1 00:00:02,520 --> 00:00:08,119 Speaker 1: This is Let's Be Clear with Shannon Doherty. Hi everyone, 2 00:00:08,240 --> 00:00:12,280 Speaker 1: I'm doctor Amani Jambiar. I'm the medical director of Surgical 3 00:00:12,280 --> 00:00:15,720 Speaker 1: breast Oncology at Christas Saint Vincent in Santa Fe, New Mexico, 4 00:00:16,120 --> 00:00:18,480 Speaker 1: and it is my pleasure to be hosting this episode 5 00:00:18,520 --> 00:00:22,279 Speaker 1: of Let's Be Clear. I didn't know or treat Shannon Doherty, 6 00:00:22,400 --> 00:00:25,360 Speaker 1: but I have a deep appreciation for her advocacy and 7 00:00:25,400 --> 00:00:28,360 Speaker 1: for how she encouraged people to get checked for breast 8 00:00:28,400 --> 00:00:33,160 Speaker 1: cancer early and often. October is Breast cancer Awareness month, 9 00:00:33,200 --> 00:00:35,680 Speaker 1: as y'all know, and so today I'll be answering some 10 00:00:35,800 --> 00:00:38,639 Speaker 1: questions y'all sent in, so let's go ahead and get 11 00:00:38,640 --> 00:00:41,760 Speaker 1: to it. So the first question y'all asked is is 12 00:00:41,800 --> 00:00:45,559 Speaker 1: puffinus under the arm something to be worried about. It 13 00:00:45,640 --> 00:00:48,240 Speaker 1: depends on what you mean by puffiness under the arm, 14 00:00:48,320 --> 00:00:51,080 Speaker 1: but in general I recommend getting it checked. There's a 15 00:00:51,120 --> 00:00:54,160 Speaker 1: few different causes of puffiness under the arm. Sometimes it 16 00:00:54,160 --> 00:00:56,880 Speaker 1: can be because of a lymph node. Sometimes it can 17 00:00:56,920 --> 00:00:59,840 Speaker 1: be because of having extra breast tissue that's actually in 18 00:01:00,040 --> 00:01:03,600 Speaker 1: the armpit. That's pretty normal, but if you're not sure 19 00:01:03,640 --> 00:01:05,640 Speaker 1: what it is, it's worth going to a doctor and 20 00:01:05,720 --> 00:01:08,520 Speaker 1: having them check it out, and your primary care doctor 21 00:01:08,600 --> 00:01:11,880 Speaker 1: can recommend you see a breast specialist or a surgeon 22 00:01:11,880 --> 00:01:14,760 Speaker 1: who operates on breast cancer like me, who can help 23 00:01:14,800 --> 00:01:17,679 Speaker 1: get imaging, get an ultrasound done, and figure out exactly 24 00:01:17,680 --> 00:01:21,680 Speaker 1: what it is. So the second question I have is 25 00:01:21,760 --> 00:01:25,520 Speaker 1: do you think that hormone replacement therapy increases or decreases 26 00:01:25,640 --> 00:01:28,520 Speaker 1: the risk of breast cancer? And that's a little bit 27 00:01:28,520 --> 00:01:32,720 Speaker 1: of a complicated question. Studies have shown that it slightly, 28 00:01:33,240 --> 00:01:36,600 Speaker 1: very slightly increases the risk for breast cancer, But in 29 00:01:36,640 --> 00:01:39,959 Speaker 1: my practice, where I see patients who are potentially high 30 00:01:40,040 --> 00:01:42,800 Speaker 1: risk for breast cancer as well, I don't recommend that 31 00:01:42,800 --> 00:01:46,479 Speaker 1: anyone not do hormone replacement therapy because of that very 32 00:01:46,600 --> 00:01:50,200 Speaker 1: very small increase in risk for a potential future breast cancer. 33 00:01:50,720 --> 00:01:53,560 Speaker 1: I think that the benefits of hormone replacement therapy for 34 00:01:53,720 --> 00:01:57,800 Speaker 1: women who are postmenopausal outweigh the risks, and I see 35 00:01:57,800 --> 00:02:00,480 Speaker 1: many patients in my clinic who have never been on 36 00:02:00,520 --> 00:02:03,680 Speaker 1: hormone replacement therapy but do end up developing a future 37 00:02:03,720 --> 00:02:08,160 Speaker 1: breast cancer. The next question I have is does chemo 38 00:02:08,360 --> 00:02:11,920 Speaker 1: cause cancer? No, it doesn't. I think in the past 39 00:02:12,000 --> 00:02:16,240 Speaker 1: there was a very small association between chemo and then 40 00:02:16,320 --> 00:02:19,880 Speaker 1: suppressing the immune system and the bone marrow and potentially 41 00:02:19,919 --> 00:02:23,920 Speaker 1: causing cancers because of that later on. Nowadays, it really 42 00:02:23,960 --> 00:02:27,120 Speaker 1: doesn't happen at all. We give a lot smaller doses 43 00:02:27,120 --> 00:02:29,240 Speaker 1: of chemo than we used to in the past. So 44 00:02:29,880 --> 00:02:33,240 Speaker 1: if you're being recommended chemo to treat your breast cancer, 45 00:02:33,800 --> 00:02:36,000 Speaker 1: you should take it and not worry about getting a 46 00:02:36,040 --> 00:02:40,920 Speaker 1: second cancer. The next question is, how is it possible 47 00:02:41,240 --> 00:02:44,800 Speaker 1: for someone with breast cancer to look fine one week 48 00:02:45,280 --> 00:02:48,560 Speaker 1: and unfortunately pass away the next week. How does it 49 00:02:48,600 --> 00:02:52,040 Speaker 1: happen so quickly. So the answer to that is it 50 00:02:52,320 --> 00:02:57,280 Speaker 1: doesn't really happen that quickly. Usually, the reason why someone 51 00:02:57,320 --> 00:03:01,840 Speaker 1: looks fine one week and unfortunately passes away from their 52 00:03:01,880 --> 00:03:04,200 Speaker 1: breast cancer the next week is because these changes are 53 00:03:04,200 --> 00:03:07,440 Speaker 1: already happening in their body. So for someone who has 54 00:03:07,520 --> 00:03:10,880 Speaker 1: metastatic breast cancer or cancer that has spread in other 55 00:03:11,000 --> 00:03:14,200 Speaker 1: places in the body, it's already having the effect on 56 00:03:14,280 --> 00:03:18,000 Speaker 1: the organs, and someone may be compensating for it and 57 00:03:18,040 --> 00:03:21,320 Speaker 1: their body might be fighting it. But then it progresses 58 00:03:21,560 --> 00:03:23,960 Speaker 1: and it can look very dramatic week to week, but 59 00:03:24,280 --> 00:03:26,959 Speaker 1: that cancer's been there and it's been growing the whole time. 60 00:03:29,360 --> 00:03:32,920 Speaker 1: The next question is what can you tell me about recurrence? 61 00:03:33,040 --> 00:03:36,800 Speaker 1: I had a her too positive breast cancer with a lump. 62 00:03:37,480 --> 00:03:40,080 Speaker 1: I think that the person who asked this question meant 63 00:03:40,120 --> 00:03:42,640 Speaker 1: that they had a cancer that is her too positive 64 00:03:42,680 --> 00:03:44,640 Speaker 1: and they had a lump back to me, or they 65 00:03:44,720 --> 00:03:47,360 Speaker 1: just had part of the breast removed that area that 66 00:03:47,440 --> 00:03:51,280 Speaker 1: had the cancer and then didn't have the whole breast removed. 