Breast cancer is the most common cancer for women in the US.

We look at the biggest risk factors, the latest treatments, and why early detection is key for survival.

That and more, stay with us as we dive into "Your South Florida."

Hello and welcome to "Your South Florida."

I'm Pam Giganti.

Breast cancer is the most common cancer in women in the United States and around the world.

The American Cancer Society estimates nearly 300,000 new cases of invasive breast cancer will be diagnosed in US women this year alone.

And nearly 44,000 women will die from it.

Most at risk are Black women with the highest rates of death and a higher chance of developing breast cancer before the age of 40 than white women.

But with advances in breast cancer research and treatments, and most importantly, with early detection from mammograms, survival is possible.

Joining me now to talk more about breast cancer prevention and the latest in treatments is Dr. Louise Morrell, medical oncologist and medical director of the Lynn Cancer Institute, part of Baptist Health South Florida at Boca Raton Regional Hospital.

And Gabriele Bauer, a breast cancer survivor.

Thank you both so much for being here.

Gabriele, I should say.

Thank you so much.

Thanks, Pam.

Doctor, let's start with you.

Let's talk about the latest research when it comes to breast cancer.

What are we finding out?

Well, I think that, first of all, we know that there's a variety of breast cancers, but what most women would like to understand and what I actually start with explaining, is that the whole problem of breast cancer originates from that single kind of cell unique to the milk duct that can produce milk.

And so that's why we talk about estrogen producing and all of those things because it relates to that milk duct cell that is the origin or the thing that's growing in an abnormal fashion.

And you can have ductal carcinoma inside the duct, a cancer that can't really spread but could transform into invasive ductal cancer.

You can have infiltrating ductal carcinoma, which is the most common type.

You can have a type called lobular, which is something that starts further out in the duct.

But either way, it's the same cell of origin that we're tackling and that we're trying to detect at the earliest stage.

Let's talk about that early detection, if you will.

And you and I were just speaking moments ago about how it's been out in the news that now the recommendation for women to start their breast cancer screenings was originally from 50, now to 40.

So kind of elaborate for us on that, because a lot of women do start their screenings, their mammography and sonograms much earlier than that, don't they?

40 has been the age of benefit for mammography, except for one thing, which is when it's either in the family or a genetic predisposition, and then it's earlier than that.

But otherwise, 40 is the standard year to start.

We've had wavering from different countries, different studies.

Should it be every other year before age 50?

Should it be starting at age 50?

But the bottom line is, you can get breast cancer in your 40s and you're not gonna have a chance at finding it at that earliest stage.

The other thing that's tricky about these studies is they're only looking at survival.

But we're looking, can we avoid chemotherapy, can we avoid radiation, can we avoid mastectomy?

Those are all things that are more likely if you detect the cancer early.

So we're recommending 40 every year, unless you have a reason to do it earlier.

There'll be some debate and there'll be some discussions with women on pros and cons, but I think that's gonna be our standard recommendation from the women's center, from the radiology departments and things like that.

And every year.

Once you start, every year.

Gabriele, you are a breast cancer survivor.

Yes.

And you were, you discovered your breast cancer through mammography, did you not?

Yes.

I did start when I was 40 to have it done once a year.

And on my 48th birthday, they found breast cancer.

Walk us through that.

What was that like for you when you were diagnosed?

First of all, you're in disbelief and really thinking they made a mistake.

Let's check again and check again.

And then when the reality hits, for me, it was like, "Oh my god, what's gonna happen to my children and what's gonna happen to my husband?"

Because for me, cancer is death in the first moment.

So it was very...

It was, yeah, part of my dark days, I have to say.

It was hard.

It was very difficult, yes, to accept.

It was very difficult to accept it.

And then you went on to have genetic testing, did you not?

With Dr. Morrell, right?

Yes, yes, Dr. Morrell.

Yes, we had the genetic testing.

And on top of that, found out that I have the BRCA gene, so I was positive.

So, in my case, it was from maybe having an option of lumpectomy to immediately having a double mastectomy and chemotherapy radiation, and then also having the- [Dr. Morrell] The hysterectomy, .

Yes, having the hysterectomy, I'm sorry.

I will mention that the change in genetic testing happened between 2012, 2015.

