WEBVTT - Be Aware Of Your Breasts 0:00:03.279 --> 0:00:07.320 Welcome everyone to the Amy and TJ Podcast. It is 0:00:08.039 --> 0:00:10.840 a very special month. It is October, and that means 0:00:10.840 --> 0:00:14.960 it is Breast Cancer Awareness Month. And it's an important 0:00:14.960 --> 0:00:17.759 month because, first of all, it's time to honor those 0:00:17.800 --> 0:00:21.160 who have been treated for breast cancer. It's time to 0:00:21.239 --> 0:00:24.560 honor those who are fighting cancer who have metastatic breast cancer. 0:00:25.160 --> 0:00:28.760 And almost as important, it's time to raise awareness, to 0:00:28.800 --> 0:00:33.040 continue to raise awareness about early detection, about reminding women 0:00:33.400 --> 0:00:37.200 to make those appointments with their ogyns, to get those 0:00:37.240 --> 0:00:41.160 mammograms scheduled, and to show up for the actual appointment. 0:00:41.880 --> 0:00:44.560 And just to remind everyone, breast cancer is the most 0:00:44.600 --> 0:00:48.199 commonly diagnosed cancer in women in the United States. A 0:00:48.280 --> 0:00:52.640 woman in this country is diagnosed every two minutes, and 0:00:52.760 --> 0:00:57.000 great strides have been made with breast cancer research and 0:00:57.040 --> 0:01:00.200 certainly in treating women and men with this disease, but 0:01:00.240 --> 0:01:02.360 there is still so much more to do because breast 0:01:02.360 --> 0:01:06.240 cancer remains the leading cause of cancer death in American women. 0:01:06.360 --> 0:01:10.720 And so to get all the latest information on where 0:01:10.720 --> 0:01:13.800 we are with this disease, on the research being done, 0:01:14.000 --> 0:01:18.320 and what you can do to prevent breast cancer, or 0:01:18.520 --> 0:01:20.840 at the very least, if you've been a patient, or 0:01:20.880 --> 0:01:22.959 you are currently fighting it or someone you know, is 0:01:23.360 --> 0:01:26.320 what you can do to live a better life, a 0:01:26.319 --> 0:01:30.480 healthier life, and prevent recurrence and for all of that 0:01:30.640 --> 0:01:33.520 very important information. TJ and I are so excited to 0:01:33.680 --> 0:01:39.039 welcome my personal oncologist. She's a star at NYU, doctor 0:01:39.120 --> 0:01:42.680 Ruth Ratz. Thank you so much for being with us. 0:01:43.280 --> 0:01:46.959 Amy and Tji am really really happy to be back 0:01:46.959 --> 0:01:49.480 with you in the studio. I always love seeing you 0:01:49.640 --> 0:01:50.720 and especially here. 0:01:51.680 --> 0:01:53.800 Thank you Ruth and doctor Ratz. You know, I think 0:01:53.880 --> 0:01:57.320 some people roll their eyes up Breast Cancer Awareness Month, 0:01:57.360 --> 0:02:00.680 the pink ribbons. This is so much more than just 0:02:00.680 --> 0:02:03.920 this month, But can you explain why this month is 0:02:04.040 --> 0:02:06.480 actually truly important. 0:02:07.080 --> 0:02:13.320 This month is really really important because it represents what 0:02:13.680 --> 0:02:17.240 women did in the late nineteen seventies and in the 0:02:17.320 --> 0:02:22.320 nineteen eighties to really speak out and say to the 0:02:22.360 --> 0:02:26.160 medical profession and to all of the sort of public 0:02:26.200 --> 0:02:31.800 health officials out there, breast cancer is the single most 0:02:31.840 --> 0:02:36.000 important cancer that affects women. A lot of people get it, 0:02:36.520 --> 0:02:40.880 and we want to have more information and we want 0:02:40.919 --> 0:02:43.919 to have a say about what happens with our treatment. 0:02:45.000 --> 0:02:48.200 So in the nineteen seventies, when My mother was diagnosed 0:02:48.200 --> 0:02:51.760 with breast cancer in her forties because she felt a 0:02:51.800 --> 0:02:54.880 little lump in her breast. No screening, mammogram or anything 0:02:54.919 --> 0:03:00.000 like that. She went to her doctor. She was admitted 0:03:00.200 --> 0:03:04.440 to the hospital and the surgeon came in and said, 0:03:05.840 --> 0:03:07.480 missus aur so, I'm going to take you to the 0:03:07.480 --> 0:03:11.320 operating room and we're going to remove the lump. If 0:03:11.360 --> 0:03:16.079 it's cancerous, I have to do a mestectomy. If it's 0:03:16.120 --> 0:03:18.760 not cancer, you'll wake up and everything will be great. 