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Speaker 1: Welcome to the Therapy for Black Girls Podcast, a weekly

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Speaker 1: conversation about mental health, personal development, and all the small

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Speaker 1: decisions we can make to become the best possible versions

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Speaker 1: of ourselves. I'm your host, doctor Joy hard and Bradford,

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Speaker 1: a licensed psychologist in Atlanta, Georgia. For more information or

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Speaker 1: to find a therapist in your area, visit our website

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Speaker 1: at Therapy for Blackgirls dot com. While I hope you

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Speaker 1: love listening to and learning from the podcast, it is

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Speaker 1: not meant to be a substitute for a relationship with

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Speaker 1: a licensed mental health professional. Hey, y'all, thanks so much

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Speaker 1: for joining me for session three twenty nine of the

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Speaker 1: Therapy for Black Girls Podcast. We'll get right into our

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Speaker 1: conversation after a word from our sponsors. The reviews for

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Speaker 1: to aid in our healing process. Thank you so much

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Speaker 1: for the beautiful review.

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Speaker 1: Get one for yourself and a friend at Sisterhoodheels dot com.

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Speaker 1: We're continuing to bring attention to Breast Cancer Awareness Month

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Speaker 1: by sharing resources and celebrating the experiences of survivors. In

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Speaker 1: Session three twenty seven, we heard from breast cancer survivor

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Speaker 1: Marissa Thomas.

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Speaker 2: This week, we're.

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Speaker 1: Joined by doctor Ryland Gore, a Board certified, Fellowship trained

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Speaker 1: surgeon specializing in breast surgical oncology. Her work focuses on

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Speaker 1: the diagnosis and surgical treatment of benign and malignant breast disease.

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Speaker 1: She is actively involved in studies on breast cancer and

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Speaker 1: serves in community outreach programs as an advocate to help

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Speaker 1: spread breast cancer awareness. During our conversation, doctor Gore breaks

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Speaker 1: down what exactly breast cancer is and what it does

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Speaker 1: to the body, the unique risks of advanced types of

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Speaker 1: breast cancer that Black women should be aware of. In

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Speaker 1: small ways we can minimize our lifetime risk of a

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Speaker 1: breast cancer diagnosis. If something resonates with you while enjoying

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Speaker 1: our conversation, please share with us on social media using

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Speaker 1: the hashtag TVG in session or join us over in

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Speaker 1: the Sister Circle. To talk more about the episode, you

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Speaker 1: can join us at community dot therapy for Blackgirls dot com.

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Speaker 1: Here's our conversation. Thank you so much for joining me today,

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Speaker 1: doctor Gore. Very exciting to have you. So you are

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Speaker 1: a board certified, fellowship trained surgeon specializing in breast surgical oncology.

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Speaker 1: So I feel like those are a lot of words.

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Speaker 1: It sounds like very very important work. Can you tell

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Speaker 1: us what you do and what oncology actually is.

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Speaker 3: Yes, So I am a breast surgical oncologist. Oncologist are

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Speaker 3: physicians involved in cancer care, whether that's medical oncology, surgical oncology,

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Speaker 3: or radiation oncology. So I'm on the surgery side, and

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Speaker 3: all of those words basically mean is After my general

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Speaker 3: surgery residency, I did further training so that I could

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Speaker 3: specialize in breast and take care of women with breast cancer.

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Speaker 2: Can you tell us what a typical day looks like

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Speaker 2: for you.

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Speaker 3: Yes, So on clinic days, my clinic normally starts at

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Speaker 3: eight am, and so I'm up early every day. I've

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Speaker 3: never been a morning person, but surgery will force you

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Speaker 3: to be a mourning person, and so I'm up early,

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Speaker 3: usually by five thirty six o'clock every day. Most days,

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Speaker 3: two days out of the week, I have my clinic

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Speaker 3: days where I'm seeing patients all day in the office.

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Speaker 3: And what's important for people to know, not everybody comes

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Speaker 3: in with the cancer diagnosis. Some people are high risk,

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Speaker 3: or they have benign tumors or lesions that require surgical care,

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Speaker 3: but not everybody is a cancer patient. Then I have

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Speaker 3: two our days a week, and so I'm literally in

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Speaker 3: the operating room all day taking care of woman after

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Speaker 3: woman after woman, whether it's benign.

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Speaker 4: Or malignant disease. And I have a few male patients

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Speaker 4: as well.

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Speaker 1: So can you talk to us a little bit more

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Speaker 1: about what breast cancer specifically is what does that mean

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Speaker 1: When we hear that somebody has a diagnosis of a

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Speaker 1: breast cancer.

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Speaker 3: That means in their breast, they've had malignant transformation of

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Speaker 3: the cells in the breast. And it can be in

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Speaker 3: the breast ductal cells, the cell that line the milk ducks,

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Speaker 3: or in the lobules, and the lobules are the glands

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Speaker 3: that create the milk, and the ducts transports milk to

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Speaker 3: the nipple. Most cancers start in the milk ducts. Seventy

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Speaker 3: five to eighty percent of them. And so when you

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Speaker 3: have that malignant transformation, whether it's invasive or non invasive,

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Speaker 3: at that point you have cancer. And so with most things,

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Speaker 3: early detection is key, which is why I love October.

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Speaker 3: I love Breast Cancer Awareness Month because I get to

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Speaker 3: really hone in on the fact that early detection is

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Speaker 3: what saves lives. Knowing yourself, knowing your body saves lives,

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Speaker 3: and holding your family, holding yourself, holding your friends accountable,

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Speaker 3: that saves lives, and so I love October.

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Speaker 1: I was not aware that seventy five to eighty percent

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Speaker 1: of cancers come from the milk ducks.

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Speaker 2: Can you say more about why that is?

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Speaker 3: I think because there's so many of them and they

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Speaker 3: all converge and go into the nipple. But I think

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Speaker 3: because of the sheer number of milk ducts that is

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Speaker 3: what increases the commonality.

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Speaker 4: We completely honest.

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Speaker 2: With you, got it, okay?

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Speaker 1: And so you talked about kind of knowing your body

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Speaker 1: and kind of recognizing some of those signs. Can you

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Speaker 1: talk to us about some of the symptoms somebody might

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Speaker 1: be experiencing that would be like a prerequisite or a

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Speaker 1: precursor to needing to get something checked.

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Speaker 3: Out, Yes, so my caveat. I tell everybody, most people

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Speaker 3: will not feel anything, and that's why the mammogram is

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Speaker 3: so important. The overwhelming majority of cancers you cannot feel.

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Speaker 3: And it's so important because mammograms can catch cancers up

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Speaker 3: to two years before a patient can feel them, so

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Speaker 3: that's really important to know.

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Speaker 4: But other signs.

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Speaker 3: If a patient is going to have a physical sign,

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Speaker 3: the most common is the man or woman feeling a

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Speaker 3: lump in their breast or underneath their arm in the armpit.

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Speaker 3: I've seen patients with new weird skin, dimpling, redness of

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Speaker 3: the skin, any new nipple changes, whether it's nipple rashes,

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Speaker 3: nipple inversion, or nipple discharge. Those are the most common

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Speaker 3: sign and symptoms if a patient is going to experience

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Speaker 3: something else.

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Speaker 1: So, doctor Glory, you have just blown my mind because

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Speaker 1: all and my team is typing me notes too. We've

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Speaker 1: all been taught to do a monthly breast exam and like,

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Speaker 1: you know, you're supposed to be feeling for stuff, and

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Speaker 1: now you're saying most people won't even ever feel anything.

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Speaker 3: Yeah, so most of my breast cancers. The patient is like,

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Speaker 3: how could this happen to me? I didn't feel anything.

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Speaker 3: Good job forgetting your mammogram, because most people don't feel anything.

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Speaker 3: I would say seventy percent of my patients who come

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Speaker 3: in with a breast cancer diagnosis they had no clue

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Speaker 3: that it was coming. They were just getting their annual

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Speaker 3: check up or annual mammogram. But I will say this though,

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Speaker 3: because I think it's important from an education standpoint. I

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Speaker 3: have women who come in sometimes with these large masses

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Speaker 3: or something is obviously abnormal, one breast larger than the

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Speaker 3: other or something like that, and I'm like, did you

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Speaker 3: not feel this? Because I can look at you and

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Speaker 3: tell something is wrong, and they're like, oh, no, I

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Speaker 3: don't touch my breast.

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Speaker 4: I don't do that. I don't what is yours? Touch it? Please?

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Speaker 3: You need to know what's going on with your body.

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Speaker 3: And some people are like, well, my breast are super lumpy,

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Speaker 3: Like how do I know?

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Speaker 4: And I feel like the.

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Speaker 3: More comfortable you get with knowing what your breast feels like,

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Speaker 3: the easier it will be for you to pick something out.

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Speaker 3: And so, yeah, most people don't feel anything. But you

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Speaker 3: also have that contention of patients who don't want to touch,

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Speaker 3: don't want to know, because if something were to happen.

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Speaker 3: They don't want to face it, and so there's a

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Speaker 3: whole huge fear component involved with self care, knowing your

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Speaker 3: body and things like that.