67 00:03:52,080 --> 00:03:55,440 Speaker 1: And I will say that a her too positive type 68 00:03:55,480 --> 00:03:57,960 Speaker 1: of breast cancer is a cancer that has a slightly 69 00:03:58,080 --> 00:04:01,320 Speaker 1: higher risk of coming back in the breast and in 70 00:04:01,360 --> 00:04:04,720 Speaker 1: other parts of the body. But for people who follow 71 00:04:04,760 --> 00:04:08,320 Speaker 1: the recommended treatments for the cancer, which includes treatments to 72 00:04:08,360 --> 00:04:12,840 Speaker 1: block the HERTU receptor as well as radiation, that risk 73 00:04:12,920 --> 00:04:15,280 Speaker 1: that the cancer comes back or the risk of recurrence 74 00:04:15,360 --> 00:04:19,440 Speaker 1: is pretty low. It also, though, depends on how large 75 00:04:19,440 --> 00:04:21,640 Speaker 1: the cancer was to start with, and if it was 76 00:04:21,680 --> 00:04:24,560 Speaker 1: in the lymph nodes or not. The next question I 77 00:04:24,600 --> 00:04:28,280 Speaker 1: have is breast cancer hereditary? And the answer is yes, 78 00:04:28,360 --> 00:04:31,560 Speaker 1: it can be hereditary. There's a few different ways that 79 00:04:31,600 --> 00:04:34,400 Speaker 1: can be the case. First of all, there can be 80 00:04:34,839 --> 00:04:37,800 Speaker 1: genes like braco ie or brack of two, which we've 81 00:04:37,839 --> 00:04:41,360 Speaker 1: all heard of because Angelina Jolie was impacted by those 82 00:04:42,480 --> 00:04:45,400 Speaker 1: and they if you have a gene like that, then 83 00:04:45,440 --> 00:04:48,640 Speaker 1: you could have an up to fifty to eighty percent 84 00:04:48,720 --> 00:04:52,839 Speaker 1: lifetime risk of a future breast cancer. There's other genes 85 00:04:52,839 --> 00:04:54,920 Speaker 1: as well that get talked about a lot less than 86 00:04:54,960 --> 00:04:58,839 Speaker 1: BRACO one and two. There's genes such as PALBI two, 87 00:04:59,080 --> 00:05:02,839 Speaker 1: CHEP two, and eight, which also significantly increased breast cancer 88 00:05:02,920 --> 00:05:05,320 Speaker 1: risk if you do inherit that gene from your mom 89 00:05:05,400 --> 00:05:10,120 Speaker 1: or your dad. But aside from those genes, there are 90 00:05:10,680 --> 00:05:13,200 Speaker 1: other genes that we don't know about because we don't 91 00:05:13,240 --> 00:05:16,599 Speaker 1: have panels that can catch those genes yet, but studies 92 00:05:16,600 --> 00:05:19,799 Speaker 1: are being done on them. And for people who don't 93 00:05:19,800 --> 00:05:22,360 Speaker 1: have a gene that we've identified yet but still have 94 00:05:22,400 --> 00:05:25,279 Speaker 1: a family history of breast cancer, they are at increased 95 00:05:25,360 --> 00:05:29,200 Speaker 1: risk of breast cancer themselves. And when we talk to 96 00:05:29,279 --> 00:05:31,640 Speaker 1: patients about their risk of a future of breast cancer, 97 00:05:31,680 --> 00:05:34,760 Speaker 1: the family history is something that we consider, even if 98 00:05:34,800 --> 00:05:38,440 Speaker 1: they don't have a mutation or something that is an 99 00:05:38,480 --> 00:05:42,320 Speaker 1: alteration in their genes that is increasing their risk. So, yes, 100 00:05:42,440 --> 00:05:45,760 Speaker 1: breast cancer is the cancer that can be hereditary, and 101 00:05:45,880 --> 00:05:49,479 Speaker 1: having a first degree relative such as your mother or 102 00:05:49,480 --> 00:05:52,320 Speaker 1: your sister or your daughter who has breast cancer. Does 103 00:05:52,360 --> 00:05:55,720 Speaker 1: increase your risk of a future breast cancer unless you're 104 00:05:55,760 --> 00:05:59,599 Speaker 1: in a situation where you say, your mother had breast 105 00:05:59,600 --> 00:06:02,840 Speaker 1: cancer and they had the braco one mutation, and then 106 00:06:02,920 --> 00:06:05,839 Speaker 1: you get testing and you don't and you haven't inherited 107 00:06:05,839 --> 00:06:08,240 Speaker 1: the braco one mutation from them, and you don't have 108 00:06:08,279 --> 00:06:11,360 Speaker 1: that mutation. In that situation, you wouldn't be at an 109 00:06:11,360 --> 00:06:14,039 Speaker 1: increased risk for a future breast cancer just because your 110 00:06:14,040 --> 00:06:17,520 Speaker 1: mom had breast cancer and was braco one positive, if 111 00:06:17,520 --> 00:06:22,200 Speaker 1: that makes sense. The next question is a great question, 112 00:06:22,880 --> 00:06:24,719 Speaker 1: and it's if you have dense breasts, should you be 113 00:06:24,800 --> 00:06:29,800 Speaker 1: requesting an ultrasound. So there's a few different things I 114 00:06:29,920 --> 00:06:32,320 Speaker 1: like to talk about when I talk about dense breasts. 115 00:06:33,279 --> 00:06:36,840 Speaker 1: First of all, there's different categories of breast density. It 116 00:06:36,880 --> 00:06:41,880 Speaker 1: goes A, B, C, and D. And C is heterogeneously dense, 117 00:06:41,920 --> 00:06:43,919 Speaker 1: meaning that there's parts of the breast that are dense, 118 00:06:43,960 --> 00:06:46,800 Speaker 1: and D is extremely dense, meaning pretty much all of 119 00:06:46,800 --> 00:06:49,800 Speaker 1: the breast is dense. If you have category D or 120 00:06:49,880 --> 00:06:53,560 Speaker 1: extremely dense breasts, then I do recommend that you get 121 00:06:53,560 --> 00:06:56,560 Speaker 1: an ultrasound, and certainly the type of mammogram that you 122 00:06:56,600 --> 00:07:00,120 Speaker 1: get should be a three D mammogram or which homosynthesis 123 00:07:00,160 --> 00:07:04,120 Speaker 1: and not a two D mammogram. Now, three D mammograms 124 00:07:04,240 --> 00:07:06,599 Speaker 1: are the standard of care pretty much everywhere in the 125 00:07:06,640 --> 00:07:10,400 Speaker 1: country in the United States. There are some places that 126 00:07:10,440 --> 00:07:13,440 Speaker 1: don't have access to three D mammograms yet, but those 127 00:07:13,480 --> 00:07:17,680 Speaker 1: make a huge difference for women with dense breasts. If 128 00:07:17,720 --> 00:07:20,440 Speaker 1: you have category D breasts, most of the time the 129 00:07:20,560 --> 00:07:24,360 Speaker 1: radiologists will recommend doing an ultrasound as well with your 130 00:07:24,400 --> 00:07:28,400 Speaker 1: annual screening. Sometimes they will also recommend getting an MRI, 131 00:07:29,080 --> 00:07:31,840 Speaker 1: and if they do recommend that because your tissue is 132 00:07:31,840 --> 00:07:34,360 Speaker 1: that dense and they think it will help catch any 133 00:07:34,400 --> 00:07:37,560 Speaker 1: cancers if they were to happen, then it's worth getting 134 00:07:37,560 --> 00:07:41,560 Speaker 1: that ordered as well. Typically, for patients who do have 135 00:07:41,680 --> 00:07:45,600 Speaker 1: extremely dense or category D breast density, in order to 136 00:07:46,240 --> 00:07:50,040 Speaker 1: get an MRI or get an ultrasound, sometimes you may 137 00:07:50,080 --> 00:07:53,040 Speaker 1: need to be evaluated by a high risk breast clinic first, 138 00:07:53,680 --> 00:07:57,440 Speaker 1: and sometimes that may be more accessible in some parts 139 00:07:57,480 --> 00:07:59,640 Speaker 1: of the country than it is in others. Here in 140 00:07:59,720 --> 00:08:02,720 Speaker 1: San I see a lot of these patients who have 141 00:08:02,840 --> 00:08:06,040 Speaker 1: extremely dense breasts, and we individualized the plan. We talk 142 00:08:06,120 --> 00:08:09,000 Speaker 1: to the radiologists and we figure out what combination of 143 00:08:09,040 --> 00:08:13,280 Speaker 1: imaging works for them, and usually it's ultrasound and the mammogram. 