0:03:20.040 --> 0:03:23.360 So she signed on the dotted line. They put it 0:03:23.360 --> 0:03:26.200 her sleep in the operating room, and she woke up 0:03:26.320 --> 0:03:30.880 alone in the recovery room, put her hand on her chest, 0:03:30.919 --> 0:03:34.960 felt that huge bandage, and that's how she figured out 0:03:35.000 --> 0:03:40.360 she had cancer. Wow, a lot has changed since then, 0:03:40.400 --> 0:03:44.000 but that is a chilling, chilling story. Yeah. So you know, 0:03:44.200 --> 0:03:45.760 a good friend of mine wrote a book called The 0:03:45.760 --> 0:03:49.040 Breast Cancer Wars, doctor barn learn her same thing happened 0:03:49.080 --> 0:03:52.160 to his mother, And the women's movement said, hey, wait 0:03:52.200 --> 0:03:54.080 a second, no, no, no, no, you can't do this 0:03:54.160 --> 0:03:58.120 to us anymore, and then the doctors and scientists started listening. 0:03:59.400 --> 0:04:03.400 It was it is now illegal in New York State 0:04:03.480 --> 0:04:07.120 and pretty much everywhere else to do surgery for cancer 0:04:07.160 --> 0:04:11.040 without first doing a biopsy and having a conversation with 0:04:11.120 --> 0:04:14.000 that woman. And this was only you know, this is 0:04:14.040 --> 0:04:17.120 the nineteen seventies. It's not that long ago, and we 0:04:17.200 --> 0:04:19.720 certainly have made great strides. And I didn't know that 0:04:19.839 --> 0:04:23.440 story about your mom doctr Ratsky at all, and has 0:04:23.440 --> 0:04:25.839 that motivated you in so many ways I can only 0:04:25.880 --> 0:04:30.000 imagine as an oncologist. Yeah, of course. I mean I 0:04:30.120 --> 0:04:32.640 was in college and I remember my dad calling me. 0:04:32.760 --> 0:04:34.359 I was on my way home for spring break and 0:04:34.400 --> 0:04:37.760 he called and said, okay, I'll pick you up at 0:04:37.760 --> 0:04:39.760 the station. I came down from Boston to you know, 0:04:39.800 --> 0:04:41.720 took the train to Penn station. He picked me up 0:04:41.720 --> 0:04:44.240 and we're heading uptown. I thought he's taking me out 0:04:44.279 --> 0:04:47.200 to dinner. Next thing, I know, like the taxi cab 0:04:47.279 --> 0:04:49.960 pulls up in front of a hospital. I said, well, 0:04:50.000 --> 0:04:52.320 wait a second, like what's going on here? And that's 0:04:52.320 --> 0:04:53.640 when I went up and saw my mom in the 0:04:53.680 --> 0:04:54.920 hospital after the surgery. 0:04:55.279 --> 0:04:55.880 My goodness. 0:04:56.000 --> 0:04:58.880 Yeah. So yes, of course I knew I wanted to 0:04:58.920 --> 0:05:00.920 be a doctor, but I think that kind of sealed 0:05:01.000 --> 0:05:03.360 where I was headed in my career. 0:05:03.560 --> 0:05:05.839 That makes a lot of sense, a lot of sense. 0:05:05.880 --> 0:05:12.320 So this month now some what fifty years later, do 0:05:12.440 --> 0:05:17.200 you see a rise in breast cancer diagnoses this month 0:05:17.240 --> 0:05:20.280 because women are reminded to come in and get their mammograms, 0:05:20.279 --> 0:05:22.719 and so then more women are actually diagnosed this month 0:05:22.760 --> 0:05:23.240 than others. 0:05:23.600 --> 0:05:26.480 Yes, Actually we do see that variation during the course 0:05:26.520 --> 0:05:28.680 of the year, and I think it's fantastic that we 0:05:28.760 --> 0:05:31.839 have breast cancer Awareness Month. People do go in and 0:05:31.880 --> 0:05:34.840 schedule their tests. We don't get that many diagnoses over 0:05:34.839 --> 0:05:38.520 the summer, everyone's on vacation. But back to school, Breast 0:05:38.520 --> 0:05:42.599 Cancer Awareness Month. Make your checkup appointments, go in, get tested, 0:05:42.640 --> 0:05:43.840 and if you need us, we're here. 0:05:44.360 --> 0:05:46.320 Yeah, you are there. You were there for me, and 0:05:46.360 --> 0:05:49.320 you still are here for me. In terms of where 0:05:49.320 --> 0:05:52.680 we are with getting the mammogram, there are different options. 