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Speaker 1: That's interesting that you talk about it as like a

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Speaker 1: fear of if something were to be wrong, I don't

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Speaker 1: want to face it. It also feels like there may

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Speaker 1: be a part I think, even culturally around like this

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Speaker 1: taboo around touching yourself.

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Speaker 3: Absolutely, absolutely, and I hear it all the time. Not

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Speaker 3: so much in my younger patients. I do have some

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Speaker 3: very young patients with breast cancer diagnoses, but in my

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Speaker 3: older ladies, not necessarily my white has but certainly in

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Speaker 3: my patients of color, the older generation, there is this

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Speaker 3: taboo still, this taboo around touching your body and is

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Speaker 3: it dirty?

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Speaker 4: Am I wrong for doing that?

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Speaker 2: Yeah? Yeah?

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Speaker 1: So is the recommendation still that people get their first

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Speaker 1: mammogram at around the age of forty or is it

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Speaker 1: something different?

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Speaker 3: Thank you for asking that. Absolutely start at forty, and

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Speaker 3: I'm glad that the US government has finally caught up

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Speaker 3: with what medical societies and surgical societies have been saying

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Speaker 3: for a long time before they said you should start

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Speaker 3: at fifty, which is laughable to me. Considering Black women

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Speaker 3: specifically are more likely to be diagnosed with breast cancer

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Speaker 3: before the age of forty, So yes, we're supposed to

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Speaker 3: start at forty. But there has also been this suggestion

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Speaker 3: by several medical societies as well for the last five

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Speaker 3: six years that women of color, not just Black women,

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Speaker 3: but Hispanic women should probably consider getting their mammograms starting

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Speaker 3: at the age of thirty five because of the fact

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Speaker 3: that we are more likely to be diagnosed the age

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Speaker 3: of forty.

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Speaker 1: Okay, so I need to hear more about this, doctor Gore.

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Speaker 1: So we do know that, as with a lot of things,

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Speaker 1: women of color, black women specifically, they're disproportionately impacted by

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Speaker 1: a lot of these diagnoses. So what is it about

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Speaker 1: breast cancer that we are seeing higher rates in women

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Speaker 1: of color?

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Speaker 3: So we are more likely to be diagnosed before the

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Speaker 3: age of forty. As I mentioned, we are being diagnosed

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Speaker 3: with breast cancer at the same rates as our white counterparts,

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Speaker 3: but our death rates are forty percent higher than white women.

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Speaker 3: We also know that black women are utilizing mammograms at

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Speaker 3: the same rates as white women, because before the argument

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Speaker 3: was like, oh, black women don't get their mammograms done, Well,

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Speaker 3: that's a lot, and we're actually outpacing white women in

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Speaker 3: mammogram utilization for the first time as of twenty twenty one,

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Speaker 3: so we know that's not it. We're just more likely

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Speaker 3: to be diagnosed with aggressive disease, more aggressive tumors, and

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Speaker 3: we're more likely to be diagnosed at a later stage.

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Speaker 3: And I think the reason for that is multi factor.

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Speaker 3: I've heard everything from you just had your mammogram, there

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Speaker 3: can't be anything going on, your mammogram's fine, or you're

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Speaker 3: too young to have breast cancer come back. And then

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Speaker 3: on top of social things that we have to think about,

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Speaker 3: we're less likely to have private insurance, we're less likely

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Speaker 3: to go to radiology places where we are getting mammograms

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Speaker 3: by trained specialists and the mammograms are being read by

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Speaker 3: trained radiologists. We are behind the ball from screening all

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Speaker 3: the way to survivorship, and so this is a multifactorial

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Speaker 3: situation that needs to be addressed on multiple levels. But

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Speaker 3: Black women we are taking care of our health, and

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Speaker 3: I think now with self care being such a sounding

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Speaker 3: board since COVID, we're even more tapped in. We want

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Speaker 3: to do better, we want to take care of ourselves,

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Speaker 3: we want to have physicians that look like us and

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Speaker 3: believe us, and so we're doing all the things. But

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Speaker 3: as you know, the medical system within itself is a

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Speaker 3: very hard thing to change, and some of the ideas

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Speaker 3: that have been prevalent for a very long time, it's

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Speaker 3: very hard to dismantle some of these outdated beliefs.

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Speaker 1: Mm hm. So you mentioned doctor Gore that we are

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Speaker 1: less likely to be going to like radiology facilities with

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Speaker 1: trained people who can read the mammogram. So all mammogram

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Speaker 1: facilities are not created equal.

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Speaker 2: Like, what should we be looking for in a facility?

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Speaker 4: So where is it? Number one?

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Speaker 3: I tell people go to a large center, a large

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Speaker 3: hospital system, or a large academic center. If it is

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Speaker 3: a freestanding radiology facility. I ask for patients to have

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Speaker 3: a discussion with their primary care physician or whoever wrote

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Speaker 3: the order for that mammogram. Is this somebody you trust?

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Speaker 3: Do you know these people here? Do you know that radiologists?

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Speaker 3: It's sad that you even have to ask is there

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Speaker 3: a radiologist there? So I had a patient maybe six

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Speaker 3: months ago with the radiology report. I'm reading the report,

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Speaker 3: and you want to know who read the report and

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Speaker 3: signed it. It was not a radiologist. It was a chiropractor.

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Speaker 3: I had to like, I put the paper down and

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Speaker 3: I walked away. I was like, I've been here a

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Speaker 3: long time, Like maybe I'm going crazy. No, it was

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Speaker 3: a chiropractor. And so these are the things that patients

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Speaker 3: have to think about. And if you don't have a

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Speaker 3: physician that cares, if you don't have a physician that's

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Speaker 3: going to pay attention to the details, then this is

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Speaker 3: the kind of stuff that's trapping people. How can a

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Speaker 3: chiropractor tell you what is or isn't in your breast?

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Speaker 3: And outside of who's reading it, what about the machinery,

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Speaker 3: what about the equipment?

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Speaker 4: Is it safe? Is it up to date?

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Speaker 3: Is it the newest technology so that everything that needs

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Speaker 3: to be seen will be seen. It sucks that patients

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Speaker 3: have to think about this, especially patients of color, who

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Speaker 3: are more likely to have public insurance or no insurance,

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Speaker 3: and so they are more likely to go to these

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Speaker 3: places because it's usually a flat feed. You know how

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Speaker 3: much it's going to be when you walk through the door.

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Speaker 1: Well, thank you for that. I was not away of

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Speaker 1: that either.

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Speaker 3: It's absolutely wild some of the things.

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Speaker 1: Yeah, now I have heard that black women should seek

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Speaker 1: out specific kinds of mammograms because our breast tissue tends

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Speaker 1: to be denser. Do you know what I'm talking about?

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Speaker 1: Can you help me out on what we're talking about there?

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Speaker 3: Yeah, So these are the three D mammograms or you

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Speaker 3: may see your report or the order may say mammogram

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Speaker 3: with tumosynthesis.

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Speaker 4: So basically you still get the.

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Speaker 3: Same two or three images per breast, but the way

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Speaker 3: that the images are reconfigured it shows multiple slices even

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Speaker 3: though you've only gotten two or three pictures taken, and

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Speaker 3: so it looks almost like a CT scan of the breast.

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Speaker 3: When you roll through the images, it's much easier to

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Speaker 3: parse through what's just thick tissue or denser tissue and

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Speaker 3: what may actually be a mask. Does this look like

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Speaker 3: assist or does this look like a solid tumor I

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Speaker 3: need to be worried about. It's been a game changer

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Speaker 3: because it allows the radiologists to see finer cuts of

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Speaker 3: the breast and really parse through what's abnormal and normal.

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Speaker 3: And it also has cut down on the number of

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Speaker 3: unnecessary biopsies that patients have had to have. And so

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Speaker 3: at this point, three D mammograms are considered standard of care.

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Speaker 1: So I know you mentioned that most people won't find anything,

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Speaker 1: but if people are doing like their routine breast exams

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Speaker 1: and they do feel something, what should they do? So

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Speaker 1: is this something that you go to your primary care

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Speaker 1: doctor for?

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Speaker 2: Would you go to the er?

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Speaker 1: Because we know it sometimes can be difficult to even

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Speaker 1: get an appointment with your primary care doctor.

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Speaker 2: So what should you do if you do feel alone?

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Speaker 3: I would say go to your PCP or OBEGUID asap

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Speaker 3: or call them asap and say, hey, this is what's

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Speaker 3: going on. And at that point they should order additional

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Speaker 3: breast imaging for you. Even if you just got breast

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Speaker 3: imaging less than a year ago.

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Speaker 4: It doesn't matter.

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Speaker 3: If you feel something new, then that requires a new

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Speaker 3: work up. And so at this point, it's not screening mammogram.

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Speaker 3: Your mammogram should be diagnostic, and that's important because that

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Speaker 3: means you get your imaging done and the radiologist reads

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Speaker 3: that the same day as soon as it's done and

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Speaker 3: orders additional imaging as needed, and most patients will go

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Speaker 3: ahead and have an ultrasound at the same time to

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Speaker 3: look and see if there's something there that the mammogram

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Speaker 3: did not pick up on.

