Speaker 1: Welcome to Symptomatic.
Speaker 2: Today, we're recording from the twenty twenty four Asco American
Speaker 2: Society of Clinical Oncology Annual Meeting, talking about breast cancer.
Speaker 2: One in eight women will navigate a diagnosis of breast
Speaker 2: cancer during their lifetime, and it accounts for nearly one
Speaker 2: third of all cancer cases and women. I am joined
Speaker 2: by two esteemed warriors in the battle against breast cancer.
Speaker 2: Doctor Nan Chen Breast, a medical oncologist at University of
Speaker 2: Chicago Medicine, where she is also an Assistant Professor of Medicine,
Speaker 2: and doctor Sarah Shuback, a surgeon who specializes in breast cancer,
Speaker 2: also at the University of Chicago Medicine, where she is
Speaker 2: an Assistant Professor of Surgery. Welcome doctors, Thank you so
Speaker 2: much for joining me.
Speaker 3: Thank you, thank you so much for having us.
Speaker 2: Before we even dive in, I would love to ask
Speaker 2: both of you what drew you to breast cancer as
Speaker 2: a specialty in Doctor Chin, why don't you start sure?
Speaker 4: I initially became really interested in oncology because I really
Speaker 4: liked the idea that we were taking care of the
Speaker 4: whole patient. I just thought that it was really mentally
Speaker 4: fascinating and then there really was no relationship that I
Speaker 4: enjoyed seeing more as a medical student than the relationship
Speaker 4: between a patient oncologist. They just felt really important in
Speaker 4: their lives, and I really felt like I wanted to
Speaker 4: be that person. I think the simplest way to describe
Speaker 4: why I like breast cancers, I just really enjoy taking
Speaker 4: care of women. I just think it's such a special
Speaker 4: group of people. I can get along with them really well.
Speaker 4: I also like the fact that, compared to some other cancers,
Speaker 4: there are a lot of things that I can do.
Speaker 4: There are a lot of options that I have, and
Speaker 4: I feel like I can be more helpful.
Speaker 3: I really love it.
Speaker 1: Excellent doctor Shueback.
Speaker 5: Yeah, so I was first really drawn to surgery as
Speaker 5: a job because I like to have a one day
Speaker 5: event where I fix something, and that felt really satisfying
Speaker 5: to me. Cancer, though, is this long term relationship that
Speaker 5: also really grabbed my attention and restargible. Oncology was the
Speaker 5: last thing I thought I would actually end up doing
Speaker 5: until I similarly fell in love with the idea of
Speaker 5: taking care of women. And I think mostly because what
Speaker 5: we do is pull people back from feeling like a
Speaker 5: puddle when They're usually the pillar in their family, and
Speaker 5: so I think we often meet people on their worst
Speaker 5: day and get to watch women rise from whatever their
Speaker 5: ashes may be and become again that force, that strength,
Speaker 5: that pillar of their family. And that was ultimately what
Speaker 5: I fell in love with. And I think, like so
Speaker 5: many of us, they have a lot of breast cancer
Speaker 5: in my family, and I always wanted the opportunity, need
Speaker 5: to be the one to do it right for people,
Speaker 5: because I saw it be so hard for the people
Speaker 5: I loved.
Speaker 3: What do you.
Speaker 2: Both find remain the most prevalent misconceptions or myths about
Speaker 2: breast cancer in general?
Speaker 4: I think that one of the most common scenarios that
Speaker 4: we encounter is women when we first meet them, think
Speaker 4: that they did something to cause this breast cancer, that
Speaker 4: some decisions that they made in their life have led
Speaker 4: them to hear and in the vast majority of cases,
Speaker 4: that's really not true. And so one of the things
Speaker 4: I think we do when we first meet patients is
Speaker 4: to almost unpack that guilt and make sure that we
Speaker 4: understand that this unfortunately just happens. As you mentioned before,
Speaker 4: and one in eight women, that's probably one of the
Speaker 4: most common misconceptions.
Speaker 3: I see.
Speaker 5: I also think that we think of breast cancer as
Speaker 5: one disease entity, but it really is a whole collection
Speaker 5: of diseases that interact with people's lives at different times
Speaker 5: of their life, of different scenarios. And just because your
Speaker 5: neighbor had one experience doesn't mean you will. So I
Speaker 5: think a lot of what we spend time with saying,
Speaker 5: you know in twenty twenty four this is each person
Speaker 5: has a different story, each person needs different interventions, and
Speaker 5: trying to kind of separate what one woman is facing
Speaker 5: based on what maybe she's read or heard about is
Speaker 5: really important to give her clarity, to put her as
Speaker 5: kind of the captain of the ship, and to allow
Speaker 5: her to make good decisions for her health.
Speaker 2: Also, I should think that there is a misconception that
Speaker 2: we're just talking about lumps. Yeah, you know, less than
Speaker 2: five percent of cases, pain is actually an indicator.
Speaker 5: Yeah. I think when we consider how different women present,
Speaker 5: it's a whole host of things. You know, it's new
Speaker 5: nipple discharge that they hadn't noticed before. It's a size change,
Speaker 5: it's nipple retraction or dimpling of the skin. Things that
Speaker 5: just don't sit right with someone. Usually warrant evaluation. You know,
Speaker 5: we know our body's best and so I think that
Speaker 5: a lot of the women that doctor Tenn and I
Speaker 5: take care of are often too young for mammograms right
Speaker 5: or are diagnosed before they would have started routine screening.
Speaker 5: So we're really relying on them or their doctors to
Speaker 5: just notice something is different and to feel that that
Speaker 5: difference might be a real health concern and to get
Speaker 5: it evaluated.
Speaker 2: In what sense does timing still remain one of the
Speaker 2: most important weapons in your arsenal against breast cancer?
Speaker 4: We know in breast cancer, the earlier we find the cancer,
Speaker 4: the better it is, and I say better in many
Speaker 4: different ways. First and foremost, we know that your prognosis
Speaker 4: is better, the chances of you surviving this cancer are better.
Speaker 4: It also means in many cases we can de escalate
Speaker 4: your therapy. If you have an earlier stage cancer, we
Speaker 4: can give you less treatment for it, which I would love.
Speaker 4: And so to doctor Schubek's point, it's so important for
Speaker 4: women to know their bodies and to make sure that
Speaker 4: doctors and other providers are listening to these women when
Speaker 4: they mention things going on, and.
Speaker 3: Also the timing in one's life.
Speaker 5: You know, we take care of young women who go
Speaker 5: on to live full lives, have healthy pregnancies, fulfill whatever
Speaker 5: it is that's in their goals and desires. We also
Speaker 5: take care of women later decades of life who have
Speaker 5: you know, even shorter intervention periods for care, and that's
Speaker 5: because we're learning more that these diseases vary across a
Speaker 5: lifetime and very based on the person. And then really,
Speaker 5: as dutch Chun mentioned, the earlier we can find a problem,
Speaker 5: the less likely it is to threaten someone's safety. And
Speaker 5: that is why early intervention, early identification is just critical
Speaker 5: and why you know, screening has made so many improvements
Speaker 5: for women who are eligible for screening because we're finding
Speaker 5: breast cancers at earlier and earlier stages.
Speaker 2: And I believe that in stages one and two, eighty
Speaker 2: five percent of the cases you diagnose are treatable.
