OCTOBER IS BREAST CANCER AWARENESS MONTH.

EACH YEAR DURING THIS TIME, PEOPLE AROUND THE WORLD SHOW THEIR SUPPORT FOR THOSE AFFECTED BY THE DISEASE.

TONIGHT, WHAT EVERY WOMAN SHOULD KNOW ABOUT THE RISK FACTORS, SYMPTOMS, TREATMENTS AND PREVENTION STRATEGIES.

THAT’S NEXT ON INSIGHTS ON PBS HAWAII.

THE AMERICAN CANCER SOCIETY ESTIMATES MORE THAN 75 HUNDRED PEOPLE IN HAWAII WILL BE DIAGNOSED WITH CANCER THIS YEAR.

THE MAJORITY OF CASES WILL LIKELY BE WOMEN WITH BREAST CANCER, BUT A DIAGNOSIS IS NOT A DEATH SENTENCE.

EARLY DETECTION, VARIOUS TREATMENT OPTIONS AND PREVENTATIVE MEASURES, ARE PART OF THE ARSENAL OF TOOLS TO HELP OVERCOME THIS OBSTACLE.

TONIGHT’S LIVE BROADCAST AND LIVESTREAM OF INSIGHTS ON PBS HAWAI’I START NOW.

¶¶ ¶¶ ALOHA AND WELCOME TO INSIGHTS ON PBS HAWAII.

I'M OLENA HEU.

THE STATISTICS ARE SOBERING.

ABOUT ONE IN EIGHT AMERICAN WOMEN WILL DEVELOP INVASIVE BREAST CANCER OVER THE COURSE OF HER LIFETIME.

IN FACT, ACCORDING TO THE WORLD HEALTH ORGANIZATION, BREAST CANCER IS NOW THE WORLD’S MOST COMMONLY DIAGNOSED CANCER, BUT EXPERTS SAY TREATMENT CAN BE HIGHLY EFFECTIVE, ESPECIALLY IF THE CANCER IS FOUND EARLY.

REGULAR SCREENINGS, SELF EXAMS, GENETIC COUNSELING AND EVEN PREVENTATIVE SURGERY COULD REDUCE THE RISK OF BREAST CANCER IN WOMEN.

BREAST CANCER HAS TOUCHED MY LIFE MANY TIMES, FIRST MY AUNT, MY GRANDMOTHER AND MY MOTHER.

AFTER MY MOM PASSED AWAY FROM METASTATIC BREAST CANCER I TESTED POSITIVE FOR A GENETIC MUTATION, THAT MEANT I WAS NOT ONLY HIGH RISK OF THE DISEASE BUT EXTREMELY HIGH RISK.

TWO YEARS AGO, I OPTED TO UNDERGO A PROPHYLACTIC BILATERAL SIMPLE MASTECTOMY.

WHICH MEANS I HAD BOTH OF MY NATURAL BREASTS REMOVED WITHOUT RECONSTRUCTION WHICH REDUCED MY CHANCES OF BREAST CANCER BY OVER 90%.

I AM HONORED TO BE ABLE TO SHARE MY PREVENTATIVE STORY TONIGHT ALONG WITH DISCUSSING HOW BREAST CANCER HAS IMPACTED OTHERS, HOW BEST TO PREVENT THE DISEASE, WHAT TREATMENT IS LIKE, WHAT IS NEW WITH TECHNOLOGY AND HOW YOU CAN HELP.

WE LOOK FORWARD TO YOUR PARTICIPATION IN TONIGHT'S SHOW.

YOU CAN EMAIL OR CALL IN YOUR QUESTIONS AND YOU’LL FIND A LIVE STREAM OF THIS PROGRAM AT PBSHAWAII.ORG AND THE PBS HAWAII FACEBOOK PAGE.

NOW, TO OUR GUESTS.

DR. LISA GRININGER IS A SURGEON AT KAISER PERMANETE MOANALUA MEDICAL CENTER.

SHE’S A FELLOW OF THE AMERICAN COLLEGE OF SURGEONS, A MEMBER OF THE AMERICAN SOCIETY OF BREAST SURGEONS AND HAS BEEN INVOLVED WITH THE ALOHA MEDICAL MISSION VOLUNTEER ORGANIZATION FOR NEARLY 30 YEARS.

JOANNE HAYASHI WAS DIAGNOSED WITH BREAST CANCER IN 2015.

SHORTLY AFTER, SHE CO FOUNDED THE WEBSITE BREAST CANCER HAWAII AND IN 2019 SHE LEFT HER CORPORATE JOB TO FOCUS ON THE NON PROFIT.

SHE’S ALSO A FREELANCE TRANSLATOR FOR JAPANESE DRAMAS, MANGA AND ANIME.

MARY HICKMAN IS A CERTIFIED GENETICS COUNSELOR WHO SPECIALIZES IN ONCOLOGY CANCER GENETICS AT THE KAPIOLANI MEDICAL CENTER FOR WOMEN AND CHILDREN.

GENETIC COUNSELING CAN HELP ASSESS INDIVIDUAL OR FAMILY RISK FOR A VARITY OF INHERITED CONDITIONS, INCLUDING CANCER.

AND DR. RYON NAKASONE IS AN MD AND CERTIFIED ONCOLOGIST AND HEMATOLOGIST.

HE’S THE ASSISTANT CHIEF OF THE ONCOLOGY DEPARTMENT AT THE QUEEN’S MEDICAL CENTER AND IS ALSO AN ASSOCIATE PROFESSOR OF MEDICINE AT THE UNIVERSITY OF HAWAII.

THANK YOU ALL FOR JOINING US TONIGHT.

OF COURSE, BREAST CANCER AWARENESS MONTH.

APPRECIATE YOU TAKING IT'S TIME.

MY FIRST QUESTION, JOANNE, I WANT TO DO TALK MORE WITH YOU AS YOU ARE BREAST CANCER SURVIVOR IF YOU COULD SHARE WITH US YOUR STORY HOW THAT HAPPENED.

HOW HAS ACTUALLY CHANGED YOUR LIFE THEREAFTER AS WELL.

>> CHANGED MY LIFE.

UNDERSTATEMENT.

SO I WAS 33 YEARS OLD.

FOUND A LUMP IN MY BREAST.

MAMMOGRAM USUALLY ONLY HAPPEN FOR WOMEN 40 OR 45 AND ABOVE.

WHEN I FOUND IT, IT WAS ALREADY LUMPED THAT I COULD FEEL.

AND LUCKILY, MY PRIMARY CARE PHYSICIAN.

TO BE IT SERIOUSLY.

SENT ME IMMEDIATELY TO SCANS.

IT WAS IN FACT BREAST CANCER NOT A CYST AS MANY YOUNG WOMEN DO GET.

I OPTED FOR CHEMOTHERAPY FIRST TO REDUCE THE SIZE OF THE TUMOR.

THEN GOT SURGERY.

I CHOSE LUMPECTOMY.

JUST TAKING PORTION OF THE TUMOR OUT.

THEN FOLLOW BY RADIATION.

WHEN I WAS DIAGNOSED GOING THROUGH TREATMENT, DID WAS LIKE JUST VERY OVERWHELMING.

AMOUNT OF INFORMATION, DECISIONS THAT YOU HAD TO MAKE.

FACING MORALITY, MAKING FRIENDS WITH OTHER PEOPLE WHO HAVE HAD BREAST CANCER.

THOSE PEOPLE PASSING AWAY.

JUST ALL VERY OVERWHELMING A LOT OF RESOURCES AND THE SUPPORT.

SIFTING THROUGH THAT OVERWHELMING.

STARTED BREAST CANCER HAWAII REDUCE OVERWHELM FOR OTHER PATIENTS THAT MIGHT BE FACING THE DISEASE.

>> WHAT EXACTLY DOES BREAST CANCER HAWAII DO?

>> SURE.

SO OUR MISSION IS TO CONNECT PEOPLE WITH RELEVANT RESOURCES AND MEANINGFUL SUPPORT THROUGH A NUMBER OF WAYS.

>> WE HAVE OUR WEBSITE LIST RESOURCE LIBRARY, RECENTLY UPLOADED A DIRECTORY FAMILY THERAPIST THAT HAVE EXPERIENCED WITH PEOPLE FACING CANCER DIAGNOSIS AND ARE ACCEPTING NEW PATIENTS CURRENTLY.

WE EDUCATIONAL EVENTS WHERE WE CAN CONNECT PEOPLE TO INFORMATION AND RESOURCES.

AND THEN IN TERMS OF SUPPORT, WE DO ONE ON ONE PEER SUPPORT.

AND WE HAVE DIFFERENT GROUP EVENTS WHERE PEOPLE CAN NETWORK WITH OTHER PATIENTS AND SURVIVORS.

>>Olena: WONDERFUL.

I'VE HAD THOSE DIAGNOSED WITH BREAST CANCER.

REACH OUT TO ME SUPPORT AND GUIDANCE.

DON'T KNOW WHAT TO DO, WHAT THEIR OPTION ARE.

HAD PEOPLE CAN ME WHY DID I DECIDE TO HAVE MASTECTOMY?

SO OFFERING THOSE RESOURCES FOR PEOPLE IS INVALUABLE.

AND SO MARY, I WANTED TO KIND OF TURN IT OVER TO YOU AS A GENETICS COUNSELOR.

THAT WAS HOW I HAD DETERMINED TO HAVE MY SURGERY BECAUSE NOT ONLY DID I HAVE THE FAMILY HISTORY, BUT I ALSO TESTED POSITIVE FOR GENETIC MUTATION.