So anybody who tested before that time negative would be eligible to retest because we do have a broader test that now looks at other gene.

PALB2 is one of them.

CHECK2 is another one.

So there is a opportunity to identify some people who tested negative in the past, but they don't...

The most potent ones are the BRCA1 and the BRCA2.

And one of the questions that comes up quite a bit, which I don't think was your situation, but it's worth clarifying, is the Ashkenazi Jewish, so Eastern European Jewish population does have this gene at a much higher frequency.

So anyone who is in that population who's had breast cancer in their family should be tested.

But any woman can have this gene.

So it isn't only that Jewish population, it's any woman can have a mutation of the BRCA gene.

And then when you have that, it's about a 50% chance that other family members or offsprings could inherit it.

But if you don't have it, if you have normal genes, you can't pass on something you don't have.

So even Gabriele was asking about her children.

So they should be tested at some point, yes?

Right.

So the thing we believe, and I strongly believe, about when to do that testing, 'cause these are gonna be your genes from the minute you were conceived.

So you could test any time and you're gonna have the same result.

But if you think about a young adult, 17, 18, 16 years old, facing thoughts about what to do with your breast or your ovaries or worrying about that when you can't do anything about it, and shouldn't do anything about it, is really something that we try to avoid.

25 is the earliest that we would have any action that we would take, such as early screening.

So we're guiding people to do it mid-20s, a little earlier.

Also, insurance issues and things like that are more likely to be straightened out.

And for men, I think their age of being impacted by this because it's considerably less, is more like 40.

But if they're having family planning, it's something you might wanna do earlier.

Gabriele, let's talk a little bit about how you walked your way through this journey.

'Cause you and I were talking about, you said there was a lot in the genetic testing.

You had the double mastectomy, you had a hysterectomy.

You had a lot.

Yes.

They had to remove your lymph nodes.

Yes.

Yes, so I was very blessed because I have an incredible family community.

The community overall was just a very, stronghold for me.

My neighbors, my friends, the Lynn Cancer Institute.

I mean, it's not just one doctor looking at you, it's a whole team making decisions of every step.

And it's not like they see your screen and say, "Okay, this is what we're gonna do on this month."

It's like every step will be rechecked with the whole team, and that gave me the comfort that I'm definitely in good hands and decisions, what will be made are the best for me and my situation.

So that was definitely a huge support for me.

Having a team of people around you.

Yes.

And doctor, talk about that multimodality.

I mean, that's a really important part of how you treat patients, correct?

Yes, as you experienced, there's so many pieces to this, and what we wanted to do is bring expertise to each piece.

So the imagers, the people who are looking at the MRI and doing the biopsies, the pathologists, understanding what additional tests and why and which tissue it should be doing, are people that you don't even think of as part of your clinical team.

But every single area, radiation, medical, genetics, all of these areas have had advancements.

Even the social work and the psychological things and the support services that we need to get through this the best we can, all of those, we wanted experts and we wanted to talk to each other and we wanted to meet the patient and have that person's input.

And so this has been an efficient way, that within a week of diagnosis, everyone can see those patients meet together, put together a plan, and then talk to each other.

What's been so gratifying for me, because we've been doing this for many years now, and it's everyone.

It can be a 95-year-old who wants to do very little, but let's make sure we're doing the right things.

It can be somebody who's very young and is thinking about having children and should they preserve their eggs, and how do we integrate that into care?

It allows us to all be part of that thought process to learn from each other, but also to very early adopt things that we might not need to do that we used to do.

So it's been a very gratifying way for the patients, for the doctors, for everyone to take care of patients.

And very personalized, it sounds, for each person's needs.

Yes.

And I know too, Gabriele, that you are involved with the beautiful program.

Talk a little bit about that and take us through the journey.

Because you're a hairdresser.

Yes.

And you said that one of the things that was the worst part of your, the hardest part of your journey was going through chemotherapy and losing your hair.

Yes, of course.

So, for me, that was definitely very difficult to overcome.

And just to find the right solution and, what am I gonna do, where am I gonna find the wig, is it gonna be the right fit?

I wanted to continue to work.

I really did not wanted to, during that time, share my story, so I wanted to stay as normal of a day routine as possible.