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Speaker 2: Got it Okay?

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Speaker 1: So we do often hear chemotherapy as the treatment that

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Speaker 1: is often suggested after somebody has a breast cancer diagnosis.

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Speaker 1: Can you tell us a little bit about what chemotherapy

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Speaker 1: does and like how it impacts the body.

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Speaker 3: Not every patient needs chemotherapy. So for example, patients with

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Speaker 3: non invasive breast cancer, they're not going to get chemotherapy

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Speaker 3: because the cells are still confined to the duct or

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Speaker 3: the lobial and so chemotherapy isn't going to touch it.

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Speaker 3: So most patients who need chemotherapy there are typically stage

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Speaker 3: two or above, and chemotherapy is important. Your regiment will

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Speaker 3: depend on several factors, and so I can't just say, oh,

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Speaker 3: this is your chemo regiment. It just depends on certain things.

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Speaker 3: But it's a systemic treatment. Most patients need to port

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Speaker 3: to deliver the chemotherapy because chemotherapy the medication is strong,

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Speaker 3: so it'll destroy the normal veins in your arm, but

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Speaker 3: it's important it kills any cancer cells that may be

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Speaker 3: traveling throughout the body that have left the breast. Also,

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Speaker 3: if a patient has a large tumor and large lymph

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Speaker 3: notes underneath the arm, the chemotherapy will shrink the lymphnodes

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Speaker 3: shrink the tumor and make surgery easier for the patient,

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Speaker 3: and it helps with given the patient more surgical options,

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Speaker 3: and also it decreases the risk of breast cancer recurrence,

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Speaker 3: and so it's necessary for the overwhelming majority of patients. Unfortunately,

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Speaker 3: but as chemotherapy can be quite harsh and while it's

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Speaker 3: killing cancer cells, it does kill some normal cells also,

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Speaker 3: which is why patients experience some of the things they experience,

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Speaker 3: everything from nausea, vomiting, decrease appetite. We all have seen

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Speaker 3: people with hair that fallen out because it's destroyed, you know,

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Speaker 3: normal hair followbles, normal hair sales. It can cause numbness

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Speaker 3: of the extremities, neuropathic pain. We always check a patient's

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Speaker 3: echo and make sure their heart is functioning properly because

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Speaker 3: it can affect the heart as well, depending on what

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Speaker 3: regimen you're on. And so some patients experience all of

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Speaker 3: the above and chemo is just hard. And then some patients.

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Speaker 3: I have some who have no side effects at all,

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Speaker 3: and they're like, I'm rocking and rolling. Let's just do

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Speaker 3: this so I can move on with my life. Everybody

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Speaker 3: experiences chemo differently, and.

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Speaker 1: Does chemotherapy often work in combination with surgery, So you

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Speaker 1: do chemo and then have a surgery, Like, what is

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Speaker 1: the treatment plan?

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Speaker 4: There? Good questions.

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Speaker 3: So for patients whose tumors are large or they have

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Speaker 3: particularly aggressive tumors, for example triple negative breast cancers, which

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Speaker 3: are more common in black women, we will give their

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Speaker 3: chemo before surgery to facilitate surgery. Some patients will still

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Speaker 3: need additional chemo after surgery, some don't, but we can

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Speaker 3: give it before or after. It just depends on how

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Speaker 3: the patient presents and what the goal is. It is

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Speaker 3: important to say, though, if a patient has stage four

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Speaker 3: cancer out the gate metastatic breast cancer and so we

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Speaker 3: know it's all over the body, surgery is not an

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Speaker 3: option for you typically, so you will be on chemo indefinitely.

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Speaker 1: More from our conversation after the break. So something else

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Speaker 1: that I think a lot of us have heard about

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Speaker 1: is family history and genetics in the role of breast

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Speaker 1: cancer diagnosis.

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Speaker 2: Can you talk to us a little bit.

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Speaker 1: About that and whether that changes how early you should

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Speaker 1: get a mammogram?

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Speaker 4: Good question.

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Speaker 3: So one thing that I make sure patients know. The

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Speaker 3: overwhelming majority of patients to have a breast cancer diagnosis

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Speaker 3: do not have a family history. Seventy five to eighty

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Speaker 3: percent of patients with a breast cancer diagnosis don't have

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Speaker 3: a family history at all. Yes, I know, sounds crazy, right,

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Speaker 3: This is how common breast cancer. It sounds ridiculous, but

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Speaker 3: it's true. And then of that other twenty to twenty

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Speaker 3: five percent with a family history, five to ten percent

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Speaker 3: of that twenty to twenty five percent with the family

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Speaker 3: history will have a genetic mutation that is responsible for

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Speaker 3: their breast cancer diagnosis.

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Speaker 4: The most common.

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Speaker 3: Breast cancer mutation or genetic mutation affiliated with breast cancer

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Speaker 3: is the brack of one and brack of two genetic mutations.

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Speaker 4: Angelina Joe Lee Jean.

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Speaker 3: I remember when she came out and discussed her family

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Speaker 3: history and her diagnosis.

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Speaker 4: That's what she has.

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Speaker 3: She's brack on one, and so that increases your risk

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Speaker 3: of developing breast and ovarian cancer. You are almost guaranteed

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Speaker 3: a breast cancer or ovarian cancer diagnosis. But we do

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Speaker 3: know that there are other genes associated with breast cancer,

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Speaker 3: and so every breast cancer patient should be offered genetic testing,

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Speaker 3: regardless of if they have a family history or not.

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Speaker 3: And so that's something I'm really diligent about and I've

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Speaker 3: seen all kinds of mutations and it's not something that

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Speaker 3: just affects white women. It's not something that just affects

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Speaker 3: We used to say, oh, bracko wan bracka two only

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Speaker 3: in Oshkaronnazi Jewish patients, But we know that breast cancer mutations,

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Speaker 3: particularly bracken one and brack of two, are just as

401
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Speaker 3: high in black women as it is in the Oshkonazi

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Speaker 3: Jewish population. So it's important that even before you get

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Speaker 3: to your breast surgeon, if a PCP or OBI guid

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Speaker 3: knows that a patient has a family history, this is

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Speaker 3: something they should be all over and should be offering

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Speaker 3: as well.

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Speaker 1: So you've talked a little bit about the surgeries and

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Speaker 1: it seems like maybe two of the most common are

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Speaker 1: lumpectomies and mass sectomies. Can you talk a little bit

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Speaker 1: about like the difference between those two and like what

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Speaker 1: kinds of things would you need to know before making

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Speaker 1: a decision about either of those.

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Speaker 3: So, lumpectomy is when we remove the cancer rim of

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Speaker 3: healthy tissue around the cancer because we want negative margins

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Speaker 3: negative margins, and we save the breast. Mastectomy is when

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Speaker 3: the entire breast is removed, and that's with or without

417
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Speaker 3: breast reconstruction. One thing that patients will say to me,

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Speaker 3: doctor Gore, just take it off, just remove the whole breast.

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Speaker 3: I don't want this to ever happen again. Well, that's

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Speaker 3: not quite how it works. And I tell patients when

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Speaker 3: you look at the studies, when you look at all

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Speaker 3: the breast cancer studies, especially the main ones that determine

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Speaker 3: why we do what we do, there's no difference in

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Speaker 3: disease free survival, distant disease free survival, or overall survival

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Speaker 3: between patients who get a lumpectomy with radiation and a

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Speaker 3: patient who gets a mastectomy.

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Speaker 4: There's no difference between those groups. They're going to do

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Speaker 4: equally well.

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Speaker 3: And so I think it's important for patients to make

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Speaker 3: a surgical decision that's going to work for them and

431
00:22:46,280 --> 00:22:48,760
Speaker 3: what their goals are. There are some patients who feel

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Speaker 3: very strongly about saving their breasts. So if they have

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Speaker 3: a large tumor, for example, I say, okay, since you

434
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Speaker 3: feel really strongly about saving your breast, let's do chemo first.

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00:22:58,480 --> 00:23:01,280
Speaker 3: Let's shrink this as much as possible, and then go

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Speaker 3: back to the drawing board, repeat, imaging and see where

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00:23:03,840 --> 00:23:06,080
Speaker 3: we are and go from there. And then you have

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Speaker 3: patients on the other end of the spectrum who have

439
00:23:08,160 --> 00:23:11,400
Speaker 3: the tiniest tumor and they're like, I've never been attached

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00:23:11,400 --> 00:23:14,359
Speaker 3: to my breasts anyway, take them off. And even after

441
00:23:14,400 --> 00:23:18,200
Speaker 3: you explain all the risks and benefits, and so people

442
00:23:18,240 --> 00:23:21,800
Speaker 3: make different decisions for different reasons. If you get a lumpectomy,

443
00:23:21,880 --> 00:23:26,000
Speaker 3: it is strongly recommended that you get radiation after surgery,

444
00:23:26,359 --> 00:23:28,280
Speaker 3: and so there are some patients who are like, I'm

445
00:23:28,280 --> 00:23:30,439
Speaker 3: not interested in radiation, I don't want to do it,

446
00:23:30,440 --> 00:23:32,600
Speaker 3: and so they'll choose mispect to me for that reason.