CAN YOU EXPLAIN WHAT YOU DO AROUND WHAT IT MEANS TEST POSITIVE.

>> GENETIC COUNSELORS EXPERTS NAVIGATING GENETIC TESTING AND FAMILY HEALTH HISTORY.

BECAUSE WE KNOW THAT?

IN ADDITION TO POSSIBLY INHERITED CANCER SYNDROMES FAMILY HISTORY PLAYS A HUGE PART IN WHAT OUR RISKS FOR DEVELOP CANCER IN OUR LIFETIMES ARE.

WHEN SOMEONE MEET WAS A GENETIC COUNSELOR, OFTEN IN THE CONTEXT OF HAVING A PERSONAL OR FAMILY HISTORY OF CANCER.

DISCUSS CERTAIN FEATURES THAT WE'RE LOOKING FOR THAT COULD BE MORE CONCERNING FOR INHERENTED SYNDROME SUCH AS VERY YOUNG AGES OF ON SET OR MANY FAMILY MEMBERS WITH SIMILAR DIAGNOSES.

OR EVEN SOME OTHER RARE FORMS OF CANCER.

IF SOMEBODY ELECTS TO UNDER GO GENETIC TESTING, WE DETERMINE IF THAT'S APPROPRIATE, EITHER THROUGH WHETHER OR NOT TESTING IS INDICATED BUT ALSO IF IT'S RIGHT DECISION FOR A PERSON TO UNDER GO, BECAUSE THAT CAN ILLUMINATE MORE INFORMATION ABOUT WHETHER OR NOT SOMEONE HAS INHERITABLE RISK FOR CANCER.

DESCRIBE IT AS ONE OF THE BARRIERS IN OUR BODY HELPING TO PROTECT US FROM DEVELOPING CANCER ESSENCE BROKEN DOWN.

DOES NOT MEAN THAT A PERSON WILL DEVELOP CANCER.

BUT IT HELPS GUIDE A PATHWAY FOR WHAT TYPES OF SCREENING OR SURGERIES MIGHT BE INDICATE TO DO HELP LOWER THAT RISK AND MAKE SURE THAT DIAGNOSIS DOESN'T HAPPEN TO OTHER PEOPLE IN THE FAMILY AS WELL.

>>Olena: CAN YOU DESCRIBE WHAT A GENETIC MUTATION MEANS.

>> OF COURSE.

THOUSANDS OF GENES THAT ARE INSTRUCTIONS FOUR GROWTH AND FOR OUR DEVELOPMENT.

SUBSET OF THESE GENES, AND TUMOR SUPPRESSERS, WHAT THEY SOUND LIKE, WORK TO REGULATE HOW OUR CELLS DIVIDE AND NATURALLY DIE OFF.

IF THESE GENES AREN'T WORK PROPERLY, MUTATION, TYPO IN THAT IT GENETIC CODE, CAN SEE A PERSON HIGHER RISK FOR DEVELOPING CANCER.

ALL GENETIC TESTING IS SPECIALIZED SPELL CHECK TO LOOK TO SEE IF WE CAN IDENTIFY ONE OF THOSE MUTATIONS.

>>John: WHAT TIMES OF PEOPLE HIGHER RISK.

>> COMMON FEATURES YOUNG AGES OF ONSET.

DIAGNOSED PREMENOPAUSAL BREAST CANCER BENEFIT FROM GENETIC TESTING.

SEE MANY FAMILIES BREAST CANCER AND OTHER FORMS.

OVARIAN, PANCREATIC.

GENETIC COUNSELOR COMES IN.

LOOK FOR PATTERNS.

>>Olena: BREAST HEALTH IS YOUR FORTE.

HOW CAN WOMAN DISTINGUISH BETWEEN LUMP AND CYST.

WHAT WOULD BE YOUR ADVICE TO THEM IF THEY FEEL SOMETHING MIGHT BE WRONG.

>> NOTICE SOMETHING DIFFERENT IN THEIR BREAST, LUMP, CYST GOOD FOR HER TO CHECK WITH PRIMARY CARE PHYSICIAN.

OR NURSE OR A LOT OF WOMEN IN TO SEE THEY ARE GYN PROVIDER.

OFTEN, DEPENDING A LITTLE BIT ON THE AGE AND EXAM, WOMAN IS AROUND 40, WE ALWAYS LOOK TO SEE IF SHE'S HAD A MAMMOGRAM.

OR DUE FOR A MAMMOGRAM.

OFTEN, ALSO FOR SOMETHING THAT IS PALPABLE OR SOME TYPE OF LUMP THAT WE FEEL, WE'LL ALSO DOULTRASOUND.

BEST WAY TO TELL.

SEES FLUID VERY WELL.

CYSTS VERY COMMON, SACKS FILLED WITH FLUID.

CAN SEE THOSE VERY WELL BY ULTRASOUND.

MOST OF THE TIME, WE'LL DO SOME SORT OF IMAGING AS INITIAL TEST.

>>Olena: WHAT IS THE DIFFERENCE BETWEEN A TUMOR AND CYST.

>> YOU MENTIONED CYST COULD HAVE LIQUID.

THEN WHAT ARE THE STEPS THAT ARE TAKEN WHEN SOMETHING IS SAID TO BE A TUMOR?

>> WELL, WHEN WE FEEL, CALL A DOMINANT MASS OR LUMP THAT REALLY FEELS DIFFERENT FROM THE REST OF THE WOMAN'S BREAST TISSUE, CAN BE DIFFERENT A LOT OF WOMEN HAVE FIBROCYSTIC CHANGES BREAST TISSUE FEELS MORE FIBROUS AND LUMPY.

GENERALLY, WE'LL DECIDE KIND OF LOOK TO SEE WHEN THEIR MAMMOGRAM WAS OR IF THEY'RE DUE FOR A MAMMOGRAM.

POSSIBLY FOCUS ON THE AREA AS WELL AS ULTRASOUND TO KIND OF EVALUATE THE MASS OR THE LUMP.

>> WHEN WE TALK ABOUT A MASS, JUST A TERM FOR KIND OF LUMP BASICALLY.

A LOT OF TIME, WHAT WE WANT DO IS INITIALLY TELL IF IT'S FLUID SOMETHING FILLED WITH FLUID, WHICH ALMOST ALWAYS IS BENIGN OR NOT CANCEROUS VERSUS SOLID LUMP WHICH COULD BE SOMETHING THAT COULD BE CANCEROUS.

ALTHOUGH, A LOT OF THOSE ARE ALSO BENIGN TOO.

SO IT'S IMPORTANT TO GET IT CHECKED OUT.

AND I THINK ONE OF IMPORTANT THINGS TO KNOW IS MOST LUMPS DON'T TURN OUT TO BE CANCEROUS.

SO VERY FRIGHTENING TO FIND SOMETHING.

WE WANT TO, IF IT WERE CANCER, WANT TO CATCH IT AS EARLY AS POSSIBLE.

BUT MOST OF THE LUMPS DON'T TURN OUT TO BE CANCEROUS.

IT'S NOT, THERE'S ALWAYS SO MUCH ANXIETY INVOLVED.

>>Olena: HOW DOES THE LUMP FEEL DIFFERENT MAYBE FROM REGULAR BREAST TISSUE?

>> CYSTS TEND TO BE ROUND AND SMOOTH AND MOVE AROUND.

CANCERS IN GENERAL, GET TO THE SIZE WHERE WE CAN FEEL THEM, TEND TO BE HARDER AND KIND OF LITTLE MORE IRREGULAR.

BUT IT'S VERY DIFFICULT TO TELL JUST BY FEELING.

>>Olena: DEFINITELY.

I REMEMBER GOING TO AN EVENT DOWNTOWN.

THERE WERE BREASTS COULD YOU FEEL.

FELT LIKE A MARBLE OR PEA SOMETHING TO REMEMBER WITH THE SELF EXAMS.

DOCTOR, YOU ARE ONCOLOGIST.

SO DEAL WITH THOSE THAT HAVE CANCER.

SO WHAT ARE THE NEXT STEPS WHEN SOMEONE COMES IN AND THEY HAVE BREAST CANCER AND CAN YOU ALSO DISTINGUISH WHAT YOUR METHOD OF TREATMENT WOULD BE IF THEY'RE STAGE 1 VERSUS STAGE 4?

>> YES.

SO GREAT QUESTION.

A LOT OF THINGS GO INTO MAKING DECISIONS DECIDE A PATH PUT THE PERSON ON.

HAVING DIAGNOSIS OF BREAST CANCER CAN BE DAUNTING.

SCARY.

SO WE REALLY DO A LOT OF EDUCATION.

DO A LOT OF SUPPORT.

AND WE FOLLOW NATIONAL GUIDELINES AND STANDARDS OF CARE TO DETERMINE WHICH WAY WE'RE GOING TO GO WITH THAT PERSON.

SO STAGE ONE, FOR EXAMPLE, TRADITIONALLY CAN BE TREATED WITH SURGERY.

NOT NECESSARILY NEEDING CHEMOTHERAPY, BUT A LOT OF FACTORS THAT GO INTO THAT.

IF IT'S A LUMPECTOMY FOLLOWED BY RADIATION, MASTECTOMY TRADITIONALLY DOESN'T NEED NECESSARILY NEED RADIATION AFTERWARD.

STAGE 4 FOR EXAMPLE, THAT MEANS CANCER ALREADY SPREAD OUTSIDE THE BREAST.

LOFT OPTIONS CHEMOTHERAPY TO SHRINK THE CANCER.

SLOW IT DOWN.

HORMONE THERAPISTS.

DIFFERENT USE TO ATTACK DIFFERENT ANGLE.

