly for
Speaker 3: young women who were diagnosed with breast cancer. Let me
Speaker 3: just back up and talk about the man. You know,
Speaker 3: we do want everyone to have mammogram screening, but as
Speaker 3: I always say, it's not one size fits all, and
Speaker 3: for many young women, the mammogram won't show early stage
Speaker 3: breast cancer because the breast tissue is very dense in
Speaker 3: young women and the mamogram doesn't show enough. So that's
Speaker 3: why it's really important for each individual to speak with
Speaker 3: her doctor about what are the other potential factors that
Speaker 3: could be contributing to a risk of breast cancer and
Speaker 3: do we need to change up or add something to
Speaker 3: the screening and surveillance. Now, the Breast Cancer Risk Assessment
Speaker 3: Tool could be helpful. It's a statistical model that was
Speaker 3: developed many years ago. We've had this, you know, for
Speaker 3: probably fifteen twenty years already, and it's a simple computer model.
Speaker 3: It's free. It's available online. You can click on a
Speaker 3: website and bring it up, and it asks a few
Speaker 3: basic questions about a woman's personal history. It's really developed
Speaker 3: for women. We know men can get breast cancer, we'll
Speaker 3: come to that later, but focusing on women, it is
Speaker 3: they ask about age, family history of breast cancer, focusing
Speaker 3: on close relations we call those first degree relatives, mother, sister, daughter,
Speaker 3: whether or not the person has had a prior biopsy
Speaker 3: of the breast that showed any atypical cells. And then
Speaker 3: some questions about reproductive history. How old you were when
Speaker 3: you had your first menstrual period, how if you've had pregnancies,
Speaker 3: how old you were at the time of that first pregnancy.
Speaker 3: And then there's a calculation that's made that gives an estimate.
Speaker 3: I mean it's not perfect, but an estimate. You know,
Speaker 3: what's your risk of getting breast cancer in the next
Speaker 3: five years? Or over your lifetime up to age ninety
Speaker 3: and compares that to the general population.
Speaker 1: I think that the test is what's throwing everybody right now. Okay,
Speaker 1: you tell people, tell women, go get a manogram, You
Speaker 1: tell them what age to do it, how often to
Speaker 1: do it, You go in, mamogram's clear and you should
Speaker 1: be in the clear. Now, why would you take the
Speaker 1: next step or why isn't everyone being told to take
Speaker 1: do a mammogram and go online and everybody do this
Speaker 1: risk assessment test.
Speaker 3: Yeah, that's sort of actually a great question. We have
Speaker 3: not made that recommendation. In this case, it did lead
Speaker 3: to a diagnosis of breast cancer. I think maybe the
Speaker 3: concern is that if everyone did it, there would be
Speaker 3: kind of like mass panic because a lot of people
Speaker 3: might have a slightly increased risk. I don't know how
Speaker 3: hurt test actually, you know what the numbers were or
Speaker 3: how it came out.
Speaker 1: So thirty seven actually was it?
Speaker 3: I have it right? Thirty seven lifetime risk. Yeah, so
Speaker 3: that is higher than the average American woman who has
Speaker 3: a twelve percent lifetime risk. So that was high enough
Speaker 3: that it triggered the extra testing by her doctor. So
Speaker 3: you know, as I was thinking about that. I mean,
Speaker 3: maybe you're right, TJ. Maybe more people should go online
Speaker 3: kind of get a rough idea where they fall out
Speaker 3: on that. But remember it's just a rough idea. So
Speaker 3: Olivia did the right thing. She took the next step
Speaker 3: and went to her doctor and said, what does this mean.
Speaker 2: This is also something that has been interesting to me
Speaker 2: because yeah, I had never even heard of this test was.
Speaker 2: We had to look it up and figure out what
Speaker 2: it was. But I think most people know my history
Speaker 2: that I had a mammogram at age forty because I
Speaker 2: had a work assignment, not even because I was going
Speaker 2: in there. Because at the time I was diagnosed, the
Speaker 2: recommendation was fifty, then it went to forty five, and
Speaker 2: now it's down to forty, which we're all applauding. I
Speaker 2: know you are as well. Anyone who works with breast
Speaker 2: cancer patients is saying, yes, forty years old. But I
Speaker 2: ended up getting a sonogram after the mammogram showed abnormal.
Speaker 2: If the sonogram is a better test than a mammogram,
Speaker 2: or at least maybe a clearer test for younger women
Speaker 2: who have potentially dense breast tissue, why wouldn't there always
Speaker 2: be a sonogram or maybe even a sonogram versus a mammogram.
Speaker 3: Well, I think you're right, Amy, And in my personal practice,
Speaker 3: when I see young women at risk for breast cancer,
Speaker 3: they haven't had breast cancer, but at risk, let's say,
Speaker 3: because of family history, or they had a concern about
Speaker 3: something and came in to be evaluated, we do always
Speaker 3: add the sonogram. Some people who are very young, I
Speaker 3: do the sonogram and I skip the mammogram because I
Speaker 3: know that mammogram's not going to show me a whole
Speaker 3: lot in someone who's very young, maybe in her thirties.