447
00:23:33,000 --> 00:23:35,040
Speaker 3: So I never try to push a patient in one

448
00:23:35,080 --> 00:23:38,280
Speaker 3: direction or the other. But for patients who have particularly

449
00:23:38,320 --> 00:23:42,199
Speaker 3: aggressive tumors or large tumors, or tumors close to the nipple,

450
00:23:42,640 --> 00:23:45,280
Speaker 3: that's when I'll say, listen, i'm offering mistec to me.

451
00:23:45,359 --> 00:23:47,960
Speaker 3: And so I try not to gate keep and I'm

452
00:23:48,000 --> 00:23:50,920
Speaker 3: really diligent about making sure the patient feels like they

453
00:23:50,960 --> 00:23:52,800
Speaker 3: are a part of their care team and not just

454
00:23:52,840 --> 00:23:55,399
Speaker 3: being told what to do. But there are some instances

455
00:23:55,440 --> 00:23:59,120
Speaker 3: where you have to draw the line, and.

456
00:23:59,080 --> 00:24:01,800
Speaker 1: I believe this was the case for Angelina Jolie, is

457
00:24:01,800 --> 00:24:04,760
Speaker 1: that you found out this information and then decided on

458
00:24:04,880 --> 00:24:08,400
Speaker 1: a mess sectomy to prevent and eat cancer from recurring.

459
00:24:08,400 --> 00:24:08,720
Speaker 4: Correct.

460
00:24:08,840 --> 00:24:11,200
Speaker 3: Yes, And if you have a genetic mutation, you can

461
00:24:11,280 --> 00:24:16,760
Speaker 3: actually do bilateral prophylactic mistectomies with or without reconstruction to

462
00:24:16,960 --> 00:24:20,320
Speaker 3: drastically minimize the risk of a breast cancer diagnosis happening.

463
00:24:20,560 --> 00:24:23,600
Speaker 3: So with the mastectomy, your risk after a mastectomy never

464
00:24:23,640 --> 00:24:27,320
Speaker 3: falls to zero, but have you drastically reduced the likelihood

465
00:24:27,359 --> 00:24:28,280
Speaker 3: of it happening again?

466
00:24:28,600 --> 00:24:29,280
Speaker 4: Absolutely?

467
00:24:29,320 --> 00:24:32,720
Speaker 3: So the average person lifetime risk ten to twelve percent

468
00:24:33,119 --> 00:24:36,040
Speaker 3: after bilateral mastectomies, that may fall the one to three

469
00:24:36,119 --> 00:24:39,080
Speaker 3: percent over the rest of your lifetime. And so I

470
00:24:39,080 --> 00:24:40,399
Speaker 3: think those are pretty good odds.

471
00:24:41,160 --> 00:24:45,160
Speaker 1: And you mentioned with or without reconstructive surgery several times.

472
00:24:45,200 --> 00:24:45,840
Speaker 2: What does that mean?

473
00:24:46,480 --> 00:24:50,120
Speaker 3: So if you have to do a mastectomy, I always

474
00:24:50,200 --> 00:24:54,280
Speaker 3: offer a patient, if they are a good candidate, I

475
00:24:54,359 --> 00:24:57,760
Speaker 3: always offer them consultation with the plastic surgeon to discuss

476
00:24:57,840 --> 00:25:02,679
Speaker 3: breast reconstruction, whether it's implant using their own tissue to

477
00:25:02,760 --> 00:25:06,639
Speaker 3: recreate the breast. Most patients take me up on that offer,

478
00:25:06,760 --> 00:25:10,760
Speaker 3: and most women want to have breast reconstruction because it's

479
00:25:10,760 --> 00:25:14,879
Speaker 3: already hard enough going through cancer and deciding on or

480
00:25:14,960 --> 00:25:17,680
Speaker 3: needing a mastectomy. So most people want to wake up

481
00:25:17,760 --> 00:25:21,200
Speaker 3: and there is something there that still resembles a breast.

482
00:25:21,280 --> 00:25:23,560
Speaker 3: But I will say the number of my patients who

483
00:25:23,560 --> 00:25:26,400
Speaker 3: are choosing not to do reconstruction, those numbers are going up.

484
00:25:26,760 --> 00:25:30,760
Speaker 3: And if you just google go flat movement, it's a

485
00:25:30,760 --> 00:25:34,000
Speaker 3: thing right now. There are so many Facebook groups devoted

486
00:25:34,040 --> 00:25:37,479
Speaker 3: to it, so many forums where people are choosing to

487
00:25:37,520 --> 00:25:40,280
Speaker 3: not do reconstruction. They just don't want to go through

488
00:25:40,359 --> 00:25:45,400
Speaker 3: the rigamarole of what plastic surgery and subsequent surgeries entail.

489
00:25:46,000 --> 00:25:48,360
Speaker 1: And so it sounds like often this is happening at

490
00:25:48,359 --> 00:25:50,399
Speaker 1: the same time, right, So you might go in and

491
00:25:50,440 --> 00:25:53,080
Speaker 1: do the mistectomy and then the plastic surgeon follows you.

492
00:25:53,680 --> 00:25:55,800
Speaker 4: Absolutely, you can do it immediately.

493
00:25:56,040 --> 00:25:58,240
Speaker 3: And so with my plastic surgeons, we have a great

494
00:25:58,280 --> 00:26:01,760
Speaker 3: relationship and we work together, and so while I do

495
00:26:01,800 --> 00:26:05,040
Speaker 3: the mistectomy, the plastic surgeon is reconstructing the breast. And

496
00:26:05,080 --> 00:26:07,280
Speaker 3: then there are some patients who do choose to do

497
00:26:07,320 --> 00:26:10,000
Speaker 3: it in a delayed fashion, so six to twelve months

498
00:26:10,080 --> 00:26:13,800
Speaker 3: later or even longer, and patients will choose that because

499
00:26:14,720 --> 00:26:18,160
Speaker 3: for some people dealing with the cancer alone is enough

500
00:26:18,200 --> 00:26:20,400
Speaker 3: for them. They're like, let me just get through my treatments.

501
00:26:20,480 --> 00:26:23,479
Speaker 3: Let me remove this cancer and get surgery for the cancer,

502
00:26:23,640 --> 00:26:27,600
Speaker 3: whatever treatments I need, whether it's chemotherapy, radiation, I want

503
00:26:27,640 --> 00:26:29,680
Speaker 3: to get through all of that first and then once

504
00:26:29,720 --> 00:26:32,919
Speaker 3: that is done, then focused on the reconstruction part. So

505
00:26:33,160 --> 00:26:35,040
Speaker 3: there's no wronger right answer. You can do it in

506
00:26:35,080 --> 00:26:36,439
Speaker 3: whatever order you want to do it.

507
00:26:36,720 --> 00:26:40,080
Speaker 1: So we had a conversation with another position about menopause,

508
00:26:40,440 --> 00:26:43,480
Speaker 1: and one of the things she mentioned was that not

509
00:26:43,640 --> 00:26:47,400
Speaker 1: having children and I believe not breastfeeding was a higher

510
00:26:48,040 --> 00:26:52,080
Speaker 1: risk factor for some breast cancers or some cancers. Is

511
00:26:52,119 --> 00:26:54,400
Speaker 1: that the case for breast cancer? Is there any connection

512
00:26:54,480 --> 00:26:56,600
Speaker 1: there related to like having children.

513
00:26:56,640 --> 00:27:01,200
Speaker 3: Being Nola paris, not having children, not breast feeding, that

514
00:27:01,280 --> 00:27:05,240
Speaker 3: will slightly increase your risk because you've increased your overall

515
00:27:06,000 --> 00:27:10,000
Speaker 3: exposure to estrogen. And so that's where the risk comes from.

516
00:27:10,359 --> 00:27:14,240
Speaker 3: Exposure to estrogen increase breast cancer risk, and some of

517
00:27:14,280 --> 00:27:17,680
Speaker 3: it you just can't control. Being a woman, we cannot

518
00:27:17,680 --> 00:27:20,879
Speaker 3: control that. We cannot control our exposure to estrogen. But

519
00:27:21,000 --> 00:27:25,480
Speaker 3: in my menopausal women, I feel very strongly about hormone

520
00:27:25,520 --> 00:27:28,439
Speaker 3: replacement therapy and I get it going through menopause, the

521
00:27:28,480 --> 00:27:31,960
Speaker 3: hot flashes, the vaginal dryness, the feeling like you're crazy.

522
00:27:32,440 --> 00:27:34,160
Speaker 3: It's a lot, and they don't want to go through

523
00:27:34,160 --> 00:27:36,320
Speaker 3: that and they want some relief. But then you have

524
00:27:36,480 --> 00:27:40,320
Speaker 3: these people who are on hormone replacement therapy for years,

525
00:27:40,520 --> 00:27:43,920
Speaker 3: I mean years uninterrupted. That will absolutely increase your breast

526
00:27:43,920 --> 00:27:46,600
Speaker 3: cancer risk. And so I'm not a fan of it,

527
00:27:46,720 --> 00:27:51,000
Speaker 3: and I do let my menopausal patients have it short bursts.