0:05:52.680 --> 0:05:55.040 Now we've talked about these before, but I'm seeing more 0:05:55.120 --> 0:05:59.280 and more evidence that three D mammograms are the gold standard, 0:05:59.320 --> 0:06:01.680 and yet they're not available to everyone. Tell us a 0:06:01.720 --> 0:06:04.560 little bit about where we are on mammogram technology and 0:06:05.000 --> 0:06:07.279 what women should be able to ask for. 0:06:08.320 --> 0:06:12.000 You're right, Amy, the technology in imaging has really really 0:06:12.080 --> 0:06:15.760 changed over the years, Even just the mammogram technology mammogram 0:06:15.800 --> 0:06:18.680 is just an X ray of the breast, and as 0:06:18.760 --> 0:06:22.680 anyone who's had it done knows, you get kind of 0:06:22.720 --> 0:06:26.120 squished between these plates so that the X ray can 0:06:26.279 --> 0:06:29.279 actually compress the tissue and give us an image of 0:06:29.320 --> 0:06:32.480 what's going on in the breast tissue if the tissue 0:06:32.520 --> 0:06:36.599 is very dense, and that's more common in younger women, 0:06:37.080 --> 0:06:39.960 because as we get older that breast density, the breast 0:06:39.960 --> 0:06:43.800 tissue itself becomes a little less active, and really the 0:06:43.800 --> 0:06:47.800 breast is fundamentally made of fat, and that's easy to 0:06:47.839 --> 0:06:50.800 see little spots and dotson, But when the breast tissue 0:06:50.839 --> 0:06:54.360 is active in younger women, more proliferative, sometimes it's hard 0:06:54.360 --> 0:06:58.760 to see stuff. So by improving our technology with two 0:06:58.880 --> 0:07:07.120 D and then three imaging and adding computer assisted detection, 0:07:07.240 --> 0:07:09.920 which we've had for a long time now, several years, 0:07:10.400 --> 0:07:15.160 and layering on top of that even more intelligence, both 0:07:15.240 --> 0:07:19.720 the doctor's intelligence but artificial intelligence, adding that in where 0:07:19.720 --> 0:07:24.240 our computers can help us see through the background noise 0:07:24.360 --> 0:07:26.720 and say here's something we really should pay attention to 0:07:26.760 --> 0:07:31.280 on the mammogram, and then the radiologist might say we 0:07:31.280 --> 0:07:34.440 should also add an ultrasound sonogram of the breast or 0:07:34.480 --> 0:07:39.320 maybe this person also needs an MRI. So it's very individualized. 0:07:39.400 --> 0:07:40.720 It's not one size fits all. 0:07:42.080 --> 0:07:45.520 And you mentioned dense breast tissue. I was just reading 0:07:45.520 --> 0:07:49.280 and I realized just this month a new regulation is 0:07:49.320 --> 0:07:54.960 actually in place September tenth, they now have new regulations 0:07:55.440 --> 0:08:00.160 which allow patients or empower patients, I should say, with 0:08:00.200 --> 0:08:02.400 the information that they need to make an informed decision 0:08:02.440 --> 0:08:06.679 about breast cancer screening based on their breast density. Now 0:08:06.800 --> 0:08:10.080 it actually will show on your mimography report if you 0:08:10.280 --> 0:08:13.120 have dense breast tissue, and a lot of women don't 0:08:13.120 --> 0:08:16.120 realize that they have it. Why is that significant? 0:08:17.000 --> 0:08:20.360 You're right Amy that that's now going to be regulated. 0:08:20.400 --> 0:08:22.840 I think more and more across the country. We've been 0:08:22.840 --> 0:08:25.600 doing it in New York State for a while. It's 0:08:25.720 --> 0:08:29.760 very important because if the breast tissue is dense, we 0:08:29.840 --> 0:08:33.520 may need to add that other modality, whether it's ultrasound 0:08:33.640 --> 0:08:38.119 or MRI. And don't forget the clinical exam because sometimes 0:08:38.160 --> 0:08:41.440 we see something or feel something that doesn't show up 0:08:41.440 --> 0:08:43.920 on imaging. So we kind of need to do a 0:08:43.960 --> 0:08:44.840 little bit of everything. 