So after I went through my process, my incredible staff at Gabriele Kafer definitely met up with a beautiful program to help and support for patients who go through the chemotherapy, losing hair, and to meet them up with the perfect wig.

It's all voluntary, it's donated.

And simply to give them that feeling of, this is one thing I do not have to worry about.

So the beautiful program meets every month, every second Monday of the month where we share a makeup kit.

And people can learn about the different makeups when they don't have their eyebrows, the lashes.

And Gabriele Kafer comes in that situation and introduces how to work with the wigs and how we can fit them for them correctly.

But it's not all about that either.

It's really to listen to their stories.

Because everybody shares what they're going through, and that's personally, from what I learned, is more important for them.

Like, it's nice to say, "Okay, how can I make myself feel better?"

But really, it's about to hear from each other what they're going through, what they went through, and how they feel.

And I have to say, this feeling of release, of breathing, saying, "Ah, I'm not alone, I'm here, and there is a plan."

You know what I mean?

That is, for me, the biggest reward to be part of that beautiful program.

Gabriele, so nice to meet you.

Doctor, thank you so much for being here, for all this information.

We really appreciate it.

Thank you.

Well, while prevention and early detection is vital to breast cancer survival, uninsured women are less likely to seek preventative care due to the costs and are more at risk.

That's why Susan G. Komen founder, Nancy Brinker, stepped in to help bridge that gap.

She created the Promise Fund of Florida, a nonprofit dedicated to removing barriers to quality healthcare with the goal of reducing deaths through early detection, diagnosis, and treatment.

Things don't happen unless they happen in a community first.

People don't like to travel to go be taken care of somewhere with healthcare, they wanna be treated in their hometown.

And they wanna know who's treating them and they wanna understand what's going on.

And we have an obligation not only to treat people, but educate people.

I know that sometimes the fear kind of paralyze us as a woman.

We're taking care of everybody else, of ourself.

I know for women, our family is the most important thing that we can have.

But if we don't protect ourself, we won't be able to protect our family.

I moved back to Florida after I served overseas and in Washington for over 10 years, and had lived in different places of the country, but something wasn't right.

And I did a lot of asking when I got back, "How are things in our community going on in Palm Beach County?"

When I found out that women's healthcare, certain women in our community, 80 to a hundred thousand was suffering, and they were suffering as a result, having no primary care.

And the only real source of care I came to find was part of the Federally Qualified Healthcare Center, centers that we have all over the United States.

And as I looked around, a great friend of mine was very involved in a federally qualified healthcare center here called FoundCare.

And then I approached them with my friends that we had gathered now to create the Promise Fund with this clear understanding that we're going to build a center for such cases that we were concerned about.

So Promise Fund target population is for women who are underserved.

As we know, the stats shows that minority women, African American and Latino or Hispanic women, are at higher risk of getting breast and cervical cancer.

So we want to make sure that when we go out there, that we provide that education component.

This is exactly what I wanted to do after I had spent almost 40 years building out an organization I named in honor of my sister, Susan Komen, and answering the second wish.

First, she asked me to see if I could cure the disease.

And then the second wish was really, "I want every woman to have access to care the way I did."

This is the natural follow on of building years and years of large funding to research, building the organization and communities.

And the Promise Fund now has created a real footprint in our community.

Over the last five years, we now have engaged over 22,000 women in our community who have either been through our program, screening, getting education, and connecting them to a source of primary care, so that now 7,000 of them easily now have a medical home and they know who to talk to.

And we have only found 94 cancers, largely early stage cancers, out of that many people taken care of.

Now, how did that happen?

Because we brought on over 20 patient navigators.

I think the way I see Promise Fund, we are that bridge.

We are that bridge that connects the community with the services.

Many times, the fear of this, of the people in our community is that, "Okay, so if they come back and say, you need a biopsy, I don't have funding to do that."

We are here.

We will provide that funding.

The biopsy, let's say, comes back positive.

Again, we sit down with the participant, and then we will follow up the next step and is connecting to treatment.

And we are working with partners in our community who will be able to provide that treatment.

And again, from A to Z, the entire what we call continuing of care, we will walk that with our patients.

These are people who become guides, just exactly what it sounds like, who can take a patient by the hand, start with a phone call.

And then once they have this bond of friendship, of guidance, of lack of fear.