>> HAVE YOU USED NEW TECHNOLOGY YOU WOULD LIKE TO SHARE WITH US.

>> ALWAYS NEW THERAPIES COMING OUT TO GO AGAINST CANCER ITSELF.

LATEST IMMUNOTHERAPY.

GIVES US EXTRA OPTIONS WE CAN EMPLOY.

>>Olena: YOU MENTIONED THAT YOU OPTED TO HAVE A LUMPECTOMY AND RADIATION.

WHAT LED YOU TO THAT DECISION.

>> NUMBER OF FACTORS.

>> CHEMOTHERAPY WAS HARD ON MY BODY.

SET ON GETTING DOUBLE MASTECTOMY RECONSTRUCTION.

MORE THAT I LOOKED INTO THE DIFFERENT OPTIONS, I JUST WANTED TO DO SOMETHING THAT WAS NOT AS HARD ON MY BODY.

AFTER I HAD BEEN THROUGH SO MUCH DURING CHEMOTHERAPY.

DOCTOR DID EXPLAIN TO ME DIFFERENCES IN SURVIVAL RIGHTS WHICH ACTUALLY WERE THE SAME BETWEEN LUMPECTOMY AND MASTECTOMY.

SO IF THAT WAS THE CASE, I THOUGHT MAYBE JUST DOING THE SMALLER SURGERY WOULD BE BEST FOR ME.

AT THAT TIME.

>>Olena: IF YOU COULD MAYBE CLARIFY WHAT THE DIFFERENCES BETWEEN MASTECTOMY AND LUMPECTOMY.

>> GOOD QUESTION.

SO MASTECTOMY GENERALLY MEANS REMOVING ALL OF THE BREAST TISSUE.

THERE'S ACTUALLY DIFFERENT TYPES OF MASTECTOMIES WE DO NOW.

SOMETIMES IT ALSO INVOLVES BREAST RECONSTRUCTION.

THE TERM MASTECTOMY MEANS REMOVING MOST OF THE TISSUE OFTEN INCLUDING NIPPLE.

WHEREAS LUMPECTOMY TYPICALLY JUST REMOVING A PORTION OF THE BREAST.

IN GENERAL, LIKE TO REMOVE THE CANCEROUS TUMOR PLUS LITTLE MARGIN OF NORMAL TISSUE AROUND IT.

>>Olena: THANK YOU.

WE'RE STARTING TO GET VIEWER QUESTIONS.

I WOULD ALSO LIKE TO REMIND EVERYBODY IF YOU HAVE A QUESTION, YOU CAN CALL IN, YOU CAN ALSO FACEBOOK US.

I WOULD BE HAPPY TO REVIEW YOUR QUESTION AND MAYBE WE'LL ASK IT LIVE ON TV.

AND SO THIS ONE IS ACTUALLY MAY BE FOR MARY.

IT'S FROM LORI MAKA WE UNDERSTAND THAT GENETIC RISK FACTORS, GENETIC RISK ARE FACTORS.

WHAT DO YOUR SPEAKERS HAVE TO SAY ABOUT DIET AND ENVIRONMENTAL AND OTHER RISK FACTORS AND WHAT CAN WE DO PREVENT CANCER.

>> I ALWAYS SAY FROM THE GENETICS PERSPECTIVE, IS ONE PIECE OF THE PUZZLE.

INDIVIDUALS WHO HAVE GENE MUTATION PUTS THEM AT HIGHER RISK FOR BREAST OR OTHER CANCERS.

>> DOESN'T MEAN THEY WILL DEVELOP CANCER IN THEIR LIFETIME.

COMBINATION OF GENETIC AND ENVIRONMENT.

HORMONES ONCOLOGY AND SURGERIES, CAN DISCUSS MORE ON THAT FRONT.

ENCOURAGE HEALTHY LIFESTYLE.

ALL OF THIS CONTRIBUTES SIGNIFICANTLY.

>>Olena: WOULD YOU RECOMMEND GOING VEGAN, ELIMINATING SUGAR FROM YOUR DIET?

HAVE YOU SEEN RESULTS.

>> GREAT QUESTION.

WE GET THAT QUESTION A A LOT.

DIETRY CONTROL OF CANCER VERY DIFFICULT.

CONSIDER CANCER CELL IS JUST A NORMAL CELL GONE AWRY.

TRY TO NORMAL ELIMINATE DIET, NORMAL CELLS NEED THOSE THINGS NOT GOING TO GET NUTRIENTS THEY NEED.

DIETRY CONTROL CAN BE DIFFICULT.

YOU CANNOT SELECT WHICH CELLS DO NOT GET NUTRIENT OR SUGAR FOR EXAMPLE.

>>Olena: GOOD TO KNOW.

WE ALSO HAVE ANOTHER FROM UNCLE DON FROM NEWTOWN.

HE WOULD LIKE TO KNOW IF IT'S TRUE ASIAN WOMEN ARE MORE LIKELY TO GET CANCER IN THE UNITED STATES THAN IN ASIA.

I FEEL LIKE IN TERMS OF MAYBE TALKING ABOUT RACE, THERE ARE CERTAIN TIMES OF RACES MORE PRONED TO GET BREAST CANCER.

>> I CAN'T NECESSARILY SPEAK TO SOUNDS LIKE THAT IS MORE OF A QUESTION TOWARDS ENVIRONMENT OF LIVING AND CERTAIN AREAS.

VERSUS OTHERS.

BUT FROM QUESTION ABOUT OUR ANCESTRY AND RACE, THERE ARE CERTAIN GENETIC MUTATIONS MORE COMMON IN CERTAIN POPULATION.

>> OUR APPROACH TO GENETIC TESTING AND THAT ASSESSMENT BECOME WHAT HE CALL PANAFRIC TESTING.

WE'RE DISCOVERING MORE AND MORE THIS OVERLAP OF WHO CAN HAVE GENE MUTATION AND WHERE IT'S MORE COMMON THAT ULTIMATELY, WE TAKE THAT AS A FACTOR INTO CONSIDERATION.

WHAT WE MIGHT BE CONCERNED OR SUSPICIOUS FOR.

APPROACH IT DIFFERENTLY ANY PATIENT.

>>Olena: DIFFERENT TYPES OF BREAST CANCER?

DIFFERENT STAGES.

BEFORE STAGE ONE EVEN.

CAN ONE OF YOU SPEAK ON DIFFERENT TYPES AS WELL?

>> MOST OF THE CANCERS START IN THE DUCTILE SYSTEM.

DUCTS IN THE BREAST CARRY THE MILK.

SO PROBABLY ABOUT 85% OF THE BREAST CANCER WE SEE ARE WHAT WE CALL DUCTILE EITHER INVASIVE DUCTILE CARCINOMA OR EARLIER STAGE DUCTILE CARCINOMA.

15% FROM THE LOBULES MORE STRUCTURAL COMPONENTS OF BREAST.

WE TREAT THEM VERY SIMILARLY.

AND VERY RARE TUMORS THAT CAN START IN THE BREAST.

SUCH AS LYMPHOMAS AND THINGS.

PROBABLY VAST MAJORITY ARE WHAT WE CALL INVASIVE DUCTILE CARCINOMA.

WE DON'T KNOW WHAT CAUSES THEM.

ONE OF THE THINGS THAT DESPITE SO MANY YEARS OF RESEARCH AND EVERYTHING HAVEN'T QUITE FIGURED OUT HOW TO PREVENT BREAST CANCER.

AT THIS POINT, USUALLY ACCEPT FOR MAYBE THE MORE LIKE SURGICAL PREVENTION, THINGS LIKE THAT.

MOST OF FOCUS HAS BEEN ON EARLY DETECTION.

>>Olena: I KNOW FOR ME, AFTER I HAD MY MASTECTOMY.

ACTUALLY SAID THAT IF THEY HAD DETECTED ANY CANCER WITHIN THE CELLS, THEY MIGHT HAVE TO TAKE OUT MY LYMPH NODES IN MY ARMPIT.

WHY WOULD THAT BE?

>> WE KNOW WHEN BREAST CANCER DEVELOPS, AND AT SOME POINT, OVER TIME, DIFFICULT TO TELL EXACTLY WHEN, IT COULD POTENTIALLY SPREAD OUTSIDE OF THE BREAST.

IF IT DOES, MOST OF THE TIME, FIRST PLACE IT GOES TO IS LYMPH NODE UNDER THE ARM.

OR WHAT WE CALL AXILLARY LYMPH NODES.

IN GENERAL, FOR EARLIER STAGE BREAST CANCER.

PART OF THE SURGICAL TREATMENT IS TO DO WHAT WE CALL LYMPH NODE BIOPSY OR IDENTIFY AND TESTED LYMPH NODE BREAST DRAINS TO ON THAT SIDE.

JUST TO ACCURATELY STAGE AND TO MAKE SURE THAT IS NO SPREAD OUTSIDE OF THE BREAST.

>>Olena: HAVE YOU NOTICED A OTHER KIND OF TREATMENT SUCCESSFUL OTHER THAN RADIATION AND CHEMOTHERAPY?

>> I DO SURGICAL PART.

SO MOST, I WOULD SAY MOST OF THE PATIENTS ESPECIALLY IF FOR EARLIER STAGE AND LATER STAGE SURGERY, IS INVOLVED AT SOME POINT.

LIKE DR. NAKASONE WAS MENTIONING, SOMETIMES CHEMOTHERAPY MIGHT BE FIRST.

DEPENDING ON THE STAGE.