Speaker 3: So again, you know, those screening recommendations are that everybody
Speaker 3: should do the same thing, and I think we have
Speaker 3: to tailor our recommendations to the individual person. And this
Speaker 3: risk assessment test is some thing I run in the office.
Speaker 3: I do it, and I might share that information with
Speaker 3: my patient and say, look, your risk isn't as high
Speaker 3: as we thought, or maybe it's higher than we expected,
Speaker 3: or gee, we should do some genetic testing in you
Speaker 3: because of your family history. So you know, there are
Speaker 3: many factors we look at, and this should be one
Speaker 3: of those things that gets incorporated into risk assessment. Lots
Speaker 3: of gynecologists do it and I think that's what happened
Speaker 3: in this instance. Or doctor said, let's just run this
Speaker 3: on you and see how it comes out, like you
Speaker 3: don't know what it triggered.
Speaker 2: It's free, and why not Why wouldn't you do that?
Speaker 2: There's no argument to not do it correct.
Speaker 3: I mean, you know, I always say knowledge gives us power.
Speaker 1: The sonogram versus mammogram does one? Is there a difference
Speaker 1: in cost to the or or what insurance will cover,
Speaker 1: so neither.
Speaker 3: Of them are expensive tests. And but for whatever reason,
Speaker 3: the insurance companies and Medicare and whatever has set up
Speaker 3: this paradigm that you have to do the mammogram first.
Speaker 3: Huh before you can order the sonogram.
Speaker 2: Huh.
Speaker 3: Yep, it's kind of a crazy thing. I cannot understand it.
Speaker 1: Insurance generally cover both.
Speaker 3: Yeah, it will eventually get covered, but sometimes you have
Speaker 3: to go through the mammogram and then we can order
Speaker 3: the ultrasound and for our older patients. Actually, just this
Speaker 3: past year, Medicare changed their system so that we cannot
Speaker 3: order the mammogram and ultrasound to be done on the
Speaker 3: same day. The prus has to have the mammogram and
Speaker 3: then if we think the sonogram is indicated we order
Speaker 3: it and she has to go back a second time.
Speaker 2: It's it's absurd and look, I have shared the story before,
Speaker 2: but I haven't here on this podcast. I was outraged
Speaker 2: when I had the first mammogram and the Mamma Van
Speaker 2: in the middle of Times Square. They just saw something suspicious.
Speaker 2: There was no nothing specific to cancer. They just said,
Speaker 2: you know what, we'd like you to get another mammogram
Speaker 2: because something looks a little off. And so when I
Speaker 2: went to go make the follow up appointment at Nyu
Speaker 2: Lang Gone, I got a call the night before from
Speaker 2: my insurance company saying we are not going to cover this.
Speaker 2: And so NYU called me and said, you're going to
Speaker 2: have to give us your credit card if you want
Speaker 2: to keep the appointment for tomorrow. And I almost did
Speaker 2: not do it because I was annoyed A that I
Speaker 2: was going back for a second one and B that
Speaker 2: I was going to have to pay at least eight
Speaker 2: hundred dollars out of pocket. Eight hundred dollars to a
Speaker 2: lot of people is not even an option. That's their
Speaker 2: rent payment, that's food on their table. I was lucky
Speaker 2: enough to be able to afford it, but to think
Speaker 2: that insurance companies get involved in a way where they
Speaker 2: make life so much more difficult and potentially could could
Speaker 2: be costing women lives, time, money, etc. I know you,
Speaker 2: as a doctor have to be so frustrated by this.
Speaker 3: We are very frustrated by it. And you know that
Speaker 3: eight hundred dollars bill is probably including other costs than
Speaker 3: just the cost of doing the X ray, because we
Speaker 3: know that when we've done mass screening projects sending those
Speaker 3: vans out, for example, we can bring the cost down
Speaker 3: significantly and we don't want cost ever to be a
Speaker 3: barrier for women to get the right screening that they need,
Speaker 3: So that's really really important. It is very frustrating. And
Speaker 3: again in our younger patients in particular, people say, oh, well,
Speaker 3: breast cancer doesn't happen in people that age, but it
Speaker 3: sure does, you know, and you know that too all
Speaker 3: too well.
Speaker 1: The doctor oris with a living mon here help me.
Speaker 1: And again I'm familiar to a certain degree and to
Speaker 1: feel maybe familiar little more because of who I'm in
Speaker 1: love with here and the history of breast cancer. But
Speaker 1: the order someone's told to go get a mammogram, you
Speaker 1: get that mammogram. If it's clear, then there is no
Speaker 1: next step necessarily right, You're done until your next scheduled appointment.
Speaker 1: A living your month is saying the doctor. So the
Speaker 1: clear mammogram, but still we went ahead and did the
Speaker 1: risk the risk assessment, and if they hadn't done that,
Speaker 1: then maybe they wouldn't have taken that. So I am
Speaker 1: trying to find the order and trying to get women
Speaker 1: to understand because I don't understand what the understand what
Speaker 1: they should They run out and get online see their
Speaker 1: risk assessment score and then immediately go talk to the
Speaker 1: doctor about it. Is that what everybody should be doing.
Speaker 3: I think everyone has to be aware of what's going
Speaker 3: on in her own personal health and that family history story.