0:08:45.840 --> 0:08:48.360 And how do you know as a patient what you 0:08:48.440 --> 0:08:51.040 can ask for, what your insurance will cover. I mean, 0:08:51.120 --> 0:08:54.320 so much of this has to do with accessibility. It's 0:08:54.320 --> 0:08:57.679 about information and knowing your rights, but also knowing what 0:08:57.720 --> 0:08:59.720 you have to pay for and what right your insurance 0:08:59.760 --> 0:09:01.560 come we'll be willing to pay for. 0:09:02.160 --> 0:09:04.600 I think the best thing is for each person to 0:09:04.640 --> 0:09:08.800 have a dialogue with her doctor. If it's the obg 0:09:09.000 --> 0:09:12.120 i N, they're usually pretty well informed and can talk 0:09:12.160 --> 0:09:15.280 to the breast imaging center the radiologist about well, what's 0:09:15.320 --> 0:09:18.960 going to be best for this patient. If it's a 0:09:18.960 --> 0:09:21.480 primary care doctor and they may not be as well 0:09:21.600 --> 0:09:24.960 informed about those options, then have your patient go for 0:09:25.000 --> 0:09:27.880 a consultation and speak to the radiologist or speak to 0:09:27.920 --> 0:09:30.520 the obg i N about what the best exam is. 0:09:31.160 --> 0:09:33.040 Yeah, you have to know your rights and then use 0:09:33.040 --> 0:09:35.240 your voice, right, Yeah, that's a huge part of it. 0:09:35.840 --> 0:09:38.959 This has been a big troubling trend. Yes, we've had 0:09:39.040 --> 0:09:42.240 great strides made in keeping women alive for those first 0:09:42.280 --> 0:09:46.560 five years. It's ninety nine percent correct survivor survivor rate. 0:09:46.640 --> 0:09:50.640 That's phenomenal, and yet we're seeing more and more, in 0:09:50.720 --> 0:09:55.880 a fairly alarming rate, women under fifty getting breast cancer. 0:09:56.640 --> 0:10:01.840 Do doctors know why? I'm really concerned about that. We 0:10:02.000 --> 0:10:06.200 have seen a trend that more young women are getting diagnosed, 0:10:07.520 --> 0:10:09.400 So we have to ask the question, is it because 0:10:09.440 --> 0:10:14.120 more young women are getting screened. Maybe we're picking up 0:10:14.160 --> 0:10:16.480 little things and people who are a little younger because 0:10:16.480 --> 0:10:19.559 they're coming in in their early forties to get that screening. 0:10:19.960 --> 0:10:22.640 But I'm seeing patients even in their thirties and sometimes 0:10:22.760 --> 0:10:27.240 late twenties more than we used to see. One factor 0:10:27.600 --> 0:10:32.120 is that the genetic mutations that can increase the risk 0:10:32.160 --> 0:10:35.559 of getting breast cancer. People have heard of the BRCA mutations, 0:10:35.960 --> 0:10:40.160 and there are other ones check two, rip one, a 0:10:40.200 --> 0:10:42.880 whole bunch of new genes that we know about. But 0:10:42.960 --> 0:10:47.880 what we're seeing is with each generation, the women getting 0:10:47.920 --> 0:10:51.080 breast cancer are also getting younger and younger, and we're 0:10:51.080 --> 0:10:54.360 not really sure what that's all about. May have to 0:10:54.400 --> 0:10:58.160 do with our environment and may have to do you know, 0:10:58.200 --> 0:11:00.559 what we're eating and drinking, what we're being exposed to, 0:11:01.320 --> 0:11:18.800 not sure. 0:11:10.800 --> 0:11:13.320 To what you're saying right there. To that point, big 0:11:13.800 --> 0:11:16.920 headlines this week specifically, or at least the past couple 0:11:16.920 --> 0:11:20.959 of weeks that there's a new study out that links 0:11:21.360 --> 0:11:24.240 not just the food but the food packaging that we're 0:11:24.240 --> 0:11:28.920 all using to transfer our food to eat, our food 0:11:29.000 --> 0:11:34.040 with to breast cancer carcinogens. Those are scary headlines and 0:11:34.080 --> 0:11:37.160 seemingly impossible to deal with because what am I supposed 0:11:37.200 --> 0:11:41.760 to do about how we package our food as a country, 0:11:43.160 --> 0:11:46.120 And what would you say to women? What are we 0:11:46.200 --> 0:11:49.000 supposed to do with these headlines and this information. It 