Speaker 4: I would actually say that one hundred percent are potentially curable.
Speaker 4: And really, our therapies are getting better and better every year.
Speaker 4: And I think doing this at ASCO twenty twenty four
Speaker 4: is just such a stark reminder of the progress we
Speaker 4: have made in breast cancer even the last decade, and
Speaker 4: the progress we're continuing to make that when I meet
Speaker 4: a woman, I say, we can cure you right now.
Speaker 3: We can get rid of this cancer.
Speaker 4: The bigger problem and the bigger goal I have is
Speaker 4: to make sure this cancer doesn't come back. And we
Speaker 4: are getting better and better every day with our therapies
Speaker 4: to make sure that that doesn't happen.
Speaker 2: And the whole concept that don't worry about breast cancer
Speaker 2: till you're forty is dated.
Speaker 4: That is quite dated, and I would argue that's a
Speaker 4: really dangerous message because we aren't screening women.
Speaker 3: Usually before the age of forty.
Speaker 4: We can actually miss early cancers in younger women because
Speaker 4: we're not looking, and those women are also not necessarily
Speaker 4: educated to know to look for these things in their body. Unfortunately,
Speaker 4: the rate of young breast cancer is actually rising since
Speaker 4: like the early two thousands, and so another reason that
Speaker 4: we really need to be careful in the younger population.
Speaker 1: What do you attribute that to.
Speaker 4: I think the short answer is, really I don't know,
Speaker 4: And the longer answer is, I think there are a
Speaker 4: lot of things happening. Girls are getting their periods earlier,
Speaker 4: and so you just have a longer time in your
Speaker 4: life that you're getting hormonal exposure and that can increase
Speaker 4: your risk of developing breast cancer. This is actually, unfortunately
Speaker 4: a trend we're seeing in other cancers as well, like
Speaker 4: cooling cancer. So there's probably lots of reasons that are
Speaker 4: environmental and societal that are leading this, but it's a
Speaker 4: concerning trend that we should all very much be aware of.
Speaker 2: I want to jump into the topic of collaboration. But
Speaker 2: before we even get their doctor chin. Despite breast cancer
Speaker 2: being fairly common, unfortunately and straightforward in terms of the diagnosis,
Speaker 2: is there an individual aspect to each case you diagnose.
Speaker 4: So the road to individualizing cancer medicine is a long
Speaker 4: road that we are on and will be on for
Speaker 4: a long time. We know in twenty twenty four we
Speaker 4: are still over treating some women, and we know in
Speaker 4: twenty twenty four we are also under treating some women.
Speaker 4: We are starting to become smarter using biomarkers and genomic
Speaker 4: tools to better thread that needle and make sure that
Speaker 4: patients are getting the appropriate amount of therapy, but it
Speaker 4: can be difficult sometimes to figure out whether we're being
Speaker 4: too aggressive or not aggressive enough, whether patient's cancer and
Speaker 4: everything really should be tailored to each individual cancer.
Speaker 3: Two women sitting next to each other.
Speaker 4: Even if they have on the surface very similar cancer features,
Speaker 4: stage all a subtype, all of that may still have
Speaker 4: very different tumors. We now can do genomic testing and
Speaker 4: molecular testing to really be able to dive deeper into
Speaker 4: how the cancer actually functions, the biological way that it works.
Speaker 2: And doctor Schuebeck, how do you emphasize the importance of teamwork.
Speaker 2: You know, a multidisciplinary team of doctors when treating breast
Speaker 2: cancer patients, and why is it crucial for all members
Speaker 2: of that medical team to work towards moving in the
Speaker 2: same direction.
Speaker 5: Yeah. The reason why I think it's particularly timely now
Speaker 5: is because the game is changing for the better. In
Speaker 5: the origin story is of breast cancer, we thought it
Speaker 5: was a surgery disease, just cut it out. And most
Speaker 5: patients are still kind of referred from their primary physician
Speaker 5: or provider to a surgeon when they have a new diagnosis.
Speaker 5: But very often I'm not the first person at that,
Speaker 5: so it's really figuring out for each person who their
Speaker 5: starting quarterback should be. And so I think that's not
Speaker 5: really something that happens in isolation. Right, Some patients need
Speaker 5: medical therapy first to make their surgery smaller. Some patients
Speaker 5: need surgery first to help understand how much medicine they need,
Speaker 5: and that's not one size fits all.
Speaker 3: That depends on.
Speaker 5: Who the patient is, what cancer they have, how much
Speaker 5: cancer they have, what can they tolerate? And so if
Speaker 5: I were to decide just all of those things, that's
Speaker 5: kind of like an electrician telling you what a plumber
Speaker 5: should do. And I think there's a lot of value
Speaker 5: in constantly learning from one another and most importantly holding
Speaker 5: the patient's values and what they can endure or want
Speaker 5: to endure, or just how they're facing their journey as
Speaker 5: the centerpiece of our discussions.
Speaker 3: And during a patient's treatment journey, there are many touch
Speaker 3: points in which decisions that I make will very much
Speaker 3: influence what doctor Schubeck does, and things that she is
Speaker 3: thinking of will very much influence what I do.
Speaker 4: Just last week, I called you on my way home
Speaker 4: because we just had a stuff patients where I was like,
Speaker 4: I want to give you some updates as to kind
Speaker 4: of what's going on, to make sure that you're in
Speaker 4: the loop and that you can make decisions.
Speaker 3: With the most update information that you have.
Speaker 5: And I think it's important to say too that the
Speaker 5: surgeries are getting smaller, right, So breast cancer surgery is
Speaker 5: a story of de escalation almost uniformly, which I'm thrilled for.
Speaker 3: I can't wait to be put out of a job.
Speaker 5: And I think that's because the medicines are not necessarily
Speaker 5: getting bigger, but getting more tailored. Right, So the medicines
Speaker 5: are getting more effective in the upfront setting, which allows
Speaker 5: me to do really small surgeries that lead to less
Speaker 5: disfigurement for people, leads to better function after surgery. We
Speaker 5: need to be supportive of our patients in getting the
Speaker 5: right intervention. And so if that means in twenty years
Speaker 5: there's no role for surgery and breast cancer, I'll retool.
Speaker 3: I'll be just fine.
Speaker 5: But how amazing would that be if that story and
Speaker 5: that trend continues.
Speaker 2: You mentioned team, and you mentioned the different roles plumber, electrician,
Speaker 2: you know, but ideally, who would you guys like to
Speaker 2: see on your ideal breast cancer management team?
Speaker 4: You know, honestly, that team is as big as a
Speaker 4: football team, really is.
Speaker 3: It's huge.
Speaker 4: It is both a surgical oncologist, a medical oncologist, a
Speaker 4: radiation oncologist, a reconstructive surgeon. Potentially it is a nurse navigator.
Speaker 4: It may be a genetic counselor a therapist.
Speaker 3: Who can help with a lot of the you.
Speaker 4: Know, mental health struggles that women go through throughout this diagnosis.
Speaker 4: It is a physical therapist who can help maintain motion
Speaker 4: after surgery.
Speaker 3: It really is such a large.
Speaker 4: Team of people that we work with that would make
Speaker 4: up the ideal team.
Speaker 5: And often it's things like genetic counselors, right, it's risk
Speaker 5: producing for the patient and also thinking about their whole families.