Speaker 3: Every woman should see the doctor once a year or
Speaker 3: you know, it could be a nurse practitioner or a PA,
Speaker 3: whoever the person is who's providing your health care for
Speaker 3: a GYN exam and a clinical breast exam, so sometimes
Speaker 3: you can feel something that may not show up right
Speaker 3: away on the X ray. Also, checking under the arms
Speaker 3: for lumps is very important. So the clinical breast examination
Speaker 3: and the mammogram is the way we start. I personally,
Speaker 3: you know, as Amy knows, younger patients feel that ultrasound,
Speaker 3: that sonogram should be part of that evaluation, and then
Speaker 3: in discussing those results. It's not just when and done,
Speaker 3: you're clear, it should be a discussion afterwards, well what
Speaker 3: did my mammogram show? If there's very dense breast tissue there,
Speaker 3: do I need a follow up test? If oh, yeah,
Speaker 3: I didn't tell you my mom had breast cancer, or
Speaker 3: my mom and her two sisters had breast cancer, or
Speaker 3: in taking that reproductive history you find out that that
Speaker 3: person had their first child over age thirty, and maybe
Speaker 3: you know other issues in their personal health that might trigger.
Speaker 3: In this case, it triggered you know, Olivia's doctor to
Speaker 3: run that risk assessment score. It's not wrong for someone
Speaker 3: to go online and do it herself. We just want
Speaker 3: to be careful that people don't get misinterpreted. So once
Speaker 3: you run it, go in and talk to an extra
Speaker 3: about what that means and what you should do.
Speaker 2: That.
Speaker 1: I hear you right that a lot of women may
Speaker 1: be getting the risk assessment and don't even know it
Speaker 1: because they might be in there with their doctor. It
Speaker 1: sounds like you were saying you were asking the questions
Speaker 1: and doing the risk assessment even though the woman didn't
Speaker 1: realize that.
Speaker 3: Then I told her. They told her about Yeah, you
Speaker 3: have to always tell them like right, what it is?
Speaker 2: Right? And it's interesting because we've had this conversation. I
Speaker 2: was among the more than eighty percent of breast cancer
Speaker 2: patients who have no family history, so I would have
Speaker 2: been considered average risk. I wouldn't have considered myself at
Speaker 2: elevated risk. But you mentioned this to me way back
Speaker 2: when my daughters were really young. Now, but now Avis
Speaker 2: twenty one and Analyse is about to be eighteen, and
Speaker 2: you had said, because of my history, their history is
Speaker 2: now they are at an elevated risk.
Speaker 3: Correct, So what.
Speaker 2: Is the age because it's been so confusing for women
Speaker 2: who are of average risk when they should have their
Speaker 2: first mammogram. But what about people like my daughters whose
Speaker 2: mom had breast cancer at a young age, When should
Speaker 2: they have their first mammogram?
Speaker 3: Is that clear? Yes? What we do is that we
Speaker 3: recommend they start seeing an expert ten years before the
Speaker 3: age at which their mom was diagnosed, so thirty round thirty.
Speaker 3: That doesn't mean they have to go into a whole
Speaker 3: intensive thing, but they have to talk to someone who
Speaker 3: is an expert and go through their personal history, maybe
Speaker 3: run a risk assessment score, and then figure out, okay,
Speaker 3: what's going to be the best way of keeping track
Speaker 3: of them and getting started a little bit early or
Speaker 3: so we're ahead of the curve and watching closely.
Speaker 2: I mean, obviously I had access to the best doctors
Speaker 2: in the world, you doctor Ratz and the incredible surgeons
Speaker 2: and everyone there at NYU Langona, and I had a
Speaker 2: credible insurance. For women who don't have those means or
Speaker 2: have access to healthcare like that, are they going to
Speaker 2: find it hard? Say they go online and they take
Speaker 2: this breast cancer risk assessment test and they see it's
Speaker 2: elevated significantly above that twelve percent average. What are their options?
Speaker 2: Will they What could you suggest to them? What is
Speaker 2: your advice to them?
Speaker 3: Well, first of all, we have an amazing network of
Speaker 3: National Cancer Institute designated cancer centers in every state of
Speaker 3: the Union, all fifty states. Now we have you know,
Speaker 3: four or five of them right here in New York City,
Speaker 3: So we have a lot of density of population and
Speaker 3: a lot of healthcare providers. In other parts of the country,
Speaker 3: it could be a big geographic distance for someone to
Speaker 3: travel to, but at least if you end up at
Speaker 3: a cancer center or a university medical center, or or
Speaker 3: a medical center affiliated with a medical school. So we're
Speaker 3: talking about places that are a little more academic. You'll
Speaker 3: get access to someone who's an expert. There are some
Speaker 3: other organizations that are out there that provide amazing information
Speaker 3: and screening for women. Planned Parenthood is one of them.