AS FAR AS OTHER TREATMENTS, THERE IS SOME I THINK RESEARCH GOING ON AS FAR AS FREEZING TUMORS OR ABLADING THEM WITH LASERS OR OTHER TYPES OF TREATMENTS.

BUT AT THIS POINT, THOSE ARE KIND OF ALL IN THE EXPERIMENTAL PHASE.

>>Olena: WOW.

INTERESTING.

ANYTHING WANT TO ADD, DR. NAKASONE?

>> YEAH.

100% CORRECT.

THREE MAIN PILLARS OF TREATING CANCER IN GENERAL IS SURGERY.

EARLY STAGE BREAST CANCER, SURGERY IS ABSOLUTELY PIVOTAL.

THEN RADIATION.

RADIATION TECHNIQUES HAVE GOTTEN BETTER.

USE DIFFERENT TYPES OF MACHINERY NOW THAT THEY DID CAN LOCALIZE TUMORS BETTER AND DECREASE THE SIDE EFFECTS FROM THE RADIATION ITSELF.

SYSTEMIC THERAPY.

CHEMOTHERAPY AND HORMONE THERAPY.

THREE PILLARS OF TREATING BREAST CANCER.

SOME PEOPLE GET ALL THREE.

SOME PEOPLE ONLY GET TWO.

REALLY DEPENDING ON THE TYPE OF CANCER AND STAGE.

>>Olena: HOW DO YOU RECOMMEND WHICH ONE IS BEST AND ADDRESS THE ISSUE OF HAIR LOSS?

THAT COULD BE A CONCERN FOR SOME PEOPLE?

>> DEFINITELY.

HAIR LOSS HAVE VERY TANGIBLE THING THAT PEOPLE SEE.

WHEN THEY'RE GETTING TREATMENT.

JUST VERY VISCERAL AND VISUAL.

SO IT CAN BE VERY IMPACTFUL.

IN TERMS OF HOW THEY FEEL AND HOW THEY KIND OF PERCEIVE WHAT THEY'RE GOING THROUGH.

SO WE DEFINITELY TELL THEM THAT CERTAIN MEDICATIONS LIKE CERTAIN CHEMOTHERAPY DRUGS DOES HAVE UNFORTUNATE SIDE EFFECT OF HAIR LOSS.

FOR THE MAJORITY WILL COME BACK AND WE TELL THEM WEAR A BADGE OF HONOR.

SHOWING THAT YOU'RE FIGHTING THIS DISEASE.

AND YOU ARE FIGHTING YOUR LIFE.

SO IT'S IMPORTANT THAT THEY TRY TO TURN INTO A POSITIVE THAT THEY ARE GOING THROUGH THIS THING.

TOGETHER WITH OTHER PEOPLE AROUND THEM AS WELL.

>>Olena: I KNOW A LOT OF PEOPLE FEEL CONCERNED THAT IF THERE'S FAMILY HISTORY OTHER TYPE OF CANCERS MIGHT BE AT RISK.

SOMEONE TOLD ME UNCLE HAD COLON CANCER.

ANY CORRELATION?

>> WHEN WE FIRST MEET A PATIENT, CONSULTATION, TRY TO TAKE A VERY THOROUGH FAMILY HISTORY.

SCREEN FOR INCLUDING POINT US IN THE GENERATION MIGHT HAVE UNDERLYING CAUSE.

FAMILY MEMBERS HAVE CANCER.

HOW OLD.

WHAT TYPE OF CANCER.

PUT IT INTO A RUBRIC TO HELP US DECIDE IF THEY HAVE A HIGH RISK OF HAVING ABNORMALITY.

SEND THEM TO TESTING.

SCREEN PEOPLE FOR THAT POSSIBILITY.

>>Olena: FOR YOU, DID YOU HAVE ANY FAMILY HISTORY OF CANCER?

>> WE DO HAVE SOME FAMILY HISTORY OF CANCER.

BUT IT WASN'T ANYTHING OUT OF THE EXPECTED AGE RANGE.

BUT BECAUSE I WAS PREMENOPAUSAL.

GENETIC COUNSELING AND THEN TESTING WAS DEFINITELY RECOMMENDED FOR ME.

THAT WAS ACTUALLY ONE OF THE FACTORS THAT WENT INTO ME DECIDE ON A LUMPECTOMY.

RISK PROFILE WAS SPECIFIC TO ME NOT HAVING GENETIC MUTATION.

IF I DID, WOULD HAVE GONE FOR THE MASTECTOMY ROUTE.

>>Olena: WHAT DO A LOT OF WOMEN ASK YOU WHEN THEY COME TO YOU FOR GUIDANCE?

>> AM I GOING TO BE OKAY.

HOW BAD IS CHEMOTHERAPY.

YOU KNOW, IT REALLY DEPENDS.

I SAID EARLIER, KIND OF HARD FOR ME I HAVE FRIENDS WHO WORKED THROUGH THEIR CHEMOTHERAPY.

REALLY DIFFERS BY PERSON AND HOW MUCH THEY CAN TOLERATE.

ONE THING YOU DO ADVISE PEOPLE DEFINITELY REACH OUT FOR SUPPORT.

IF PEOPLE ARE OFFERING IT TO YOU, TAKE IT.

THAT IS SOMETHING THAT I TELL PEOPLE.

>>Olena: ONE THING IMPRESSED ME MY MOM.

DRIVING HERSELF FROM KILAUEA TO WILCOX HOSPITAL FOR HER TREATMENTS TO THE END.

IF YOU'RE FROM KAUAI, YOU KNOW THAT'S REALLY FAR.

OKAY, WE DO HAVE A FEW MORE QUESTIONS COMING IN.

THIS ONE LITTLE TECHNICAL.

PLEASE HAVE THE GUESTS TALK ABOUT THE DIFFERENT TYPE OF BREAST CANCER WHICH WE KIND OF DID, BUT THIS ONE WANTS US TO FOCUS ON TRIPLE NEGATIVE.

>> SO DR. NAKASONE?

>> YEAH.

SO ALLUDED TO EARLIER, DIFFERENT TYPES OF BREAST CANCER.

WE LOOK AT THE CELL ARCHITECTURE TO DETERMINE IF IT'S DUCTILE CARCINOMA.

CERTAIN TYPES OF HORMONE RECEPTORS.

80% ARE HORMONE POSITIVE.

THAT MEANS SENSITIVE TO HORMONE MEDICATIONS THAT WE CAN USE TO TRY AND FIGHT THE CANCER ITSELF.

TRIPLE NEGATIVE IS A FORM OF BREAST CANCER WHICH THEY ARE NEGATIVE FOR ALL THREE OF OUR TRADITIONAL MARKERS THAT WE TEST FOR ON THE SURFACE OF THE CELL.

SO ER NEGATIVE, PR NEGATIVE AND WHAT IS CALLED HER 2 NEGATIVE.

ONE OF THE MORE RARER FORMS OF BREAST CANCER.

>> ONLY ABOUT 10 TO 15% OF BREAST CANCER TRIPLE NEGATIVITY IT CAN BE A MORE AGGRESSIVE FORM OF BREAST CANCER AS WELL.

LIMITS US IN TERMS OF THERAPEUTIC OPTIONS.

IF THEY DON'T HAVE THE RECEPTORS, CANNOT USE CERTAIN MEDICATIONS THAT TARGET THOSE RECEPTERS.

>>Olena: ANOTHER QUESTION COMING IN FROM A VIEWER.

MIKE IN KAHULUI.

SAID, THE KIND OF STATEMENT BUT I ENCOURAGE PEOPLE FACING CANCER TO GET GENETIC TESTING AS WELL AS SEEING PSYCHOLOGIST TO MANAGE ANGER, STRESS, DEPRESSION AND PTSD.

SENSE OF HUMOR AND DEEP BREATHING ALSO HELPS.

SO I WANTED TO ASK YOU, OBVIOUSLY, THIS PERSON RECOMMENDING GENETIC TESTING.

HOW IMPORTANT IS IT TO GETGENETIC TESTING ALREADY BEEN DIAGNOSED, MAJORITY OF MY PATIENTS HAVE ALREADY HAD CANCER.

ONE OF THE MOST FREQUENT CONSULTS THAT I HAVE ARE ACTUALLY WITH WOMEN WHO HAVE BEEN RECENTLY DIAGNOSED WITH BREAST CANCER.

SO PEOPLE WHO HAVE CANCER ARE ACTUALLY SOME OF THE MOST IMPORTANT PEOPLE TO GET GENETIC TESTING FOR MULTIPLE REASONS.

FIRST IS THAT SOMETIMES IT CAN HELP TO IMPACT TREATMENT.

AND OPTIONS IN TERMS OF SURGERY, RADIATION, AND OTHER INTERVENTIONS.

THE SECOND IS THAT PERSON WHO HAS HAD CANCER IS THE MOST IDEAL INDIVIDUAL IN A FAMILY TO GET TESTING.

BECAUSE IF WE CAN RULE IN OR OUT THEIR CANCER WAS CAUSED BY GENE MUTATION, EVEN MORE INFORMATIVE FOR FAMILY MEMBERS WHO HAVE NEVER HAD CANCER AS TO WHETHER OR NOT THEY SHOULD GET TESTING.

BECAUSE IF WE CAN DETERMINE SOMEONE WHO HAS CANCER HAS A GENE MUTATION THAT CAUSED IT, LET'S SAY CHILDREN ALL TEST NEGATIVE FOR THAT GENE MUTATION.

THERE IS A CHANCE PARENTS CAN'T PASS THAT DOWN TO THEIR CHILDREN.

WHAT THAT MEANS IS THEIR KIDS DON'T CARRY THAT FAMILIAL RISK FOR CANCER.