Speaker 5: It's fertility doctors for patients who are getting fertility preservation
Speaker 5: before surgery. It's primary care doctors, right. It's the person
Speaker 5: who knows that patient before their diagnosis and is going
Speaker 5: to continue to care for them long after. So it's
Speaker 5: all of those people and more. And then if I
Speaker 5: had everything I ever wanted, it'd be the PA's family,
Speaker 5: it'd be the patient's employers, it'd be all the patients
Speaker 5: surrounding ecosystems so that we together can support that person
Speaker 5: in their journey. I think that we also all have
Speaker 5: to work for the same person, and that's the patient.
Speaker 2: So let's just talk about the importance of collaboration between
Speaker 2: specialists like oncologist surgeons to enhance patient outcomes.
Speaker 4: I think one of my favorite parts of our relationship
Speaker 4: is how open we are with each other and how
Speaker 4: even if something maybe didn't go as well as I
Speaker 4: wanted it to, I'm like, hey, this is what happened,
Speaker 4: this is where we are, this is how we go forward.
Speaker 4: Or it's like, oh, hey, I had this conversation with
Speaker 4: a patient. It kind of went off in a left
Speaker 4: direction and I didn't really like it, but just so
Speaker 4: you know, so when she brings it up, this is
Speaker 4: kind of what we discussed, and I think there's no
Speaker 4: judgment on that part that you know, this is life
Speaker 4: and we do the best we can.
Speaker 5: I think also one of the really breakthrough moments for
Speaker 5: me with Nan and our practice that we share is
Speaker 5: I was sitting at my kids gymnastics class on a
Speaker 5: Friday night and she calls me, and you know, usually
Speaker 5: there's a warm up text message to say, you know,
Speaker 5: we need to discuss some patients. But I just got
Speaker 5: this call and I had like two minutes where I
Speaker 5: was able to answer.
Speaker 3: I was otherwise, you know, wrapping up some work for.
Speaker 5: The week, and she called me and told me about
Speaker 5: one of our mutually loved kind young patients who was
Speaker 5: experiencing a devastating outcome from her breast cancer journey, and
Speaker 5: we just kind of sat there together in shock. One
Speaker 5: thing that deut Or Chunnan and I both do is
Speaker 5: we really emotionally invest our patients, maybe to a point
Speaker 5: where it's a bit much, and sometimes we lean on
Speaker 5: each other to pull us back. And so in that moment,
Speaker 5: the exact person I needed to talk to was somebody
Speaker 5: else who was present with that patient, was connected to
Speaker 5: that person. You know, cancer is unfortunately still really unfair
Speaker 5: in so many ways to such beautiful lives, and so
Speaker 5: when things go really south, I know that I can
Speaker 5: call her and have that life raft.
Speaker 2: I was going to next venture into the emotional component
Speaker 2: of you do, But before I even get there, how
Speaker 2: did your paths initially cross?
Speaker 4: I consider myself so lucky that Sarah and I happened
Speaker 4: to start our jobs respectively at the University of Chicago
Speaker 4: at the same month, literally, and as we got talking,
Speaker 4: it was like our philosophies of how we care for
Speaker 4: patients and how we practice medicine.
Speaker 3: Are really really similar.
Speaker 5: You know, there's a lot of times we call patients
Speaker 5: together on the phone I've gotten really good at connecting
Speaker 5: people in through phone calls, and patients really are blown
Speaker 5: away when we're both on the phone. But I think
Speaker 5: one of the hardest things about patient care is that
Speaker 5: often they're retelling their story to every single person on
Speaker 5: their team. And if we can sit there together and
Speaker 5: I can hear how they're interacting with what doctor Chen
Speaker 5: is telling them, you know, and she can hear about
Speaker 5: my surgical take, it really helps a lot. It's kind
Speaker 5: of forced us to melt together, and it's only making
Speaker 5: it feel more seamless, I hope for our patients, and
Speaker 5: it feels more seamless for me.
Speaker 4: We're starting to sound like each other. It's a little
Speaker 4: creepy time I'm.
Speaker 5: Say things that she does when she's not in the room. Yeah,
Speaker 5: because it's fun. Like when we see patients together. If
Speaker 5: I'm just sitting and I have a few minutes, I'll
Speaker 5: just barge right in and I'll sit on the you know,
Speaker 5: on the bed, and I'll listen because I want to
Speaker 5: know how she's explaining the same thing I'm trying to.
Speaker 2: That is such honestly an intelligent approach, though, because you
Speaker 2: are saving time, but you were also protecting the patient
Speaker 2: from having to go through their entire case history.
Speaker 5: Again, Yeah, I think that is a huge, huge advantage
Speaker 5: because it's like a shared flock, right, Like, it really
Speaker 5: has made it so that we're all getting the same
Speaker 5: information and we're really making decisions as a team with
Speaker 5: a patient in charge.
Speaker 2: We touched upon the emotional aspect of what you do
Speaker 2: in terms of the heavy lifting of that personally, But
Speaker 2: what would you say remains the most difficult aspect of
Speaker 2: both of your work to navigate.
Speaker 4: I see advanced breast cancer, which is not curable, and
Speaker 4: that means that despite for the vast majority of these women,
Speaker 4: despite what I do with the best treatments available, they
Speaker 4: are unfortunately going to pass from their disease. To be
Speaker 4: perfectly honest, I am always very very scared of that happening,
Speaker 4: because I know it will happen and it's just part
Speaker 4: of my job. But it remains such a constant fear
Speaker 4: that I'm going to have to emotionally deal with that
Speaker 4: and have to kind of deal with what happens after,
Speaker 4: which is that I have to think about, you know,
Speaker 4: all the time we spent together and continue doing what
Speaker 4: I do.
Speaker 5: On the other side, I think almost similarly, but I'm
Speaker 5: even less helpless than doctor chen Is. When patients cross
Speaker 5: over the line as being local, locally advanced to being metastatic.
Speaker 5: My entire job is to basically sit it out. I
Speaker 5: think that's really incredibly humbling. Has I then call on
Speaker 5: my teammate, who I already burden with my emotional needs
Speaker 5: and my you know, collaborative needs, and say, I've got
Speaker 5: nothing as a surgeon to help this patient. Cancer has
Speaker 5: this knack of being unexpectedly terrible when things are going okay.
Speaker 5: Oh absolutely, you know, it has felt so often like
Speaker 5: these humans you see, so full of life and so
Speaker 5: full potential that's stolen by cancer. And I think that's motivating,
Speaker 5: but it's it's a really hard thing to carry.
Speaker 3: You know.
Speaker 2: There's so much to process in terms of receiving a diagnosis.
Speaker 2: How do you help patients navigate that emotionally but also
Speaker 2: in terms of information overload?
Speaker 4: I think for that, Sarah and I have wonderful teams
Speaker 4: of people that help us. And so, for example, if
Speaker 4: someone needs to undergo chemo therapy, I have a wonderful
Speaker 4: nurse who goes in there and spends another twenty minutes
Speaker 4: just discussing the.
Speaker 3: Logistics of chemo therapy.
Speaker 4: I have a breast cancer pharmacist who goes in there
Speaker 4: for twenty additional minutes and talks about these chemos.
Speaker 3: To the last detail.
