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>> Hello and welcome to HealthLine this Tuesday evening.

I'm Jennifer Blomquist.

I have the privilege of hosting the program tonight and I'm so glad you joined us.

We have a wonderful guest.

She is new to Fort Wayne .

She is new to our program.

We're going to be talking about cancer and she is the expert.

She is the one to go to for this.

So we're going to be talking about that and advances in treatment.

It's a whole different ball ballpark out there when it comes to this horrible disease.

But much better outcomes.

So I want you to pay attention to the phone number.

It's at the bottom of the screen and we're going to keep it up for you there throughout the show it's (969) 27 two zero if outside of Fort Wayne just put an 866- in front of there and it will still be a free call, that is the way to get your questions answered.

So call it any time the doctor who's our guest will be she and I will be talking throughout the program but please call it at any time and ask any question you may have related to cancer and surgery and treatments, anything like that.

And then I want to remind people that you have two options and you call in.

You can ask your question live.

I like that better because then you can interact with a doctor one on one.

Maybe she needs to ask you some questions to better answer give you a better answer.

But if you don't feel comfortable doing that, I totally understand when you talk to the call screener who's a very nice lady, she can take your question for you and then I can ask the doctor so you have two choices but like I said, it's kind of nice to be able to interact with the doctor.

>> Well, let's go ahead and meet this wonderful guest.

>> Like I said, she is new to our program, Dr. Patricia Clark and this was a new word to me.

You are a and I'm a plastic surgeon.

>> Yes.

So we're going to we're going to talk about what angioplasty is because I know I've written a lot of articles and things about cancer.

We've done many programs of cancer and that was a new term for me.

But we're going to go over what that means in just a minute.

So welcome.

Thank you.

Thanks so much for coming.

And she is new to Fort Wayne too.

So we want to outcomes I guess new to the program through our community.

>> You know, Dr. Clark, like I said, I've done so many articles over the years.

I've been working in media for over thirty years and I've written so much about cancer.

>> And years ago when you heard about somebody getting cancer ,it was very scary.

I mean you just figured OK, that person is probably not going to live much longer.

>> You know, maybe they can just give them some treatments to buy them some time and now in the course of a week every week I am meeting women who are cancer survivors and they look great and and it's you know, ten years ago.

Twenty years ago.

So it's it's a different it's a different scenario today.

>> It's completely different than it used to be and it's one of the reasons I really enjoy taking care of cancer patients.

We have about four million survivors in the US now.

It's just incredible.

So what's happened over the years is our surgical techniques have improved a lot.

We have early detection now where we're diagnosing cancers when they're very treatable before they've even spread to the lymph nodes.

And then one of the other things that we're doing is with the revolution in molecular genetics we're getting really targeted therapies and I have this admission when I was a resident too many years ago I didn't like cancer surgery.

I didn't like surgery and I didn't like it because our surgeries were very disfiguring and then everybody who had a one centimeter which is about a half inch size tumor, they all got chemotherapy.

Yeah.

Back then to tell if there was cancer in the lymph nodes we had to take all the lymph nodes out.

People would get lymphedema of the arm and that was just I would hurt my heart to do that .

>> And what's happened since then is cancer.

It's all a series of molecular genetic mutations that cause normal cells to go haywire and we are understanding things at that level now and we're deescalating treatment to where we don't do full axillary dissections routinely anymore.

We don't give chemotherapy to people just because of the size of the tumor like we go in and really precisely figure out who's actually going to benefit from that, whose tumors are that aggressive and we do genetic testing right on the tumors that we take out to see if they have the mutations necessary to spread.

And what of these tumors don't so those people can avoid chemotherapy completely.

So it's it's completely different.

>> People come in and they're just really frightened and yes, scary scary diagnosis to get for sure even despite all these advances.

Yeah, it's very emotional.

Yeah.

But the one thing I know that has changed and we've talked about this on this program before is it's not just you know, you and one doctor here and then you have another doctor treating this.

>> It's you do a whole team team works together all the time to make sure everything is covered which that I I've heard from a lot of patients that that's very comforting.

>> Yeah.

And that's where we've really gone with cancer care and frankly all cancer care with a cancer you actually have three different flavors of oncologist .

You have surgical oncologists, there are radiation oncologist, there are medical oncologist and then there are so many other team members like nurse navigators that help people through their siko oncology exercise oncology.

Yeah, genetic counselors just a huge team.

>> Yeah that is well there's so many components to it.

You know you've got the before the surgery and then that's right.

So before I since I promised everybody I would tell them what this onco plastic surgery is so can you discuss and this is what you specialize.

Yeah I've sort of carved my career out with the ankle plastic aspect and and as I was telling you when I first started doing surgery, I didn't like surgery because it was very disfiguring.

>> It used to be yeah.

It really used to be.

