♪ ♪ >> THE GOOD NEWS IS THAT THE MORTALITY RATE FROM BREAST CANCER IS GOING DOWN, BUT THE BAD NEWS IS THE NUMBER OF WOMEN DIAGNOSED WITH BREAST CANCER IS GOING UP.

STAY WITH US AS WE TALK WITH BREAST SPECIALIST Dr.

LAILA AGRAWAL ABOUT THE SEEMINGLY CONTRADICTORY TRENDS NEXT ON "KENTUCKY HEALTH."

>> "KENTUCKY HEALTH" IS FUNDED IN PART BY A GRANT FROM THE FOUNDATION FOR A HEALTHY KENTUCKY.

>> BREAST CANCER OCCURS IN BOTH MEN AND WOMEN, AND IN FACT, MEN ACCOUNT FOR 1% OF ALL BREAST CANCERS ANNUALLY.

HOWEVER, TODAY'S DISCUSSION WILL SOLELY FOCUS ON WOMEN.

BREAST CANCER IS THE SECOND MOST COMMON TYPE OF CANCER IN WOMEN BEHIND SKIN CANCER.

THIS YEAR ONE IN EIGHT OR 13% OF WOMEN IN THE UNITED STATES WILL BE DIAGNOSED WITH BREAST CANCER.

AND EVEN MORE WORRISOME TREND IS THAT THE NUMBER OF WOMEN DIAGNOSED UNDER THE AGE OF 50 IS INCREASING.

THERE ARE IDENTIFIABLE RISK FACTORS FOR DEVELOPING BREAST CANCER.

THESE INCLUDE MODIFIABLE FACTORS SUCH AS WEIGHT GAIN, INACTIVITY, EXCESSIVE ALCOHOL CONSUMPTION.

NON-MODIFIABLE FACTORS SUCH AS FAMILY HISTORY AND ENVIRONMENTAL RISK SUCH AS EXPOSURE TO AIR POLLUTANTS.

BREAST CANCER SCREENING HAS LED TO DISCOVERY OF MANY EARLY AND THEREFORE EASIER TO TREAT CANCERS.

BUT THERE IS SOME CONTROVERSY AROUND THE FREQUENCY OF SCREENING, WHICH MODALITY TO USE AND WHEN IT SHOULD STOP.

NEWER TREATMENT OPTIONS AND PROTOCOLS HAVE LED TO IMPROVED SURVIVAL, LOWER MORTALITY RATES AND GREATER CHANCE FOR BREAST CONSERVATION.

TO HELP US GET A BETTER UNDERSTANDING, WE HAVE AS OUR GUEST Dr.

LAILA AGRAWAL.

Dr.

AGRAWAL EARNED HER MEDICAL DEGREE FROM THE INDIANA UNIVERSITY SCHOOL OF MEDICINE IN INDIANAPOLIS, INDIANA.

AND THEN COMPLETED A RESIDENCY IN INTERNAL MEDICINE AT THE WASHINGTON UNIVERSITY SCHOOL OF MEDICINE IN ST.

LOUIS, MISSOURI.

SHE FOLLOWED THIS UP WITH A FELLOWSHIP IN HEMATOLOGY AND MEDICAL ONCOLOGY AT VANDERBILT UNIVERSITY AT THE MEDICAL CENTER IN NASHVILLE TENNESSEE.

SHE IS CURRENTLY IN PRACTICE AS A SPECIALIST IN BREAST MEDICAL ONCOLOGY WITH THE NORTON HEALTHCARE IN LOUISVILLE, KENTUCKY.

Dr.

AGRAWAL, THANK YOU FOR BEING WITH US TODAY.

>> THANK YOU SO MUCH FOR HAVING ME.

>> WAS I FAR OFF ON MY NUMBERS REGARDING BREAST CANCER?

>> YOU GOT IT.

>> I'M GOING TO IMAGINE THAT OUT THERE RIGHT NOW, THERE ARE PEOPLE WHO WANT TO SAY, I WANT TO DO WHAT SHE IS DOING.

HOW DID YOU GET TO BE THE WORLD FAMOUS Dr.

LAILA AGRAWAL BREAST CANCER SPECIALIST IN MEDICAL ONCOLOGY?

>> WELL, I DON'T KNOW ABOUT THAT, BUT TO BE A MEDICAL ONCOLOGIST, THAT COMES THROUGH A LONG ROAD OF TRAINING FROM AFTER UNDERGRAD MEDICAL SCHOOL, IT GOES TO AN INTERNAL RESIDENCY AND THEN A FELLOWSHIP IN HEMATOLOGY AND ONCOLOGY.

AND OFF AFTER THAT, I CHOSE TO SPECIALIZE IN THE TREATMENT OF BREAST CANCER.

>> WHAT WAS THE LIGHT BULB MOMENT THAT SAID I WANT TO DEDICATE MY LIFE TO CANCER?

WHAT WAS IT THAT GOT YOU DOING THAT?

>> MY BROTHER WAS DIAGNOSED WITH BREAST CANCER WHEN I WAS A CHILD.

SHE IS DOING WELL AND SHE IS, YOU KNOW, A BIG PART OF OUR LIVES.