528
00:27:51,080 --> 00:27:54,239
Speaker 3: I prefer it be three months or less. But if

529
00:27:54,280 --> 00:27:56,480
Speaker 3: you're going to do it, you got to get your

530
00:27:56,760 --> 00:28:00,960
Speaker 3: mammograms and check ups regularly. Also have some patients who

531
00:28:01,000 --> 00:28:02,719
Speaker 3: like to have it both ways. You can't be on

532
00:28:02,800 --> 00:28:05,600
Speaker 3: harmone replacement therapy for twenty years and be like I

533
00:28:05,640 --> 00:28:07,480
Speaker 3: haven't had a mammogram in five years.

534
00:28:07,760 --> 00:28:08,760
Speaker 4: Like that's not gonna work.

535
00:28:09,000 --> 00:28:12,399
Speaker 1: So can we talk about medically induced menopause? Can you

536
00:28:12,480 --> 00:28:16,359
Speaker 1: talk about how cancer can impact menopause development.

537
00:28:16,960 --> 00:28:23,360
Speaker 3: So the issue with breast cancer and inducing menopause is

538
00:28:23,440 --> 00:28:27,919
Speaker 3: for the patients who our own chemotherapy, and so, like

539
00:28:27,960 --> 00:28:30,920
Speaker 3: I said, chemotherapy kills cancer sales, but it kills healthy sales.

540
00:28:30,960 --> 00:28:34,479
Speaker 3: All sell so unfortunately it does impact the ovaries it

541
00:28:34,520 --> 00:28:37,720
Speaker 3: can put pre menopausal women into menopause. It can be

542
00:28:37,760 --> 00:28:40,800
Speaker 3: a touchy thing to talk about because a lot of

543
00:28:40,840 --> 00:28:43,600
Speaker 3: times too, you still have these women who are child

544
00:28:43,600 --> 00:28:46,400
Speaker 3: bearing age who haven't had the pleasure or the joy

545
00:28:46,400 --> 00:28:48,480
Speaker 3: of starting a family yet. And now we're having this

546
00:28:48,520 --> 00:28:51,520
Speaker 3: discussion about you might go into menopause and you might

547
00:28:51,560 --> 00:28:56,600
Speaker 3: not ever regain any ovarian function, and so having conversations

548
00:28:56,640 --> 00:29:01,120
Speaker 3: about family planning, allowing patients to do egg retrieval and

549
00:29:01,160 --> 00:29:05,440
Speaker 3: egg preservation prior to starting chemotherapy if that's the path

550
00:29:05,480 --> 00:29:07,680
Speaker 3: they want to go down. I think these are all

551
00:29:07,720 --> 00:29:11,520
Speaker 3: important conversations. I have had patients also who've had chemotherapy,

552
00:29:11,720 --> 00:29:14,040
Speaker 3: and it may have taken two or three years, but

553
00:29:14,080 --> 00:29:16,520
Speaker 3: they're all Veryan function returns and then they go on

554
00:29:16,600 --> 00:29:18,080
Speaker 3: and have kids and they do just fine.

555
00:29:18,360 --> 00:29:19,760
Speaker 4: But it warrants a conversation.

556
00:29:20,480 --> 00:29:23,000
Speaker 1: So I'm glad you brought that up because you know,

557
00:29:23,040 --> 00:29:24,560
Speaker 1: I think that you know, maybe a lot of people

558
00:29:24,560 --> 00:29:28,160
Speaker 1: who are enjoying our conversation will wonder about that. Is

559
00:29:28,200 --> 00:29:31,800
Speaker 1: there time, like after you get a breast cancer diagnosis

560
00:29:32,200 --> 00:29:36,120
Speaker 1: to be able to explore these options like egg retrieval

561
00:29:36,240 --> 00:29:38,680
Speaker 1: or other things. If starting a family is something that

562
00:29:38,720 --> 00:29:40,680
Speaker 1: you're interested in. Is there typically time for that.

563
00:29:41,280 --> 00:29:41,520
Speaker 4: Yes.

564
00:29:41,720 --> 00:29:45,360
Speaker 3: For my patients who have early breast cancers, they'll typically

565
00:29:45,520 --> 00:29:49,560
Speaker 3: opt to go ahead and get surgery, get the cancer removed,

566
00:29:50,240 --> 00:29:53,240
Speaker 3: and before moving on to the next treatment, because you

567
00:29:53,280 --> 00:29:57,920
Speaker 3: do have time after surgery before starting chemotherapy or radiation,

568
00:29:58,360 --> 00:30:02,360
Speaker 3: you have a window where it's just planning, nothing is happening,

569
00:30:02,360 --> 00:30:04,479
Speaker 3: and so during that time, most patients will go ahead.

570
00:30:04,600 --> 00:30:07,440
Speaker 3: They've had a conversation with their obi guide or a

571
00:30:07,520 --> 00:30:12,800
Speaker 3: reproductive endochronologist beforehand, after the diagnosis, and so there's that

572
00:30:12,880 --> 00:30:16,080
Speaker 3: wiggle room where they can get it done and taking

573
00:30:16,080 --> 00:30:18,440
Speaker 3: care of before starting any additional treatments.

574
00:30:18,680 --> 00:30:20,920
Speaker 1: So, you know, I think for a lot of people,

575
00:30:21,120 --> 00:30:23,560
Speaker 1: getting this kind of news is very difficult, and I'm

576
00:30:23,600 --> 00:30:26,120
Speaker 1: sure as the physician, it may be difficult for you

577
00:30:26,200 --> 00:30:29,040
Speaker 1: to deliver that news. Can you talk a little bit

578
00:30:29,040 --> 00:30:31,280
Speaker 1: about what kinds of things you are saying to the

579
00:30:31,360 --> 00:30:34,720
Speaker 1: patient so that they feel empowered and like they understand

580
00:30:34,760 --> 00:30:36,800
Speaker 1: what the process is like, I.

581
00:30:36,840 --> 00:30:39,920
Speaker 3: Make sure that I go into so much detail. Number One,

582
00:30:39,920 --> 00:30:42,000
Speaker 3: you just have to be kind and compassionate. You cannot

583
00:30:42,040 --> 00:30:45,720
Speaker 3: have a patient there who's looking afraid, be like, well,

584
00:30:46,000 --> 00:30:46,760
Speaker 3: got your results?

585
00:30:46,760 --> 00:30:47,720
Speaker 4: Back. You got cancer.

586
00:30:47,800 --> 00:30:50,120
Speaker 3: So I'm gonna give you a minute and then we

587
00:30:50,160 --> 00:30:51,480
Speaker 3: need to get it out all right.

588
00:30:51,600 --> 00:30:52,040
Speaker 4: Bye.

589
00:30:52,320 --> 00:30:55,320
Speaker 3: There are patients who go through things like this. I

590
00:30:55,400 --> 00:30:58,960
Speaker 3: sit down with them, I'm looking them in their eye.

591
00:30:58,960 --> 00:31:01,560
Speaker 3: I'm not standing over them. I'm like, so, let's have

592
00:31:01,600 --> 00:31:07,320
Speaker 3: a conversation about your results. And I try to start off, well,

593
00:31:07,880 --> 00:31:10,880
Speaker 3: the bad news is this, but the good news is

594
00:31:11,560 --> 00:31:15,560
Speaker 3: this is treatable, or the good news is xyz, and

595
00:31:15,640 --> 00:31:17,560
Speaker 3: so I try to really frame it in a way

596
00:31:17,600 --> 00:31:21,000
Speaker 3: where a patient, even with the bad news, they can

597
00:31:21,040 --> 00:31:24,120
Speaker 3: digest it. I don't use big words when I'm going

598
00:31:24,160 --> 00:31:27,400
Speaker 3: through results with patients or when I'm explaining what's happening.

599
00:31:27,480 --> 00:31:30,000
Speaker 3: I'm a drawer, and so I'll say, Okay, let's take

600
00:31:30,040 --> 00:31:32,000
Speaker 3: a look. This is what a lobbyl is. This is

601
00:31:32,040 --> 00:31:35,200
Speaker 3: what a milk duth is. This is what happened I

602
00:31:35,280 --> 00:31:37,479
Speaker 3: go through the stage I go through. Okay, so this

603
00:31:37,560 --> 00:31:39,959
Speaker 3: is what you can expect from surgery. This is what

604
00:31:40,000 --> 00:31:42,680
Speaker 3: you can expect after surgery, or if the cancer is

605
00:31:42,680 --> 00:31:45,320
Speaker 3: too big, you know what, we have a window of

606
00:31:45,440 --> 00:31:48,920
Speaker 3: opportunity here. It won't be fun, but let's shrink this tumor.

607
00:31:49,000 --> 00:31:50,840
Speaker 3: Let's do a chemotherapy for it. There's a way to

608
00:31:50,880 --> 00:31:53,920
Speaker 3: frame things and make it digestible for the patient and

609
00:31:53,960 --> 00:31:57,960
Speaker 3: make it so that they know you care. I spend

610
00:31:57,960 --> 00:31:59,320
Speaker 3: a lot of time with patients.

611
00:31:59,600 --> 00:32:00,640
Speaker 4: That's what I would want.