0:11:49.040 --> 0:11:51.760 feels like everything could be causing cancer or at least 0:11:51.960 --> 0:11:55.760 creating these types of carcinogens. Well, I certainly think that 0:11:55.920 --> 0:11:59.600 over the past fifty years we've seen a really, really 0:12:00.400 --> 0:12:07.000 enormous change in the whole chain of food production, packaging, 0:12:07.080 --> 0:12:12.160 and distribution in America and the developed world. So, you know, 0:12:12.200 --> 0:12:15.079 when my mother was a little girl, everything was fresh, right, 0:12:15.120 --> 0:12:17.080 You just bought the food for the day that you 0:12:17.120 --> 0:12:19.920 were going to eat. By the time I was growing up, 0:12:19.960 --> 0:12:22.680 we had supermarkets, but yeah, we were still buying stuff 0:12:22.880 --> 0:12:25.640 pretty much that was fresh, and we didn't have so 0:12:25.760 --> 0:12:31.680 much in the way of plastic packaging. And now kind 0:12:31.679 --> 0:12:36.160 of everything is packaged either in styrofoam or plastic, and 0:12:36.200 --> 0:12:38.960 then we're using plastic utensils and we're keeping it in 0:12:39.000 --> 0:12:44.000 our fridge for who knows how long. We don't know 0:12:44.160 --> 0:12:48.200 for sure the absolute cause and effect of that, but 0:12:48.320 --> 0:12:52.800 it's really problematic. We're hearing about these forever chemicals which 0:12:52.840 --> 0:12:55.920 are related to some of these plastic compounds. They stick 0:12:55.960 --> 0:12:59.240 around in our bodies, they're hanging out in our oceans 0:12:59.280 --> 0:13:02.360 as we're throwing all this plastic garbage into the oceans, 0:13:02.360 --> 0:13:05.440 and they're getting into the animals. We also know that 0:13:05.480 --> 0:13:08.920 the food is processed way more than it was, you know, 0:13:08.920 --> 0:13:13.319 a few decades ago, so especially the animal proteins. Animals 0:13:13.360 --> 0:13:17.360 are being fed with growth hormones and antibiotics and all 0:13:17.440 --> 0:13:20.080 kinds of stuff just to fatten them up and get 0:13:20.080 --> 0:13:20.760 more production. 0:13:21.920 --> 0:13:24.680 But then in turn, we're eating that stuff and we're 0:13:24.720 --> 0:13:28.360 getting exposed to the same antibiotics and the same hormones, 0:13:28.360 --> 0:13:32.120 and that changes what's going on in our bodies metabolically, 0:13:32.440 --> 0:13:36.280 and the microbiome, which you know you probably have heard about. Also, 0:13:36.360 --> 0:13:39.559 those healthy bacteria that live in our body, well, they 0:13:39.600 --> 0:13:42.680 get altered when they're exposed to some of these chemicals. 0:13:43.240 --> 0:13:46.120 So there's a big chain reaction going on here. 0:13:47.000 --> 0:13:49.480 Doctors. I haven't hypothetical, and I hope you take it 0:13:49.480 --> 0:13:51.160 in the spirit in which it's intended here. I know 0:13:51.200 --> 0:13:53.760 it's kind of crazy to think this way, but a 0:13:53.840 --> 0:13:57.360 child born today. You have a daughter today, and you say, 0:13:57.400 --> 0:14:00.240 I want to give her the best chance of not 0:14:00.280 --> 0:14:03.320 getting breast cancer at any point in her life. What 0:14:04.160 --> 0:14:07.880 could you do with that child? Feed that child, expose 0:14:07.920 --> 0:14:11.160 that child to to give yourself the best chance? And 0:14:11.200 --> 0:14:14.080 no matter what you do, sometimes are you just going 0:14:14.120 --> 0:14:16.200 to be unlucky and nothing you can do about it? 0:14:16.559 --> 0:14:18.800 TJ, You're right, I mean, how do we take control 0:14:18.800 --> 0:14:22.240 over this? And what do we do? I think, you know, 0:14:22.360 --> 0:14:24.640 just on the personal level, we can pay attention to 0:14:25.520 --> 0:14:29.360 the kinds of foods we buy. It is a little 0:14:29.360 --> 0:14:32.760 bit crazy that it costs more money to buy healthier 0:14:32.800 --> 0:14:37.400 food than to buy junk food. So we've got to 0:14:37.480 --> 0:14:39.920 address that as a nation and say, how can we 0:14:39.960 --> 0:14:42.480 get people