AND I JUST FELT PULLED OR CALLED TO DO THIS.

>> NOW WE KNOW THAT IN THE BREAST THERE ARE A LOT OF DIFFERENT TYPES OF STRUCTURES.

WHAT ARE THEY AND CAN CANCER OCCUR IN ALL OF THESE THINGS?

>> SO THE MOST COMMON TYPE OF BREAST CANCER WILL START IN THE MILK DUCT SO IT'S CALLED A DUCTIL CARS KNOW NAH CARCINOMA AND THAT CAN BE AN INVASIVE CANCER MEANING THE CANCER CELLS THAT STARTED IN THE MILK DUCT HAVE INNOVATED HAVE ADDED OUT OF THE DEDUCT DUCT AND HAVE THE CHANCE TO INVADE IN THE BLOODSTREAM OR SOMEWHERE ELSE IN THE BODY.

THE OTHER STRUCTURE THAT BRANSZER CAN DEVELOP FROM IS THE TYPE OF CANCER CALLED INVASIVE LAVULAR CARS NOPA AND THOSE ARE THE TWO MOST COMMON STRUCTURES THAT BREAST CANCER CAN DEVELOP FROM.

>> THESE STRUCTURES ARE THROUGHOUT THE ENTIRE BREAST.

>> YES.

>> HOW COMMON?

I SAID 13% OF THE WOMEN.

THAT'S A BIG NUMBER.

IS IT REALLY THAT COMMON?

>> THAT'S RIGHT.

UNFORTUNATELY BREAST CANCER IS VERY COMMON AND THAT STATISTIC ONE IN EIGHT REPRESENTS WHAT IS CALLED THE AVERAGE RISK.

SO SOMEBODY WHO HAS AN AVERAGE RISK OF BREAST CANCER, BUT OTHER PEOPLE HAVE HIGHER THAN AVERAGE RISKS.

>> BREAK IT DOWN FOR ME.

>> THERE ARE MANY RISK FACTORS THAT WE KNOW ABOUT AND PEOPLE MAY HAVE SOME OF THESE RISK FACTORS AND PLACE THEM AT A HIGHER RISK AND A BIG ONE IS FAMILY HISTORY.

>> REALLY.

SO HOW MUCH DOES FAMILY HISTORY INCREASE ONE'S RISK FOR DEVELOPING BREAST CANCER?

>> THERE ARE DIFFERENT WAYS THAT FAMILY HISTORY CAN CONTRIBUTE TO SOMEBODY'S RISK OF BREAST CANCER.

SOMETIMES HAVING FAMILY MEMBERS THAT DOES INCREASE THE RISK BUT ALWAYS ENCOURAGE PEOPLE TO KNOW THEIR FAMILY HISTORY, MEANING WHO IN THE FAMILY MIGHT HAVE BEEN DIAGNOSED WITH BREAST CANCER BUT ALSO WHAT AGE WERE THEY BECAUSE THAT CAN INFLUENCE THE RISK.

IF THERE IS ADDITIONAL INFORMATION, ARE THERE MULTIPLE PEOPLE IN THE FAMILY.

AND THEN WHEN I'M TALKING TO PEOPLE ABOUT THEIR RISK OF BREAST CANCER, WE ACTUALLY ARE ALSO INTERESTED IN OTHER TYPES OF CANCER THAT MIGHT BE IN THE FAMILY AS WELL.

AND THAT'S BECAUSE SOMETIMES CERTAIN TYPES OF CANCER CAN CLUSTER TOGETHER WITH WHAT IS CALLED A GENETIC MUTATION.

>> HAVING THESE MUTATIONS OR HAVING FAMILY HISTORY OF BREAST CANCER, DOES AT THAT TIME MEAN THAT A WOMAN IS GOING TO GET BREAST CANCER?

>> NO.

PEOPLE CAN HAVE FAMILY HISTORY.

IT DOESN'T MEAN THEY'RE GOING TO HAVE BREAST CANCER.

BUT IT MIGHT MEAN THAT THEIR RISK IS HIGHER THAN AVERAGE.

>> WHAT ARE SOME OF THE GENETIC THINGS THAT YOU SPEAK OF?

>> THE MOST COMMON GENETIC MUTATION THAT I'M TALKING ABOUT IS CALLED BRCCA.

THERE IS BRCA 1 AND 2.

>> THAT'S BRCA.

>> YES.

THIS IS A GENE AND WHEN THERE ARE PARTICULAR MUTATIONS IN THE GENES WHICH CAN BE PASSED ON THROUGH FAMILIES, INDIVIDUALS WHO CARRY THAT GENETIC MUTATION HAVE A HIGHER RISK OF DEVELOPING BREAST CANCER.

AND ONE THING THAT WE KNOW IS THAT THERE MAY BE PEOPLE OUT THERE WHO CARRY THE MUTATION OR WHOSE FAMILY CARRIES THIS MUTATION AND THEY MAY NOT EVEN KNOW.