Speaker 4: There are also some visits where you know, for example,
Speaker 4: on a first visit, there's certain pieces of information I
Speaker 4: want to impart, but sometimes I don't get to most
Speaker 4: of them because we're just really upset and we're just
Speaker 4: trying to process and this just isn't a good day
Speaker 4: for me to talk about exactly what chemo you need.
Speaker 4: And that happens, and if it does, then we'll see
Speaker 4: you in two weeks and we'll.
Speaker 3: Kind of have that discussion again.
Speaker 5: I've also adopted that if I get a bunch of
Speaker 5: messages about a person, I pick up the phone and
Speaker 5: I just introduce.
Speaker 3: Myself on the phone to people.
Speaker 5: It's amazing how different the first visit goes when they
Speaker 5: just know that I'm going to show up and that
Speaker 5: I'm going to be a person too. And I feel
Speaker 5: like in so much in healthcare now, when you try
Speaker 5: to schedule a doctor's appointment, you talk to forty two people,
Speaker 5: but you don't know what you're going to get, and
Speaker 5: so often I just call them and I'm like, Hey,
Speaker 5: I'm Sarah Shueck, I'm a breast cancer doctor.
Speaker 3: How are you.
Speaker 5: Being a humans really valuable for people? And so I
Speaker 5: do it for myself too, because I want to know
Speaker 5: who I'm walking into. I want to ask them who
Speaker 5: they're going to bring with because then I know who's
Speaker 5: important to them. One of the hardest things is covering
Speaker 5: the stress of a cancer diagnosis, the next steps of it,
Speaker 5: and still getting to know a person as a person
Speaker 5: and being able to understand in that forty minute conversation
Speaker 5: what matters most to them, what are they most afraid of,
Speaker 5: and how do they feel about this, because usually that
Speaker 5: forty minute sounds like doctor Trennon and I rattling off
Speaker 5: medical facts to them. And I always tease that my
Speaker 5: first favorite visit is the six month post surgery visit
Speaker 5: because they usually are themselves and we've never met themselves,
Speaker 5: you know, we've never met them like they would be
Speaker 5: at the grocery store. They're scared, they're stress, they're families
Speaker 5: on edge.
Speaker 4: And then it's so much fun to really get to
Speaker 4: know them as we get them through their vivorship.
Speaker 3: That's so much fun.
Speaker 2: One hundred percent you mentioned having that support system present
Speaker 2: for some patients who have that go to person with them.
Speaker 1: In what way.
Speaker 2: Does that help in terms of talking through risk assessment
Speaker 2: with patients and how do you ensure that there is
Speaker 2: actual clarity in these conversations.
Speaker 4: Having a support system is so so huge. Sarah and
Speaker 4: I share a patient who when she was diagnosed, she
Speaker 4: called on her gang of girlfriends, like a dozen of
Speaker 4: these women, and literally every time she came there was
Speaker 4: a different girlfriend that came with her that was like
Speaker 4: diligently taking notes and asking us questions, and it was
Speaker 4: just the most beautiful thing to see. But if a
Speaker 4: patient comes alone, I specifically ask like, can we call someone,
Speaker 4: because they're going to remember two percent of what I say.
Speaker 4: Maybe if there's someone on the phone, they're going to
Speaker 4: remember ten percent of what I say. But having support,
Speaker 4: I think is just so crucial.
Speaker 5: And I think too, whatever that means to the person
Speaker 5: is fine with us. Yes, you know, I've walked into
Speaker 5: rooms where somebody has their neighbor, the ophthalmologists, their sister,
Speaker 5: the nurse, and their spouse with them. Whoever is your
Speaker 5: army who's going to help you make a decision is great,
Speaker 5: But Ultimately, especially as a breast surgeon, what physically happens
Speaker 5: to your body, right, the changes that are going to
Speaker 5: happen to your breast, the way your breats are going
Speaker 5: to look and feel afterward. The only opinion I care
Speaker 5: about is the patience. But I want everybody else in
Speaker 5: the room, you know, it's amazing. Sometimes I tell my
Speaker 5: patients that I'm going to be the first one to
Speaker 5: make their dad blush if he comes in, and I'm
Speaker 5: fine with that. You know, I'm a breast surgeon. We
Speaker 5: have to talk about what your body does. We have
Speaker 5: to talk about how your body's going to change. We
Speaker 5: have to talk about your feelings of whole self, your embodiment,
Speaker 5: your sexuality.
Speaker 3: All that has to happen.
Speaker 5: So as long as you're comfortable with the people you
Speaker 5: bring hearing all that, I'm comfortable too. It can be
Speaker 5: your mailman, you're an uber driver, your whatever, just whoever's
Speaker 5: going to show up for you in a time when
Speaker 5: you need them. I also to always ask if they
Speaker 5: are the person who usually is the one keeping it
Speaker 5: together in their life, because if they're the matriarch, right,
Speaker 5: if they're the pillar, this is not going to be
Speaker 5: a season of life where they get to do that,
Speaker 5: and so it's also a really nice opportunity to kind
Speaker 5: of say to everyone in the room, Mom, sister neighbor
Speaker 5: is not going to be the quarterback for a little while,
Speaker 5: to be again because women are strong, but during that season,
Speaker 5: somebody else has to take control.
Speaker 2: Going back to an earlier conversation, just in terms of
Speaker 2: confusion and misconception, there remains a lot of confusion surrounding
Speaker 2: genomic risk. Yeah, how would you break it down and
Speaker 2: how does it ultimately influence the treatment decision, particularly for
Speaker 2: early stage breast cancer.
Speaker 4: So I think that there are multiple genomic tests now
Speaker 4: that are available. I think the most important thing when
Speaker 4: we have a test is we need to use it appropriately, right,
Speaker 4: because if we're not using it appropriately, then it's really
Speaker 4: hard to interpret what those results are. But genomic testing,
Speaker 4: especially in ER positive her too negative breast cancer, has
Speaker 4: been so instrumental to helping us understand what are the
Speaker 4: actual treatments that are going to benefit patients and that
Speaker 4: they can spare patients toxic chemotherapy and other drugs. It's
Speaker 4: also a great time to have a conversation with a
Speaker 4: patient because they always want to know what are the
Speaker 4: chances my cancer is going to come back. And I'm
Speaker 4: never able to say that with like one hundred percent certainty,
Speaker 4: but I can say like, oh, I have these tests
Speaker 4: that can help me do a better job of estimating
Speaker 4: that for you, so we can better tailor treatment.
Speaker 5: It's often something patients ask me as a surgeon about,
Speaker 5: But I think what's so important about genomic testing is
Speaker 5: it's not necessarily what's happening right where we're cutting it out.
Speaker 5: There's this notion that like where it is where we're
Speaker 5: cutting it out from is the only problem. But so
Speaker 5: much of this testing and so much of the therapy
Speaker 5: we give is for all of that possible confetti that's
Speaker 5: trying to make its way elsewhere. So it's a hard
Speaker 5: thing for me, and I'm as confused often as our
Speaker 5: patients are about the newest genomic tests that we're doing,
Speaker 5: the newest indication for it. And so that's where it's
Speaker 5: incredibly critical for me as a surgeon to say to patients, Hey,
Speaker 5: I get your surgery pathology back. I'm calling you first,
Speaker 5: and I'm calling doctor Chen's second, because I want her
Speaker 5: to decide if we need specialty testing, if we need
Speaker 5: to do anything more so that she can set the
Speaker 5: dial right for the medical therapy, just as we worked
Speaker 5: hard beforehand to set the dial right for the surgical therapy.