to have a healthier diet, not just in 0:14:42.560 --> 0:14:46.280 terms of cancer, but even cardiovascular health. Everything, More fresh 0:14:46.280 --> 0:14:49.800 fruits and vegetables into the diet, more fiber, less fat, 0:14:50.680 --> 0:14:55.080 less junk food of course, less processed food, especially the 0:14:55.120 --> 0:15:00.560 stuff coming from animal products, so dairy products, milk, eggs, cheese, 0:15:01.560 --> 0:15:04.960 and then all the meat products chicken and fish, and 0:15:05.760 --> 0:15:08.520 you know, beef, which we eat a lot of in America, 0:15:09.000 --> 0:15:12.120 much more than in other places. So if you can 0:15:12.160 --> 0:15:15.680 buy organic food where the animals are not fed all 0:15:15.760 --> 0:15:19.800 those antibiotics and hormones. That's probably healthier. Same with the 0:15:19.920 --> 0:15:25.280 dairy products, the eggs and the cheese and milk. I 0:15:25.320 --> 0:15:28.640 think that probably long term might make a difference, hard 0:15:28.680 --> 0:15:33.040 to say for sure. The other thing is just being 0:15:33.080 --> 0:15:38.400 healthy in terms of not being obese, doing physical exercise, 0:15:39.800 --> 0:15:44.280 not smoking, and not drinking excessive amounts of alcohol because 0:15:44.320 --> 0:15:45.640 all of those things make us sick. 0:15:45.480 --> 0:15:49.240 Too, and we need to just grow our own leafy 0:15:49.280 --> 0:15:52.240 drinks in the backyard, eat those the rest of our life. 0:15:52.280 --> 0:15:53.880 Don't leave the house, I think, is what you're saying, 0:15:53.880 --> 0:15:54.600 and we should be fine. 0:15:54.680 --> 0:15:58.880 Yeah, you know. And I also just I know some 0:15:58.960 --> 0:16:02.320 women are scared. They don't want to know. It's like 0:16:02.400 --> 0:16:05.120 ignorance is bliss. And obviously that is not a good 0:16:05.200 --> 0:16:09.840 way to deal with a potential cancer diagnosis. Because people 0:16:09.880 --> 0:16:13.200 are afraid of getting one, they avoid perhaps the tests altogether. 0:16:13.280 --> 0:16:18.720 But early detection is absolutely the way to save lives 0:16:18.720 --> 0:16:20.240 when it comes to breast cancer. And I was hoping 0:16:20.280 --> 0:16:22.000 you could expound on that because I think some people 0:16:22.040 --> 0:16:24.280 just think, well, I'll just kick the can down the 0:16:24.320 --> 0:16:25.080 road to next year. 0:16:25.760 --> 0:16:30.080 Don't do that. Early detection is still key. It's a very, 0:16:30.200 --> 0:16:34.280 very very powerful tool that each woman can have to 0:16:34.360 --> 0:16:38.360 take control over her own health. And I always tell 0:16:38.400 --> 0:16:41.520 people that, you know, going for the mammogram doesn't prevent cancer, 0:16:41.840 --> 0:16:45.400 but it could prevent you from dying from cancer. So 0:16:45.560 --> 0:16:49.040 it's really really important if we find a small tumor, 0:16:49.160 --> 0:16:51.800 even if it's an aggressive subtype, because not all breast 0:16:51.840 --> 0:16:54.600 cancers are the same, lots of different kinds of breast cancer, 0:16:55.440 --> 0:17:01.040 but we know that size in this situation still counts, 0:17:01.360 --> 0:17:04.000 and if it's small and if it hasn't spread too far, 0:17:04.760 --> 0:17:08.040 we usually have a much better chance of eradicating it 0:17:08.080 --> 0:17:11.200 completely and eliminating those problems down the road. 0:17:11.400 --> 0:17:13.280 Can you give us a good news in trends? We 0:17:13.320 --> 0:17:15.639 always talk about we see younger women, that's troubling, and 0:17:15.680 --> 0:17:18.280 all these troubling things. What's the good news you're seeing 0:17:18.280 --> 0:17:18.800 in trends. 