AND THAT'S WHY I THINK IT'S SO IMPORTANT THAT WE TALK ABOUT FAMILY HISTORY AND BRING THAT INFORMATION TO OUR MEDICAL TEAMS TO FIGURE OUT IF THIS IS SOMETHING THAT COULD BE ASSOCIATED WITH A GENETIC MUTATION.

>> ONE OF THE THINGS WHICH IS FASCINATING TO ME, HAS BEEN BODY HABITUS AND/OR DIETARY FACTORS THAT INFLUENCE THE RISK OF BREAST CANCER.

TELL ME A LITTLE BIT MORE ABOUT THAT.

>> RIGHT.

WE KNOW THAT LIFESTYLE PLAYS A BIG ROLE IN THE RISK OF DEVELOPING CANCER.

AND THERE IS MANY FACTORS THAT GO INTO THAT.

OBESITY IS ONE OF THOSE FACTORS AS WELL AS NUTRITIONAL HABITS, EXERCISE, SMOKING AND OTHER THINGS.

ONE THING THAT EVERYBODY KNOWS IS THAT ALCOHOL INTAKE IS ACTUALLY TIED TO RISK OF DEVELOPING BREAST CANCER.

>> HOW DOES OBESITY LEAD TO INCREASED RISK OF BREAST CANCER?

>> SO THERE IS PROBABLY MANY DIFFERENT MECHANISMS THAT ARE AT PLAY WITH OBESITY.

AND WE ARE LEARNING MORE AND MORE ABOUT THEM.

CERTAIN INFLAMMATORY PATHWAYS, CHANGES IN HORMONE METABOLISM, AND OTHER FACTORS THERE.

BUT WE KNOW THAT BODY WEIGHT CAN BE ASSOCIATED OR GAINING WEIGHT ALSO CAN BE SOBERED WITH INCREASED RISK OF CANCER.

>> SO ONE OF THE THINGS SOMETIMES WE TELL PEOPLE, WATCH THE ALCOHOL CONSUMPTION, AND WATCH THE WEIGHT AND EVERYTHING.

AS WE SEE THE AGE AT WHICH BREAST CANCER IS STARTING TO COME DOWN, THE QUESTION BECOMES WHAT IS THE TYPICAL AGE NOW FOR A WOMAN TO DEVELOP BREAST CANCER AND HOW YUG YOUNG IS YOUNG?

>> SO THE AVERAGE AGE OF DIAGNOSIS FOR BREAST CANCER IS IN THE 60s.

SO AROUND 62 THE MOST COMMON DECADES WHEN SOMEONE WOULD BE DIAGNOSED WITH BREAST CANCER WILL BE IN THE 60s AND 70s, BUT WE ARE SEEING A WORRISOME TREND IN RISING CASES OR RISING DIAGNOSES IN WOMEN YOUNGER THAN AGE 50.

>> TO WHAT DO YOU ATTRIBUTE THIS?

>> SIMILARLY, THERE IS PROBABLY MULTIPLE DIFFERENT THINGS THAT ARE GOING INTO THOSE RISING TRENDS IN YOUNGER WOMEN.

THE LIFESTYLE FACTORS THAT WE DISCUSSED, INCLUDING, YOU KNOW, NUTRITION, EXERCISE HABITS, PERHAPS ALCOHOL, ENVIRONMENTAL CHANGES AS WELL.

MANY DIFFERENT THINGS MIGHT BE LEADING TOWARDS THAT.

I DON'T THINK THERE IS ONE THING THAT WE CAN POINT TO.

>> WHAT ARE SOME OF THE ENVIRONMENTAL FACTORS.

THERE SEEMS TO BE SO MUCH GOING ON, WHICH WE KIND OF, THE ENVIRONMENT IS KIND OF TILTING THE SCALE A LITTLE BIT FOR US.

ARE THERE THINGS IN PARTICULAR YOU CAN PUT YOUR FINGER ON.

>> AIR POLLUTION IS ONE.

THERE HAVE BEEN RESEARCH STUDIES THAT HAVE COME OUT RECENTLY THAT HAVE LINKED HIGHER RATES OF BREAST CANCER TO AREAS WHERE THERE MIGHT BE MORE AIR POLLUTION.

BUT MORE RESEARCH IS NEEDED TO REALLY UNDERSTAND IS THERE A PARTICULAR FACTOR THAT IS AT PLAY HERE?

WHAT PERIOD OF A PERSON'S LIFE, YOU KNOW, WOULD THIS EXPOSURE CAUSE THE GREATEST RISK.

BUT I THINK IT'S IMPORTANT TO UNDERSTAND, YOU KNOW, WE TALK ABOUT MODIFIABLE RISK FACTORS AND NON-MODIFIABLE RISK FACTORS BUT SOME OF THESE MIGHT BE MODIFIABLE AS A COLLECTIVE.

MAYBE NOT AS AN INDIVIDUAL.

WHAT IS SCREENING AND WHAT ARE YOU TRYING TO DO WITH THAT?

>> BREAST CANCER SCREENING IS TRYING TO DIAGNOSIS OR CATCH A CANCER BEFORE IT CAN BE FELT OR PAL PAY THED.

BECAUSE-- PAL PALPATED BECAUSE EARLIER DIAGNOSIS IS LINKED TO BETTER OUTCOMES.