144 00:08:13,400 --> 00:08:18,400 Speaker 1: Sometimes it's also the MRI. The next question I have 145 00:08:18,640 --> 00:08:21,280 Speaker 1: is are there any new developments when it comes to 146 00:08:21,360 --> 00:08:24,240 Speaker 1: what causes breast cancer? So I spoke a little bit 147 00:08:24,240 --> 00:08:29,640 Speaker 1: about this earlier. There are expanded gene panels that are 148 00:08:29,640 --> 00:08:33,240 Speaker 1: not available yet to us to actually order, that are 149 00:08:33,240 --> 00:08:35,880 Speaker 1: being studied that show that there are more genes than 150 00:08:35,880 --> 00:08:39,000 Speaker 1: the ones that we know about which do cause breast cancer. 151 00:08:39,440 --> 00:08:42,120 Speaker 1: And that's great because if we know about breast cancers 152 00:08:42,120 --> 00:08:45,240 Speaker 1: which are caused by gene mutations, then we can develop 153 00:08:45,400 --> 00:08:51,040 Speaker 1: treatments to target those specific mutations and essentially develop individualized 154 00:08:51,080 --> 00:08:54,160 Speaker 1: treatment plans for each patient which will help them live longer. 155 00:08:55,120 --> 00:08:59,800 Speaker 1: In terms of are there any new developments regarding diet 156 00:09:00,120 --> 00:09:03,080 Speaker 1: which I get asked about all the time, or any 157 00:09:03,160 --> 00:09:05,440 Speaker 1: kind of exercise you should be doing, or any sort 158 00:09:05,440 --> 00:09:08,320 Speaker 1: of lifestyle you should be living. No, not really, you know, 159 00:09:08,400 --> 00:09:11,360 Speaker 1: in general, I recommend everyone exercise at least twenty minutes 160 00:09:11,400 --> 00:09:15,800 Speaker 1: a day, but there isn't any specific diet or cutting 161 00:09:15,840 --> 00:09:18,599 Speaker 1: out sugar or anything which has been shown to guarantee 162 00:09:18,640 --> 00:09:20,880 Speaker 1: that you won't get a breast cancer in the future. 163 00:09:21,440 --> 00:09:25,120 Speaker 1: Living a healthy lifestyle is great. Enjoying sugar and alcohol 164 00:09:25,120 --> 00:09:28,040 Speaker 1: and moderation and not smoking are really important, not just 165 00:09:28,080 --> 00:09:30,880 Speaker 1: to prevent breast cancer, but to prevent other things like 166 00:09:30,960 --> 00:09:35,000 Speaker 1: high cholesterol and heart disease. But most of the time, 167 00:09:35,120 --> 00:09:38,480 Speaker 1: breast cancer boils down to bad luck. And I see 168 00:09:38,520 --> 00:09:40,920 Speaker 1: people in my clinic all the time, especially in Santa Fe, 169 00:09:41,000 --> 00:09:45,200 Speaker 1: New Mexico, who live extremely healthy, very active lifestyles, who 170 00:09:45,200 --> 00:09:48,560 Speaker 1: are vegan, who only eat organic, and who are in 171 00:09:48,640 --> 00:09:53,000 Speaker 1: great shape, but have unfortunately developed a breast cancer as well. 172 00:09:53,040 --> 00:09:55,600 Speaker 1: So no matter what lifestyle changes we make, there's really 173 00:09:55,600 --> 00:10:00,360 Speaker 1: no guarantee that a certain type of lifestyle will mean 174 00:10:00,360 --> 00:10:02,600 Speaker 1: that you'll never get a future breast cancer, if that 175 00:10:02,640 --> 00:10:05,479 Speaker 1: makes sense. And I think that's a really important conversation 176 00:10:05,640 --> 00:10:08,200 Speaker 1: to have because I think that a lot of the 177 00:10:08,280 --> 00:10:12,400 Speaker 1: time women come to my clinic and think that something 178 00:10:12,440 --> 00:10:15,800 Speaker 1: that they personally have done out or not done in 179 00:10:15,840 --> 00:10:18,440 Speaker 1: their life, like they didn't exercise enough, or they ate 180 00:10:18,480 --> 00:10:21,480 Speaker 1: too much soy or something like that cause their breath cancer, 181 00:10:21,520 --> 00:10:24,120 Speaker 1: and that's really just not the case. Most of the time, 182 00:10:24,600 --> 00:10:30,240 Speaker 1: breast cancer boils down to bad luck, and sometimes bad genes. 183 00:10:42,440 --> 00:10:46,280 Speaker 1: The next question I have are how can I keep 184 00:10:46,280 --> 00:10:49,000 Speaker 1: myself safe when my doctor says I'm too young for 185 00:10:49,040 --> 00:10:52,319 Speaker 1: a mammogram. This is a great question as well. Unfortunately, 186 00:10:52,360 --> 00:10:54,840 Speaker 1: I have seen patients in my clinic who have developed 187 00:10:54,840 --> 00:10:58,560 Speaker 1: a breast cancer as young as their twenties, and I've 188 00:10:58,600 --> 00:11:02,240 Speaker 1: seen a very typical story. They can be bounced around 189 00:11:02,280 --> 00:11:05,280 Speaker 1: from provider to provider. They go to an urgent care, 190 00:11:05,400 --> 00:11:07,400 Speaker 1: someone says it's a cyst, you're too young to have 191 00:11:07,440 --> 00:11:11,400 Speaker 1: a cancer, doesn't order any type of breast imaging, and 192 00:11:11,440 --> 00:11:13,960 Speaker 1: then they go home and the lump actually grows, and 193 00:11:14,000 --> 00:11:18,319 Speaker 1: then they seek another person's opinion, and sometimes it can 194 00:11:18,400 --> 00:11:22,160 Speaker 1: take two or three different healthcare providers before they actually 195 00:11:22,160 --> 00:11:24,840 Speaker 1: get the diagnosis of breast cancer and someone says, oh, 196 00:11:24,880 --> 00:11:29,880 Speaker 1: we should be worried about this. So my recommendation for 197 00:11:30,080 --> 00:11:33,199 Speaker 1: anyone of any age that feels a lump in their 198 00:11:33,240 --> 00:11:37,080 Speaker 1: breast is to make sure that your healthcare professional that 199 00:11:37,200 --> 00:11:40,920 Speaker 1: sees you orders some kind of breast imaging. So if 200 00:11:40,960 --> 00:11:43,440 Speaker 1: you end up at an urgent care, ask them to 201 00:11:43,760 --> 00:11:46,840 Speaker 1: order an ultrasound, a breast ultrasound to be done at 202 00:11:46,880 --> 00:11:50,920 Speaker 1: a breast imaging facility. If you are seen by your 203 00:11:50,960 --> 00:11:54,440 Speaker 1: primary care doctor, which hopefully most of y'all have, ask 204 00:11:54,480 --> 00:11:57,440 Speaker 1: them to order a breast ultrasound that's being done at 205 00:11:58,080 --> 00:12:01,480 Speaker 1: a facility that does mammograms and ultra sounds for people 206 00:12:01,480 --> 00:12:05,240 Speaker 1: with breasts, so that way a breast fellowship trained or 207 00:12:05,280 --> 00:12:08,280 Speaker 1: an experienced breast radiologist will be the one reading it. 208 00:12:09,360 --> 00:12:12,320 Speaker 1: I think that the most important thing is that you 209 00:12:12,400 --> 00:12:16,680 Speaker 1: do get some type of imaging, because no doctor or 210 00:12:16,960 --> 00:12:21,600 Speaker 1: PA or NP or nurse, no one's