Speaker 2: In terms of the different types of prognostic testing available,
Speaker 2: how do they ultimately influence the treatment plan for breast
Speaker 2: cancer patients?
Speaker 4: Generally speaking, if you have a higher risk cancer, we
Speaker 4: want to do things to try to mitigate that risk,
Speaker 4: and more often than not, that means more medical therapy
Speaker 4: or stronger medical therapy. This is something that allows us
Speaker 4: to say we think that you have a higher recurrence risk.
Speaker 4: That means that we need to give you, you know, intensive chemotherapy,
Speaker 4: or we can say, oh, you have a low recurrence risk.
Speaker 3: We can just give you let resolve for a few
Speaker 3: years and we think you'll be fine.
Speaker 2: This might seem a little bit redundant, but how do
Speaker 2: you go about identifying other risk factors for patients, such
Speaker 2: as through bio marker.
Speaker 1: Tests, and how do they shape treatment plans.
Speaker 4: So there are genomic tests such as oncotype that are
Speaker 4: run on pre treated surgical samples, whether it's at the
Speaker 4: time of surgery if doctor Trubek goes first, or.
Speaker 3: On the biopsy sample.
Speaker 4: These tests can give us a recurrence score, and this
Speaker 4: is a test that is both predictive and prognostic, predictive
Speaker 4: to the benefit of chemotherapy and prognostic to their recurrence risk.
Speaker 4: So these tests have been really helpful in the last
Speaker 4: decade in helping us better tailor therapies to women and
Speaker 4: helping us make sure that we are treating women appropriately
Speaker 4: to match their cancer risk.
Speaker 2: When it comes to recurrence. There remains significant unmet need
Speaker 2: in the treatment of stage two and three hormone receptive
Speaker 2: positive early breast cancer. Despite best efforts and the range
Speaker 2: of available treatment options, a concerning number of patients persistently
Speaker 2: face the risk of both long term and short term recurrence.
Speaker 2: According to a study published in the Journal of Clinical Oncology,
Speaker 2: approximately one third of individuals diagnosed with stage two hormone
Speaker 2: receptive positive her too negative breast cancer are at risk
Speaker 2: of recurrence. The Mayo Clinic further states that women who
Speaker 2: have had breast cancer are more likely to experience a
Speaker 2: second occurrence. Regrettably, most recurrences progress to metastatic disease for
Speaker 2: which there is currently no cure. It is essential for
Speaker 2: patients to have access to treatments that allow them to
Speaker 2: live their lives to the fullest. Adherence to therapy is
Speaker 2: crucial in effectively reducing the risk of occurrence. However, considering
Speaker 2: that many patients will need to undergo therapy for years,
Speaker 2: their ability to tolerate the treatment becomes vitally important. After
Speaker 2: the break, we'll resume our conversation with doctor Chen and
Speaker 2: doctor Shuebeck, delving deeper into the harsh reality of breast
Speaker 2: cancer recurrence and its unfortunate potential to evolve into metastatic
Speaker 2: breast cancer.
Speaker 1: We'll be right.
Speaker 2: Back now back to our conversation with doctor Nanchen and
Speaker 2: doctor Sarah Schuebeck.
Speaker 3: Now, you just.
Speaker 2: Mentioned recurrence, but if you could, doctor Scheeback, delve into
Speaker 2: the reality of breast cancer recurrence and how unfortunately it
Speaker 2: can transform into metastatic breast cancer.
Speaker 5: Sure, so, I think when we think about the first
Speaker 5: journey through breast cancer, right when we close that first chapter.
Speaker 5: My other favorite kind of analogy is to think of
Speaker 5: these as choose your own adventure books. Right, so at
Speaker 5: the end of each chapter we have to kind of
Speaker 5: push the reset button. And after the initial phase of treatment,
Speaker 5: whether that's surgery, medicines, and or radiation, we have to
Speaker 5: start over and that means screening, being vigilant, listening to
Speaker 5: our bodies, you know, routinely seeing patients taking whatever adjuvant
Speaker 5: medical therapies are required for risk reduction and to kind
Speaker 5: of have ongoing treatment for their breast cancer, but then
Speaker 5: very importantly be vigilant when something changes. So a lot
Speaker 5: of times recurrence events are basically found in breast imaging,
Speaker 5: so patients get their next mammogram or another MRI, for example,
Speaker 5: where they present with a palpable finding something they can
Speaker 5: feel that's different along a scar line or something. When
Speaker 5: it's that kind of local event, often your breast surgeons
Speaker 5: back involved straight away. We do biopsies, we facilitate additional imaging,
Speaker 5: and then very importantly, we often make sure it hasn't
Speaker 5: gone elsewhere, because if patients have metastatic breast cancer, meaning
Speaker 5: it's spread outside of the local area, then they're not
Speaker 5: really a candidate for kind of curative intent therapy in
Speaker 5: the traditional sense of surgery and medicines as a joint venture,
Speaker 5: but rather we lean on medicines as their solution and
Speaker 5: at least their treatment modality.
Speaker 4: Breast cancer is unique in that this is one of
Speaker 4: the only cancers in which we do not do routine
Speaker 4: body imaging after they complete their curative therapy, and so
Speaker 4: a lot of us trying to surveil for recurrence is
Speaker 4: dependent on the patient knowing their own body. When I
Speaker 4: talk to patients, I give them incredibly vague instructions for
Speaker 4: the kind of things to let us know about.
Speaker 3: I truly say, if you have.
Speaker 4: Any new symptom that lasts more than a few days
Speaker 4: and you're not sure what it's caused by, me, let
Speaker 4: me know.
Speaker 2: Circling back for a second, because you touched upon it,
Speaker 2: but breaking down what it actually means. So hormone receptor positive,
Speaker 2: human epidermal growth factor to negative.
Speaker 3: A mouthful, it is?
Speaker 1: It is.
Speaker 2: I can see why it's abbreviated, but you know it's
Speaker 2: the most common subtype of breast cancer, accounting for over
Speaker 2: two thirds of all cases. Can you break down what
Speaker 2: it actually means and unmet needs in treating it?
Speaker 4: Early breast cancer cells, just like our normal cells, have
Speaker 4: hundreds to thousands of flags on the outside. Estrogen receptor
Speaker 4: and HER two are two examples of said flags. When
Speaker 4: someone is ER positive her too negative. I think of
Speaker 4: it as estrogen is one source of food or fuel
Speaker 4: to help the cancer grow. The foundational way that we
Speaker 4: treat these cancers is with the anti estrogen therapies. There
Speaker 4: are a portion of patients that may be, for example,
Speaker 4: are less dependent on estrogen signaling or of other high
Speaker 4: risk features in which anti estrogen therapy alone is very
Speaker 4: much not enough to prevent recurrence. There are newer drugs
Speaker 4: now that previously we're used in the metastatic setting, but
Speaker 4: are now being brought into early stage breast cancer, which
Speaker 4: have shown successfully to be able to mitigate that risk
Speaker 4: for certain groups of high risk patients.