>> DO YOU RECOMMEND WOMEN DO SELF EXAMINATION?

>> IT IS IMPORTANT TO UNDERSTAND THAT SOMETIMES BREAST CANCER IS DIAGNOSED BECAUSE A WOMAN FEELS A LUMP HERSELF AND THAT PLIGHT BE DURING JUST DAILY ACTIVITY LIKE TAKING A SHOWER OR KIND OF BRUSHING YOUR HAND AGAINST YOUR BREAST AND FINDING A LUMP.

SO, YOU KNOW, I THINK THERE IS A BIT OF A CONFUSION ABOUT SHOULD WE BE DOING MONTHLY SELF EXAMS BUT I WANT TO CONVEY THAT IT IS CRITICALLY IMPORTANT THAT WOMEN ARE AWARE OF THEIR BODIES AND AWARE OF THEIR BREASTS AND CHECK THEM ON A REGULAR BASIS.

BECAUSE THAT IS ONE OF THE WAYS THAT CANCER IS DETECTED THROUGH SOMEBODY FINDING A LUMP.

ESPECIALLY IN YOUNGER WOMEN WHO MIGHT BE YOUNGER THAN WHEN SCREENING IS RECOMMENDED TO START.

SO YOUNGER THAN AGE 40.

A CANCER THAT DEVELOPS IN THAT AGE GROUP IS NOT GOING TO BE CAUGHT ON A SCREENING TEST.

SO IT'S IMPORTANT THAT EVERYBODY IS AWARE OF THEIR BODIES.

AND IF YOU NOTICE SOMETHING, TO BRING IT TO MEDICAL ATTENTION.

>> THAT'S GREAT TO HEAR BECAUSE I WAS HEARING FOR A WHILE THERE, WE DON'T NEED TO DO BREAST SELF EXAMINATIONS.

I WOULD THINK WAIM, THIS IS THE SIMPLEST EASIEST THING FOR PEOPLE TO DO.

THANK YOU FOR SAYING THAT.

WHO SHOULD GET SCREENED AND WHEN DOES IT START?

>> ANOTHER QUESTION THAT CAN HAVE MULTIPLE DIFFERENT ANSWERS BUT AS A MEDICAL ONCOLOGIST WHO FREQUENTLY TREATS BREAST CANCER YOUNG WOMEN, FOR, THIS MY OPINION, WOMEN WHO ARE AT AVERAGE RISK WOULD START THEIR SCREENING MAMMOGRAMS AT AGE 40 AND HAVE ANNUAL EXAMS.

RECOMMENDATIONS FROM A VARIETY OF DIFFERENT MEDICAL GROUPS THAT MAY HAVE A DIFFERENT STARTING AGE OR DIFFERENT FREQUENCY OF TESTING SO IT'S ALWAYS IMPORTANT TO TALK TO YOUR OWN DOCTORS AND MEDICAL TEAMS TO HAVE KIND OF A RISK-BASED DISCUSSION FOR EACH PERSON.

BUT THAT'S FOR WOMEN WHO HAVE AVERAGE RISK.

BUT HOW DO YOU KNOW IF YOU ARE AT AVERAGE RISK OR NOT?

TO PART PARTNER WITH THAT, EVERY WOMAN STARTING AT AGE 25 OR EARLIER SHOULD DO SOMETHING CALLED A RISK ASSESSMENT.

AND THAT'S TRYING TO FIGURE OUT AM I SOMEBODY WHO HAS AN AVERAGE RISK OR AM I SOMEBODY WHO HAS AN INCREASED RISK BECAUSE THE SCREENING RECOMMENDATIONS CAN LOOK VERY DIFFERENT.

>> WHAT ABOUT THE PERSON WHO HAS THE FAMILY HISTORY OF BREAST CANCER?

WHEN ARE THEY STARTED?

>> SO FOR INDIVIDUALS WHO HAVE A FAMILY HISTORY, THIS MAY CHANGE WHEN THEY'RE RECOMMENDED WHEN TO START THE SCREENING DEPENDING ON THE AGE OF THE PERSON WHO WAS DIAGNOSED.

SO, FOR EXAMPLE, IN MY CASE, MY MOTHER WAS DIAGNOSED IN HER 40S SO I STARTED MY OWN BREAST CANCER SCREENING 10 YEARS BEFORE HER DIAGNOSIS.

BUT FOR OTHER PEOPLE, IF THEIR FAMILY MEMBER WHO WAS DIAGNOSED WITH CANCER CARRIED A GENETIC MUTATION LIKE THE BRCA MUTATION AND THE DAUGHTER TESTIFIED POSITIVE FOR THE BRCA MUTATION AS WELL, SCREENING WOULD START AS YOUNG AS 25.

>> WHAT ABOUT THE PERSON WHOSE AVERAGE RISK WHO IS NOW 70 YEARS OLD?

>> SO, IN MY OPINION, THERE IS NOT AN AGE NUMBER THAT IS A CUTOFF TORE STOPPING MAMMOGRAMS.

WHAT I THINK ABOUT IS WHAT IS THE HEALTH OF THE INDIVIDUAL, WHAT IS THE LIFE EXPECTANCY AND WHAT ARE THEIR WISHES?