Speaker 3: People think Planned Parenthood was only out there to provide
Speaker 3: contraception and help women if they needed to terminate a pregnancy,
Speaker 3: but actually they also provide the entry point into the
Speaker 3: healthcare system for breast health as well. And other organizations
Speaker 3: that are out there with who can provide services at
Speaker 3: low cost or accepting insurances that are like Medicaid or
Speaker 3: public health insurance, but all the major medical centers will
Speaker 3: accept other insurances. And here in New York City, for example,
Speaker 3: in our public hospital system, Health and Hospitals Corporation HC
Speaker 3: hospitals can go in even without insurance and be seen
Speaker 3: in our breast clinic and be evaluated.
Speaker 1: Can you give some perspective to this Olivia mun story
Speaker 1: that it's getting a lot of attention. She's a famous person.
Speaker 1: She put it out there, and that's great to bring
Speaker 1: attention to. But just how rare is a case like hers,
Speaker 1: and that a mammogram didn't catch something, you'd then take
Speaker 1: a risk assessment, and the mammogram missed that she has
Speaker 1: this aggressive form of breast cancer in both breasts. Is
Speaker 1: this that kind of an anomaly of a case here.
Speaker 3: Well, I think it's not so unusual in our young
Speaker 3: patients where the mammogram is not necessarily the best test
Speaker 3: because of that dense breast tissue. And maybe she had
Speaker 3: an ultrasound or an MRI or something. She had both,
Speaker 3: she had both after the risk assessment test. I know
Speaker 3: they keep saying this is an aggressive form of breast cancer,
Speaker 3: but I think that's a strong word. She chose that word.
Speaker 3: And I'll give you a little biology lesson here. Breast
Speaker 3: cancer is not just one disease. There are many types
Speaker 3: of breast cancer. She really has an intermediate form. I
Speaker 3: think that luminole B I've I've never even heard of it.
Speaker 3: So we have four molecular subtypes of breast cancer. Luminal
Speaker 3: A B and then the her too enriched or her
Speaker 3: too new positive breast cancer, and then the basoloid breast cancer,
Speaker 3: which is unfortunately called triple negative, which is kind of
Speaker 3: not a great name, But what that's referring to are
Speaker 3: the three receptors that we look at that give us
Speaker 3: a lot of information about the biologic behavior of that cancer,
Speaker 3: and that's the estrogen and progesterone receptors, the hormone receptors.
Speaker 3: Those are the luminal A and B cancers. And then
Speaker 3: there's the her too positive that's her too new positive
Speaker 3: and triple negative means there's no receptors present for estrogen,
Speaker 3: progester on her too new. All three of those are absent,
Speaker 3: and that helps us to determine what treatments to use
Speaker 3: in targeting the cancer and making sure we're treating that
Speaker 3: individual with the right kind of treatment. So, the estrogen
Speaker 3: positive breast cancers are all luminal and we subdivide them
Speaker 3: into A and B, and there are tests that we
Speaker 3: can use that help us figure out which subtype it
Speaker 3: is and that helps us determine if we should add
Speaker 3: chemotherapy to just the anti estrogen endocrine therapy. And Amy
Speaker 3: knows about that. Yes, I do do genomic assays. One
Speaker 3: of them is called the acotype test. There's also a
Speaker 3: mamma print test. There are several tests we can run
Speaker 3: on the tumor tissue that tells us Okay, we know
Speaker 3: it's estrogen receptor positive, but are there other factors at
Speaker 3: play here which tell us, well, maybe we need to
Speaker 3: add a little something else to the treatment.
Speaker 1: And I'm sorry, just a quick thing.
Speaker 3: So it's not super super aggressive, but it's a little
Speaker 3: more aggressive than.
Speaker 1: The you said, not super aggressive and not necessarily an
Speaker 1: anomaly because a mammogram isn't the best test for a
Speaker 1: younger woman. When you say young in your world, when
Speaker 1: you talk in breast cancer and women young, what is
Speaker 1: the age we're talking about when you're thinking.
Speaker 3: Young, less than forty five?
Speaker 1: Okay, yeah, she's forty three.
Speaker 3: Yeah she's forty three.
Speaker 2: And you know, it is remarkable hearing you talk about
Speaker 2: there have been so many advances. I mean even when
Speaker 2: I was diagnosed ten years ago, I got the ANCA
Speaker 2: score and you were able. That was I remember you
Speaker 2: sat me down and you said, sorry, you got chemotherapy
Speaker 2: ahead of you because my AUNCA score was I believe intermediate.
Speaker 2: And you can actually predict or at least say whether
Speaker 2: or not what your chances are of having it recur
Speaker 2: and become metastatic. So I think mine's intermediate.
Speaker 3: It was, And it's not just that score. We also
Speaker 3: look at the clinical factors, age, size of the tumor,
Speaker 3: did any cells get into the lymph node? And we
Speaker 3: put all of that together. So you know, nothing in
Speaker 3: medicine is just like an on off switch. It's not
Speaker 3: just one thing that determines what we do. It's kind
Speaker 3: of all of the information and then that soft thing
Speaker 3: we call clinical judgment. That's why you can't replace me
Speaker 3: with a robot just yet. Isn't she great?