The navigator basically becomes a member of their family and is always there to help them with whatever they need, whether it not be like for a breast or cervical cancer screening.

We'll connect them to like food banks, any resources that they may need, financial assistance, rental assistance, anything like that.

We're basically just there to help them and their families through any barriers that they may be facing at the time.

Patient navigators represent them.

Patient navigators are part of the community, and that makes a big difference.

They are not only bilingual, but also bicultural.

They understand the culture.

Culture plays such a big important part when we are working with the woman in our community.

Being a navigator for these women is such a fulfilling role for me, just because I do come from an immigrant family and I did see like all the stuff that my mom had to go through, and she was an early breast cancer survivor, and my parents, they had to work so many jobs.

So just giving back to the community is such a fulfilling role.

Movements are not easy to start.

It takes quite a while.

And in this case, this also represents a movement.

Work in the community.

If a community responds to a problem, the chances of the survival, of the solution, are great because people are involved.

And so with me, and I wake up every morning after all these years and smile because I know someone, somewhere today in our county is gonna get a mammogram, gonna have a checkup, gonna become part of a healthcare system, and very likely move through it and have a healthy life.

Breast cancer researchers at Nova Southeastern University are studying an alarming trend in South Florida.

It seems the rate of advanced breast cancer here exceeds the state and national average.

Now with a $100,000 research grant from the Florida Breast Cancer Foundation, NSU researchers are trying to figure out why.

Our next guest is leading the team, looking at the environment's role in advanced breast cancer cases, particularly among Black women.

Here to share more is Dr. Jean Latimer, director of NSU's AutoNation Institute for Breast Cancer Research and Care.

Doctor, thank you so much for being here.

We really appreciate it.

Thank you.

So walk us through the study.

How long have you been looking at these cases now, particularly in Broward and Miami-Dade County, right?

We started the study a year and a half ago, and we discovered through a report by the University of Miami and some of the Florida Department of Health literature that there's an increased rate of advanced breast cancers in South Florida, particularly in certain areas in Miami-Dade and Broward.

And in looking at these, we also discovered that there's a rather high level of arsenic between 40 times to 250 times higher than healthy limits present in the tap water.

So we wanted to put these things together and we can actually grow cells from reduction mammoplastys, women having their breasts made smaller.

We get these reduction mammoplastys locally from African American women and non-Hispanic white women.

And we are looking at the impact of some of the environmental chemicals from South Florida on these cells.

So, why arsenic in the water here?

Where's that coming from?

Arsenic is a naturally occurring heavy metal.

It apparently is part of our landscape in South Florida, but can also be increased by agriculture.

And arsenic has been used in the past on golf courses.

So those two sources may also be increasing the naturally occurring arsenic in our water.

Were you surprised to see that much arsenic in the water?

Yes, I was.

Because South Florida is reputed to have clean water, clean air, clean land.

So the other chemical that we looked at, arsenic is a very well-studied old carcinogen, but the other chemical we looked at is a rather new one called glyphosate.

And it's present in many lawn products and it's part of our food supply.

It's part of genetic modification of organisms.

They are made resistant to glyphosate.

So it's in our food supply, but also in our tap water in South Florida where we use glyphosate 12 months of the year, not just during a summer season, like other parts of the country.

Yeah, and we're talking about advanced breast cancers.

And we said in the intro, more particularly in Black women, why is it hitting that community harder than other communities?

First, in South Florida, we have a plethora of groups of African ancestry, Haitian, Bahamian, Jamaican.

They're not, quote, unquote, "African American" necessarily.

They're from many places with African ancestry.

And they're present in South Florida in greater numbers than we see in cities like Detroit or Pittsburgh or the middle of the country.

So, we think some of the higher breast cancer, the advanced stage breast cancers are coming from that community because women of color tend to get a type of breast cancer called triple-negative breast cancer.

And we have no targeted therapy for triple-negative breast cancer and it's intrinsically aggressive.

It advances more quickly than the type that non-Hispanic white women get.

We often talk about, when we discuss breast cancer, a genetic component.

Yes.

A lot of women are screened for the BRCA gene and now other genes that are determined to possibly cause cancer.

But you're saying, it's less genetic than it is environmental, right?

Extremely so.