SO TYPICALLY IF SOMEBODY'S LIFE EXPECTANCY IS GOING TO BE 10 YEARS OR MORE, THEY'RE ACTIVE AND HEALTHY AND THEY WOULD WANT TO DO SOMETHING IF AN ABNORMALITY WAS FOUND ON A SCREENING MAMMOGRAM, THEN IT'S REASONABLE TO CONTINUE.

BUT FOR OVER PEOPLE, IF THAT'S NOT THE CASE, THEN SCREENING MAMMOGRAMS CAN END AND THAT OCCURS WITH A DISCUSSION WITH THEIR MEDICAL TEAM.

>> TO PUT YOU ON THE SPOT.

WE KNOW THAT THE PREVENTATIVE TASK FORCE CAME UP WITH SOME INTERESTING RECOMMENDATIONS AS FAR AS HOW FREQUENTLY WE SHOULD HAVE TESTING DONE.

WHAT IS YOUR RECOMMENDATION HOW OFTEN SCREENING SHOULD BE YEARLY, TWICE A YEAR?

WHAT?

>> RIGHT, SO DIFFERENCE ORGANIZATIONS HAVE DIFFERENT RECOMMEND I GOESATIONS AND THAT CAN MAKE IT CONFUSING FOR PEOPLE TO DECIDE WHAT THE BEST SCREENING IS.

SOME RECOMMEND YEARLY.

SOME RECOMMEND EVERY OTHER YEAR, TRYING TO BALANCE DIAGNOSING CANCERS IN A TIMELY FASHION VERSUS THE POTENTIAL FOR INCREASED ADDITIONAL TESTING OR, YOU KNOW, FOLLOWUP EXAMS.

SO, YOU KNOW, WE ARE SEEING RISING RATES OF BREAST CANCER.

AND WE CAN SEE CANCERS THAT DEVELOP EVEN IN A ONE-YEAR PERIOD OR IN A TWO-YEAR PERIOD.

SO I THINK THIS IS REALLY A ROLE WHERE PEOPLE CAN HAVE INDIVIDUAL DISCUSSIONS WITH THEIR DOCTORS AND THERE I MEDICAL TEAMS TO DECIDE WHAT MAKES THE MOST SENSE FOR THEM BASED ON THEIR OWN RISK.

BUT IF A FRIEND OR A FAMILY MEMBER... >> I'M NOT GOING TO LET YOU GET AWAY WITH THAT ANSWER.

THERE IS NO WAY I'M LETTING YOU GET AWAY WITH THAT ONE.

>> IF A FAMILY MEMBER OR A FRIEND ASKED ME, I WOULD DEFINITELY WANT THEM TO BE GETTING YEARLY MAMMOGRAMS.

>> AND WHAT TEST DO YOU RECOMMEND AND WHAT IS THE PROS AND CONS OF THE DIFFERENT TESTS THAT ARE OUT THERE.

>> THE STANDARD TESTING IS A MAMMOGRAM.

AND NOWADAYS IT'S PRETTY STANDARD TO GET WHAT IS CALLED A 3D MAMMOGRAM.

BUT, AS I MENTIONED, WE TALKED ABOUT RISK A LOT.

AND FOR WOMEN WHO ARE FOUND TO HAVE AN INCREASED RISK OF DEVELOPING BREAST CANCER, WHICH MEANS A LIFETIME RISK INSTEAD OF THE AVERAGE LIFETIME RISK OF AROUND 13%, 20% OR HIGHER, THEY MAY BE ELIGIBLE FOR WHAT I CALL SUPPLEMENTAL OR MORE INTENSIVE SCREENING WHICH CAN INCLUDE A SCREENING BREAST MRI IN ADDITION TO A MAMMOGRAM.

>> GOTCHA.

WHAT ABOUT ULTRASONOGRAPHY.

>> ULTRASOUND IS A VERY USEFUL TOOL FOR BREAST IMAGING AND WE OFTEN USE IT WHEN AN ABNORMALITY IS FOUND.

IF A MA'AM GRAHM DETECTS SOMETHING ABNORMAL OR IF SOMEBODY FEELS A LUMP OR SOME OTHER CHANGE IN THE BREAST, AN ULTRASOUND CAN HELP GET A BETTER VIEW AND BETTER UNDERSTANDING OF IT.

SOMETIMES IT IS RECOMMENDED AS A METHOD OF SCREENING BUT WE RECOMMEND SCREENING MRIS WHICH ARE MORE SENSITIVE.

>> OUT OF CURIOSITY FOR A WOMAN WHO HAS HAD A HISTORY OF BREAST CANCER, DO YOU STILL RECOMMEND A MASTECTOMY OR DO YOU RECOMMEND THE PLIER STUDY DOWN THE ROAD?

>> SO FOR WOMEN WHO HAVE HAD BREAST CANCER, IF THEY STILL HAVE-- IF THEY HAVEN'T HAD A MASTECTOMY OR REMOVAL OF THE ENTIRE BREAST, WE WILL CONTINUE TO DO SCREENING IMAGING.