612
00:32:00,920 --> 00:32:03,560
Speaker 2: Right right, Yeah, the kindness and compassion.

613
00:32:04,080 --> 00:32:06,440
Speaker 1: So we've already talked a little bit about, you know,

614
00:32:06,520 --> 00:32:08,480
Speaker 1: black women and other women of color kind of being

615
00:32:08,520 --> 00:32:12,520
Speaker 1: disproportionately impacted, and you're talking about you know, more severe

616
00:32:13,080 --> 00:32:15,600
Speaker 1: mortality rates and all of these things. So we know

617
00:32:15,680 --> 00:32:18,959
Speaker 1: that black people often have a very tenuous relationship with

618
00:32:19,080 --> 00:32:22,080
Speaker 1: medical professionals. What kinds of things do you think that

619
00:32:22,240 --> 00:32:25,040
Speaker 1: the black women listening to our conversation should know about

620
00:32:25,360 --> 00:32:28,480
Speaker 1: how to advocate for themselves with their medical professionals.

621
00:32:29,040 --> 00:32:32,280
Speaker 3: So one thing I love to do every time I

622
00:32:32,280 --> 00:32:34,200
Speaker 3: have to give a talk or a lecture or whatever,

623
00:32:34,360 --> 00:32:38,920
Speaker 3: especially when it's to lay people, regular people, I'll.

624
00:32:38,680 --> 00:32:39,440
Speaker 4: Give them a list.

625
00:32:39,480 --> 00:32:41,800
Speaker 3: I'll be like, Okay, if this happens, these are the

626
00:32:41,880 --> 00:32:44,200
Speaker 3: kind of questions you need to go to the doctor with.

627
00:32:44,720 --> 00:32:46,840
Speaker 3: I'm like, take a screenshot if you need to write

628
00:32:46,840 --> 00:32:48,600
Speaker 3: it down, if you need to. But I find that

629
00:32:48,680 --> 00:32:51,720
Speaker 3: when patients know what to expect and they know what

630
00:32:51,880 --> 00:32:54,320
Speaker 3: questions to ask. Sometimes we just get caught up because

631
00:32:54,360 --> 00:32:56,200
Speaker 3: it's like I don't even know what I don't know,

632
00:32:56,280 --> 00:32:59,360
Speaker 3: and I don't know what to ask. Even giving them

633
00:32:59,400 --> 00:33:03,320
Speaker 3: that script helps them to feel empowered. Take a buddy,

634
00:33:03,640 --> 00:33:06,160
Speaker 3: especially if you know it's probably going to be bad news.

635
00:33:06,280 --> 00:33:09,960
Speaker 3: Take somebody with you, because then there's accountability. If your

636
00:33:10,000 --> 00:33:12,800
Speaker 3: doctor is crazy, they're less likely to cut up because

637
00:33:12,800 --> 00:33:16,160
Speaker 3: there's somebody else there, right, And so you have a springboard.

638
00:33:16,160 --> 00:33:18,520
Speaker 3: You have somebody that can ask questions for you if

639
00:33:18,520 --> 00:33:20,480
Speaker 3: you're not able to think straight. And you also have

640
00:33:20,560 --> 00:33:23,920
Speaker 3: somebody that can take notes for you while you're asking

641
00:33:23,960 --> 00:33:26,840
Speaker 3: the questions and just having the conversation, because it's sometimes

642
00:33:26,880 --> 00:33:30,000
Speaker 3: it's just hard to do both. And one thing I'm

643
00:33:30,000 --> 00:33:34,160
Speaker 3: a fan of and it's just amazing to see businesses

644
00:33:34,240 --> 00:33:37,720
Speaker 3: like yours, businesses like health in her Hue for example,

645
00:33:37,840 --> 00:33:43,000
Speaker 3: just completely thrive and take off during COVID, especially if

646
00:33:43,000 --> 00:33:45,280
Speaker 3: you don't like the way things went with your doctor,

647
00:33:45,360 --> 00:33:46,920
Speaker 3: or you're getting a bad vibe, or you feel like

648
00:33:46,960 --> 00:33:51,080
Speaker 3: it's very paternalistic, or they're just condescending. Get a second opinion.

649
00:33:51,120 --> 00:33:53,600
Speaker 3: I am a big fan of second opinions and just

650
00:33:53,760 --> 00:33:57,320
Speaker 3: curating a health team that works for you where you

651
00:33:57,400 --> 00:34:00,520
Speaker 3: feel supported, you feel like you can trust that, and

652
00:34:00,560 --> 00:34:02,720
Speaker 3: you feel heard more.

653
00:34:02,760 --> 00:34:16,040
Speaker 1: From our conversation after the break, I would imagine, like

654
00:34:16,120 --> 00:34:19,560
Speaker 1: many medical specialties, there are not a lot of doctor core's.

655
00:34:20,080 --> 00:34:21,200
Speaker 2: Can you talk with.

656
00:34:21,120 --> 00:34:24,719
Speaker 1: Me about like the numbers of black physicians who are

657
00:34:24,960 --> 00:34:27,239
Speaker 1: like oncological surgeons like you are.

658
00:34:27,920 --> 00:34:31,680
Speaker 3: It's so small because black men and women, we're only

659
00:34:31,800 --> 00:34:36,520
Speaker 3: I want to say, like five or six percent of physicians.

660
00:34:36,600 --> 00:34:39,040
Speaker 3: It's a very small number. I don't have the latest

661
00:34:39,120 --> 00:34:42,440
Speaker 3: data from American Medical Association, but it's a very small number.

662
00:34:42,600 --> 00:34:46,200
Speaker 3: And then the number of black surgeons about two percent

663
00:34:46,760 --> 00:34:49,880
Speaker 3: of physicians. Trust me when I say a lot of

664
00:34:49,920 --> 00:34:52,960
Speaker 3: the black dots, especially surge as we know each other

665
00:34:53,080 --> 00:34:55,480
Speaker 3: and if you don't know somebody, then you know somebody

666
00:34:55,520 --> 00:34:58,280
Speaker 3: that knows them, and they're not hard to find. It's

667
00:34:58,320 --> 00:35:01,520
Speaker 3: a small number. And so even the black female breast

668
00:35:01,719 --> 00:35:05,000
Speaker 3: surgery group, most of us know each other.

669
00:35:05,640 --> 00:35:09,080
Speaker 1: Yeah. So since we know the numbers aren't increasing fast

670
00:35:09,200 --> 00:35:12,160
Speaker 1: enough in terms of more black professionals entering the field,

671
00:35:12,560 --> 00:35:14,720
Speaker 1: what other kinds of things do you think the healthcare

672
00:35:14,760 --> 00:35:17,680
Speaker 1: system needs to do to provide the kind of support

673
00:35:17,719 --> 00:35:19,120
Speaker 1: that black women patients need.

674
00:35:19,800 --> 00:35:23,640
Speaker 3: It just needs a complete overhaul, and it starts with

675
00:35:24,480 --> 00:35:28,400
Speaker 3: our numbers also in making room for more black physicians

676
00:35:28,440 --> 00:35:31,600
Speaker 3: and other physicians of color. Why is it the highest

677
00:35:31,680 --> 00:35:35,240
Speaker 3: numbers of black physicians and physicians of color were actually

678
00:35:35,520 --> 00:35:38,160
Speaker 3: actually in the sixties and seventies, and those numbers continue

679
00:35:38,239 --> 00:35:38,920
Speaker 3: to dwindle.

680
00:35:39,320 --> 00:35:39,839
Speaker 4: And all of.

681
00:35:39,800 --> 00:35:43,440
Speaker 3: Those old school docs, they're old, they're retiring, they're in

682
00:35:43,520 --> 00:35:47,279
Speaker 3: their eighties and approaching ninety now. I've met some, and

683
00:35:47,320 --> 00:35:51,160
Speaker 3: it's disheartening, I think, especially when it comes to medical

684
00:35:51,200 --> 00:35:55,919
Speaker 3: school and residency programs, getting into medical schools, staying into

685
00:35:55,960 --> 00:35:58,920
Speaker 3: medical school, making sure that black students have the support

686
00:35:59,000 --> 00:36:02,160
Speaker 3: they need in residency, making sure they have the support

687
00:36:02,160 --> 00:36:04,400
Speaker 3: that they need. We're more likely to be kicked out

688
00:36:04,440 --> 00:36:09,600
Speaker 3: of our residency programs for issues that our other counterparts do,

689
00:36:09,880 --> 00:36:14,239
Speaker 3: or our counterparts do a lot worse sometimes, but just

690
00:36:14,320 --> 00:36:18,160
Speaker 3: being under that microscope and not having the support you need.

691
00:36:18,320 --> 00:36:20,839
Speaker 3: But then it's a trickle down effect, right. We need

692
00:36:20,880 --> 00:36:23,520
Speaker 3: to make sure that these older docs who pay the

693
00:36:23,560 --> 00:36:26,640
Speaker 3: way for us, that they're getting into positions where they

694
00:36:26,719 --> 00:36:30,799
Speaker 3: have a voice also and where they can actually advocate

695
00:36:31,040 --> 00:36:33,240
Speaker 3: for black physicians and training.