physical exam replaces 211 00:12:22,200 --> 00:12:26,040 Speaker 1: breast imaging. The way that assist looks versus what a 212 00:12:26,080 --> 00:12:29,160 Speaker 1: cancer looks like, versus what a fibrad noma looks like. 213 00:12:29,320 --> 00:12:32,760 Speaker 1: All of these different things have different characteristics on an ultrasound, 214 00:12:33,040 --> 00:12:35,120 Speaker 1: and a radiologist will be able to get a lot 215 00:12:35,200 --> 00:12:39,280 Speaker 1: more information from an ultrasound than any doctor or healthcare 216 00:12:39,320 --> 00:12:42,240 Speaker 1: professional will be able to get from a physical exam. 217 00:12:43,040 --> 00:12:46,240 Speaker 1: I'm a surgeon who specializes in breast cancer, and I 218 00:12:46,280 --> 00:12:49,160 Speaker 1: do physical exams of patients with breast cancer all day, 219 00:12:49,200 --> 00:12:52,640 Speaker 1: every day. And still if I see a patient who 220 00:12:52,640 --> 00:12:54,839 Speaker 1: comes to me with a lump in their breast, regardless 221 00:12:54,880 --> 00:12:57,679 Speaker 1: of what their age is, I order breast imaging because 222 00:12:57,720 --> 00:13:01,440 Speaker 1: even I can't tell definitively just by feeling it that 223 00:13:01,559 --> 00:13:04,360 Speaker 1: it is or isn't a cancer. So I think if 224 00:13:04,400 --> 00:13:07,440 Speaker 1: you feel a lump, the way to advocate for yourself 225 00:13:07,520 --> 00:13:09,840 Speaker 1: is to make sure that you get an ultrasound at 226 00:13:09,880 --> 00:13:13,360 Speaker 1: the very least of that lump. Now, most mammography places 227 00:13:13,400 --> 00:13:17,199 Speaker 1: are not going to do a mammogram on someone who's 228 00:13:17,240 --> 00:13:21,480 Speaker 1: younger than thirty because everyone has extremely dense breasts younger 229 00:13:21,520 --> 00:13:25,840 Speaker 1: than thirty, and the thought is the radiation risk of 230 00:13:25,840 --> 00:13:29,640 Speaker 1: a mammogram isn't worth the benefit of getting the mammogram 231 00:13:30,120 --> 00:13:33,920 Speaker 1: for a woman who is under thirty. So most of 232 00:13:33,960 --> 00:13:37,440 Speaker 1: the time they won't do it. Rarely they will, but 233 00:13:37,559 --> 00:13:40,760 Speaker 1: they all will do an ultrasound if your doctor or 234 00:13:41,160 --> 00:13:44,000 Speaker 1: app orders it when they see you, so get some 235 00:13:44,080 --> 00:13:48,560 Speaker 1: breast imaging. Cannot stress this enough. The next question I 236 00:13:48,720 --> 00:13:53,120 Speaker 1: have is if a person tests negative for the breast 237 00:13:53,120 --> 00:13:56,400 Speaker 1: cancer gene, can they still get breast cancer? Also a 238 00:13:56,440 --> 00:14:01,560 Speaker 1: great question. The answer is yes. So we talked about 239 00:14:01,600 --> 00:14:04,480 Speaker 1: it a little bit before. But let's say that you 240 00:14:04,800 --> 00:14:09,240 Speaker 1: have a mom who has breast cancer and she tested 241 00:14:09,240 --> 00:14:12,839 Speaker 1: positive for the braco one gene. If you now test 242 00:14:12,920 --> 00:14:16,280 Speaker 1: negative for a braco one gene, it means that you're 243 00:14:16,320 --> 00:14:19,440 Speaker 1: not in an increased risk compared to the general population, 244 00:14:20,400 --> 00:14:23,960 Speaker 1: but it doesn't mean that you'll never get a breast cancer. Unfortunately, 245 00:14:24,000 --> 00:14:26,760 Speaker 1: the biggest risk factors for breast cancer are having breasts 246 00:14:26,760 --> 00:14:30,440 Speaker 1: and getting older. So even if you don't have the 247 00:14:30,440 --> 00:14:33,120 Speaker 1: brac of one gene at some point in your life 248 00:14:33,120 --> 00:14:35,360 Speaker 1: in your seventies or your eighties, you may still develop 249 00:14:35,400 --> 00:14:40,640 Speaker 1: a breast cancer. Now, if you have genetic testing done 250 00:14:40,840 --> 00:14:42,880 Speaker 1: and you find out you don't have any of these genes, 251 00:14:43,520 --> 00:14:46,600 Speaker 1: but you still have a family member who had breast cancer, 252 00:14:46,680 --> 00:14:51,080 Speaker 1: like your mom or your sister, who also tested negative 253 00:14:51,240 --> 00:14:55,280 Speaker 1: or didn't have the opportunity to do genetic testing, then 254 00:14:55,400 --> 00:14:58,080 Speaker 1: you still have an increased risk of a future breast 255 00:14:58,080 --> 00:15:02,960 Speaker 1: cancer because we don't if they had a gene and 256 00:15:03,320 --> 00:15:06,080 Speaker 1: you don't have the gene, or you both have a 257 00:15:06,120 --> 00:15:10,600 Speaker 1: gene that we just haven't discovered yet, and we don't 258 00:15:10,640 --> 00:15:14,720 Speaker 1: know exactly how to quantify how much risk that is, 259 00:15:15,320 --> 00:15:17,600 Speaker 1: but we do know that you're at increased risk. So 260 00:15:18,360 --> 00:15:21,680 Speaker 1: just testing negative for the breast cancer genes like brak 261 00:15:21,800 --> 00:15:25,360 Speaker 1: of one BRACKA tube HOWB two, doesn't mean that you 262 00:15:25,800 --> 00:15:28,000 Speaker 1: that you'll never potentially get a breast cancer. It just 263 00:15:28,040 --> 00:15:30,120 Speaker 1: means that you're at average risk like the rest of 264 00:15:30,160 --> 00:15:35,360 Speaker 1: the population, and you still need to get mammograms and ultrasounds. 265 00:15:35,360 --> 00:15:37,520 Speaker 1: If you have extremely dense press you still need to 266 00:15:37,520 --> 00:15:41,160 Speaker 1: get your regular screening, just like you would need to 267 00:15:41,160 --> 00:15:43,840 Speaker 1: get your regular screening if you test negative for a 268 00:15:43,880 --> 00:15:45,920 Speaker 1: colon cancer gene as well, you would still need to 269 00:15:45,920 --> 00:15:50,000 Speaker 1: get colonoscopies. The next question I have is I had 270 00:15:50,000 --> 00:15:52,200 Speaker 1: a mass tex to me in April, is it normal 271 00:15:52,280 --> 00:15:56,560 Speaker 1: to feel tenderness around my back? So I would say, no, 272 00:15:56,800 --> 00:15:59,400 Speaker 1: it is not normal to feel tenderness around your back. 273 00:16:00,480 --> 00:16:04,320 Speaker 1: I'm trying to understand exactly where this question came from. 274 00:16:04,800 --> 00:16:07,280 Speaker 1: It is possible that there was some type of surgical 275 00:16:07,360 --> 00:16:11,600 Speaker 1: issue that led to a nerve problem, and that may 276 00:16:11,640 --> 00:16:15,400 Speaker 1: be why there's pain in the back. I personally have 277 00:16:15,520 --> 00:16:18,760 Speaker 1: not seen any patients who have back pain after a 278 00:16:18,760 --> 00:16:23,000 Speaker 1: mass dectomy, but in my practice we give everyone something 279 00:16:23,000 --> 00:16:26,160 Speaker 1: called a pet block with a medication called experol, which 280 00:16:26,200 --> 00:16:30,760 Speaker 1: means that we inject a numbing medication in the pectrelis muscle, 281 00:16:30,760 --> 00:16:33,640 Speaker 1: which is the muscle behind the breast, and when we 282 00:16:33,760 --> 00:16:38,640 Speaker 1: do that, we actually take the edge off. After a 283 00:16:38,680 --> 00:16:42,440 Speaker 1: mass dectomy for about three to seven days, and so 284 00:16:42,520 --> 00:16:45,440 Speaker 1: it makes a huge difference in pain control. It's the 285 00:16:45,440 --> 00:16:48,080 Speaker 1: standard of care at a lot of leading breast centers 286 00:16:48,120 --> 00:16:52,320 Speaker 1: all over the country, and because of that, I really 287 00:16:52,400 --> 00:16:55,360 Speaker 1: don't see a lot of pain after a mass dectomy period. 