THAT THEIR PARENT MIGHT HAVE.

>>Olena: CAN YOU TAKE US THROUGH THE PROCESS OF JENNIE I CAN TESTING.

WHAT PERSON IS PROVIDING WHAT'S BEING TESTED AND HOW LONG YOU GET THE RESULTS?

>> OF COURSE.

GENERAL OVERVIEW OF THE PROCESS IS WHEN I MEET WITH A PATIENT, WE GO THROUGH DETAILED MEDICAL HIMSELFRY AND MEDICAL HISTORY.

AUNTS, COUSINS UNCLES, CHILDREN, ASKING ABOUT AGES AND EVER HAD CANCER.

BASED SOME OF THE PATTERNS OR INDICATIONS WE'RE SEEING DISCUSS WHETHER OR NOT IT'S INDICATED WE SHOULD CONSIDER GENETIC TESTING.

WE TALK ABOUT THE OPTION.

BECOME MUCH MORE ACCESSIBLE AND AFFORDABLE IN RECENT HISTORY.

USE THAT INFORMATION TO DETERMINE IF GENETIC TESTING IS SOMETHING THAT PATIENT WOULD WANT TO DO.

I FEEL THAT MANY OF MY PATIENTS DECLINE FOR REASONS THAT'S NOT A GUARANTEE THEY'LL DEVELOP CANCER.

IT'S NOT A GUARANTEE THAT THEY'LL HAVE A GENE MUTATION.

SOME PEOPLE DON'T WANT THAT INFORMATION.

HELP THAT SHARED DECISIONMAKING.

THAT'S WHERE THE COUNSELOR COMING IN.

FULLY INFORMED ABOUT THE PROCESS AND COMFORTABLE MOVING FORWARD.

GENETIC TESTING PAINLESS.

BLOOD JAR, SALIVA SWAB.

2 WEEKS, I'M THE ONE WHO WILL DISCLOSE THOSE RESULTS.

>>Olena: WE ALSO HAVE NEWS COMING OUT OF THE U.H.

CANCER CENTER.

THEY RECENTLY RELEASED RESULTS FROM A STUDY ARTIFICIAL INTELLIGENCE COULD IMPROVE RISK ASSESSMENT TO HELP WITH EARLY DESK.

DO YOU THINK THAT AI COULD ONE DAY PLAY SIGNIFICANT ROLE IN IMPROVING DETECTION OF BREAST CANCER AS WELL?

>> COUPLE OF COMPANIES RELEASED AI TECHNOLOGY, CHAT SETH BOTT PEOPLE CAN INPUT SOME OF THAT HISTORY.

CHAT BOTS.

BASED ON CRITERIA IF YOU MEET TESTING CRITERIA.

WHAT THE AI MODELS ARE DOING.

PLUGGING IT IN A FORMULA TO DETERMINE IF THOSE CHAT BOTS ARE MET.

CERTAINLY MORE NUANCED TO IT.

BENEFIT IN TERMS OF OF ACCESS FOR PEOPLE WHO MAYBE DON'T HAVE GENETICS PROVIDER.

EXPAND RESOURCES IN HAWAII.

PROVIDE TELE MEDICINE SERVICE ACROSS NEIGHBOR ISLANDS.

SO THE SOMETHING THAT IF WE CAN DO IN IN PERSON OUTREACH, THAT'S THE GOAL.

I THINK THERE IS A PURPOSE FOR IT.

>>Olena: WE'VE HEARD MAINLY ABOUT WOMEN WITH BREAST CANCER.

DO MEN GET BREAST CANCER TOO?

DO YOU HAVE ANY MALE PATIENTS?

>> I HAVE A FEW MALE PATIENTS.

ABOUT 1% OF BREAST CANCER IS OCCUR IN MEN.

THAT IS A VERY GOOD POINT.

NOT ANY SCREENING THAT IS RECOMMENDED FOR MEN.

BUT DEFINITELY, IF A MAN NOTICES A LUMP, IN HIS CHEST BREAST, GOOD TO SEE HIS PHYSICIAN OR NURSE PRACTITIONER TO HAVE IT CHECKED.

THERE ARE SOME FAIR NUMBER OF BENIGN LUMPS THAT CAN OCCUR IN MEN AS WELL.

SOMETHING CALLED GYNOCOMASTIA THAT IS ACTUALLY MORE COMMON THAN BREAST CANCER IN MEN.

FINDING LUMP DOESN'T MEAN HE AUTOMATICALLY HAS BREAST CANCER.

IT'S GOOD POINT TO GET CHECKED OUT.

I THINK ANY MAN WHO HAS BREAST CANCER IS GENERALLY RECOMMENDED TO HAVE GENETIC TESTING.

IT IS SOMETHING THAT COULD BE PASSED ON TO SAY HIS DAUGHTERS,.

>>Olena: HOW DO THEY USUALLY FIND IT?

NOTICE LUMP IN THE AREA.

>> YEAH.

>> ALMOST ALWAYS JUST A LUMP.

>>Olena: WHEN DO YOU GUYS RECOMMEND LADIES OR POSSIBLY MEN GET MORE TESTING AND FOR WOMEN PERHAPS STARTING MAMMOGRAM?

40 YEARS OLD RIGHT?

>> MOST ORGANIZATIONS RECOMMEND STARTING ONCE EVERY, SAY ONE TO TWO YEARS AT AGE 40.

FEW THAT RECOMMEND STARTING AT AGE 50.

AMERICAN CANCER SOCIETY AND COLLEGE OF OB GYN PRETTY MUCH ALL RECOMMEND STARTING AT AGE 40.

WITH SOME EXCEPTIONS IF THERE IS SOME VERY YOUNG WOMEN IN THE FAMILY THAT HAVE HAD BREAST CANCER SOMETIMES WILL START BIT EARLIER.

>>Olena: ALSO HAVE A QUESTION COMING IN FROM CARROLL FROM PEARL CITY.

SAYS, DOES A MAMMOGRAM REALLY DETECT VERY WELL AND WHAT CONDITION WOULD NEED A 3D SCAN TO BE DETECTED?

WE WERE ALL TALKING ABOUT THIS EARLIER.

ALL HAD MAMMOGRAMS AND TALKED ABOUT HOW UNCOMFORTABLE IT CAN BE.

EXPERIENCED 3D ONE AS WELL.

HOW GOOD IS THAT AND DOES THE MAMMOGRAM DO A GOOD JOB?

>> MAMMOGRAM IS REALLY THE BEST SCREENING TEST WE HAVE.

MEANING GO AND ONCE A YEAR, CHECK BOTH BREASTS, DO TWO VIEWS AND THAT ALONE WILL CATCH PROBABLY 85 TO 90% OF BREAST CANCERS.

IT'S STILL INVOLVES SOME COMPRESSION AND UNCOMFORTABLE, BUT IT'S REALLY THE ONLY TEST THAT IS HAS EVER BEEN SHOWN IN THE UNITED STATES AND ACROSS THE WORLD TO ACTUALLY DECREASE THE NUMBER OF WOMEN DYING FROM BREAST CANCER.

VERY GOOD DATA THAT THEY'RE VERY EFFECTIVE.

IT'S NOT PERFECT.

SO IT'S ALSO IMPORTANT FOR WOMEN TO KNOW IF SHE DOES NOTICE A LUMP, EVEN IF SHE'S HAD A MAMMOGRAM KIND OF RECENTLY, THAT WAS NEGATIVE, STILL GOOD TO GET IT CHECKED OUT.

YOU KNOW A LOT OF WOMEN SAY, CAN I DO ULTRASOUND RATHER THAN MAMMOGRAM?

BECAUSE IT DOESN'T INVOLVE THE COMPRESSION?

THERE'S SOME STUDIES LOOKING AT SCREENING ULTRASOUNDS.

AT THIS POINT, ONE OF THE PROBLEMS WITH ULTRA SOUND, ALMOST TOO SENSITIVE.

SO WHEN YOU JUST LOOK ALL OVER, YOU KNOW, BOTH BREASTS WITH ULTRA SOUND, SOME OF THE STUDIES ABOUT 30% OF THE TIME, YOU FIND SOMETHING THAT IS QUESTIONABLE LEADS TO A BIOPSY.

MOST OF THOSE ARE NEGATIVE.

MOST OF THOSE ARE NEGATIVE.

MAMMOGRAM IS REALLY THE BEST SCREENING TEST WE HAVE.

DOES INVOLVE SOME COMPRESSION.

MOST TIME, IT'S PRETTY FAST AND HOPEFULLY WORTHWHILE.

>>Olena: SOMETIMES THEY'RE DONE TOGETHER.

WHERE YOU HAVE, SOMETHING THAT YOU'RE TRYING TO FIND.

AND THEN FOR ME, WITH MY HIGH DETECTION PLAN, I WAS ALTERNATING MAMMOGRAM AND EITHER ULTRASOUND OR BREAST MRI EVERY SIX MONTHS.

SO THAT WAS I THINK STARTED, I WAS DOING THAT FOR MAYBE 7 YEARS.

DO YOU FIND THAT IS ALSO A GOOD THING TO DO?

>> FOR WOMEN, THAT ARE CONSIDERED AT HIGH RISK, SOME INCLUDE THE WOMEN WHO WITH NO GENETIC MUTATIONS, MRIS ARE OFTEN RECOMMENDED ONCE A YEAR FOR WOMEN CONSIDERED VERY HIGH RISK.

IN GENERAL, A LOT OF ORGANIZATIONS WOMAN ESTIMATED LIFETIME RISK 20% OR OR HIGHER BASED ON TESTING.