0:17:18.880 --> 0:17:22.080 Yeah, the good news is our treatment's way better, way 0:17:22.119 --> 0:17:26.320 better than it was, so we understand much more about 0:17:26.320 --> 0:17:31.720 the biology of breast cancer. Basic science research is critically 0:17:31.760 --> 0:17:35.280 important to pushing this field forward, So we have to 0:17:35.359 --> 0:17:39.520 keep funding research in the laboratory where the scientists are 0:17:39.600 --> 0:17:43.520 digging into those molecular mechanisms of why is that cell 0:17:43.600 --> 0:17:46.920 turning into a cancer cell, what's making it grow, what's 0:17:46.960 --> 0:17:49.880 making it travel, what's making it spread? And now our 0:17:49.920 --> 0:17:53.600 therapies are more and more targeted to the type of 0:17:53.640 --> 0:17:57.000 breast cancer that someone has, and they work better. The 0:17:57.040 --> 0:17:59.920 treatments are more effective. We can learn to turn on, 0:18:00.280 --> 0:18:02.760 switch on, and off all those different pathways in the cell. 0:18:02.800 --> 0:18:06.280 It's really really exciting. I've seen that change over the 0:18:06.280 --> 0:18:08.600 course of my career, and I know there are people 0:18:08.640 --> 0:18:13.040 alive and well who wouldn't have been when I first 0:18:13.080 --> 0:18:19.760 went into practice, and that is the greatest, greatest joy 0:18:19.800 --> 0:18:20.760 in my clinical work. 0:18:21.320 --> 0:18:22.960 I would say that brings tears to my eyes just 0:18:23.000 --> 0:18:24.119 to hear that, yeah, it's. 0:18:23.960 --> 0:18:28.480 True, but to that, yes, the advancement's research, advancement's technology 0:18:28.480 --> 0:18:31.119 advancements and treatment are is it going to be a 0:18:31.119 --> 0:18:34.800 while though, before those advancements are going to show up 0:18:34.840 --> 0:18:37.480 in those trends you talk about with Okay, not so 0:18:37.600 --> 0:18:40.240 many young women are getting it anymore? Okay, not as many? 0:18:40.520 --> 0:18:41.600 Is that showing up yet? 0:18:42.200 --> 0:18:46.120 Well, I think we have reduced breast cancer mortality overall 0:18:46.720 --> 0:18:51.240 in America, so we have seen that already in terms 0:18:51.320 --> 0:18:53.399 of the causation thing. I think we have to do 0:18:53.440 --> 0:18:56.359 a little more work there, but we're definitely doing better 0:18:56.400 --> 0:18:59.200 on treatment for sure, Doctor Ortsa. 0:18:59.320 --> 0:19:02.720 Anyone who's listening to this podcast, I'm sure is familiar 0:19:03.040 --> 0:19:07.320 with our dear friend Morgan Mitchell, who is stage four metastatic. 0:19:07.640 --> 0:19:11.840 She is going to be celebrating her seven year anniversary 0:19:12.320 --> 0:19:16.080 come December. That also brings tears to my eyes and 0:19:16.119 --> 0:19:19.199 gives me chills because that was unheard of not that 0:19:19.359 --> 0:19:22.200 long ago, or at least in recent history. Where are 0:19:22.240 --> 0:19:25.480 we in terms of women who are living with stage 0:19:25.480 --> 0:19:28.520 four and how they're living and how long they're. 0:19:28.359 --> 0:19:31.960 Living, right, And that's where a lot of our research 0:19:32.080 --> 0:19:36.120 starts in that stage four setting with people who have 0:19:36.240 --> 0:19:40.040 advanced cancer, because the cancer is right there, so we 0:19:40.080 --> 0:19:42.879 can see how the treatments are working, and we start there. 0:19:44.840 --> 0:19:47.320 I lost a patient last week who was very, very 0:19:47.320 --> 0:19:50.280 dear to me, but I took care of her for 0:19:50.280 --> 0:19:55.560 twenty seven years wow, and the last ten of those 0:19:55.640 --> 0:19:59.639 years she had metastatic breast cancer. But she lived a 0:19:59.680 --> 0:20:03.479 good life with a really good quality of life. She 0:20:03.560 --> 0:20:06.000 was able to work and continue her career and be 0:20:06.119 --> 0:20:10.000 with her family and travel and enjoy herself, and it 0:20:10.040 --> 0:20:12.280 was only at the very end in the last few 0:20:12.320 --> 0:20:16.520 months where it got really rough, But that would never 0:20:16.560 --> 0:20:19.320 have happened in the past. And that's because of all 0:20:19.400 --> 0:20:22.679 of these new targeted therapies. Not only are they more effective, 0:20:23.080 --> 0:20:26.360 but we really, really really work on trying to help 0:20:26.400 --> 0:20:30.719 people live well