288 00:16:55,920 --> 00:16:58,640 Speaker 1: So if you're out there listening to this and you've 289 00:16:58,640 --> 00:17:02,400 Speaker 1: been diagnosed with breast cancer and you're considering having surgery, 290 00:17:02,920 --> 00:17:06,520 Speaker 1: especially a mastectomy or the whole breast removed, definitely ask 291 00:17:06,600 --> 00:17:09,359 Speaker 1: your surgeon about a peck block and if that's available 292 00:17:09,359 --> 00:17:12,399 Speaker 1: to you or not, because it makes a huge difference 293 00:17:12,400 --> 00:17:14,960 Speaker 1: in the recovery, and studies have shown it helps patients 294 00:17:15,320 --> 00:17:17,520 Speaker 1: get back on their feet and be back to normal 295 00:17:17,640 --> 00:17:22,760 Speaker 1: much faster. This person who's asking this question, it's now October, 296 00:17:22,840 --> 00:17:25,680 Speaker 1: so it's probably been four months or almost four months 297 00:17:25,720 --> 00:17:29,240 Speaker 1: since they're surgery. Definitely not normal to still have pain 298 00:17:29,320 --> 00:17:32,600 Speaker 1: four months after the surgery, and there are a lot 299 00:17:32,600 --> 00:17:34,719 Speaker 1: of different things that can be done for someone who 300 00:17:34,800 --> 00:17:39,200 Speaker 1: does still have that pain. There's physical therapy, there's acupuncture, 301 00:17:39,400 --> 00:17:41,760 Speaker 1: all kinds of stuff. So I do recommend that if 302 00:17:41,760 --> 00:17:45,000 Speaker 1: you're in that circumstance, to return to your surgeon and 303 00:17:45,359 --> 00:17:47,800 Speaker 1: ask them what can be done to manage this pain. 304 00:17:49,000 --> 00:17:53,520 Speaker 1: The next question that I have is every year I 305 00:17:53,600 --> 00:17:56,359 Speaker 1: get a mammogram and a breast MRI because my mother 306 00:17:56,440 --> 00:17:59,800 Speaker 1: lost her battle with cancer. Are they safe? Yes, they 307 00:17:59,840 --> 00:18:03,960 Speaker 1: are perfectly safe. A breast MRI does not have any 308 00:18:04,040 --> 00:18:08,480 Speaker 1: radiation risk at all. It does involve some kind of contrast, 309 00:18:08,880 --> 00:18:11,760 Speaker 1: and most of the contrasts that is used these days 310 00:18:11,920 --> 00:18:16,560 Speaker 1: is pretty low risk in terms of its side effects. 311 00:18:17,119 --> 00:18:20,480 Speaker 1: Most breast MRIs use a type of contrast called gatavist, 312 00:18:21,200 --> 00:18:24,640 Speaker 1: which doesn't have a lot of problems with brain accumulation 313 00:18:25,240 --> 00:18:30,200 Speaker 1: or kidney issues like some older types of MRI contrast did. 314 00:18:30,240 --> 00:18:32,800 Speaker 1: And I think that's a misconception. I come across a lot. 315 00:18:33,200 --> 00:18:34,880 Speaker 1: There's a lot of people who don't want to get 316 00:18:34,880 --> 00:18:38,119 Speaker 1: an MRI, even when it is recommended for them, because 317 00:18:38,119 --> 00:18:41,400 Speaker 1: they are high risk, like this person here, because they're 318 00:18:41,400 --> 00:18:44,359 Speaker 1: worried about the effect of the contrast. The contrast is 319 00:18:44,400 --> 00:18:48,080 Speaker 1: perfectly safe in my practice. I've personally never seen anyone 320 00:18:48,119 --> 00:18:51,240 Speaker 1: have a problem with MRI contrast, but I know that 321 00:18:51,359 --> 00:18:54,960 Speaker 1: rarely it can happen, and rarely people can have allergic 322 00:18:55,000 --> 00:18:59,359 Speaker 1: reactions as well. Now, in terms of the mammogram, mammograms 323 00:18:59,359 --> 00:19:02,440 Speaker 1: are also completely safe. There's a myth out there that 324 00:19:02,520 --> 00:19:06,959 Speaker 1: a mammogram is like too much radiation, and a mammogram 325 00:19:07,160 --> 00:19:09,960 Speaker 1: is roughly the same amount of radiation that you would 326 00:19:09,960 --> 00:19:13,320 Speaker 1: get living at sea level in about six to seven 327 00:19:13,359 --> 00:19:17,280 Speaker 1: weeks anyways, just from background radiation. Now, as I mentioned, 328 00:19:17,320 --> 00:19:19,679 Speaker 1: I'm in Santa Fe, New Mexico, so i live at 329 00:19:19,720 --> 00:19:23,400 Speaker 1: seven thousand feet. I'm getting more radiation in a much 330 00:19:23,400 --> 00:19:26,440 Speaker 1: shorter time period because I'm closer to the Sun than 331 00:19:26,480 --> 00:19:31,040 Speaker 1: someone at sea level, and I'm getting a mammogram is 332 00:19:31,080 --> 00:19:35,000 Speaker 1: not adding more to the radiation exposure I'm getting just 333 00:19:35,119 --> 00:19:40,439 Speaker 1: living at elevation, And so the overall radiation from a 334 00:19:40,480 --> 00:19:44,119 Speaker 1: mammogram is really really tiny, the amount of exposure that 335 00:19:44,160 --> 00:19:47,000 Speaker 1: you're getting. And I saw a study that said something 336 00:19:47,080 --> 00:19:51,639 Speaker 1: like you would need one thousand mammograms in order to 337 00:19:52,160 --> 00:19:56,399 Speaker 1: really build up enough radiation in the body to experience 338 00:19:56,440 --> 00:19:59,520 Speaker 1: some sort of toxicity from it. And I don't know 339 00:19:59,600 --> 00:20:03,119 Speaker 1: anyone who's going to have one thousand mammograms in their life, 340 00:20:03,200 --> 00:20:07,080 Speaker 1: so very small radiation risk. It is completely safe, and 341 00:20:07,160 --> 00:20:10,640 Speaker 1: it is really the best screening test for breast cancer, 342 00:20:10,680 --> 00:20:14,639 Speaker 1: and there is nothing that even comes close. The next 343 00:20:14,760 --> 00:20:19,200 Speaker 1: question I have is will a pet CT show cancer 344 00:20:19,240 --> 00:20:21,840 Speaker 1: in organs. This is a good question as well. Yes 345 00:20:21,880 --> 00:20:25,240 Speaker 1: it will. Now the caveat is that there are some 346 00:20:25,520 --> 00:20:29,199 Speaker 1: very slow growing breast cancers that may not show up 347 00:20:29,240 --> 00:20:33,360 Speaker 1: well on a PET scan, such as lobular cancers. There 348 00:20:33,440 --> 00:20:36,240 Speaker 1: are new types of PET scans that are being done 349 00:20:36,720 --> 00:20:40,640 Speaker 1: that our potentially are being formulated really to pick up 350 00:20:40,720 --> 00:20:46,119 Speaker 1: slow growing cancers like lobular cancers, and hopefully with that 351 00:20:46,240 --> 