Speaker 5: So it's tricky and surgery because a lot of the
Speaker 5: role that I'm having to play is really in gathering
Speaker 5: information about hormone receptor positive or too negative cancer in
Speaker 5: the sense that we often do surgery as a bit
Speaker 5: of a diagnostic test. Right for a lot of patients,
Speaker 5: the surgery is really a fancier MRI. We go in,
Speaker 5: we remove the tumor, we understand the size of it,
Speaker 5: We check their lymph nodes. That tells us how big
Speaker 5: it is and how extensive it is, and then that
Speaker 5: information gets fed back in to make treatment decisions. And
Speaker 5: so I think of surgery as really gathering more information
Speaker 5: instead of being a definitive treatment, so that Dector Chen
Speaker 5: can tailor therapies, especially in this hormone receptor positive group,
Speaker 5: because that surgery information sometimes can change the game so substantially.
Speaker 4: And there are some types of breast cancer, such as
Speaker 4: popular carcinomas, which are most commonly HR positive hurto negative,
Speaker 4: where it can be really hard to tell in mammograms
Speaker 4: and MRIs exactly how big things are, how much for
Speaker 4: our things have spread, and it may only be at
Speaker 4: the time of surgery that we truly discovered the extent
Speaker 4: of disease and thus how risky the cancer actually is.
Speaker 2: We've talked about navigating the information overload that comes with
Speaker 2: the diagnosis, and you know that educational hurdles that exist
Speaker 2: for every single patient, But we haven't really touched upon
Speaker 2: racial disparity gap.
Speaker 1: You know, in.
Speaker 2: Terms of Black women are forty percent more likely to
Speaker 2: die from breast cancer than white women. How do you
Speaker 2: wrestle with that statistic.
Speaker 4: One of the reasons that I came to the University
Speaker 4: of Chicago is actually to take care of black women.
Speaker 4: In all of my training, I have always taken care
Speaker 4: of underserved populations. I find it incredibly gratifying. There are
Speaker 4: so many facts about black women in breast cancer that
Speaker 4: are uncomfortable.
Speaker 3: You are correct that they are more likely to die
Speaker 3: of their disease.
Speaker 4: They are more likely to be diagnosed later, they are
Speaker 4: more likely to have triple negative breast cancer, which is
Speaker 4: the most aggressive subtype.
Speaker 3: They are more likely to have delays.
Speaker 4: In treatment once they get started, they are more likely
Speaker 4: to not complete their treatment, and so there are many,
Speaker 4: many factors, both biological as well as socioeconomic, that contribute
Speaker 4: to that terrible statistic. Sarah and I think about this
Speaker 4: every day to not even be hyperbolic about it because.
Speaker 3: Of the patients that we see. A few months ago.
Speaker 4: We had a couple really terrible outcomes, and Sarah Astuteley
Speaker 4: was like, I feel like, we're just seeing what young
Speaker 4: black breast cancer looks like. And that was just the
Speaker 4: simplest way to kind of describe what was happening. It's
Speaker 4: really really terrible, and I think that as a community
Speaker 4: and as a cancer community, we really really should be
Speaker 4: doing better.
Speaker 5: We also traditionally have not done a good enough job
Speaker 5: of recruiting women of color to clinical trials, to providing
Speaker 5: everyone with the same opportunities for intervention, genetic testing, different
Speaker 5: surgical options, different reconstructive options, and so it's so many
Speaker 5: things that we have not done well enough to serve
Speaker 5: the whole breast cancer community. And like doctor Chen, I
Speaker 5: think that really being able to take care of everyone
Speaker 5: and look at them and say, hey, this data, this
Speaker 5: brilliant science, this is exactly for you. We don't have
Speaker 5: that right now for every patient. So some of our
Speaker 5: trials are north of ninety five percent white women, and
Speaker 5: then we're extrapolating to all people. That's something that we
Speaker 5: really feel, especially at the University of Chicago, is a
Speaker 5: priority for us to offer every single patient to be
Speaker 5: on a cancer registry, every single patient to be in
Speaker 5: a clinical trial. That's appropriate, and that's because we need
Speaker 5: to get those numbers to be reflective of the population
Speaker 5: we actually serve. Serving people who are different from me
Speaker 5: for whatever reason, is the greatest joy of my life.
Speaker 5: I didn't necessarily know that would be such a passion
Speaker 5: or such an important part of my practice, but it
Speaker 5: has been the greatest learning opportunity of working at the
Speaker 5: University of Chicago on the South Side of Chicago. There
Speaker 5: are patients who teach me every day about what they've
Speaker 5: been told to fear about doctors, what they've been told
Speaker 5: is not important enough to bring to your doctor. And
Speaker 5: I think that if we can break down those barriers
Speaker 5: and really empower people to look out for their own
Speaker 5: health across everything, we'll get there.
Speaker 2: It's interesting because you would use the word unfair to
Speaker 2: describe cancer, and that said, then it's compounded on what
Speaker 2: makes the outcome even more unfair for some of your patients?
Speaker 5: Absolutely, and I think patients who have social challenges, right,
Speaker 5: women who are the one keeping it together for their family,
Speaker 5: the earner, the head of household, maybe somebody who's relying
Speaker 5: on social resources to support their children or their family members,
Speaker 5: and then we take.
Speaker 3: Her out of the fight. Man, that's really unfair.
Speaker 5: So we'll have young women clinic who are just starting
Speaker 5: their careers, are just building their family, are just you know,
Speaker 5: just really starting life, and they come in and they're
Speaker 5: these incredible humans now with this really terrible problem. That's
Speaker 5: when we call each other and we talk about exactly
Speaker 5: how unfair this business feels. You know, Like I have
Speaker 5: these really incredible women come to my clinic and I'm
Speaker 5: just sitting there, like I just want to hang out
Speaker 5: with this person. I want to be best friends with
Speaker 5: this person. I just want to learn from her. I
Speaker 5: want to see what she's going to do in thirty
Speaker 5: years with her passions.
Speaker 3: Well, that's here we are.
Speaker 2: That's the other side of the same coin, because today
Speaker 2: breast cancer survival rates are much higher.
Speaker 3: Absolutely, how do you factor.
Speaker 2: Planning for life after cancer into the treatment journey?
Speaker 4: I think it is so hard for patients to even
Speaker 4: visualize the after cancer when they're in the thick of it,
Speaker 4: because it just feels so rotten to be going through treatment,
Speaker 4: to be thinking about surgery, to be planning for post
Speaker 4: surgical recovery periods. Really, like what Sarah said earlier about
Speaker 4: kind of six months afterwards, you really get to see
Speaker 4: them come out. It is the favorite part of my
Speaker 4: job to see them getting back into their thing. I
Speaker 4: have patients who previously golfed and now like during treatment
Speaker 4: that you did in golf, And I saw her a
Speaker 4: few weeks ago, She's like, Yeah, I kind of went
Speaker 4: out a couple of weeks ago, and I was like,
Speaker 4: this is amazing.
Speaker 3: This is exactly what I'm hoping for.
Speaker 4: Our hope for everyone is that this is a speed bump,
Speaker 4: like it's a big speed bump, and it's a horrible
Speaker 4: speed bump, but that it is a speed bump, and
Speaker 4: when we get through the other side, you are as
Speaker 4: close to the person that you were before as you
Speaker 4: can be, recognizing that you've now gone through this transformative,
Speaker 4: life changing experience.