And now survival with lumpectomies and radiation is actually higher than survival with mastectomies and ankle plastic surgery combines plastic surgery techniques to reconstruct lumpectomy defects so that you avoid those deformities or the divots or depressions so people can actually come out after cancer center looking better than they did before.

>> But that was the one thing because we've had sadly a lot of cancer and my husband's side of the family it took his mom's life and a number of her sisters and the one thing I heard from a lot of them was you know, they're just saying they want to do this lumpectomy but I just want the whole removed.

I just want it gone.

And they said take the other one too.

And you know, there was this this has been in the last ten to 15 years but the surgeons were like no, it's better just to do the lumpectomy.

So can you talk about that because I think a lot of people think let's just get rid of it.

>> But then I've heard they do not the right way to go.

Well, and particularly the younger patients it's such a frightening diagnosis that everybody is like no, just I want a double mastectomy and if they look on social media, a lot of the people on social media oh I had a double and I found it in the other that's actually very, very unusual.

>> The the risk of getting another cancer in either it's brand new not a recurrence is only about three percent a decade.

Oh so yeah.

So double mastectomies for that you know it's just there's not a good there's not a good return on that.

Yeah.

And then the other is the recurrence rate is only a couple of percentage points lower for a mastectomy than is for a lumpectomy but then survival is higher with a lumpectomy.

>> So I hear people that you know they want to live they want to live for their children.

Sure mastectomy is not going to do that and the reason mastectomy doesn't do that is if somebody is going to have a lethal cancer they metastasize at metastasis, may not show up for a couple of years after the surgery.

But if you think about it, if I did a lumpectomy and all the margins are negative and I got at all or did a mastectomy which we ensure that that's the case, those metastatic cells were already present at the time we did the surgery and it just took that couple of years for them to grow enough to become symptomatic enough that we found them.

So it's just really important for cancer patients to know that mastectomy that's not survival is not the reason to get a mastectomy and for people that don't have a genetic mutation that would predispose them like Angelina Jolie.

Yeah, that's a lot of people here.

Yeah.

About the you know, famous people and experiences and then they they gravitate or that yeah.

>> About eighty five percent of people that get cancer don't even have a family history.

So they're not at high risk of getting a second new cancer.

>> Well there was that whole phase yeah.

With the rocka you know wanting to do the genetic testing and yeah like I said we've had a lot on my husband's side and of course all of his cousins and their daughters are nervous but they they've all been tested and they haven't found it either and they were sure that that that it was something because it's been so widespread in his family but it doesn't exist.

>> Well, there are some families that it's very widespread and we'll test a broad gene panels maybe 60 to genes.

But there are some families that there's something going on there but we don't know what gene that is.

OK, and it's interesting there's a woman in Washington state who discovered the bracket gene.

Yeah.

And she is collecting these patients with families that have huge family histories.

>> We can't find anything.

She's studying them, Detective.

Yeah.

So about that.

Yeah.

Because there are what I worry for my daughter to do that so well we do have somebody who wanted to ask you a question wanted me to ask it for them.

So Wesley called and wanted to know how often do women have to go back in for a mammogram after if something is found so and is that is that common?

Is it something to worry about if they find maybe a little suspicious area but it turns you know, then I mean do you have to go back more often than for the mammogram?

Yes.

So one of the downsides of the early detection of cancer is weird detecting very minor things that probably are nothing and we follow those for two years typically.

Oh yeah.

There's a rating scale on mammograms and that's called a Biraj and it goes from one to six one is pristine which most people don't get.

>> I was wondering if anyone gets that it's really OK too is what most people get three is where there's something a little funny there.

I think we should watch it and not typically bring those people back every six months for an ultrasound or just a little extra.

So when people get a Bayridge three it's nothing to panic about.

A lot of times they're fibrocystic changes and actually over half of women have dense tissue and can have some of those types of changes.

>> So it's not panic time but you know and I'm glad you're talking about the mammograms and the ultrasounds because there was a lot of confusion for a while from some of the national you know, programs or medical organizations that where they were contradicting maybe you don't have to have a mammogram every year after a certain age.

>> I realize it's totally different if you have the family history right.

My understanding is you you go you know, like if your mom had cancer at fifty you start your or maybe even let's say 40 you would start your mammograms earlier than that earlier.

Is it that much OK?

>> I thought it was five years it's ten years earlier than the youngest person the age that of the youngest diagnosis in the family and you would go every year at that point?

>> Yeah, And if what had happened is the US Preventative Task Force, they came out with recommendations to start mammograms at 50 and not get them every year and because it was 40 that was the standard forever and then they changed back.

>> Oh they did OK to have this left.

Yeah.

This was so controversial and the radiologists, the gynecologist, the surgeons, everybody said forty and the preventative task force their their concern was all the anxiety that these mammograms that have abnormalities on the MRI or biopsies where we go and biopsy and we didn't find cancer and women between 40 and forty nine don't get cancer as often as women over 50.