00:20:51,360 Speaker 1: generation of PET scans will have better detection for disease 352 00:20:51,480 --> 00:20:54,040 Speaker 1: outside of the breast and outside of the lymph nodes 353 00:20:54,080 --> 00:21:10,000 Speaker 1: than we ever had before. The next question I have 354 00:21:10,440 --> 00:21:13,480 Speaker 1: is how does someone go from remission to stage four? 355 00:21:14,200 --> 00:21:18,399 Speaker 1: So this is a great question and the answer is 356 00:21:19,520 --> 00:21:22,359 Speaker 1: a little bit complex, but I'll break it down for you. 357 00:21:22,920 --> 00:21:26,560 Speaker 1: So when we treat not just breast cancer, but all 358 00:21:26,600 --> 00:21:29,800 Speaker 1: types of cancer, we have two goals. The number one 359 00:21:29,880 --> 00:21:32,000 Speaker 1: goal is to get rid of it wherever it started, 360 00:21:32,280 --> 00:21:34,560 Speaker 1: and in terms of breast cancer, it's in the breast, 361 00:21:34,880 --> 00:21:36,480 Speaker 1: and we want it to not come back in the 362 00:21:36,480 --> 00:21:39,880 Speaker 1: breast or in the lyptnotes because that's the local area. 363 00:21:40,000 --> 00:21:43,159 Speaker 1: But the other goal in treating cancer in general is 364 00:21:43,160 --> 00:21:45,159 Speaker 1: that we don't want it to go anywhere else in 365 00:21:45,200 --> 00:21:49,280 Speaker 1: the body. And that's what we call metastatic disease. And 366 00:21:49,320 --> 00:21:52,280 Speaker 1: we know that when the cancer goes somewhere else in 367 00:21:52,320 --> 00:21:56,000 Speaker 1: the body or becomes stage four, that's when people get 368 00:21:56,040 --> 00:22:01,960 Speaker 1: into trouble. Right. The theory is that even for a 369 00:22:02,119 --> 00:22:06,720 Speaker 1: cancer that's really really tiny and that gets treated and 370 00:22:06,960 --> 00:22:10,520 Speaker 1: someone's in remission, there can be cells that are floating 371 00:22:10,560 --> 00:22:13,760 Speaker 1: in the bloodstream waiting for our immune system to be 372 00:22:13,840 --> 00:22:17,240 Speaker 1: down for some other reason, that are just kind of 373 00:22:17,240 --> 00:22:20,600 Speaker 1: waiting for their opportunity to come back and cause a 374 00:22:20,600 --> 00:22:23,840 Speaker 1: problem somewhere else in the body. And we right now 375 00:22:23,960 --> 00:22:28,720 Speaker 1: don't have the technology to detect them yet, and we 376 00:22:28,760 --> 00:22:31,480 Speaker 1: can't see them on a pet scan and we can't 377 00:22:31,480 --> 00:22:34,000 Speaker 1: see them with our eyes, but they're there, and we 378 00:22:34,119 --> 00:22:37,440 Speaker 1: know that they're there because otherwise, every single person who 379 00:22:37,480 --> 00:22:40,280 Speaker 1: had a stage one breast cancer or an early stage 380 00:22:40,600 --> 00:22:45,680 Speaker 1: small cancer, every single person would be alive five years 381 00:22:45,680 --> 00:22:48,400 Speaker 1: from their diagnosis and no one's cancer would come back ever. 382 00:22:48,960 --> 00:22:52,159 Speaker 1: But we know that that's not exactly the case. The 383 00:22:52,240 --> 00:22:55,040 Speaker 1: vast majority of people are still alive at five years 384 00:22:55,040 --> 00:22:57,919 Speaker 1: and their cancer doesn't come back, probably ninety five percent, 385 00:22:59,400 --> 00:23:02,600 Speaker 1: but that five percent there could be that cell that's 386 00:23:02,600 --> 00:23:06,200 Speaker 1: floating around somewhere that's waiting to cause a problem somewhere else, 387 00:23:06,400 --> 00:23:09,879 Speaker 1: and that's how cancer goes from remission to stage four. 388 00:23:10,920 --> 00:23:13,960 Speaker 1: It's hard to predict right now who that's going to 389 00:23:14,000 --> 00:23:18,159 Speaker 1: happen to. For patients who have cancer in the lymph nodes, 390 00:23:18,320 --> 00:23:20,480 Speaker 1: that is a little bit more likely than someone who 391 00:23:20,560 --> 00:23:23,480 Speaker 1: has a small breast cancer that's confined just to the breast. 392 00:23:24,320 --> 00:23:27,359 Speaker 1: And for people that maybe had cancer in the lymph 393 00:23:27,359 --> 00:23:30,560 Speaker 1: nodes or a large breast cancer who had chemotherapy or 394 00:23:30,600 --> 00:23:34,040 Speaker 1: some other type of targeted treatment where the response wasn't 395 00:23:34,080 --> 00:23:37,159 Speaker 1: as good as what we would have expected, then it 396 00:23:37,200 --> 00:23:39,080 Speaker 1: may be a little bit more likely that the cancer 397 00:23:39,119 --> 00:23:42,400 Speaker 1: can come back somewhere else and they can be stage four. 398 00:23:43,240 --> 00:23:47,320 Speaker 1: That being said, stage four cancer, there are a lot 399 00:23:47,359 --> 00:23:50,240 Speaker 1: of different targeted treatments and a lot of clinical trials 400 00:23:50,280 --> 00:23:54,199 Speaker 1: that are going on right now. And the more we 401 00:23:54,280 --> 00:23:57,359 Speaker 1: learn about breast cancer and the more we can individualize 402 00:23:57,400 --> 00:24:01,600 Speaker 1: treatment to your specific cancer, what are the genes within 403 00:24:01,680 --> 00:24:06,840 Speaker 1: your cancer itself, the better prognosis people have and the 404 00:24:06,920 --> 00:24:09,600 Speaker 1: longer people are living. And even in the last five 405 00:24:09,680 --> 00:24:11,840 Speaker 1: years that I've been in practice, since I graduated from 406 00:24:11,880 --> 00:24:15,040 Speaker 1: my fellowship, I've seen tremendous advancement, and I think that 407 00:24:15,119 --> 00:24:19,200 Speaker 1: will just continue and continue and continue until everyone who 408 00:24:19,240 --> 00:24:22,400 Speaker 1: is stage four will be getting some kind of treatment 409 00:24:22,440 --> 00:24:25,000 Speaker 1: like it's a chronic disease, but it doesn't mean that 410 00:24:25,000 --> 00:24:28,399 Speaker 1: their life is necessarily shorter. And so I'm seeing a 411 00:24:28,440 --> 00:24:32,000 Speaker 1: lot of advancements coming that way, and I'm hoping that 412 00:24:32,040 --> 00:24:35,520 Speaker 1: we also develop ways to detect if a cancer is 413 00:24:35,560 --> 00:24:38,439 Speaker 1: going to come back earlier. And one way that we 414 00:24:38,520 --> 00:24:40,200 Speaker 1: have that's sort of in the mix is by looking 415 00:24:40,280 --> 00:24:45,240 Speaker 1: at circulating tumor DNA and that that is being studied 416 00:24:45,320 --> 00:24:48,600 Speaker 1: right now to see if we find out that there 417 00:24:48,720 --> 00:24:52,439 Speaker 1: is tumor DNA that's floating in the bloodstream, if we 418 00:24:52,520 --> 00:24:56,440 Speaker 1: start treating it earlier, we start someone on chemotherapy because 419 00:24:56,440 --> 00:24:58,439 Speaker 1: we know that their cancer is going to come back 420 00:24:58,480 --> 00:24:59,879 Speaker 1: and we're going to see it at some point on 421 00:24:59,880 --> 00:25:02,400 Speaker 1: it a CT scan or on a PET scan. Does 