Speaker 5: In the middle, I'm in a shamelessly stale phrase from
Speaker 5: one of my patients who told me that she's decided
Speaker 5: her breast cancer is a rude bump in the road.
Speaker 5: It's not going to derail her, it's not going to
Speaker 5: change her course. But it's a rude bump in the road.
Speaker 5: And I've ever since she told me that, and I
Speaker 5: hope someday she hears us to know how wise I
Speaker 5: think she is. I tell patients that because often patients
Speaker 5: will say to me, I don't care what happens to
Speaker 5: my body. I just want to live. And then to that,
Speaker 5: I say, hold on, I care what happens to your body,
Speaker 5: because in six months you're going to be really mad
Speaker 5: at me when you start to be a person again,
Speaker 5: your whole self. If you have an ugly scar, if
Speaker 5: the first thing you think of when you walk out
Speaker 5: of the shower is your breast cancer, if your sexuality
Speaker 5: is impacted by what we put you through. I have
Speaker 5: to think and hold space for you to be a
Speaker 5: person again after breast cancer, and whether that's preserving your
Speaker 5: fertility so that you could have a pregnancy in a
Speaker 5: few years, if that's putting your breasts back together in
Speaker 5: a way that you've always wanted, giving you a breast reduction,
Speaker 5: doing all those things that seem really trivial when you're
Speaker 5: facing cancer but are really vitally important when you're facing
Speaker 5: life again. And that transition for some people is really rocky,
Speaker 5: but for others is really natural.
Speaker 2: When you are in a situation where someone isn't handling
Speaker 2: it well, how do you integrate the psychological impact of treatment.
Speaker 4: I tell every single one of my patients that this
Speaker 4: is an extraordinary experience and that I personally feel that
Speaker 4: everyone should be getting psychological support because this is just
Speaker 4: so incredibly hard. Sometimes I feel like the best thing
Speaker 4: I can do for a patient during a clinical visit
Speaker 4: is just hear them out, hear what they're going through,
Speaker 4: and just commiserate and validate that, like, Yeah, this sucks.
Speaker 4: The emotional component of this, I think is just as
Speaker 4: relevant as the physical part.
Speaker 3: It's just so overwhelming.
Speaker 5: I think also patients have perceived support from their family
Speaker 5: in a lot of ways, but their family their friends
Speaker 5: are also going through something. The biggest kind of disconnect
Speaker 5: I see in my practice is when your family and
Speaker 5: friends have decided the fight is over right, treven is done.
Speaker 5: That's a really lonely time for a survivor, and so
Speaker 5: I think people kind of unexpectedly fall off their cliff
Speaker 5: at very different times. Some people it's right away, they
Speaker 5: can say that they need support, and we are like, yes,
Speaker 5: we have mental health resources available for you. The harder
Speaker 5: thing is figuring out somebody who's maybe in survivorship or
Speaker 5: maybe just finished therapy, and that their struggle is actually
Speaker 5: becoming a person again, as opposed to a patient with cancer.
Speaker 5: And so the notion that support is really only during
Speaker 5: that active journey, I think is a really misguided one,
Speaker 5: and that we have to make sure patients understand that
Speaker 5: survivorship also is loaded, because it's really full of trauma
Speaker 5: and history and physical scars and obviously psychological ones too.
Speaker 1: And it is such a loaded.
Speaker 2: Breasts in general, really what they represent to women, what
Speaker 2: they represent to society, so many things, but also to
Speaker 2: base one's femininity.
Speaker 5: Our gender expression, our sexuality, our embodiment, everything.
Speaker 4: Our maternal it's such a personal part of our body.
Speaker 5: I often tease that it's amazing that everybody's going to
Speaker 5: have an opinion about your breasts, but we're not actually
Speaker 5: supposed to talk about them any other time. Right, your
Speaker 5: neighbor will tell you to have a bilateral mistake to me,
Speaker 5: But man, have you ever talked to your name or
Speaker 5: about your breast before? Right, It's meant to be private,
Speaker 5: you know. It's a space where we judge one another
Speaker 5: about you know, augmentation or how much we're exposing or
Speaker 5: you know. And I think it's really funny how then
Speaker 5: during a cancer journey, women are supposed to surrender that
Speaker 5: notion of modesty and allow us to kind of strip
Speaker 5: them of their femininity and in the name of heroism.
Speaker 4: But also all the other things surrounding breast cancer care,
Speaker 4: meaning fertility. We have so many fertility conversations, talking about
Speaker 4: vaginal health.
Speaker 3: It's just a lot of personal things.
Speaker 2: How do you navigate that fertility conversation, particularly with young patients.
Speaker 4: One of the things I hate the most about this
Speaker 4: conversation is that, on top of all the cancer stuff,
Speaker 4: you now have to think about this that you shouldn't
Speaker 4: have had to make a decision about this for years,
Speaker 4: And now you're sitting here in my page box clinic,
Speaker 4: and I'm asking you these horrible questions and you have
Speaker 4: to sit here and figure out way too early whether
Speaker 4: or not you want to have kids, and whether how
Speaker 4: much you want to have kids is how that's going
Speaker 4: to impact your breast cancer care.
Speaker 3: And that's terrible.
Speaker 5: I agree with doctor Tennant. It's breast cancer so often
Speaker 5: robs people of their potential that they haven't even decided yet.
Speaker 6: You know.
Speaker 5: Often we'll see twenty five year old women and we're like, so,
Speaker 5: you know, on top of all this trauma.
Speaker 3: Have you thought about having kids? And tell me now?
Speaker 5: Yeah, and tell me now in front of these seven
Speaker 5: people you've brought with you.
Speaker 1: Somebody who may or may not be in a relation.
Speaker 5: Sure, yeah, correct, right, And I think, and it's so
Speaker 5: amazing to think about how, you know, we put people
Speaker 5: through this intense stress test of making all those decisions
Speaker 5: in quick succession because they feel that they're delaying their
Speaker 5: chemote therapy if they choose fertility, So then it.
Speaker 3: Feels selfish, but it's actually essential.
Speaker 5: You know, I always kind of think of it as like,
Speaker 5: we have to do the one on one level course first, right,
Speaker 5: we have to do breast cancer one on one, and
Speaker 5: then the graduate level course is all of this other stuff,
Speaker 5: and we have to build capacity in the patient to
Speaker 5: go to the next phase. So we have to have
Speaker 5: a shared foundational understanding of what she's up against, of
Speaker 5: what decisions she has to make, and then on top
Speaker 5: of that, we put all of those things afterward that
Speaker 5: will make her whole again after cancer.
Speaker 2: But at the same time, you guys are constantly reevaluating
Speaker 2: your role in the journey of treatment. You know, we've
Speaker 2: spoken about current patients journey and how it varies and
Speaker 2: differs in how your help in supporting them throughout that
Speaker 2: has to vary along with it.
Speaker 1: But taking a step back for a.
Speaker 2: Moment in terms of doing what you do right now
Speaker 2: in this moment in time, what is the best thing
Speaker 2: in terms of the advancements that you've seen.
Speaker 3: I think that we've come so far.
Speaker 5: So I alluded to some family history earlier, and I
Speaker 5: have my grandmother's medical records from her breast cancer journey.