AND USUALLY THAT'S STILL WITH A MAMMOGRAM.

IN SOME CASES, WE ADD ON A SCREENING BREAST MRI, ALTHOUGH WE TRY TO KIND OF HONE THIS TO THE PEOPLE WHO WILL BENEFIT THE MOST FROM THAT.

AND SO OFTEN THAT'S AN INDIVIDUAL DISCUSSION.

>> I WANT TO HEAR ABOUT THE SURGICAL OPTIONS.

I THINK WHERE THE BIGGEST CHANGE THAT HAS COME ABOUT AS FAR AS MANAGING PATIENTS WHO HAVE DEVELOPED BREAST CANCER IS IN THE MEDICAL ONCOLOGY SIDE, WHAT YOU ARE DOING.

SO CHEMOTHERAPY, WE ALL SAY CHEMOTHERAPY.

THERE IS A LOT MORE TO IT THAN THAT.

TELL ME WHAT IS GOING ON AS FAR AS THIS MODALITY.

>> YEAH, THERE ARE DIFFERENT TYPES OF TREATMENTS FOR BREAST CANCER.

SOME OF THEM ARE SURGERY, THERE IS RADIATION.

AND THEN AS A MEDICAL ONCOLOGIST, THE THINGS THAT I DO INVOLVE SOMETIMES CHEMOTHERAPY, NOW THERE IS MORE AND MORE TYPES OF TREATMENTS THAT ARE CALLED TARGETED THERAPIES.

MEANING THAT THROUGH RESEARCH, DIFFERENT SPECIFIC CHANGES ARE FOUND IN A CANCER AND THEN TREATMENTS ARE OUT THERE THAT CAN TARGET THOSE CHANGES OR MUTATIONS OR FACTORS OF CANCER.

SOME OF THESE INVOLVE IMMUNOTHERAPY.

SOME OF THEM ARE CALLED HER 2 TARGETED TREATMENTS AND MANY BREAST CANCERS ARE HORMONE SENSITIVE CANCERS SO THERE IS A FORM CALLED ENDOCRINE THERAPY WHICH IS BLOCKING OR LOWERING TREATMENTS THAT HELP REDUCE RISK OF RECURRENCE.

>> WHAT IS HER-2.

>> WHEN SOMEBODY IS DELEGATED WITH BREAST CANCER, THERE ARE THREE IMPORTANT RECEPTORS THAT ARE ON THE CANCER THAT TELL US WHAT KIND OF CANCER IT IS, WHAT WHAT IS THE PROGNOSIS GOING TO BE AND THE BEST TREATMENT.

TWO OF THEM ARE HORMONE RECEPTORS, ESTROGEN RECEPTOR AND PROGESTERONE REACCEPTOR AND THE OTHER IS HER 2.

WE HAVE IT ON NORMAL HEALTH THE CELLS BUT IN CERTAIN TYPES OF BREAST CANCER, IT OVERLY EXPRESSED AND CAN SEND THE CANCER INTO A MORE ACTIVE OR PROLIFIC STAGE.

AND SO THERE ARE NOW TREATMENTS THAT CAN TARGET THE HER-THE RECEPTORS.

SEVERAL DIFFERENT TYPES THAT CAN BE USED TO TREAT AND AND HELP PEOPLE WHO HAVE METASTATIC.

>> NOW WE HEAR THE JARGON, THE JARGON YOU HAVE IS DIFFERENT FROM EVERYBODY ELSE.

SOMEBODY IS TRIPLE NEGATIVE, TRIPLE POSITIVE.

WHAT DOES THIS HAVE TO DO WITH PROGNOSIS OR DOES IT HAVE ANYTHING TO DO WITH PROG FOES AND WHAT DO THOSE THINGS REALLY MEAN?

>> THOSE ARE THE THREE RECEPTORS.

ESTROGEN, PROCEED JEST RINE-- PROCEED JESSE TRIN-- AND HER2.

IF THEY ARE ALL NEGATIVE.

THAT IS AN AGGRESSIVE FORM OF BREAST CANCER AND BECAUSE IT LACKS THE ESTROGEN RECEPTOR AND HORMONE RECEPTORS IN THE HER2 EXPRESSION, THE TYPES OF TARGETED TREATMENTS AGAINST THOSE ARE NOT EFFECTIVE TO TREAT TRIPLE NECK-- NEGATIVE.

SO WE OFTEN TREAT TRIPLE NEGATIVE BREAST CANCER WITH CHEMOTHERAPY BUT SOME ADVANCES HAVE COME THROUGH THAT HAVE CHANGED THE WAY WE TREAT CERTAIN TYPES OF TRIPLE NEGATIVE BREAST CANCER BY INCORPORATING IMMUNOTHERAPY INTO PART OF THE TREATMENT PLAN.

>> WHAT KIND OF IMMUNOTHERAPY ARE YOU TALKING ABOUT?

ARE YOU STIMULATING THEIR IMMUNE SYSTEM OR GIVING SOMETHING?

>> THIS IS A CATEGORY OF CANCER TREATMENTS THAT HAS SHOWN TO BE EFFECTIVE IN NOT ALL BUT MANY DIFFERENT TYPES OF CANCER.