422 00:25:02,440 --> 00:25:04,480 Speaker 1: it make a difference in how long they live? And 423 00:25:04,560 --> 00:25:07,800 Speaker 1: so far the studies have been promising. We're waiting to 424 00:25:07,840 --> 00:25:12,840 Speaker 1: get more data, but I'm hoping that as time goes on, 425 00:25:13,400 --> 00:25:16,760 Speaker 1: we can pick up if someone is going to recur 426 00:25:17,359 --> 00:25:22,000 Speaker 1: sooner and we can stop someone before they're clinically staged four. 427 00:25:22,080 --> 00:25:24,280 Speaker 1: But when we know that those cells are there, we 428 00:25:24,320 --> 00:25:27,359 Speaker 1: can stop them from progressing the stage four because we 429 00:25:27,440 --> 00:25:30,399 Speaker 1: can start them on treatment right then and there. So 430 00:25:30,440 --> 00:25:32,280 Speaker 1: that's a little bit of a long witted answer to 431 00:25:32,320 --> 00:25:35,320 Speaker 1: that question, but I hope it gives some context to 432 00:25:35,880 --> 00:25:39,760 Speaker 1: how that can happen, which, unfortunately, it can happen. And 433 00:25:39,800 --> 00:25:42,359 Speaker 1: it's something that I know every patient of mine and 434 00:25:42,440 --> 00:25:45,359 Speaker 1: everyone that I've met who has not only had breast 435 00:25:45,359 --> 00:25:47,520 Speaker 1: cancer but other types of cancer. I know it's something 436 00:25:47,520 --> 00:25:50,359 Speaker 1: that everyone thinks about and lives in fear of. But 437 00:25:50,440 --> 00:25:53,399 Speaker 1: I do feel confident that the treatments are getting better 438 00:25:53,480 --> 00:25:56,600 Speaker 1: and better and better, and the detection is also getting 439 00:25:56,600 --> 00:26:01,159 Speaker 1: earlier and earlier and earlier and earlier. The next question 440 00:26:01,200 --> 00:26:06,639 Speaker 1: I have is can IVS cause breast cancer? The answer 441 00:26:06,720 --> 00:26:11,680 Speaker 1: is no. IVF is an increase in hormones, similar to 442 00:26:11,720 --> 00:26:15,400 Speaker 1: the earlier question about hormone replacement treatment, and it is 443 00:26:15,960 --> 00:26:19,280 Speaker 1: kind of augmenting the female hormones that we already have. 444 00:26:19,440 --> 00:26:22,640 Speaker 1: That's the point in order to sort of get our 445 00:26:22,640 --> 00:26:26,360 Speaker 1: body on board for these fertility treatments, to harvest eggs, 446 00:26:26,720 --> 00:26:30,520 Speaker 1: to fertilize the eggs, and then to reimplant them, and 447 00:26:30,560 --> 00:26:35,160 Speaker 1: it's sort of artificially stimulating a pregnancy, so to speak, 448 00:26:35,480 --> 00:26:39,280 Speaker 1: in order to get the body ready. The amount of 449 00:26:39,320 --> 00:26:43,280 Speaker 1: hormones that people are given when they are undergoing IVF 450 00:26:43,400 --> 00:26:46,040 Speaker 1: is more than what they would ordinarily have just going 451 00:26:46,119 --> 00:26:50,000 Speaker 1: through their periods every month as someone who has periods 452 00:26:50,040 --> 00:26:54,760 Speaker 1: every month. So when someone is undergoing IVF, they are 453 00:26:54,880 --> 00:26:59,320 Speaker 1: getting more hormones than what they normally would get and 454 00:26:59,480 --> 00:27:02,760 Speaker 1: normally would have circulating through their body. That's kind of 455 00:27:02,760 --> 00:27:06,920 Speaker 1: the whole point of IVF. Does it mean that they 456 00:27:06,960 --> 00:27:09,120 Speaker 1: will definitely get a breast cancer in the future. No. 457 00:27:09,640 --> 00:27:12,680 Speaker 1: Studies have shown that it may slightly increase the risk 458 00:27:12,720 --> 00:27:15,440 Speaker 1: of a future breast cancer, but not enough to make 459 00:27:15,440 --> 00:27:20,000 Speaker 1: a difference. So for someone who is who wants to 460 00:27:20,040 --> 00:27:23,679 Speaker 1: consider IVF because they need that in order to have 461 00:27:23,760 --> 00:27:29,560 Speaker 1: a biological child, the potential slight future risk of a 462 00:27:29,600 --> 00:27:33,040 Speaker 1: breast cancer is not a reason not to pursue IVF. 463 00:27:33,200 --> 00:27:36,920 Speaker 1: So in general I answer that question as No, IVF 464 00:27:37,240 --> 00:27:42,080 Speaker 1: doesn't cause breast cancer. The next question I have is, 465 00:27:42,160 --> 00:27:45,440 Speaker 1: some years ago I had a benign cyst. Does that 466 00:27:45,520 --> 00:27:49,200 Speaker 1: put me at more risk for future breast cancer? No, 467 00:27:49,400 --> 00:27:53,000 Speaker 1: it does not. Cysts are extremely common in the breasts. 468 00:27:53,600 --> 00:27:56,879 Speaker 1: Probably at least fifty percent of the ultrasounds that I 469 00:27:57,000 --> 00:28:00,199 Speaker 1: see when I'm reviewing patients' images have cysts in them, 470 00:28:00,840 --> 00:28:04,600 Speaker 1: and they don't increase the future risk of a breast 471 00:28:04,640 --> 00:28:10,359 Speaker 1: cancer at all. They're totally normal and benign and pretty 472 00:28:10,440 --> 00:28:12,760 Speaker 1: common to see on an ultrasound. And if you speak 473 00:28:12,760 --> 00:28:14,880 Speaker 1: to any of the breast radiologists, they would agree that 474 00:28:15,040 --> 00:28:18,440 Speaker 1: they come across them lots, and most of the time 475 00:28:18,720 --> 00:28:21,080 Speaker 1: they don't even need to continue to follow them with 476 00:28:21,160 --> 00:28:24,639 Speaker 1: an ultrasound because they're so common and it's so clear 477 00:28:24,680 --> 00:28:26,760 Speaker 1: that they're benign and that they're not going to increase 478 00:28:26,800 --> 00:28:30,959 Speaker 1: the risk of breast cancer in the future. The next 479 00:28:31,080 --> 00:28:33,480 Speaker 1: question is how can you tell the difference between a 480 00:28:33,560 --> 00:28:37,080 Speaker 1: lump and a cyst. I think that the question is 481 00:28:37,119 --> 00:28:40,520 Speaker 1: being asked, what is the difference between a lump that 482 00:28:40,600 --> 00:28:44,200 Speaker 1: needs to be removed, like a breast cancer or something 483 00:28:44,240 --> 00:28:48,040 Speaker 1: like a fibrad noma or something with atypical cells versus 484 00:28:48,080 --> 00:28:51,040 Speaker 1: the benign cyst. And the answer is, they all have 485 00:28:51,280 --> 00:28:55,720 Speaker 1: very different characteristics on ultrasound, and they all look very different. 486 00:28:56,280 --> 00:28:59,120 Speaker 1: And I'm a surgeon. I look at images all the time. 487 00:28:59,200 --> 00:29:01,880 Speaker 1: I show them to my patients in my clinic, but 488 00:29:01,920 --> 00:29:05,040 Speaker 1: I also review them and discuss them with my breast 489 00:29:05,120 --> 00:29:09,640 Speaker 1: radiologists who can help guide me when I'm not sure. 490 00:29:10,640 --> 00:29:13,440 Speaker 1: But the answer is that they all present very differently 491 00:29:13,440 --> 00:29:18,360 Speaker 1: on an ultrasound, and especially cancers have a very distinct appearance. 