WORTHWHILE TO HAVE A MAMMOGRAM, MRI ONCE A YEAR FOR IN ADDITION TO MAMMOGRAM.

ULTRASOUND TARGETED STUDIES ABNORMAL AREA ON MAMMOGRAM OR SOMETHING QUESTIONABLE ON MRI LOOK AT THAT SPECIFIC SPOT TO GET MORE INFORMATION OR LUMP.

>>Olena: IMPORTANT TO RECOGNIZE YOU'RE DOING THIS THESE THINGS BECAUSE TRYING TO FIND OUT WHAT IS IN THERE.

THE TAKE A LOOK INSIDE BODY TO TRY TO IDENTIFY WHAT'S GOING ON.

FOR PEOPLE TO KIND OF ACKNOWLEDGE THAT, I DON'T REALLY KNOW WHAT IS GOING ON.

MIGHT BE SOMETHING IN THERE.

JUST TAKE A LOOK.

>> IT'S NOT, IT MIGHT NOT BE ANYTHING.

>> WHICH OFTENTIMES IS THE CASE.

>> YEAH.

>>Olena: WE HAVE A COMMENT FROM SAM.

HE SAY, OR SHE SAYS, WE HAVE A FAMILY MEMBER WHO CANCER TREATMENT OF CHEMOTHERAPY AND IMMUNOTHERAPY COST $30,000 A MONTH.

MOST IS PAID FOR BY INSURANCE.

WHY DOES IT COST SO MUCH?

DR. NAKASONE PERHAPS?

>> I WISH HAD AN EASY ANSWER FOR THAT.

I MEAN, DO PUT IN A LOT OF MONEY TO THE RESEARCH AND DEVELOPMENT OF ALL OF THESE NEW AGENTS.

BUT THE COST CAN BE PROHIBITIVE FOR MANY PEOPLE.

SO WE DEFINITELY FOUNDATIONS THAT WE CAN TRY TO APPLY PATIENTS TO TRY TO DEFER SOME OF THAT COST.

SOME PEOPLE CAN EVEN GET FREE DRUGS.

DEPENDING ON THEIR INCOME, ET CETERA.

BUT THE PRICE OF DRUGS CAN BE QUITE CONSIDERABLE.

>>Olena: WE HAVE ANOTHER QUESTION FROM VIEWER.

WHAT ARE THE CHANCES OF GETTING BREAST CANCER AGAIN AFTER BEING 15 YEARS FREE OF IT?

>> SO THE, WE USUALLY USE FIVE YEARS AS BIG MILESTONE.

SOMEBODY REACHES FIVE YEARS OUT FROM ORIGINAL CANCER DIAGNOSIS, CHANCE OF THAT CANCER COMING BACK IS VERY LOW.

UNFORTUNATELY, TEND TO THINK IT WILL NEVER BE TECHNICALLY ZERO.

PEOPLE ONCE YOU HAVE CANCER, YOUR BODY HAS DONE SOMETHING ABNORMAL.

ALWAYS A RISK THAT YOU CAN MANIFEST SECOND CANCER OR NEW CANCER IN A DIFFERENT OR BEGAN AS YOU GET OLDER.

ALWAYS GOING TO BE A RISK OF POTENTIAL RECURRENCE OF CANCER.

DOES GET LESS.

15 YEARS OUTSTANDING.

CHANCE OF THAT CANCER COMING BACK IS GOING TO BE VERY LOW.

>>Olena: OTHER QUESTIONS COMING IN.

WHAT IS THE MOST COMMON AGE RANGE OF BREAST CANCER?

THEN WOULD A PATIENT OF 80 YEARS BE TREATED THE SAME AS A PERSON OF 50 YEARS OLD?

>> SORRY.

SO WE DO TEND TO SEE BREAST CANCER MORE COMMONLY IN WOMEN MAYBE IN THEIR FIFTIES, SIXTIES AND 70.

IN WOMEN DON'T USE AGE NECESSARILY AS A HARD AND FAST RULE ABOUT WHAT TYPES OF THERAPIES SOMEBODY IS GOING TO GET.

LOOK AT THEM AS WHOLE PICTURE.

TAKE AGE INTO ACCOUNT OF COURSE HOW WELL THEY'RE FUNCTIONING, OTHER HEALTH ISSUES AND TRY TO SET AND FIGURE OUT WHICH THERAPISTS THEY CAN AND CANNOT ATOLL LATE RETAIL DENSITY AND DID TOLERATED AND HOW AGGRESSIVE WE CAN BE.

TRY TO APPLY SAME THERAPEUTIC STRUCTURE TO EVERY PATIENT.

CHEMOTHERAPY, RADIATION.

DO WE FEEL THE PATIENT CAN TOLERATE THOSE THINGS.

>>Olena: COMMENT FROM RUTH.

SHE SAID SHE THIS STAGE 4 BREAST CANCER AND SWITCHED TO VEGAN DIET.

PER DOCTOR DR. MCDOUGAL RESEARCH.

CANCER FREE SINCE HAVING SURGE ARE.

CONGRATULATIONS TO RUTH.

HAVE YOU SEEN THAT ALSO?

GOING VEGAN OR CHANGES LIKE THAT CAN HELP?

>> I THINK A LOT PEOPLE MOTIVATED TO MAKE HEALTHY CHANGES, WHETHER IT'S EXERCISE OR MORE HEALTHIER DIET.

THERE'S NOT A REAL SPECIFIC DIET THAT I THINK WORKS FOR EVERYONE.

WE DON'T HAVE GOOD MEDICAL EVIDENCE THAT ANY SPECIFIC SUPPLEMENT OR DIET WILL TREAT BREAST CANCER.

I GUESS ONE OF THE THINGS AFTER MENOPAUSE, MENTIONED A LOT OF BREAST CANCERS ARE AWAY CALL ESTROGEN RECEPTOR POSITIVE OR ESTROGEN SENSITIVE.

BEFORE MENOPAUSE, MOST OF THE ESTROGEN FROM OUR BODIES COMES FROM THE OVARIES.

AFTER MENOPAUSE MOST COMES FROM BODY FAT AND ADRENAL GLANDS.

AFTER MENOPAUSE, HAVING MORE NORMAL WEIGHT, COMPARED TO PEOPLE OVERWEIGHT.

MORE ESTROGEN CIRCULATING.

THAT'S ONE CHANGE THAT WE CAN MAKE TO HELP DECREASE OUR RISK OF BREAST CANCER.

>>Olena: JAMIE FROM HONOLULU.

WRITE, TO US SAYING, REGARDING DENSE BREAST TISSUE, DO DOCTORRINGS RECOMMEND FURTHER EVALUATION THROUGH ULTRA SOUND OR JUST WAIT FOR YOUR NEXT ANNUAL MAMMOGRAM?

>> WELL, WHEN WOMEN HAVE MAMMOGRAMS GENERALLY PART OF THE REPORT IS JUST REMARK ABOUT THE DENSITY OF THE BREAST TISSUE AND DENSE BREASTS ARE VERY, VERY COMMON.

SO GENERALLY, YOU KNOW, ONCE A YEAR MAMMOGRAM IS PROBABLY THE BEST SCREENING TOOL.

I THINK NOW, THERE IS WHAT THEY CALL 3D MAMMOGRAMS.

WHICH ARE BECOMING MORE AVAILABLE.

AND THE HAVING THE MAMMOGRAM IS THE SAME.

SO YOU DON'T FEEL ANY DIFFERENT, HAVING A 3D MAMMOGRAM, BUT THE SOFTWARE IS ABLE TO DO MORE DETAILED CALCULATIONS.

SO THEY SEEM TO BE A BIT BETTER AT DETECTING MASSES DENSE BREASTS, THAT IS SOMETHING THAT PROBABLY WORTHWHILE ASKING.

ASKING ABOUT.

>>Olena: DR. NAKASONE, WE HAVE ANOTHER QUESTION FROM A VIEWER.

HEIDI FROM KAUAI.

SAYS, PLEASE ADDRESS HER3 POSITIVE RESULTS, AND ALSO, PLEASE TALK ABOUT THE DIFFERENT SIDE EFFECTS OF BREAST CANCER TREATMENTS.

>> GREAT QUESTION.

SO WHEN I ALLUDED TO EARLIER, TALKED ABOUT THE DIFFERENT RECEPTORS, ON THE SELF SURFACE OF THESE CANCERS, ONE OF THE RECEPTORS IS CALLED THE HER 2.

SO IT'S A TARGET WE CAN USE FOR CERTAIN THERAPIST THERAPIES.

DATA SHOWS HER 2 TUMORS OFTEN TEND TO BE MORE AGGRESSIVE.

SO WE WANT TO TREAT THEM AGGRESSIVELY.

SO WE ADD HER 2 TARGETED THERAPY TO THE CHEMOTHERAPY TO MAKE THE RECIPE MORE AGGRESSIVE WHEN WE TRY TO ATTACK THOSE TUMORS WITH CHEMOTHERAPY.

IN TERMS OF SIZE EFFECTS AND TOXICITIES, IT REALLY IS SPECIFIC PER PERSON.

THERE ARE PEOPLE WHO CAN TOLERATE CHEMOTHERAPY PRETTY WELL.

JUST HAVE SOME FATIGUE.

STILL WORKING.

UNFORTUNATELY SOME PEOPLE JUST VERY SENSITIVE TO CHEMOTHERAPY.

THEY HAVE NAUSEA, VOMITING, DECREASE APPETITE, WEIGHT LOSS.

REALLY CAN BE PERSONALIZED PER PERSON.

DEPENDING ON RECIPE THEY GET AND SENSITIVITY.