AND IT WORKS IN A SIMPLE WAY TO EXPLAIN IT BY TAKING THE BRAKES OFF THE IMMUNE SYSTEM OR LETTING THE IMMUNE SYSTEM RECOGNIZE THE CANCER AS SOMETHING IT NEEDS TO ATTACK.

AND THAT'S THE GOOD PART ABOUT IT.

BUT THEN ON THE FLIP SIDE, IT CAN ALSO HAVE SIDE EFFECTS WHERE IT RECOGNIZES THE HEALTHY BODY AS SOMETHING THAT SHOULDN'T BE THERE EITHER SO IT'S A BALANCE OF THE IMMUNE SYSTEM IS UNLEASHED TO FIGHT THE CANCER BUT WE ALSO CAN SEE THESE IMMUNE MEDIATED SIDE EFFECTS COME ABOUT AS WELL.

>> WITH THE MODIFICATIONS IN CHEMOTHERAPY THAT YOU ARE ABLE TO BRING TO BEAR, ARE YOU FINDING THAT THERE IS LESS AMPUTATION OF A BREAST AND YOU ARE ABLE TO SAVE MORE OF THE BREAST TISSUE BECAUSE YOU CAN DOOR MORE WITH THESE MEDICATIONS?

>> SO WHEN IT COMES TO SURGERY FOR BREAST CANCER, THE TWO MAIN TYPES, ONE IS CALLED A LUMPECTOMY AND THAT IS DESIGNED TO REMOVE THE LUMP OR THE TUMOR AND LEAVE THE REMAINING HEALTHY BREAST IN PLACE.

OFTEN TIMES THAT IS FOLLOWED WITH RADIATION TREATMENT AS WELL ALTHOUGH NOT ALWAYS.

THE OTHER TYPE OF SURGERY IS CALLED MASTECTOMY WHERE THE BREAST TISSUE IS REMOVED AND COMPARED TO HOW THIS MIGHT HAVE BEEN DONE IN THE PAST, THESE TECHNIQUES ARE ADVANCING.

NOW THERE ARE OPTIONS TO LEAVE THE NIPPLE IN PLACE AS WELL WHICH GIVES THEM MORE NATURAL APEESHES, EVEN WITH RECONINSTRUCTIONS, BUT NOT EVERYBODY NEEDS TO HAVE THEIR BREAST REMOVES IF DIAGNOSED WITH BREAST CANCER.

>> THAT IS A BIG DIFFERENCE.

IF A WOMAN HAS A POSITIVE FAMILY HISTORY OF BREAST CANCER AND SHE IS BRCA POSITIVE, SHE IS CONCERNED ABOUT HER RISK OF DEVELOPING BREAST CANCER.

I JUST WANT BOTH BREASTS REMOVED.

WHAT DO YOU SAY TO THAT?

>> SO, IF THAT PERSON HAS NOT BEEN DIAGNOSED WITH CANCER THEMSELVES, THERE IS AN OPTION TO DO WHAT IS CALLED PROF RACK TICK-- PROPHYLACTIC SURGERY THAT GIVEN THE KNOWN RISK OF DEVELOPING CANCER IN SOMEBODY WHO CARRIES THE BRCA MUTATION, THIS IS A STEP THAT CAN BE TAKEN THAT WILL DRAMATICALLY REDUCE THE CHANCE THAT SHE WILL GET BREAST CANCER.

THIS IS SOMETHING THAT WE OFFER AND A WAY TO REDUCE THE RISK OF BREAST CANCER IN PEOPLE WHO HAVE A HIGH RISK.

>> IF A WOMAN HAS BREAST CANCER ON ONE SIDE, FAMILY HISTORY.

JUST WANT TO GET THE OTHER BREAST TAKEN OFF, TOO, IS THAT A REASONABLE THING ALSO.

>> IT IS A PERSON PERSONAL DECISION AND WHEN WOMEN ARE DIAGNOSED WITH BREAST CANCER, THEY MAY FEEL VERY DIFFERENTLY ABOUT THAT.

SO SOME PEOPLE, IF IT IS POSSIBLE TO DO A LUMPECTOMY, CAN BE TREATED WITH A LUMPECTOMY AND RADIATION, NOT EVERYBODY AGAIN WILL NEED RADIATION.

OTHER PEOPLE, IF THE TUMOR IS LARGER, MAY NEED TO HAVE A MASTECTOMY OR MAY CHOOSE TO HAVE A MASTECTOMY.

AND THE OPPOSITE SIDE IS OFTEN NOT NECESSARY FOR TREATMENT OF THE CANCER THEY DO HAVE, BUT IS SOMETHING THAT COULD BE CHOSEN FOR A NUMBER OF DIFFERENT REASONS, INCLUDING SYMMETRY WITH RECONSTRUCTION OR IF SOMEONE CARRIES A GENETIC MUTATION,.

>> I WAS WONDERING ABOUT THE RECONSTRUCTION.

DOES THAT IMPACT THE DECISION TO GIVE CHEMOTHERAPY AND IMMUNOTHERAPY OR DELAY IT?