So they were looking at the bang for the buck.

The problem is those women the younger you are a diagnosis the more likely you are to have a lethal cancer.

So the cancers the women in their 70s get a lot of times those are very slow growing.

They're not particularly aggressive.

The cancers at the very young women get those are often very aggressive and those can be deadly.

>> So that's why now we we want we want to start at 40.

OK, so yeah, we'll just clear the air here tonight.

So that is because yeah I know my doctor said no just keep going.

Yeah.

Because I was already in my forties when when that whole thing came about but yeah so it's every every year and then like you said you may have to go every six months and have an ultrasound if they see something suspicious.

>> Yeah.

If they see something that they're not quite sure of but it really doesn't look like yeah that's cancer they'll just keep an eye on it and then usually after about two years they they run out of worrying about it OK yeah and we actually have there are other modalities some some women are just exhausted because no matter what their mammograms are always abnormal and they're always going back.

One of the things that can be done now is you can IV contrast with a mammogram and it's almost yeah, it's almost like getting an MRI at the same time.

Yeah, yeah.

Those women that are just exhausted from having all these biopsies that turn out to be nothing and they're always getting called back when we have the contrast the mammogram items that reduces all those callbacks and gets them back to a once a year schedule.

>> All right.

Yeah good to know because yeah that's normally you would do a contrast with an MRI so right.

Yeah.

Good good information to know.

I just want to remind everybody that we only have Dr. Patricia Clark here for a little bit longer.

We still have plenty of time to take your questions but I'd hate for you to miss out on an opportunity to get something answered maybe a concern about yourself or a loved one or friend.

So give us a call.

It's (969) 27 two zero again it's toll free if you're outside of Fort Wayne as long as you put an six in front of there, they're showing me the cue cards.

We have ten minutes left which is in television.

That's a long time but relatively speaking but like I said, please feel free to call.

You can do what Wesley did and have me ask the question for you or you can talk live to Dr. Clark your choice.

We're going to keep talking though about this in the notes you sent me I was surprised when you were talking about trying to not have to do chemotherapy or radiation which I mean I know surgery is not pleasant but I mean that that always seems worse, you know, losing your hair or just the side effects and the illness.

I mean and that's scary too.

So that sounded really good to me that you could maybe get by without doing chemo.

>> Yeah.

And we do we assess every patient in this multidisciplinary assessment.

We're assessing every patient to see what can we Emet You know when I was talking about twenty years ago we used to take everybody's lymph nodes to see if there's cancer in it now women over 70 we don't routinely check lymph nodes at all and before 70 we just do sentinel node biopsies where we put a little dye right.

The once usually once people are asleep and it will track through the lymphatics which are the first place the cancer cells tend to migrate and if it's spread up into the if it's likely to spread it'll go to the lymph nodes first.

So we just take out the lymph nodes that pick up the dye which is usually one to three.

Because of that those women only have about a three percent chance of getting lymphedema so we don't have arm swelling problems with that and ductal carcinoma in situ is an interesting entity and those are cancer cells that are still trapped just within the normal milk so they can't even get out into the tissue and the dishes when we do lumpectomies traditionally all lumpectomies got radiation therapy and you don't lose your hair from radiation and so you go in for about twenty minutes to half hour once a day and that's anywhere from five days up to four weeks we can start radiating just part the but with ductal carcinoma in situ we can actually do genetic testing right on that disease and figure out if those people even need radiation at all with a lumpectomy and elderly women we're starting to target some elderly women with these low risk tumors that even with a lumpectomy they don't need radiation.

>> So now it's it is amazing.

My dad has a cousin who's in her early eighties and she's had cancer this past year.

You would never know it.

She looks great, you know, but yeah, like you're saying, everything's been so precise and minimally invasive she does not look like I figured she would look really worn out or she looks great and she still kind of living her life you know, doing her normal activities.

>> I mean dealing with her illness of course.

Yeah.

Yeah.

>> The goal is to restore people back to their as much as possible to their pre diagnosis state.

Yeah.

So you want them to have the energy level survival has been going up by about one percent a year every year for a decade.

>> Yeah it's really good .

Yeah.

So people are going to live thirty more years after their cancer diagnosis so we don't want to do something particularly in the elderly women.

We don't want to do something that you know they've got a quality of life and now we've been too aggressive treat the cancer but we've destroyed the rest of their quality of life.

You don't want to do that either, right?

So it's it's really, really individualized for each patient.

And one of the things with the patients the patients will come in and they'll say what would you do Dr. Yeah.

I don't know what I would personally do.

Yeah.

And they'll want me to make the decision lumpectomy or mastectomy that type thing when it doesn't when the patients understand the parameters I explained they have a choice and there are some patients that there's some patients that will never get a restful night of sleep for the rest of their life if they don't do a double mastectomy.