Speaker 3: It's wild to read what this woman went through.
Speaker 5: I look forward a generation, and I saw what my
Speaker 5: own mother went through, and nowadays, she would have benefit
Speaker 5: from these genomic advances, she would have benefited from surgical
Speaker 5: de escalation, She wouldn't have had to go through a
Speaker 5: lot of what she had to go through. My mom
Speaker 5: will say to me, do you do this because of
Speaker 5: what I went through? And I, you know, some of
Speaker 5: it is, yes, and she's going to listen to this
Speaker 5: and get mad at me, But some of it is
Speaker 5: because I get to do better. I get to let
Speaker 5: people live more often. And while you know, we perseverate
Speaker 5: on the people who haven't done well because it takes
Speaker 5: a piece of our heart with them. So many of
Speaker 5: our patients are living full lives after this, And so
Speaker 5: I think, how lucky are we that I, with all
Speaker 5: my breast cancer risk, that I'm up against my sisters,
Speaker 5: all the women I love in my family. I believe
Speaker 5: in my heart we're going to be okay. And I
Speaker 5: don't mean to make light of the devastating journeys that
Speaker 5: some people are facing, But in twenty twenty four, most
Speaker 5: of the time I can say, with a straight face
Speaker 5: and with honest intention that you're probably going to be okay,
Speaker 5: And we get to think.
Speaker 3: About life after this. That rude bump in the road
Speaker 3: is going to go away.
Speaker 5: That's a purely surgical perspective, because I don't take care
Speaker 5: of patients in the metasthetic setting, which that is the
Speaker 5: weight of a medical and collegist journey. And I sit
Speaker 5: in awe of how doctritenn does that with such grace?
Speaker 5: But I think most of the patients who sit in
Speaker 5: front of me are going to be okay. And what
Speaker 5: a gift is that from medical innovations, from screening innovation,
Speaker 5: from empowerment of people, right from saying that it's good
Speaker 5: to speak up about your health. And so I think
Speaker 5: that's my take on the landscape is like, how amazing
Speaker 5: is it that?
Speaker 3: How far have we come?
Speaker 5: All we can do is continue to amplify that messaging
Speaker 5: to say that the vast majority of people are going
Speaker 5: to be okay, So so come forward and let.
Speaker 3: Us help you.
Speaker 4: I started my oncology fellowship in twenty eighteen. There have
Speaker 4: probably been at least a dozen if not more, drug
Speaker 4: approvals and breast cancer since then. Wow, it is so
Speaker 4: much fun to be in this field and see how
Speaker 4: things are moving ahead. I tell patients, I hope by
Speaker 4: the time I retire, chemo is obsolete, that we have
Speaker 4: better targeted therapies to be doing this. I hope to
Speaker 4: be doing so much better in forty years, and I
Speaker 4: very very much share your optimism that I think we
Speaker 4: can do it.
Speaker 1: All right now. In terms of that.
Speaker 2: In terms of the future, what developments and advancements do
Speaker 2: you guys see on the horizon for breast cancer treatment
Speaker 2: and how are new medicines and therapeutics shaping the future
Speaker 2: of patient care.
Speaker 4: There is so much coming down the pipeline. There are
Speaker 4: new antibody drug conjug It's coming down the line, both
Speaker 4: with different antibodies as well as with different payloads. We
Speaker 4: are trying to better understand how immunotherapy fits into breast
Speaker 4: cancer and whether it can work in more patients than
Speaker 4: it currently works in. We are currently developing many novel
Speaker 4: endegrine therapies to disrupt the estrogen receptor in ways that
Speaker 4: just weren't really thinkable a decade ago. There is so
Speaker 4: much happening in breast cancer. There's a lot of information
Speaker 4: being presented literally in two hours at this conference to
Speaker 4: really showcase all that we've done in the last year
Speaker 4: and kind of where we're going from here.
Speaker 5: From a surgery perspective, I see a world with much
Speaker 5: less breast cancer surgery because the medicines are getting better,
Speaker 5: and I think that that is such a great thing.
Speaker 5: So I would love a world without breast cancer surgery
Speaker 5: because people are doing too well or we've learned who
Speaker 5: it's essential and who it isn't. Breast surgery is really
Speaker 5: the backup move nowadays, and I think that that's really
Speaker 5: exciting because we're doing it better. Cancer is not a
Speaker 5: local problem. Cancer is a whole body problem, and so
Speaker 5: if the medicines can do the heavy lift, it's going
Speaker 5: to be better for everybody.
Speaker 3: I'm really excited.
Speaker 5: I'm optimistic, and I think that optimism is what carries
Speaker 5: us into each room, so we can tell people with
Speaker 5: a straight face, this is what we're up against. These
Speaker 5: are the tools we have. We're going to throw everything
Speaker 5: we have at this and keep you whole.
Speaker 1: Excellent answer, both of you.
Speaker 2: And lastly, if there is one one thing that you
Speaker 2: hope people listening take away from this conversation, what would
Speaker 2: it be and why?
Speaker 5: The most important thing in breast cancer is early detection.
Speaker 5: So I'm going to be pretty expected and say that
Speaker 5: take care of yourself, get your mammogram, take somebody with
Speaker 5: you to get your mammogram, Go to your primary care
Speaker 5: physician or provider and get a breast exam.
Speaker 3: Pay attention to your body.
Speaker 5: And I think, don't be so scared of this possibility
Speaker 5: that you're not empowered enough to figure it out.
Speaker 3: And so that really for me is just take care
Speaker 3: of yourself.
Speaker 4: I'm going to say on the flip side that providers
Speaker 4: really need to listen to women.
Speaker 3: Women know their bodies really well.
Speaker 4: If someone is telling you that something not right, then
Speaker 4: we should figure out why that is. That's really important
Speaker 4: for the breast cancer journey.
Speaker 2: Doctor Chen, doctor Schuebeck, thank you so much for joining
Speaker 2: me today and thank you so much for this conversation.
Speaker 3: Thank you, thanks.
Speaker 2: Thanks for listening to this bonus episode of Symptomatic. Be
Speaker 2: on the lookout in the coming weeks for another special
Speaker 2: episode from the twenty twenty four as CO annual meeting.
Speaker 2: We'll be speaking with doctor Muhammad a Tique about the
Speaker 2: patient struggle against prostate cancer and the current state of treatment.
Speaker 6: What we're having to learn and discover in the current
Speaker 6: field is the sequencing of these treatments. Which one should
Speaker 6: go first right, we know based on some data, you know, Okay, well, yeah,
Speaker 6: and we might start with X treatment and go to
Speaker 6: the next one. But then there's just kind of a
Speaker 6: mix of options which can all be appropriate, Which one
Speaker 6: is the best to continue and LinkedIn the survival is
Speaker 6: kind of a big poin discussion.
Speaker 2: And we'll be back next week with another all new
Speaker 2: episode of Symptomatic. Until then, we would love to hear
Speaker 2: from you. Send us your thoughts on this episode, or
Speaker 2: you can share a medical mystery of your own at
Speaker 2: Symptomatic at iHeartMedia dot com. And please feel free to
Speaker 2: rate and review Symptomatic wherever you get your podcasts.
Speaker 1: We'll see you next time. Until then, be well,