Breast cancer is 80% of the time caused by the environment.

It's considered to be an environmental cancer.

But environment means lifestyle, as well as air, water, and land.

So people think about air, water, and land, but they don't think about what they're putting on their bodies and in their bodies every day.

So give us a sense of what those lifestyle choices are.

What kinds of things are we doing that are impacting us and increasing our risk potentially for cancer?

Okay, so in the African American community, we know that women of color tend to develop breasts and go into adolescents sooner than non-Hispanic white women.

And so there are some important differences, and we see those differences when we culture cells in a dish.

But when we start using cosmetics in our lives is about the time that we're going through these changes.

So cosmetics, hair care products, straighteners, these are all very important.

And nail polishes, they very often contain carcinogens.

And so healthier brands can be found on environmentalworkinggroup.org, ewg.org, so you can make healthier choices.

There are now that don't have the carcinogens.

But when you're using these products, when you start when you're 12 years old, you a long life of exposure.

So these things can be controlled.

Alcohol consumption.

If you have children, it lowers your breast cancer risk, and breastfeeding your children significantly lowers your breast cancer risk.

Why is that?

Your breasts produce milk.

And when they have not produced milk, they have not changed into a milk producing gland.

And the stem cells which change become frustrated over a lifespan of not undergoing that change, and they can then change into something that looks more like malignancy.

So, when differentiation or change doesn't happen, that's a little bit of a problem for the tissue.

The tissue can change in odd ways.

What areas are you looking at in this study, in this research project?

Historically, we've known for 15 years that the higher rates of advanced breast cancer in areas like Miami-Dade, Pembroke Pines, Lauderdale Lakes, Plantation, there are actually many in the area.

And...

So, they're not the entire town, Hollywood, but there are certain zip codes that seem to be very high.

These are not necessarily associated with poverty or lack of screening.

They may be more associated with environmental factors such as the arsenic in the water and the glyphosate in the water and the land.

And then the arsenic, the glyphosate, you say we can avoid consuming that by doing what?

Now there are affordable filters that will remove glyphosate, the charcoal filters, the kind of things that are like Brita water filters.

There are about six different brands.

When you go on the environmentalworkinggroup.org, there's a tap water assessment.

You can put in your zip code and it will actually tell you what's in the water and what filters to buy in a pitcher to take it out of the water.

You can actually do this for yourself.

In every city I've lived in, I've always had a pitcher of one type or the other depending on what my zip code contains.

So, what have you learned so far and where do you see yourself going with this study?

'cause you're sort of new into it.

You said it's only been about a year and a half.

So, so far we are seeing important differences when we expose women of color versus white women, their breast tissue and culture, we're seeing important differences in what genes change.

And we're seeing more endocrine effects in the African American or the African ancestry.

'Cause for South Florida, it's African ancestry 'cause it's not always African American.

And in the non-Hispanic whites, we see more changes in genes that protect from breast cancer that are DNA repair related.

So, these genes get lowered, so your risk of developing breast cancer goes up.

And so it's different.

The ancestry makes a difference is what we're learning, that it does matter what kind of breast cancer you get, depends on your ancestry, and how you respond to chemicals in the environment is different based on what we're finding with glyphosate and arsenic.

What is your advice to people who hear this information?

Whether you're a gene carrier, a mutation carrier, and you're worried about getting breast cancer, or you don't have a mutation, the environment impacts your breast cancer risk.

And so if you use apps from, for example, the environmentalworkinggroup.org and others, you can assess, you can curate which brands you use for your personal care products.

This also impacts men.

Endocrine disruptors feminize men.

And so we don't want to have that in our male population either, and they use hair products and lotions.

But if you use these instruments to curate your brands, you will live a healthier lifestyle.

And if you pay attention to genetic modification in your food.

Corn, wheat, oats, soy, and peanuts, avoid GMO because they're the highest levels of glyphosates in those particular plants.

Other plants are not genetically modified.

We don't have to worry about those.

But those particular plants, avoid GMO.

Do your research, make good choices.

Dr. Jean Latimer, thank you so much.

This was really informative.

We appreciate it.

Thank you very much.

And for more on this in breast cancer awareness resources, follow us on Facebook, @YourSouthFL.

I'm Pam Giganti.

As always, thanks so much for watching.