Speaker 2: Isn't she great? I love doctor writ You know. I
Speaker 2: can't believe I let a year and a half go
Speaker 2: without coming into see But when stories like this hit
Speaker 2: the news, I know a lot of women go into
Speaker 2: panic mode, and you don't want people to overreact. But
Speaker 2: also it's not a bad thing because this type of
Speaker 2: story brings awareness where women suddenly start to take their
Speaker 2: health a little bit more seriously and think, oh wow,
Speaker 2: it could happen to me. What is your reaction when
Speaker 2: you see celebrities come out and explain what happened. I mean,
Speaker 2: they might not get all the facts exactly right, but
Speaker 2: the general idea is to warn and make women aware.
Speaker 3: I'm always proud when someone steps forward to share something
Speaker 3: that's deeply personal, deeply intimate, and be able to open
Speaker 3: up to the public and say, learn from my story.
Speaker 3: I'm sharing this with you to help you. And that's
Speaker 3: a tremendous gift and I think that for people to
Speaker 3: do that is very, very courageous.
Speaker 1: This obviously raises awareness, but this is living a month
Speaker 1: story and all of the back and forth about this
Speaker 1: breast cancer or risk assessment test. Where would you caution
Speaker 1: us in this story? You want the word out there,
Speaker 1: but where do you caution everybody in listening to the story.
Speaker 3: Well, I always caution people not to panic, but I
Speaker 3: would say the test is available. And I think Amy's right.
Speaker 3: I think the more that people are aware of their health,
Speaker 3: the better they're going to be able to take care
Speaker 3: of themselves. So if a woman says, gee, I'm a
Speaker 3: little concerned about this, I'm going to go online and
Speaker 3: run that essay on myself, you know, see where my
Speaker 3: number comes out. Then make sure though that we have
Speaker 3: the support system for her so she can follow up,
Speaker 3: maybe even make that appointment with your doctor first, or
Speaker 3: go into your healthcare provider and say i'd like to
Speaker 3: do this, maybe we can do it. Together. I mean
Speaker 3: it takes about three minutes to punch the numbers in
Speaker 3: on the computer, so then you're not just sitting there
Speaker 3: and then can't get an appointment to see your doctor
Speaker 3: for two months and you're all in a panic about it.
Speaker 3: So maybe schedule that appointment and say this is something
Speaker 3: I'd like to discuss with you, and go over all
Speaker 3: the other factors. Other risk factors for developing breast cancer are,
Speaker 3: for example, alcohol, use too much drinking no good, don't
Speaker 3: drink every day, don't drink more than two drinks if
Speaker 3: you're going out to a party. You know, alcohol can
Speaker 3: be a big risk factor. Keep a healthy body weight.
Speaker 3: You don't have to be super skinny, but a healthy
Speaker 3: body weight. Physical exercise is important. Amy knows that. I
Speaker 3: think it's been a big factor in really keeping you
Speaker 3: healthy and getting you through the side effects of treatment.
Speaker 2: Oh yeah, to even be able to tolerate tomoxifen as
Speaker 2: long as I did. You know, I think staying active
Speaker 2: kept my joints working, because that's a big complaint. You know,
Speaker 2: some of the meds that they put you on makes
Speaker 2: you not want to exercise. But if you can push
Speaker 2: through it, then you can get to the other side
Speaker 2: of it, and you can make it work and stay
Speaker 2: on it for as long as possible, which obviously reduces
Speaker 2: your risk of recurrence, which is what we're all looking for.
Speaker 2: I have a question if can you, as a woman,
Speaker 2: go into your doctor and say I just want a
Speaker 2: sonogram and could you insist on it? Can you pay
Speaker 2: for it yourself if your insurance won't pay for it?
Speaker 2: If you have the means, what are your rights or
Speaker 2: options as a patient if you think you want something.
Speaker 3: I think you should have that discussion with your doctor,
Speaker 3: and I think most doctors would agree to, you know,
Speaker 3: work with you in getting the right test done for you.
Speaker 3: Sometimes we have to finesse the order in which we
Speaker 3: do things. Sometimes, even at the cancer center, I have
Speaker 3: to call the radiologist and say, you know, I'm not
Speaker 3: doing that mammogram on this thirty two year old. It's
Speaker 3: not happening. Just do the ultrasound, pick up the phone
Speaker 3: and you know, make that phone call. But we can
Speaker 3: usually get things done in the right sequence and appropriately
Speaker 3: for each patient.
Speaker 1: The test is available on the National Cancer Institute website
Speaker 1: and they say they've had a huge spike. Please caution,
Speaker 1: as women of color, black women, in particular, I think
Speaker 1: here that I think they've tried to update the tool
Speaker 1: over time, but it might not be as accurate. For
Speaker 1: women of COLT.
Speaker 3: May actually underestimate the risk and we're not sure why
Speaker 3: that is. And it's not even because when we do
Speaker 3: genetic testing we can find a particular gene. We haven't
Speaker 3: identified that yet. They also caution that for Asian women
Speaker 3: born outside of the United States, the test and Hispanic
Speaker 3: women born outside of the United States it may not
Speaker 3: be accurate. And that's because when the test was developed
Speaker 3: decades ago, it was validated on a population of pre
Speaker 3: dominantly Caucasian women, so there could be some caveats there.