HOW WELL THEY CAN TOLERATE THE CHEMOTHERAPY.

>>Olena: YOU SPOKE ABOUT IT A LITTLE BIT BEFORE YOU DID CHEMOTHERAPY AND RADIATION.

HOW DID BOTH AFFECT YOU?

YOU SAID YOU DID CHEMOTHERAPY FIRST.

>> I DID.

DID CHEMOTHERAPY FIRST TO TRY TO REDUCE THE SIZE OF MY TUMOR GAVE ME THE OPTION FOR THE LUMPECTOMY.

CHEMOTHERAPY REALLY WAS I DID NOT ONE OF THOSE THAT DID NOT TOLERATE IT WELL.

SO BY THE TIME I GOT TO EVERYTHING ELSE, EVERYTHING ELSE SEEMED LIKE A CAKE WALK COMPARED TO INITIAL CHEMOTHERAPY.

BUT THERE ARE MEDICATIONS AND DIFFERENT INTERVENTIONS THAT CAN HELP WITH THE DIFFERENT SIDE EFFECTS.

I DON'T REALLY DON'T WANT PEOPLE TO BE SCARED OF THE SIDE EFFECTS BECAUSE THE DOCTORS, AND OTHER SPECIALISTS CAN HELP WITH ALL OF THOSE DIFFERENT SIDE EFFECTS.

YOU JUST NEED TO MAKE SURE YOU COMMUNICATE WITH YOUR DOCTORS ABOUT THEM.

AS YOU FACE THEM.

>>Olena: YOU'VE BEEN CANCER FREE FOR HOW LONG NOW?

>> SO I'VE BEEN CANCER FREE FOR FIVE YEARS.

DIAGNOSED IN 2015.

>>Olena: WHAT KIND OF THINGS DO YOU DO NOW IN TERMS OF TRYING TO SPREAD THE MESSAGE OF YOUR EXPERIENCE AND SHARE YOUR STORY?

>> SURE.

SO WELL, I COME TO OPPORTUNITIES LIKE THIS FOR SURE.

WE ALSO THROUGH BREAST CANCER HAWAII, WE SHARE STORIES OF SURVIVORS.

WE REACH OUT TO THE COMMUNITY IN DIFFERENT CIRCLES.

NEXT WEEK, GOING TO BE SPEAKING TO PUBLIC HEALTH CLUB AT THE UNIVERSITY OF HAWAII.

ANY OPPORTUNITIES WHERE MIGHT BE PEOPLE THAT HAVE BEEN IMPACTED BY CANCER, A LOT OF PEOPLE, TO EVEN IF YOU YOURSELF HAVE NOT BEEN DIAGNOSED WITH CANCER, USUALLY TOUCHED BY SOMEBODY WHO HAS BEEN.

SO TO BE ABLE TO SUPPORT YOUR FRIEND OR FAMILY MEMBER, WE TRY TO EDUCATE THE GENERAL PUBLIC ABOUT THE RESOURCES AND SUPPORT THAT IS OUT THERE.

>>Olena: TALKING A LITTLE BIT MORE ABOUT SUPPORT.

FOR CAREGIVERS, WHAT KIND OF ADVICE DO YOU HAVE FOR THEM?

>> SO FOR CAREGIVERS, I KNOW THAT SOME CAREGIVERS GO THROUGH A PERIOD OF GUILT BECAUSE THEY FEEL LIKE MAYBE THEY SHOULD HAVE HAD THE CANCER.

OR THAT THEY ARE NOT THE ONES THAT ARE SICK.

SO THEY TAKE ON MORE AND DON'T MAYBE SOMETIMES PROCESS IT OPENLY.

AS MUCH AS MAYBE THE PATIENT DOES.

SOMETIMES THE PATIENT VERY OPEN ABOUT THEIR DIAGNOSIS.

THE CAREGIVER DOES NEED A LOT OF SUPPORT AND SO IF YOU'RE FRIENDS ARE FAMILY MEMBERS OF THE CAREGIVER, YOU KNOW, I WOULD ENCOURAGE THOSE PEOPLE AROUND THEM TO PLEASE SUPPORT THE CAREGIVER AS WELL AS TOO BECAUSE THEY ALSO NEED THE EMOTIONAL SUPPORT SO THEY CAN THEN SUPPORT THE PATIENT IN TREATMENT.

>>Olena: ABSOLUTELY.

I REMEMBER AFTER MY MASTECTOMY, DON'T REMEMBER HOW MUCH TIME PASSED.

MY HUSBAND SAID, I'M NOT GOING TO BABY YOU ANY MORE.

YOU HAVE TO DO THIS AND THAT ON YOUR OWN.

I WAS LIKE.

OKAY.

AFTER I WATCHED EVERYTHING ON NETFLIX.

SO I ALSO WANTED TO KIND OF SEND IT TO YOU TO EXPLAIN A LITTLE BIT MORE.

PEOPLE TEND TO SEEM TO KNOW MORE ABOUT THE BRCA MUTATION.

THEN FOR MYSELF, DIAGNOSED WITH RAD 50.

CAN YOU KIND OF DIFFERENTIATE BETWEEN THOSE AND WHAT THEY MEAN?

>> OF COURSE.

WE HAVE THOUSANDS OF INDIVIDUAL GENES CODE FOR PROTEIN BRCA GENES SOME OF THE FIRST GENES DISCOVERED THAT WE KNOW ARE ASSOCIATED WITH HEREDITARY BREAST CANCER.

BUT ALSO HEREDITARY OVARIAN CANCER.

WE CAN SEE OTHER FORMS OF CANCER FROM A SINGLE GENE MUTATION.

PROSTATE, PANCREATIC AND MELANOMA.

BEYOND THE BRCA GENES, MANY OTHER GENES OVERLAP WITH BREAST CANCER RISK BUT THAT CAN ALSO INCREASE RISK FOR CANCER IN OTHER PARTS OF BODY.

ANOTHER REASON WHY THE SO IMPORTANT FOR PEOPLE ALREADY HAD CANCER CONSIDER TESTING.

COULD BE AT RISK OTHER PARTS OF THEIR BODY.

PRIOR TO 2013, SOMEONE HAD BRCA TESTING.

GO IN GENETIC COUNSELING AGAIN AND FURTHER TESTING THERE ARE NEW GENES DISCOVERED ASSOCIATED WITH BREAST CANCER.

MAYBE THEY TESTED NEGATIVE IN THE PAST.

BUT THERE IS SOMETHING ELSE THAT COULD EXPLAIN THE FAMILY HISTORY.

SO THIS GOES BEYOND BREAST CANCER.

INHERITED COLORECTAL.

PANCREATIC SYNDROME.

LIST GOES ON.

CONVERSATION EXTENDS BEYOND BRCA.

>> DIAGNOSED WITH CANCER, GET A REFERRAL FROM ONCOLOGIST.

SOMEONE KNOWS STRONG FAMILY HISTORY WOULD LIKE TO TALK TO GENETIC COUNSELOR DETERMINE IF THEIR FAMILY HISTORY IS CONCERNING, USUALLY PRIMARY CARE, REFERRED FROM GYNECOLOGIST.

ANY PHYSICIAN, DO RUDIMENTARY FAMILY HISTORY AND DETERMINE IF IT'S APPROPRIATE MUCH.

>>Olena: ALMOST LIKE HAVING A THERAPIST TO COUNSEL YOU WHAT IS HAPPENING AND IMPACT AND GIVE YOU NUMBERS.

SO THEY CALLED IT ANGELINA JOLIE EFFECT.

WHEN SHE WAS VERY PROACTIVE.

MOM HAVING BREAST CANCER.

TESTED POSITIVE FOR GENETIC.

HAVING PROPHYLACTIC SURGERY REMOVING BREASTS.

DID YOU SEE AN INCREASE IN THOSE CHOOSING TO HAVE SURGERY.

>> DEFINITELY.

VERY PUBLIC ABOUT IT.

I THINK ADVENTURE THAT, A LOT OF MORE WOMEN WERE AWARE, A LOT MORE WOMEN WERE ASKING IS THAT SOMETHING THEY WOULD EVEN CONSIDER.

I THINK A LOT MORE WOMEN WENT TO GENETIC COUNSELING AS WELL.

ALSO, AROUND THAT TIME, THE FIELD OF GENETICS ALMOST EXPLODING.

SO MUCH MORE INFORMATION WAS COMING IN.

AND I THINK WHAT ALSO WAS GOING ON AT THE TIME, IS AS FOR WOMEN WHO ARE INTERESTED IN BREAST RECONSTRUCTION, TECHNIQUE HAVE STILL NOT PERFECT BUT HAVE GOTTEN MUCH BETTER.

ALWAYS VERY PERSONAL CHOICE.

WOMEN KIND OF TAKING THAT STEP TO DECIDE THEY WANT TO HAVE THE SURGERY.

WHETHER OR NOT THEY WOULD WANT TO DO RECONSTRUCTION.

WHOLE FIELD OF, IT STILL DESPITE ALL THE RESEARCH AND KNOWLEDGE WE HAVE, IT'S FOR PREVENTING BREAST CANCER, IT'S STILL THE PROBABLY ONE OF THE BEST TOOLS THAT WE HAVE.

SO IT IS SOMETHING I THINK WE'RE SEEING MORE AND MORE OF.

>>Olena: DO YOU FIND THAT WHEN THEY WANT TO COME IN FOR PREVENTATIVE SURGERY, THEY WANT TO HAVE RECONSTRUCTION MOST OF TIME?

HOW OFTEN ARE THEY WILLING TO JUST GO FLAT OR WHAT DO YOU HEAR?