492 00:29:19,200 --> 00:29:22,680 Speaker 1: Very rarely do we see something that looks like a 493 00:29:22,760 --> 00:29:26,280 Speaker 1: cyst that ends up being a cancer. In my career, 494 00:29:26,360 --> 00:29:29,520 Speaker 1: I've probably seen one patient who had something that really 495 00:29:29,600 --> 00:29:33,000 Speaker 1: looked like a cyst but actually was a cancer on 496 00:29:33,400 --> 00:29:37,200 Speaker 1: a mammogram and an ultrasound, So it's you can tell 497 00:29:37,240 --> 00:29:40,360 Speaker 1: the difference pretty clearly. Getting an ultrasound makes a huge 498 00:29:40,400 --> 00:29:43,760 Speaker 1: difference getting a mammogram. With an ultrasound, that's just more information, 499 00:29:44,600 --> 00:29:48,240 Speaker 1: and if there's ever any concerns, you can ask for 500 00:29:48,440 --> 00:29:52,600 Speaker 1: another opinion. For example, you can ask your primary care 501 00:29:52,680 --> 00:29:56,520 Speaker 1: doctor to have you referred to someone who is a 502 00:29:56,520 --> 00:29:59,640 Speaker 1: breast specialist like me and ask them to go over 503 00:29:59,640 --> 00:30:02,760 Speaker 1: the image just with you. And I see patients who 504 00:30:02,760 --> 00:30:05,160 Speaker 1: have cysts all the time who are worried about this 505 00:30:05,400 --> 00:30:08,520 Speaker 1: and who just want me to show those images to them, 506 00:30:08,840 --> 00:30:12,239 Speaker 1: explain the difference in the characteristics that I see and 507 00:30:12,320 --> 00:30:15,040 Speaker 1: reassure them that they're fined, and that having ASSIST is 508 00:30:15,080 --> 00:30:17,400 Speaker 1: totally normal and it's not going to increase their risk 509 00:30:17,480 --> 00:30:20,680 Speaker 1: of cancer in the future, and that we're not mistaking 510 00:30:20,840 --> 00:30:24,480 Speaker 1: ASSIST for something else like a cancer in the breast. 511 00:30:25,000 --> 00:30:27,760 Speaker 1: So I think that pretty much covers all of the 512 00:30:27,920 --> 00:30:32,800 Speaker 1: questions that came in through the Instagram about breast cancer 513 00:30:32,880 --> 00:30:37,320 Speaker 1: in general. Once again, I'm doctor Amani Jambacara. I'm the 514 00:30:37,360 --> 00:30:40,760 Speaker 1: medical director of Surgical Breast Oncology at Christis Saint Vincent 515 00:30:40,840 --> 00:30:44,520 Speaker 1: in Santa Fe, New Mexico. My handle on Instagram and 516 00:30:44,640 --> 00:30:48,920 Speaker 1: TikTok and threads is aj Victory, MD, and I do 517 00:30:49,000 --> 00:30:53,680 Speaker 1: share videos explaining most of these questions actually already as 518 00:30:53,720 --> 00:30:55,760 Speaker 1: well as the images. So for those of you who 519 00:30:55,760 --> 00:30:58,400 Speaker 1: are interested in seeing what a cancer looks like on 520 00:30:58,440 --> 00:31:01,240 Speaker 1: a mammogram, what is a systems like on an ultrasound, 521 00:31:01,960 --> 00:31:06,120 Speaker 1: what cancer looks like on an MRI, what extremely dense 522 00:31:06,160 --> 00:31:09,360 Speaker 1: breasts look like compared to breasts that are fatty. I 523 00:31:09,440 --> 00:31:12,280 Speaker 1: show all those things on my feed. And my goal 524 00:31:12,320 --> 00:31:15,720 Speaker 1: really is to educate and empower women so that way 525 00:31:15,800 --> 00:31:19,760 Speaker 1: they can advocate for themselves. So my goal on social 526 00:31:19,800 --> 00:31:24,240 Speaker 1: media and in my clinic is to empower and educate 527 00:31:24,680 --> 00:31:27,080 Speaker 1: my patients as well as patients all over the world, 528 00:31:27,600 --> 00:31:31,200 Speaker 1: so we can all advocate for ourselves for our loved ones. 529 00:31:31,400 --> 00:31:35,120 Speaker 1: We can catch breast cancers early, and even if we 530 00:31:35,120 --> 00:31:36,880 Speaker 1: don't catch some early, we can get on the right 531 00:31:36,920 --> 00:31:41,160 Speaker 1: treatments so that way they don't come back. So this 532 00:31:41,240 --> 00:31:44,560 Speaker 1: is October, It's Breast cancer Awareness Month. This is a 533 00:31:44,600 --> 00:31:48,840 Speaker 1: reminder to anyone listening to this podcast and who has 534 00:31:48,920 --> 00:31:52,200 Speaker 1: breasts and is over forty, if you haven't scheduled your 535 00:31:52,240 --> 00:31:56,400 Speaker 1: screening mammogram, please go schedule it because early detection saves lives, 536 00:31:56,400 --> 00:31:58,680 Speaker 1: and I know that's something that Shannon Doherty was very 537 00:31:58,760 --> 00:32:03,240 Speaker 1: very passionate about. Mammograms are safe. Like I said before, 538 00:32:03,720 --> 00:32:06,160 Speaker 1: the amount of radiation you get from a mammogram is 539 00:32:06,280 --> 00:32:10,680 Speaker 1: absolutely minimal, and the risks of not getting a mammogram 540 00:32:10,800 --> 00:32:16,280 Speaker 1: outweigh the risks of the potential radiation exposure. I also 541 00:32:16,320 --> 00:32:19,480 Speaker 1: want to reiterate that mammograms are the best tests that 542 00:32:19,600 --> 00:32:22,200 Speaker 1: we have out there right now, and I want to 543 00:32:22,240 --> 00:32:26,520 Speaker 1: acknowledge that they suck for everyone. No one enjoys having 544 00:32:26,560 --> 00:32:29,560 Speaker 1: their breast squished between a plate. It's uncomfortable and even 545 00:32:29,600 --> 00:32:33,400 Speaker 1: traumatic for some, but right now. It's the best imaging 546 00:32:33,440 --> 00:32:36,600 Speaker 1: study we have. MRIs are great too, but they don't 547 00:32:36,600 --> 00:32:40,800 Speaker 1: replace mammograms. Ultrasounds are great too, but they don't replace mammograms. 548 00:32:41,520 --> 00:32:45,440 Speaker 1: Thermograms absolutely do not replace mammograms and should not be 549 00:32:45,520 --> 00:32:47,600 Speaker 1: used for breast cancer screening at all. They are not 550 00:32:47,800 --> 00:32:51,200 Speaker 1: FDA approved, So mammograms are it, y'all. So if you're 551 00:32:51,320 --> 00:32:55,280 Speaker 1: listening to this podcast and you're feeling empowered and energized, 552 00:32:55,320 --> 00:32:58,480 Speaker 1: which I hope you are, please go and schedule your mammogram. 553 00:32:58,720 --> 00:33:00,800 Speaker 1: And if you're not of that a or you don't 554 00:33:00,800 --> 00:33:03,800 Speaker 1: have breast then please remind a loved one to schedule 555 00:33:03,800 --> 00:33:07,400 Speaker 1: our mammogram because catching breast cancer early is the best 556 00:33:07,400 --> 00:33:09,840 Speaker 1: shot we have to make sure that we treat it 557 00:33:09,880 --> 00:33:13,360 Speaker 1: and that it never ever comes back. I want to 558 00:33:13,480 --> 00:33:17,000 Speaker 1: thank let's be clear, for inviting me onto this podcast 559 00:33:17,080 --> 00:33:21,120 Speaker 1: to share my professional expertise with all of y'all, and 560 00:33:21,800 --> 00:33:24,880 Speaker 1: please spread the message that early detection saves lives.