Speaker 3: If a woman has a history of what we call
Speaker 3: non invasive breast cancer DCIS or LCIs, the tool is
Speaker 3: not accurate. If the person knows she has a genetic
Speaker 3: mutation like BRCA one or b r c A two
Speaker 3: or another genetic mutation that could increase the risk of cancer,
Speaker 3: the test is not accurate. So all of those kind
Speaker 3: of disclaimers are the in the small print there. You
Speaker 3: know when you open up the click on the internet
Speaker 3: to open up the test.
Speaker 2: I have a question for any woman who is listening
Speaker 2: right now. What you mentioned the things you can be
Speaker 2: doing to prevent cancer or to lower your risk of cancer,
Speaker 2: But what in terms of monitoring and making those appointments,
Speaker 2: what should women be doing at what age? Can you
Speaker 2: give us kind of that rundown, So anyone who's listening knows, Okay,
Speaker 2: if I'm this age, I should be doing this. If
Speaker 2: I'm that age, I should be doing this. How often
Speaker 2: should I be doing it?
Speaker 3: I'm going to start really young. I think any young
Speaker 3: woman who is sexually active should have an exam with
Speaker 3: a gynecologist or a gyn healthcare provider once a year.
Speaker 3: Make sure everything's okay, and that's also checking for infections
Speaker 3: or other conditions, and be sure it includes a breast exam.
Speaker 3: I think that all women from early age eighteen on
Speaker 3: check yourself every month. The best time to do a
Speaker 3: self breast examination is right after your period is finished.
Speaker 3: That's when the breast is going to be the softest
Speaker 3: and the least tender. As a lot of women know,
Speaker 3: they feel fluctuations during the month with that monthly cycle,
Speaker 3: So once things have quieted down, check yourself, poke around
Speaker 3: under the arms, make sure there are no lumps or bumps.
Speaker 3: If someone has a concern, any concern at all. Something
Speaker 3: feels weird, this looks odd, my skin color changed, there's
Speaker 3: a discharge from the nipple, something's painful. Go in and
Speaker 3: get it checked out. May turn out to be nothing,
Speaker 3: but check it out. So that's for all women. I
Speaker 3: would say from late teenage years on, go in at
Speaker 3: least once a year for checkup, and check yourself every month.
Speaker 3: In terms of when to start breast imaging, that's that
Speaker 3: ultrasound or the mammogram or if necessary, an MRI, that's
Speaker 3: where tools like this risk assessment tool might really help
Speaker 3: us figure out. Okay, we have a general guideline that
Speaker 3: says start in your forties, but maybe someone needs to
Speaker 3: start earlier because of a family history or some other
Speaker 3: factor in her health. So that's where we should maybe
Speaker 3: have our healthcare providers run that risk assessment tool when
Speaker 3: someone's coming in. Really, it literally takes three minutes. Now,
Speaker 3: I don't think every eighteen year old needs it, but
Speaker 3: maybe when we're starting to get into those early thirties,
Speaker 3: that will trigger the provider, whether that's a nurse or
Speaker 3: a doctor or who's ever seen that woman, say yeah,
Speaker 3: did anyone in your family ever have breast cancer? You
Speaker 3: know or did you have? You had any pregnancies? How
Speaker 3: old were you when that first baby was born? And
Speaker 3: that then we can plug those numbers into the tool
Speaker 3: and see where we're.
Speaker 1: At to that question. I'm so bad. I keep going
Speaker 1: back to this test this tool here, but there might
Speaker 1: be a breakdown that lets people know if your number
Speaker 1: is this, if your numbers this, But can you tell
Speaker 1: people here because a lot are going to go on
Speaker 1: and fill this out. So a living you moone's number
Speaker 1: was a thirty seven percent, and that's way, way, way high.
Speaker 1: But where do you start seeing numbers you and someone
Speaker 1: else doing it online to where you should be a lot?
Speaker 3: That's a great question, TJ. Because people are going to
Speaker 3: be doing this right. So we say that the average
Speaker 3: lifetime risk of breast cancer for an American woman is
Speaker 3: about twelve percent. So if you punch it in and
Speaker 3: your lifetime risk that's going to age ninety is fourteen percent,
Speaker 3: I wouldn't get too too worried about it. But if
Speaker 3: you if you're coming up, you know, let's say, and
Speaker 3: I'm kind of just making this up honestly, but you know,
Speaker 3: twelve percent, So if you're starting to hit closer to
Speaker 3: twenty percent, twenty five percent. She was above thirty percent.
Speaker 3: That's a higher risk. It also gives you a number
Speaker 3: within the next five years on that risk assessment tool.
Speaker 3: So the lifetime risk my hers was thirty seven percent,
Speaker 3: but I don't know what the number came out, because
Speaker 3: it gives you both within the next five years. If
Speaker 3: that number is significantly higher, you may want to go
Speaker 3: in sooner. So, for example, We're going to calculate a
Speaker 3: patient risk, and I'm going to make up the answers
Speaker 3: to the question. Let's see how it comes out. So
Speaker 3: the first question is does the woman have a medical
Speaker 3: history of DCIS or LCIs. The other thing it asks,
Speaker 3: by the way, is has she had radiation treatment to
Speaker 3: the chest area because that increases the risk of breast
Speaker 3: cancer significantly, and sometimes we give that radiation treatment to
Speaker 3: young women who have lymphoma. We don't do it so
Speaker 3: much anymore, but we used to. So I'm gonna say no,
Speaker 3: no history of those things. Is there a mutation in
Speaker 3: BRCA one, BRCA two, any genetic mutations, I'm gonna say no.