>> THAT'S A GOOD QUESTION.

THERE IS SO MANY OPTIONS AND YOU KNOW, WE WORK CLOSELY WITH OUR PLASTIC SURGEONS WHEN WOMEN ARE JUST INITIALLY CONSIDERING OR THINKING ABOUT IT.

SO WE HAVE THEM MEET WITH USUALLY IN OUR CLINIC WITH THE PLASTIC SURGEONS FIND OUT WHAT THE OPTIONS ARE.

WHAT TYPES OF RECONSTRUCTION.

SOME WOMEN DO CHOOSE TO GO FLAT AND IF THAT IS THE CHOICE YOU WANT TO MAKE SURE THAT IS DONE VERY WELL.

AND THEN THERE IS ALSO A LOT OF WOMEN I'VE SEEN, RECENTLY, SOME REALLY AMAZING TATTOO ARTISTS THAT HAVE, THAT IS OPTION AS WELL.

>>Olena: CAN YOU HAVE FLOWERS.

YOU CAN HAVE THINGS THAT LOOK LIKE NIPPLES.

TALKING ABOUT DREAM.

IF A WOMAN UNDERGOES MASTECTOMY.

HOW DOES THAT AFFECT YOUR TREATMENT AND TELL ME ABOUT THE STEPS?

HOW DOES THAT EFFECT YOUR TREATMENT?

>> MASTECTOMY.

EARLY STAGE BREAST CANCER.

TENDS TORE CURATIVE IN.

SOMETIMES A PERSON DOESN'T NEED CHEMOTHERAPY AFTERWARD.

TEND TO BE MORE HORMONE POSITIVE.

GIVE THEM HORMONE THERAPY FIVE OR TEN YEARS.

ONLY THING WE NEED TO WAIT FOR MASTECTOMY IS HEALING.

TRY TO GIVE 4 TO 6 WEEKS AFTER SURGERY TO BEGIN CHEMOTHERAPY.

>>Olena: THANK YOU.

FOR THOSE THAT RECEIVE MASTECTOMY, DO THEY HAVE TO GET MAMMOGRAMS.

>> GENERALLY NOT ON THE SIDE THAT HAD THE MASTECTOMY.

IF THEY'VE HAD A MASTECTOMY ONE SIDE, RECOMMEND DOING YEARLY MAMMOGRAM ON THE OPPOSITE BREAST.

NO.

IF WOMEN HAY MASTECTOMY, SOME WOMEN ARE LIKE, NO MORE MAMMOGRAMS OF THE ONE THING TO CONSIDER.

>>Olena: ABSOLUTELY.

HOW ARE YOU DOING AS FAR AS WHAT YOU'RE DOING IT TRY TO DETECT CANCER AS THINGS MOVE FORWARD FOR YOU?

>> SURE.

ONE THING IS THAT I'M VERY AWARE OF CHANGES IN MY BREASTS.

IF THERE ARE ANY CHANGES IN SIZE OR ANY ADDITIONAL, LUMPS AREN'T THE ONLY SIGNS OF BREAST CANCER.

SO I'M AWARE OF WHAT THE SIGNS ARE.

AND THEN IF THERE IS ANYTHING THAT I'M CONCERNED ABOUT, I DO REACH OUT TO MY DOCTOR.

>>Olena: HOW OFTEN ARE YOU GOING IN FOR MAMMOGRAM?

>> SO SINCE I PASSED MY FIVE YEARS.

NOW YEARLY.

BUT I DO ALSO IN ADDITION, I DO GET MRIS.

IN BETWEEN.

AS WELL.

>>Olena:.

WE JUST GOT LAST QUESTION FROM OUR VIEWER.

QUESTION FROM MARY.

CAN TESTS LIKE 23 AND ME AND ANCESTRY TELL US MORE ABOUT OUR BREAST CANCER RISK?

>> THIS IS AN EXCELLENT QUESTION.

THAT I GET VERY OFTEN.

I THINK THAT TESTS LIKE 23 AND ME AND ANCESTRY ARE VERY FUN FOR THAT ANCESTRY SIDE OF THINGS.

IN TERMS OF CLINICAL GENETICS AND BETTER UNDERSTANDING RISK FOR CANCER, UNFORTUNATELY, THOSE TESTS ARE NOT COMPREHENSIVE.

COUPLE OF SPECIFIC MUTATIONS THAT ARE TARGETED OF THE BRCA TESTS.

LOOKING FOR SINGLE SPELLING CHANGES THREE SPECIFIC SPELLING CHANGES RATHER THAN READING THROUGH THE ENTIRE CHAPTER OF OUR GENETIC BOOK.

SO I REALLY RECOMMEND THAT EVEN IF YOU HAVE GENETIC TESTING THROUGH 23 AND ME, SAID YOU WERE BRCA NEGATIVE.

NOT COMPREHENSIVE.

I WOULD RECOMMEND IF YOU QUALIFY TO CONSIDER GENETICS.

>>Olena: USED EVERY WELL.

>> HAVE NOT.

HAVEN'T EXPERIENCED THAT.

>>Olena: NOT THAT BAD WHEN IT COMES TO FOOD ALLERGIES.

OR FOOD SENSITIVE.

WRAPPING UP THE SHOW IN A FEW MOMENTS.

THANK ALL FOR JOINING US THIS EVENING.

IT'S BEEN A WEALTH OF INFORMATION.

ASK A FEW OF YOU FOR CLOSING STATEMENTS.

WHAT IS IS IT YOU WOULD LIKE SOME OF YOUR VIEWERS TO TAKE AWAY FROM WATCHING TODAY?

>> SURE.

IF YOU ARE DIAGNOSED WITH CANCER, I WOULD LET YOU KNOW THAT YOU'RE NOT ALONE.

THERE'S SO MANY OF US THAT ARE HERE WAITING, READY TO SUPPORT.

PLEASE DO REACH OUT FOR SUPPORT AND FOR RESOURCES.

>>Olena: HOW ABOUT FOR YOU?

>> I THINK JOANNE'S MESSAGE IS VERY POWERFUL.

FOR WOMEN TO KIND OF BE AWARE OF THEIR BREASTS.

BE AWARE OF ANY CHANGES AND GET YOUR MAMMOGRAMS.

SCREENING ONES ARE FREE.

>>Olena: THANK YOU.

AND MARY?

>> TALK TO YOUR FAMILY.

THERE'S A BIT OF STIGMA AND EMBARRASSMENT AROUND BEING DIAGNOSED WITH CANCER OR FEAR OF SHARING THAT.

>> WE KNOW FAMILY HISTORY HAS SUCH A IMPACT RELATIVE'S CARE AND WHAT TYPE OF SCREENING MIGHT BE RECOMMENDED, OPEN COMMUNICATION BETWEEN FAMILY MEMBERS IS KEY IN PRERECOMMENDATION.

>>Olena: HOW DO YOU RECOMMEND THAT THEY APPROACH FAMILY MEMBERS TO TRY TO FIND OUT HISTORY?

>> NOVEMBER IS ACTUALLY FAMILY HEALTH HISTORY MONTH.

SO IF WE'RE SITTING DOWN AT A DINNER TABLE AND WANT TO OPEN THAT CONVERSATION, IT'S NEVER EASY.

BUT SAYING THAT IT CAN HAVE AN EFFECT ON YOUR CARE, HEY, MOM, I HEARD THAT YOU WENT THROUGH SOMETHING DIFFICULT IN THE PAST.

CAN YOU TELL ME MORE ABOUT IT?

I WANT TO MAKE SURE I'M BEING PROTECTED AND DOING EVERYTHING THAT I CAN THAT CAN OPEN THE CONVERSATION IN THE DOOR.

>>Olena: THANK YOU.

REAL QUICK, LAST MESSAGE YOU WANT TO SEND?

>> JUST LIKE EVERYBODY ELSE SAYING.

EARLY DETECTION IS KEY.

WONDERFUL PEOPLE OUT THERE WORK THROUGH CRAZY TIME TRYING TO DIAGNOSE.

MIGHT HAVE A LUMP AND MIGHT HAVE BREAST CANCER.

MANY DIFFERENT RESOURCES OUT THERE.

QUEEN'S WOMEN'S HEALTH, NURSES THERE, STAFF THERE, ARE AMAZING.

GET CHECKED EARLY DETECTION IS REALLY IS THE KEY TO TRY TO BEAT THE CANCER EARLY.

>>Olena: ABSOLUTELY.

THANK ALL FOR JOINING US TONIGHT.

IT'S BEEN A PLEASURE.

TONIGHT AND WE THANK OUR GUESTS, DR. LISA GRININGER, SURGEON AT KAISER PERMANETE MOANALUA MEDICAL CENTER, PRESIDENT OF BREAST CANCER HAWAII, JOANNE HAYASHI, GENETICS COUNSELOR AT KAPIOLANI MEDICAL CENTER FOR WOMEN AND CHILDREN, MARY HICKMAN, AND DR. RYON NAKASONE, ASSISTANT CHIEF OF THE ONCOLOGY DEPARTMENT AT THE QUEEN’S MEDICAL CENTER.

NEXT WEEK ON INSIGHTS, IT’S SOMETHING THAT HAPPENS EVERY DECADE, REAPPORTIONMENT.

USING POPULATION NUMBERS FROM THE MOST RECENT CENSUS, WE’LL LOOK AT WHAT ELECTION DISTRICTS COULD BE REDRAWN ACROSS THE STATE.

PLEASE JOIN US THEN.

I’M OLENA HEU FOR INSIGHTS ON PBS HAWAI`I, ALOHA!