>> SO WE WORK VERY CLOSELY WITH OUR, YOU KNOW, SURGEONS AND PLASTIC SURGEONS AND RADIATION DOCTORS TO MAKE THE TIMING OF THIS WORK AS SMOOTHLY AS POSSIBLE.

A LOT OF TIMES PATIENTS WILL ASK ME IF I HAVE BOTH BREASTS REMOVED, DOES THAT CHANGE WHETHER OR NOT I WOULD NEED CHEMOTHERAPY.

BUT THE TREATMENT OF CHEMOTHERAPY IS PRIMARILY TRYING TO REDUCE THE CHANCE THAT CANCER WILL SPREAD TO OTHER PARTS OF THE BODY.

SO IT DOESN'T HINGE ON THAT DECISION EXACTLY.

>> WE HAVE ABOUT A MINUTE OR SO TO GO.

GIVE ME YOUR THREE BIG TAKE HOME POINTS THAT AFTER HEARING YOU, YOU HAVE SAID SO MANY GOOD THINGS, BUT I WANT YOU TO DISTILLATE DOWN TO THREE THINGS TO MAKE SURE WE KEEP IN PLIND.

>> NUMBER ONE, WOULD I LIKE EVERY WOMAN TO KNOW HER RISK OF DEVELOPING BREAST CANCER.

THROUGH FAMILY HISTORY, TALKING WITH YOUR MEDICAL TEAMS AND UNDERSTANDING THE BEST SCREENING THAT FOLLOWS WITH THAT RISK.

NUMBER 2: LIFESTYLE MATTERS.

AND THERE ARE THINGS THAT WOMEN CAN DO NOW THAT CAN REDUCE THEIR RISK LATER.

THAT INCLUDES NUTRITION, EXERCISE, HEALTHY HABITS.

AND THEN FINALLY, THAT THROUGH ADVANCES IN RESEARCH, NEW TREATMENTS COMING OUT, SURVIVAL IS IMPROVING IN BREAST CANCER.

>> JUST OUT OF CURIOSITY, ARE YOU FINDING AS OF ADVANCED STAGE DISEASE WITH PEOPLE RELUCTANT TO SEEK OUT CARE NOW OR PEOPLE COMING IN.

THEY GOT A CONCERN AND THEY'RE COMING RIGHT NOW?

>> WE SEE IT BOTH.

SO WE SEE A LOT OF PEOPLE WHO ARE BEING VERY PROACTIVE WITH SCREENING OR WHO FEEL A LUMP AND COME IN.

BUT IT'S IMPORTANT TO UNDERSTAND THAT BREAST CANCER CAN HAPPEN IN SOMEONE WHO HAS NO RISK FACTORS WHATSOEVER.

SO THAT'S WHY IT'S SO IMPORTANT FOR EVERYONE TO BE AWARE OF BREAST CANCER AND IF THERE ARE ANY CONCERNING FINDINGS LIKE A LUMP OR A PAIN, TO BRING THAT TO ATTENTION RIGHT AWAY.

>> THAT'S GOOD ADVICE.

AS I USED TO TELL PATIENTS BEFORE, SOMEONE MARRIED YOU AND WHETHER YOU HAVE TO HAVE SURGERY ON YOUR BREAST OR NOT, THEY'RE GOING TO LOVE YOU.

THANK YOU FOR BEING WITH US.

THANK YOU FOR BEING WITH US.

AS YOU HAVE HEARD, THERE IS GOOD NEWS WHEN IT COMES TO BREAST CANCER.

STILL, WE NEED TO CONTINUE BUILDING ON THE GAINS THAT WE HAVE SEEN AND FOCUS UPON PREVENTION, EARLY DIAGNOSIS AND GETTING TREATMENT.

IF YOU WISH TO WATCH THIS SHOW AGAIN OR WATCH AN ARCHIVED VERSION OF PAST SHOWS, PLEASE GO TO ket.org/HEALTH.

IF YOU HAVE A QUESTION OR COMMENT ABOUT THIS OR OTHER SHOWS, WE CAN BE REACHED AT KY HEALTH@ket.org.

I WILL LOOK FORWARD TO SEEING YOU AGAIN ON THE NEXT "KENTUCKY HEALTH."

IN THE MEANTIME, DO YOUR BREAST SELF-EXAMINATION.

IF YOU FEEL A LOCH OR A MASS OR YOU ARE CONCERNED ABOUT SOMETHING, TALK TO YOUR HEALTHCARE PROVIDER.

IF YOU HAVE NOT BEEN SCREENED, PLEASE, BY ALL MEANS, DO SEEK OUT GETTING SCREENING FOR BREAST CANCER.

WE CAN DECREASE MORTALITY THROUGH EARLY DIAGNOSIS AND WE CAN DO THIS WITH SCREENING.

I LOOK FORWARD TO SEEING YOU AGAIN ON "KENTUCKY HEALTH" AGAIN NEXT WEEK.

THANK YOU FOR BEING WITH US.

ED.

>> "KENTUCKY HEALTH" IS FUNDED IN PART BY A GRANT FROM THE FOUNDATION FOR A HEALTHY KENTUCKY.