Speaker 3: What age patients you want is to look at.
Speaker 1: Let's do let's do forty five.
Speaker 3: Forty five? Okay, forty five, so I'm gonna put that in.
Speaker 3: By the way, the essay starts at age thirty five,
Speaker 3: so a twenty eight year old can't use this. It's
Speaker 3: not valid. Oh okay, so it starts at age thirty five,
Speaker 3: So I'm going to pick forty five. What is the
Speaker 3: patient's race or ethnicity, and the choices here are white,
Speaker 3: African American, Latina, Asian, American, Native American, or Alaskan Native
Speaker 3: or unknown let's go black, okay, And has the patient
Speaker 3: ever had a breast biopsy with a benign meaning a
Speaker 3: non cancerous diagnosis. I'm going to say no, right, most
Speaker 3: women haven't had that.
Speaker 1: And as we feel this out, can you depending on
Speaker 1: what you do in your life year to year, your
Speaker 1: number can change. How do you take the test year
Speaker 1: to year?
Speaker 3: All right, that's right exactly, because things right, things are
Speaker 3: going to happen. Then we get into those questions about
Speaker 3: your reproductive history. What was the woman's age at the
Speaker 3: time of her first menstrual period. They give us three choices.
Speaker 3: A very young age which would be before age eleven,
Speaker 3: then kind of twelve to thirteen, which sort of average,
Speaker 3: and the third choice would be fourteen or older.
Speaker 1: To the average.
Speaker 3: Let's give her the average twelve to thirteen, and the
Speaker 3: age of the of her first child, so either no
Speaker 3: births or what age she was when she had a baby.
Speaker 3: Let's say twenty nine. So then okay, you're right on
Speaker 3: the edge because it goes twenty five to twenty nine.
Speaker 3: A's thirty or older. Let's give her twenty nine.
Speaker 2: Yeah, I just use my birth age. I mean my
Speaker 2: age when I gave birth. That's like, yeah, that's great.
Speaker 3: I wish.
Speaker 2: I was born in nineteen twenty nine.
Speaker 3: No, and what about that family history? Does she have
Speaker 3: a mother, sister, or daughter who had breast cancer? I
Speaker 3: don't know.
Speaker 2: What do we say? Say one?
Speaker 3: Okay, let's say her mom had braains. Okay, okay. So
Speaker 3: this is now for this individual person, and I'm calculating
Speaker 3: her risk. The risk of her developing cancer within the
Speaker 3: next five years eight fifty is only one point four percent. Wow,
Speaker 3: that's a little higher than the average risk, which is
Speaker 3: zero point nine percent for the general population. So she's
Speaker 3: not in major big trouble this year. Over the course
Speaker 3: of her lifetime, her risk is a little bit higher
Speaker 3: fourteen point four percent. Compared to nine point five percent.
Speaker 2: I'm actually surprised because with a mother who had cancer,
Speaker 2: being African American, that's actually a surprisingly low number to me,
Speaker 2: is it to you?
Speaker 3: Well a little bit? Yeah, wow, but.
Speaker 1: You get that number. That woman just filled that out.
Speaker 1: She sees fourteen point four. Now what do I do?
Speaker 3: She says, Okay, what she really should see is in
Speaker 3: the next five years it's one percent. So don't panic,
Speaker 3: but pick up the phone. Make sure you have that
Speaker 3: appointment to see your doctor. Check in your calendar. Did
Speaker 3: I do a mammogram last year? Am I up to date?
Speaker 3: If not, go in to see your doctor. Bring this
Speaker 3: information and say I want to review this with you.
Speaker 3: Am I doing enough screening? Is there something we should
Speaker 3: add to this? Gee, my mom had breast cancer, but
Speaker 3: we never did that genetic testing thing. Should I speak
Speaker 3: to the genetic counselor so, you know, follow up on
Speaker 3: all of those issues, Doctor Ratz.
Speaker 2: I just thought of something because as you plug those
Speaker 2: numbers and that information in, that would have been me
Speaker 2: except for that I didn't have a family history, I
Speaker 2: didn't have a close relative who had breast cancer, and
Speaker 2: I was forty not forty five. So my number would
Speaker 2: have been probably even lower than that because I.
Speaker 3: Might as well yes and no, I mean I don't know.
Speaker 3: We'd have to put it in and see.
Speaker 2: But by those questions, I'm fairly certain I would not
Speaker 2: have had a high percentage. And yet and yet I
Speaker 2: had I had, I had stage two breast cancer. It
Speaker 2: had spread to my lip notes. So you know, I
Speaker 2: wouldn't want people, and I know you wouldn't want people
Speaker 2: to go on take this test and think I'm good,
Speaker 2: I don't have to get a mammogram. I'm good, I
Speaker 2: don't have to go in every year and get tested,
Speaker 2: and that could happen.