696
00:36:33,760 --> 00:36:37,160
Speaker 4: And so it's multifaceted. It's multifaceted.

697
00:36:37,280 --> 00:36:41,000
Speaker 3: So many DEI programs right that were started during COVID

698
00:36:41,000 --> 00:36:41,799
Speaker 3: they're gone.

699
00:36:42,080 --> 00:36:42,680
Speaker 4: They're gone.

700
00:36:43,040 --> 00:36:46,239
Speaker 3: And so how do you advocate for your staff, your physicians,

701
00:36:46,360 --> 00:36:52,719
Speaker 3: for patients without having DEI initiatives and actually having de

702
00:36:53,280 --> 00:36:56,879
Speaker 3: and I on the DEI committees Because one thing that

703
00:36:57,239 --> 00:36:59,919
Speaker 3: was one thing that was very disappointing is to see

704
00:37:00,080 --> 00:37:04,440
Speaker 3: DEI committees and there isn't a single woman or person

705
00:37:04,480 --> 00:37:09,880
Speaker 3: of color, and so it's just virtue signaling and it's old.

706
00:37:10,160 --> 00:37:12,359
Speaker 3: And so we just have to continue to speak up,

707
00:37:12,600 --> 00:37:15,680
Speaker 3: and even if it starts with just one physician, speak up,

708
00:37:15,800 --> 00:37:19,239
Speaker 3: advocate as much as you can without burning yourself out,

709
00:37:19,920 --> 00:37:22,960
Speaker 3: and you go from there. And I feel very grateful

710
00:37:23,120 --> 00:37:27,560
Speaker 3: to know other physicians who care about patients and care

711
00:37:27,600 --> 00:37:30,200
Speaker 3: about what happens just as much as I do, and

712
00:37:30,280 --> 00:37:34,600
Speaker 3: so continuing to train people to see people the way

713
00:37:34,680 --> 00:37:37,480
Speaker 3: they want to be seen and going from there.

714
00:37:37,640 --> 00:37:39,360
Speaker 2: Honestly, thank you for that.

715
00:37:39,800 --> 00:37:42,040
Speaker 1: So you've already given us some excellent tips around like

716
00:37:42,120 --> 00:37:45,640
Speaker 1: advocating for ourselves with our medical professionals. The other part

717
00:37:45,680 --> 00:37:48,719
Speaker 1: that I think is important after a breast cancer diagnosis

718
00:37:48,800 --> 00:37:52,040
Speaker 1: is the community in your support system. Can you talk

719
00:37:52,040 --> 00:37:54,560
Speaker 1: a little bit about the role that community plays after

720
00:37:54,600 --> 00:37:57,480
Speaker 1: somebody has a diagnosis, especially as a part of recovery.

721
00:37:58,200 --> 00:38:02,560
Speaker 3: Yeah, my patients who have support, whether it's family, good friends,

722
00:38:02,680 --> 00:38:05,200
Speaker 3: a good circle, they do better than my patients who

723
00:38:05,200 --> 00:38:09,319
Speaker 3: have no support at all. And studies have also proven this,

724
00:38:09,880 --> 00:38:12,920
Speaker 3: And so I think it's important to have your circle.

725
00:38:13,000 --> 00:38:16,640
Speaker 3: And your circle isn't always family, but having people who

726
00:38:16,680 --> 00:38:19,680
Speaker 3: can sit with you, having people like I mentioned before,

727
00:38:19,840 --> 00:38:22,920
Speaker 3: can go to an appointment with you, Having people who

728
00:38:22,960 --> 00:38:26,200
Speaker 3: can go grocery shopping for you or just listen. Nobody

729
00:38:26,280 --> 00:38:28,279
Speaker 3: can tell a patient what they need. Sometimes they don't

730
00:38:28,280 --> 00:38:32,520
Speaker 3: know what they need, but being there is extremely important.

731
00:38:32,640 --> 00:38:35,960
Speaker 3: And so having your circle, those people that you trust

732
00:38:36,320 --> 00:38:37,319
Speaker 3: is tantamount.

733
00:38:37,440 --> 00:38:40,160
Speaker 1: So something I realized we didn't talk about was whether

734
00:38:40,239 --> 00:38:44,760
Speaker 1: there are any prevention measures we can take to prevent

735
00:38:44,920 --> 00:38:47,280
Speaker 1: breast cancer, Like, is it something that can be prevented?

736
00:38:47,880 --> 00:38:51,839
Speaker 3: Unfortunately, you can't really prevent cancer. I think that you

737
00:38:51,880 --> 00:38:56,960
Speaker 3: can minimize your risk, So I think it's important. Number One,

738
00:38:57,000 --> 00:38:59,840
Speaker 3: we touched on family history and so knowing what that

739
00:38:59,840 --> 00:39:02,680
Speaker 3: family history is, and I know sometimes it's hard, especially

740
00:39:02,719 --> 00:39:05,279
Speaker 3: in black families and other families of color, where they

741
00:39:05,320 --> 00:39:07,759
Speaker 3: just don't want to talk about it, but we have

742
00:39:07,840 --> 00:39:10,080
Speaker 3: to talk about it and know what other family members

743
00:39:10,120 --> 00:39:12,359
Speaker 3: went through so that we can begin to quantify our

744
00:39:12,400 --> 00:39:17,000
Speaker 3: own risk. So knowing your family history is absolutely important. Also,

745
00:39:17,800 --> 00:39:22,359
Speaker 3: I tell patients a healthy diet, healthy mix of fruits, vegetables.

746
00:39:22,440 --> 00:39:27,000
Speaker 3: Obviously you need your protein, but minimizing processed foods, minimizing

747
00:39:27,080 --> 00:39:30,799
Speaker 3: junk food is extremely important. Some people say, well, what

748
00:39:30,840 --> 00:39:34,080
Speaker 3: about sugar, Well, our bodies obviously need carbs and sugar

749
00:39:34,120 --> 00:39:38,120
Speaker 3: to function, but minimizing the processed food is huge for me.

750
00:39:38,480 --> 00:39:39,359
Speaker 4: There has been a.

751
00:39:39,480 --> 00:39:45,239
Speaker 3: Link between alcohol usage and developing breast cancer and other cancers,

752
00:39:45,520 --> 00:39:48,400
Speaker 3: and so those who binge drink or drink more than

753
00:39:48,400 --> 00:39:51,480
Speaker 3: two to three drinks a day are more likely.

754
00:39:51,800 --> 00:39:52,880
Speaker 4: To develop breast cancer.

755
00:39:52,920 --> 00:39:55,920
Speaker 3: They have an increased risk, and so that is something

756
00:39:56,200 --> 00:40:00,400
Speaker 3: that can absolutely help you prevent breast cancer. I also

757
00:40:00,440 --> 00:40:05,840
Speaker 3: tell patients minimizing outside hormones, so whether it's tossed aroone,

758
00:40:06,120 --> 00:40:10,000
Speaker 3: hormone replacement therapy, things like that, because that will absolutely

759
00:40:10,080 --> 00:40:13,040
Speaker 3: increase your risk as well. And physical activity has been

760
00:40:13,080 --> 00:40:16,239
Speaker 3: shown to decrease your risk of developing breast cancer, so

761
00:40:16,320 --> 00:40:18,960
Speaker 3: it's recommended that you do thirty minutes per day for

762
00:40:19,200 --> 00:40:20,560
Speaker 3: at least five days a week.

763
00:40:20,880 --> 00:40:21,600
Speaker 4: And so while you.

764
00:40:21,560 --> 00:40:23,960
Speaker 3: Can't really prevent cancer, there are things you can do

765
00:40:24,040 --> 00:40:25,160
Speaker 3: to mitigate your risks.

766
00:40:25,400 --> 00:40:25,879
Speaker 2: Got it?

767
00:40:26,080 --> 00:40:28,480
Speaker 1: Can you say more about the link between alcohol and

768
00:40:28,560 --> 00:40:29,200
Speaker 1: breast cancer?

769
00:40:30,080 --> 00:40:36,319
Speaker 3: So, alcohol, and we've seen alcoholics too, Alcoholics liver dysfunction,

770
00:40:36,920 --> 00:40:43,640
Speaker 3: deliver dysfunction more likely to have increased estrogen. But particularly alcohol,

771
00:40:43,840 --> 00:40:47,359
Speaker 3: it has some properties that can change normal cells to

772
00:40:48,160 --> 00:40:51,719
Speaker 3: abnormal or even malignant cells. There is a definite link

773
00:40:52,160 --> 00:40:56,480
Speaker 3: between alcohol use and developing breast cancer. And some people

774
00:40:56,560 --> 00:41:01,440
Speaker 3: ask about smoking. Also nicotine and some of the chemicals

775
00:41:01,480 --> 00:41:05,799
Speaker 3: that are in cigarettes and other things like that non

776
00:41:05,840 --> 00:41:10,839
Speaker 3: carcinogens will increase the risk of abnormal cells. And so yes,

777
00:41:11,040 --> 00:41:13,160
Speaker 3: lung cancer is more likely with smoking, but there are

778
00:41:13,239 --> 00:41:15,359
Speaker 3: other things that we could do to decrease the risk

779
00:41:15,440 --> 00:41:18,960
Speaker 3: of developing cancers in different areas of the body.