>> Yeah, OK. You can't leave somebody that way either.

It really is a choice.

>> So but patients have to go through a little sweat in the beginning while we have a shared decision making here.

Oh yeah.

So yeah it used to be the surgeon would just say this is what you're going to do do now we have treatments that may be equivalent or you know there may be one advantage here and a different advantage there and patients need to kind of wade their you know, their own feelings about their and and which one of those pluses and minuses are more important to them.

>> I agree.

I mean there's no cookie cutter.

Everyone's got their own you know, style their own their own priorities.

You know, and understand that everybody has their own relationship with their body too.

And you know, with Mastec you can like a lot of people are going flat now you can do implants one of the things that yeah, one of the my favorite mastectomy reconstructions is called a deep flap and that's where you take the abdominal tissue you would throw away in a tummy tuck.

Yeah, you can take that and you can fashion your from that and those are soft.

They're warm.

They'll last for 30, 40 years without needing a revision.

>> That's a great surgery.

Yeah, it's an all day surgery.

I actually got a friend from church who's about who's going to have that this January.

>> Yeah.

Yeah and so but yeah it's just and again she hasn't really missed a beat either you know I mean going through some major surgeries and she's going to have this reconstructive procedure done so just a lot of options now which is wonderful.

We did have another gentleman with the guys are calling it good for you guys.

They're calling in tonight with questions so I wanted to ask should men self check for cancer?

Can cancer be more aggressive in men?

>> We don't really talk about that very much but yeah, men should absolutely self-test and particularly men who have family histories of cancer, whether it be in women or men.

>> Yeah, well has your mom or yeah.

Yeah and the younger the younger at diagnosis the person with the family history is the more suspicious that is that there might be a genetic mutation causing it.

So cancer in men is fairly rare but we usually diagnose it later because men aren't checking they're not checking their right.

And when men get cancer I think they're a little bit more likely to have one of these genetic mutations like the BRAC, a gene that Angelina Jolie had.

Yeah, those are more aggressive cancers.

So we want to catch the male cancers early and I mean do they still recommend women do the monthly self checks?

I mean that was a big thing in the eighties but and then I've had some doctors come on the show and say well you know, we'd rather just have you come to the mammogram once a year.

>> But the so you should still do the self checks.

There's some controversy and differing literature on how effective that is.

The thing about the mammogram is if you're trying to detect a tumor by just palpating it, you're probably not going to be able to tell anything less than a centimeter.

And if somebody is are really large for sure they're not going to find something really small buried in there.

Yeah.

So the mammograms give the ability to detect these very, very tiny tumors that you know, those are just simple same-day outpatient surgeries.

Most people don't need anything stronger than Tylenol after having cancer surgery these days.

>> Yeah, that is amazing too because that used to be like a week long hospital stay and yeah not well even our mastectomies go home now.

Oh darn yeah.

We see the day same day we have advanced recovery protocols where we pre medicate people before surgery.

They're taking Tylenol, they're taking antiinflammatory and then with the mastectomies we'll even do nerve blocks so the whole chest is numb before we ever make an incision so they don't have to bring people as deep under anesthetic as they used to so people don't have a lot of the postop nausea ,vomiting, you know the energy levels are higher.

So with all the blocks and the other medications it really drops the narcotic needs.

So yeah, it's I'm not saying it's a walk in the park, you know, don't get me wrong but it's just it's just a completely different ballgame than it was even ten years ago.

>> Oh yeah.

No it's it's amazing and we've got I'm not sure we're gonna have time to squeeze this in but somebody was asking a quick question.

A woman named Connie said she went in for regular exam.

>> Nothing showed up three months later she was told she had estrogen cancer.

>> That's unusual is that if that was common or not but now the estrogen the estrogen positive cancers are the most common type and they're generally pretty slow growing.

>> So and I have seen somebody pop up in three in three months there are there's a sub classification of estrogen positive tumors that actually are very aggressive and act a little bit more like the triple negative or the the her two new positive ones also somebody with extreme density.

There may be other confounders that when you go back and look at that mammogram, you know, it might have been there and just was sort of lost in the chaff of other things to where it wasn't picked out that that is fortunately very unusual.

And the one thing it's not unusual is lobular carcinoma and the lobular invasive lobular carcinomas are very patchy and those are the ones that don't show up on the mammograms.

>> They're sneaky, right?

Good information.

I hated that this has been a joy you have got to come back.

>> So she's brand new to Fort Wayne so we'd love to be back on the program any time to come back.

Dr. Patricia Clark, thank you so much.

Take care.

Have a wonderful Christmas.

Hey, this is my last show for until the end of the year so have a great Christmas.

Take care.

We'll see you in the New Year.

Bye bye