Speaker 3: That could happen. And that's what I was getting back
Speaker 3: to before, where it's not just one thing. This is helpful,
Speaker 3: but remember check yourself. Go every year to see the
Speaker 3: doctor and have a clinical breast exam, and make sure
Speaker 3: that starting at age forty there's some kind of screening,
Speaker 3: and if you're at higher risk, start at a younger age.
Speaker 3: Doctor RATZ, do you have anything else? Babe?
Speaker 2: I didn't want to just s well.
Speaker 1: I was trying to put in your numbers and at
Speaker 1: your risk it does come out very very low.
Speaker 2: Yeah, And I wouldn't want someone to have a false
Speaker 2: impression that somehow they're not going to get breast cancer
Speaker 2: because this test told them their number was low.
Speaker 3: It doesn't substitute for all those other things we need
Speaker 3: to do to take care of ourselves.
Speaker 2: I remember sitting, Oh, I could get emotional hair sitting
Speaker 2: at NYU, I was about to probably see you in
Speaker 2: a few hours, and didn't realize going in for my
Speaker 2: follow up man and kind of getting nervous because they
Speaker 2: kept asking me to come back and get new images
Speaker 2: and new images, and I was trying not to get scared.
Speaker 2: So I started looking up my chances as a forty
Speaker 2: year old, otherwise healthy woman, and I said, oh, I
Speaker 2: got a one percent. I got less than a one
Speaker 2: percent chance of having breast cancer. And I put myself
Speaker 2: at ease, and I told myself to stop freaking out
Speaker 2: that I almost certainly didn't have it. And even when
Speaker 2: they found something when I had to have a biopsy,
Speaker 2: I was like, it's gonna be benign. So when I
Speaker 2: was told I had breast cancer and I saw you,
Speaker 2: I believe about an hour later, I couldn't have been
Speaker 2: more shocked. I didn't think it could happen to me.
Speaker 1: What did you get that said it was one percent?
Speaker 1: Where'd you get that?
Speaker 3: It's just the average.
Speaker 2: I mean, if you are of, if you have no
Speaker 2: family history, if you're relatively healthy. I knew I was thin.
Speaker 2: I knew I exercised, I knew I ate well. I
Speaker 2: found an average risk. A woman in my age had
Speaker 2: a less than one percent chance of developing.
Speaker 1: An I said, because I just feeled her answers out
Speaker 1: on this assessment. It came point six percent.
Speaker 3: See that chance less than one percent?
Speaker 2: Yet and yet I had breast cancer. So I just
Speaker 2: want to I wanted to point that out right. So
Speaker 2: none of these tools are fool proof. They're helpful, but
Speaker 2: I think you're writing Amy, we want to make sure
Speaker 2: that people still follow up and do all the other
Speaker 2: things they need to do to stay healthy.
Speaker 1: And look our best to Olivia mon and congratulations and
Speaker 1: thank you really for putting this out there and sparking
Speaker 1: these discussions. And I bet you the fact that she
Speaker 1: has done this is going to save lives that we
Speaker 1: don't even realize. But doctor writes, before you go, can
Speaker 1: you please talk to this one for me? And you
Speaker 1: know I've stayed on her about it, but if you
Speaker 1: can give her a little reminder of just how important
Speaker 1: it is for her to keep up with those appointments.
Speaker 3: It is important. And what I love the most about
Speaker 3: my practice is all the people who come in for
Speaker 3: their once a year check up twenty years later and
Speaker 3: they're fine. And even for some of my young patients
Speaker 3: who come in and tell me that they've had a
Speaker 3: baby since they were diagnosed, see those babies or you know,
Speaker 3: celebrating other life events and it is just fantastic. So
Speaker 3: it makes me happy, and then I know you're healthy.
Speaker 3: So I think the other thing that happens is once
Speaker 3: someone does have a cancer diagnosis, anything else that comes
Speaker 3: up we want to know about. Not because it means
Speaker 3: the cancer is coming back, but you know, we sort
Speaker 3: of have a lot of ownership around our cancer patients,
Speaker 3: and I think as oncologists, we like to know that
Speaker 3: you're well, and we also want to make sure that
Speaker 3: you're doing all the other screening tests you need to do.
Speaker 3: You know, that colonoscopy, No one wants to talk about it, right,
Speaker 3: Who's going to remind you about that? You know? So
Speaker 3: there are other things that we like to just check
Speaker 3: our boxes and make sure everybody's healthy and come in
Speaker 3: for your checkos well, doctor Ortz.
Speaker 2: I am so so happy you came in and you
Speaker 2: came to see me before I came.
Speaker 1: To see you.
Speaker 2: But I am going to be there on March twenty six,
Speaker 2: so we can catch up then, and I will have
Speaker 2: my girls get their baseline mammogram at the age of
Speaker 2: thirty after everything I just heard you say, and with
Speaker 2: a sonogram, with the sonogram, you're right with the sonogram,
Speaker 2: and that was part of what we were talking about.
Speaker 2: So I think so many women are going to be
Speaker 2: so grateful for your perspective and your information and thank you,
Speaker 2: thank you just for being you, and thank you for
Speaker 2: helping me over this past decade and for the decades to.
Speaker 3: Come, for the decades to come, and to everyone out there,
Speaker 3: don't panic. You're going to be fine.