and have a good quality of life 0:20:30.760 --> 0:20:34.359 and do whatever we can to minimize side effects and 0:20:34.480 --> 0:20:39.120 minimize the toxicity of our treatments. We're moving away from 0:20:39.119 --> 0:20:40.600 some of the things we used to do all the 0:20:40.640 --> 0:20:43.119 time because they were just too rough on people, and 0:20:43.160 --> 0:20:45.280 now we have things that are working better. Now. I 0:20:45.280 --> 0:20:47.920 can't tell you it's one hundred percent perfect, and I'm 0:20:47.960 --> 0:20:50.000 not going to tell you that every treatment comes and 0:20:50.640 --> 0:20:53.400 people feel fantastic. There are some side effects, there are 0:20:53.400 --> 0:20:56.919 some tough things we have to go through, but it 0:20:57.040 --> 0:20:59.440 is our mission to make sure that we keep doing 0:20:59.480 --> 0:21:02.080 research to get this right and to do it better 0:21:02.080 --> 0:21:02.880 and better and better. 0:21:11.760 --> 0:21:13.520 Can you put in context of how rare that is 0:21:13.560 --> 0:21:15.200 You talk about your patient that you took care of 0:21:15.200 --> 0:21:17.320 for all that time and then Morgan seven years with 0:21:17.480 --> 0:21:20.720 metastatic is do I have it right? I'm not overstating it. 0:21:20.760 --> 0:21:25.080 That's these days not so unheard of, but that's pretty 0:21:25.119 --> 0:21:26.320 rare for seven years. 0:21:26.400 --> 0:21:28.679 Depends on the subtype of breast cancer. So there are 0:21:28.720 --> 0:21:32.000 some subtypes where I certainly have patients with stage four 0:21:32.040 --> 0:21:35.800 disease five, six, seven, eight, nine, ten years. I mean, 0:21:35.840 --> 0:21:39.320 we're getting that's that's really happening. There are some other 0:21:39.400 --> 0:21:42.200 subtypes of breast cancer that are tougher to treat, a 0:21:42.240 --> 0:21:45.760 little bit more aggressive, and you know we're focusing our 0:21:45.760 --> 0:21:46.560 efforts on those. 0:21:47.200 --> 0:21:50.879 Can mindset, can attitude? Can just how you approach your 0:21:50.920 --> 0:21:53.679 life after a metastatic diagnosis like that. I say this 0:21:53.760 --> 0:21:57.400 because Morgan is the like the bubbliest, happiest person I've 0:21:57.400 --> 0:22:00.280 ever been around ever, And I think when I met 0:22:00.280 --> 0:22:03.120 her she'd already been diagnosed. I've only known her as 0:22:03.160 --> 0:22:08.040 stage four. She runs half marathons, marathons, She's just this bubbly, 0:22:08.520 --> 0:22:11.720 this ball of life all the time. Can that have 0:22:11.880 --> 0:22:14.800 an impact staying active? Can you still? Can you prolong 0:22:14.800 --> 0:22:19.480 your life? I guess by changing some things after metastatic diagnosis. 0:22:19.760 --> 0:22:22.919 This may not be a scientific answer, but yes, I 0:22:23.000 --> 0:22:27.800 believe that our heads are connected to our bodies, and 0:22:27.840 --> 0:22:29.919 when we use the word heart, we're here in this 0:22:29.960 --> 0:22:32.959 iHeart Studio we use the word heart. Yes, it's that 0:22:33.119 --> 0:22:35.399 pump that makes the blood go around your body, but 0:22:35.400 --> 0:22:39.320 it's also the seat of our emotions. So I think 0:22:39.400 --> 0:22:44.320 these are powerful connections. Our heads and our hearts, everything 0:22:44.359 --> 0:22:47.040 in our body is interconnected how we feel, how we 0:22:47.080 --> 0:22:50.440 live our lives. If we can fill our lives with joy, 0:22:50.480 --> 0:22:54.879 with hope, with love, and with trying to live in 0:22:55.040 --> 0:22:57.840 as healthy a way as possible, make the most of 0:22:57.880 --> 0:23:02.639 each day, be optimistic, maybe have some faith and whatever 0:23:02.680 --> 0:23:05.000 that is. Yeah, I think it helps. Yeah. 0:23:06.720 --> 0:23:10.080 So yes, Morgan is actually via Sarah get expecting she 0:23:10.119 --> 0:23:13.239 and her husband are expecting a baby in January, and 0:23:13.400 --> 0:23:15.919 talking about having a reason to live, a reason to 0:23:15.960 --> 0:23:17.679