780
00:41:19,520 --> 00:41:20,000
Speaker 2: Got it.

781
00:41:20,160 --> 00:41:22,880
Speaker 1: We often hear people talking about they are in remission.

782
00:41:23,280 --> 00:41:25,320
Speaker 1: What happens when you're in remission from cancer?

783
00:41:26,160 --> 00:41:30,160
Speaker 3: So when people typically say in revision, that means they

784
00:41:30,200 --> 00:41:35,399
Speaker 3: have been shown to be cancer free for at least

785
00:41:35,480 --> 00:41:39,319
Speaker 3: five years, usually minimum five years. I don't like to

786
00:41:39,400 --> 00:41:45,440
Speaker 3: say cancer free honestly, because if you were cancer free,

787
00:41:45,480 --> 00:41:47,840
Speaker 3: this never would have happened in the first place. And honestly,

788
00:41:47,960 --> 00:41:52,880
Speaker 3: once the tumor becomes invasive, you cannot control where those

789
00:41:52,880 --> 00:41:56,439
Speaker 3: cancer cells go. They may just be asleep. You don't

790
00:41:56,440 --> 00:41:58,880
Speaker 3: know if they'll stay sleep or if something will happen

791
00:41:58,880 --> 00:42:01,960
Speaker 3: in the future. So I do you prefer in remission

792
00:42:02,080 --> 00:42:06,040
Speaker 3: instead of cancer free? Just because again, I've seen so

793
00:42:06,120 --> 00:42:08,799
Speaker 3: many crazy things happen, but usually that five year mark

794
00:42:08,880 --> 00:42:11,280
Speaker 3: that's when we can do a happy dance and celebrate.

795
00:42:11,640 --> 00:42:13,640
Speaker 1: So I'm also aware, doctor Gord, that you have blown

796
00:42:13,680 --> 00:42:16,360
Speaker 1: my mind with all these misconceptions I think that I

797
00:42:16,400 --> 00:42:19,279
Speaker 1: had about breast cancer. Is there anything else that I

798
00:42:19,320 --> 00:42:21,239
Speaker 1: have not asked you about that you really feel like

799
00:42:21,360 --> 00:42:23,759
Speaker 1: is important for people to know about their risk and

800
00:42:23,800 --> 00:42:25,040
Speaker 1: taking care of themselves.

801
00:42:25,520 --> 00:42:27,279
Speaker 3: I kind of touched on it, but I really think

802
00:42:27,280 --> 00:42:30,959
Speaker 3: it's important for men to know, or for the women

803
00:42:31,040 --> 00:42:34,759
Speaker 3: who are looking at this informing their men that they

804
00:42:34,800 --> 00:42:38,120
Speaker 3: are not exempt because they are men. And men actually

805
00:42:38,120 --> 00:42:42,799
Speaker 3: comprise one percent of breast cancer cases each year, so

806
00:42:43,680 --> 00:42:47,200
Speaker 3: approximately it's gone up, so almost three thousand cases will

807
00:42:47,239 --> 00:42:50,480
Speaker 3: be diagnosed in men this year, and it's important to

808
00:42:50,520 --> 00:42:54,280
Speaker 3: know that the numbers for black men mirror the numbers

809
00:42:54,320 --> 00:42:56,560
Speaker 3: for black women, and so black men are more likely

810
00:42:56,600 --> 00:43:01,480
Speaker 3: to have more aggressive tumors later stage at diagnosis and

811
00:43:01,560 --> 00:43:05,319
Speaker 3: also more likely to have an increased mortality compared to

812
00:43:05,400 --> 00:43:08,960
Speaker 3: their white male counterparts. And so it's important that across

813
00:43:09,000 --> 00:43:13,680
Speaker 3: the board we're holding each other accountable and looking out

814
00:43:13,719 --> 00:43:14,319
Speaker 3: for each other.

815
00:43:14,760 --> 00:43:17,120
Speaker 1: So what suggestions would you give for men, because it's

816
00:43:17,120 --> 00:43:20,160
Speaker 1: typically not suggestion that they have mammograms, correct, So what

817
00:43:20,239 --> 00:43:21,920
Speaker 1: kinds of things would they be on the lookout for.

818
00:43:22,480 --> 00:43:26,439
Speaker 3: They should do breast self examinations also, and I tell

819
00:43:26,480 --> 00:43:30,480
Speaker 3: every patient man or woman or whatever pronow you go by,

820
00:43:30,600 --> 00:43:34,840
Speaker 3: if you feel something, say something and let somebody know

821
00:43:34,960 --> 00:43:36,839
Speaker 3: a sap so that we can get it worked up.

822
00:43:37,400 --> 00:43:40,680
Speaker 3: But typically it's much easier for them to examine themselves,

823
00:43:41,000 --> 00:43:43,879
Speaker 3: so to do examinations in the shower or when they're

824
00:43:43,960 --> 00:43:44,600
Speaker 3: lying on the bed.

825
00:43:44,600 --> 00:43:45,480
Speaker 2: Also, got it?

826
00:43:45,560 --> 00:43:47,840
Speaker 1: And would you say that men are more likely to

827
00:43:47,920 --> 00:43:50,000
Speaker 1: feel something or is it the same case where they

828
00:43:50,160 --> 00:43:51,240
Speaker 1: often won't feel anything.

829
00:43:51,280 --> 00:43:52,640
Speaker 4: Either, it's easier.

830
00:43:52,320 --> 00:43:55,640
Speaker 3: For them to feel something because there's less tissue and

831
00:43:55,680 --> 00:43:58,160
Speaker 3: they get the same symptoms women get. So I had

832
00:43:58,160 --> 00:44:03,359
Speaker 3: one patient he presented with nipple discharge that would happen sporadically,

833
00:44:03,960 --> 00:44:07,240
Speaker 3: like every two to three months, it ended up being cancered.

834
00:44:07,239 --> 00:44:09,759
Speaker 3: So pay attention to those signs and don't ignore them.

835
00:44:10,080 --> 00:44:12,600
Speaker 1: So where can we stay in touch with you, doctor Gore?

836
00:44:12,680 --> 00:44:15,319
Speaker 1: What is your website as well as any social media

837
00:44:15,360 --> 00:44:16,239
Speaker 1: handles you'd like to.

838
00:44:16,200 --> 00:44:19,719
Speaker 3: Share across the board on all socials, so you can

839
00:44:19,800 --> 00:44:23,239
Speaker 3: find me at Ryland Gore md R Y L A

840
00:44:23,520 --> 00:44:24,719
Speaker 3: N D G O.

841
00:44:24,800 --> 00:44:25,680
Speaker 4: R E M D.

842
00:44:26,360 --> 00:44:31,680
Speaker 1: Thank you for adding that. I appreciate it. I'm so

843
00:44:31,800 --> 00:44:34,279
Speaker 1: glad doctor Gore was able to share her expertise with

844
00:44:34,360 --> 00:44:37,280
Speaker 1: us today. To learn more about her and her work,

845
00:44:37,680 --> 00:44:40,400
Speaker 1: visit the show notes at Therapy for Blackgirls dot Com

846
00:44:40,440 --> 00:44:44,120
Speaker 1: slash Session three twenty nine, and don't forget to text

847
00:44:44,120 --> 00:44:46,520
Speaker 1: two of your girls right now to encourage them.

848
00:44:46,400 --> 00:44:47,799
Speaker 2: To check out the episode.

849
00:44:48,000 --> 00:44:50,600
Speaker 1: If you're looking for a therapist in your area, check

850
00:44:50,600 --> 00:44:53,839
Speaker 1: out our therapist directory at Therapy for Blackgirls dot Com

851
00:44:53,880 --> 00:44:57,279
Speaker 1: slash directory. And if you want to continue digging into

852
00:44:57,360 --> 00:45:00,239
Speaker 1: this topic or just be in community with other sisters,

853
00:45:00,680 --> 00:45:02,760
Speaker 1: come on over and join us in the Sister Circle.

854
00:45:03,280 --> 00:45:05,680
Speaker 1: It's our colzy corner of the Internet designed just for

855
00:45:05,760 --> 00:45:09,080
Speaker 1: black women. You can join us at Community dot Therapy

856
00:45:09,160 --> 00:45:14,080
Speaker 1: for Blackgirls dot com. This episode was produced by Frida Lucas,

857
00:45:14,160 --> 00:45:18,880
Speaker 1: Elise Ellis, and Zaria Taylor. Editing was done by Dennison Bradford.

858
00:45:19,840 --> 00:45:22,160
Speaker 1: Thank y'all so much for joining me again this week.

859
00:45:22,600 --> 00:45:25,359
Speaker 1: I look forward to continuing this conversation with you all

860
00:45:25,600 --> 00:45:26,200
Speaker 1: real soon.

861
00:45:27,040 --> 00:45:27,719
Speaker 2: Take good care.

862
00:45:32,080 --> 00:45:35,680
Speaker 1: What's The reviews for Sisterhood Heels are rolling in and

863
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864
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865
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866
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867
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868
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869
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870
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871
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