♪ ♪ THOSE BREAST CANCER IS THE MOST COMMON CANCER IN WIN, HOW WELL DO WE UNDERSTAND HOW TO PREVENT IT AND TREAT IT.

STAY WITH US AS WE TALK TO JEFFREY HARGIS ABOUT BREAST CANCER NEXT ON "KENTUCKY HEALTH."

ONE IN 10 WOMEN ARE AT RISK FOR DEVELOPING BREAST CANCER IN THEIR LIFETIME.

WE SPEAK ABOUT BREAST CANCER AS IT IF IT WERE ONE DISEASE, THERE ARE SEVERAL DIFFERENT TYPES WITH CLASSIFICATION BASED THE UPON THE SITE OF THE LOCATION AND CHARACTERISTICS OF THE CANCER.

KNOWING THE CANCER TYPE OF THE PATIENT INFLUENCES THE TREATMENT PLAN AND PROGNOSIS.

PARENTHETICALLY, AS WE GAIN A GREATER UNDERSTANDING ABOUT THE GENESIS AND BEHAVIOR OF BREAST CANCER, MORE QUESTIONS SEEM TO BE RAISED AND CREATE A GREATER DISCUSSION GENERATED REGARDING WHAT WOULD BE THE BEST TREATMENT PLAN FOR THESE PATIENTS.

FOR SOME, THESE QUESTIONS SOW THE SEEDS OF CONFUSION AND MISTRUST AND PUSH US TOWARDS REFINING THE RESEARCH INTO BETTER WAYS TO PREVENT, DIAGNOSE AND TREAT BREAST CANCER.

TO HELP US GET A BETTER UNDERSTANDING OF WHO IS GETTING BREAST CANCER AND WHAT NEW DEVELOPMENTS ARE BEING MADE IN TERMS OF SCREENING, DIAGNOSE DIAGNOSIS AND TREATMENT WE HAVE Dr. JEFFREY HARGIS COLLEGE OF MEDICINE AND DID HIS RESIDENCY IN INTERNAL MEDICINE AND A FELLOWSHIP IN MELON MEDICAL ONCOLOGY BOTH AT THE WALTER REED MEDICAL CENTER IN WASHINGTON D.C. Dr. HARGI SI IS A MEDICAL ONCOLOGIST WITH THE NORTON CANCER INSTITUTE AND YOU SPECIALIZED IN BRABSER TREATMENT.

>> THAT'S WHAT I HAVE BEEN DOING NOW FOR 10 OR 15 YEARS.

>> WOW.

THANK YOU FOR BEING WITH US TODAY.

>> YOU ARE WELCOME.

>> WHAT IS BREAST CANCER?

>> BREAST CANCER IS IS A MALIGNANCY IN WOMEN'S BREAST THAT ARISE OUT OF WOMEN'S MILK DUCTS.

AND THOSE CELLS, WHEN YOU HAVE SWOLLEN BREASTS OR TENDER BREVES, THAT'S PROLIFERATION OF THE DUCT CELLS.

EACH TIME THEY HAVE A MENSTRUAL CYCLE, THOUSANDS OF THEM GET MULTIPLIED.

THE CELLS CONTINUE AND THEY'RE THE ONES THAT KIPALLY ARE THE MOST COMMON CAUSE SUBSEQUENTLY OF BREAST CANCER.

IT'S NOT THE TISSUE THAT SURROUNDS THE DEDUCT ILL-SYSTEM.

>> NOW YOU MADE A POINT OF SAYING WOMEN BUT MEN ALSO GET BREAST CANCER, DON'T THEY?

IT'S NOT VERY COMMON.

>> 1% AND STILL VERY ONCOMMON.

IT IS THE BREAST CANCER THAT HAS MUCH MORE LIKELIHOOD OF BEING HER READ HEREDITARY IF IT IS A MALE BREAST CANCER COMPARED TO FEMALES.

BUT UNCOMMON BUT STILL HAVING THAT, YOU KNOW, MEN NEED TO BE GENERALLY AWARE WHICH WE ALL SHOULD BE OF OUR BODIES.

IF THERE IS SOMETHING THAT DOESN'T GET BETTER, TURN YOURSELF INTO SEE A DOCK DOCTOR BUT THERE IS NO REFERENCE FOR SPECIAL IMAGING.

>> ONE IN EIGHT WOMEN IS AT RISK.

WHAT IS THE TRUE INCIDENCE AND WHO IS THAT PERSON THAT IS GETTING BREAST CANCER?

>> WELL, THAT'S ALWAYS INTERESTING WHEN THEY PRESENT THAT.

THAT'S ONE IN EIGHT IF YOU MAKE IT TO YOUR 90th BIRTHDAY.

I THINK A BETTER WAY AND WHAT SHOCKS PEOPLE AND I TELL THIS TO MEDICAL GROUPS AND REGULAR DOCTORS AND ASK THEM A QUESTION, IF YOU ARE BETWEEN YOUR 40th AND 50th BIRTHDAY, WHAT IS THE LIKELIHOOD OF GETTING BREAST CANCER?

HEALTH PROFESSIONALS SAY IT'S 1.5%.

THE MEDIAN AGE OF BREAST CANCER IN THE UNITED STATES IS 63 OR 64, WHICH SHOCKS EVERYBODY.

BUT AS MOST OF THE PATIENTS ARE ACTUALLY OVER AGE 60.

SO AND I GUESS ANOTHER WAY TO LOOK AT IT, THAT IS INTERESTING IS IF YOU LOOK AT RISK OF BREAST CANCER FOR EVERY FIVE-YEAR INCREMENT, IN AGE, SO START 40 TO 45, 45-50, 50-55, THE HIGHEST INCIDENT OF BREAST CANCER PER 100 GROUP IS SCEIVET TO 75.

WE ALL HEAR ON TV, THE STORY OF THE YOUNG WOMAN, THE GOLFER, THE MOVIE STAR, AND WE MOST REMEMBER ABOUT THE PATIENTS IN OUR COMMUNITY.

BUT A DISEASE POTENTIALLY OF YOUNGER AGE BUT IT'S GENERALLY OLDER WOMEN.

>> THAT IS FASCINATING.

>> THE BIG FEAR EVERYONE HAS, AND I KNOW YOU HAVE EXPERIENCED IT WHEN-- ESPECIALLY BEING A MEDICAL ONCOLOGIST, YOU WALK INTO THE ROOM TELL SOMEBODY THEY HAVE BREAST CANCER.

WHAT ARE YOU TELLING THE PERSON WHO HAS BREAST CANCER ABOUT THEIR CHANCES OF SURVIVAL RIGHT NOW.

>> WHAT I ALWAYS SAY WITH A NEW BREAST CANCER PATIENT FAR AND AWAY MOST LIKELY THIS IS NOT GOING TO PREVENT FROM YOU MAKING IT TO YOUR 85th BIRTHDAY OR WHATEVER FAMILY ISSUE YOU HAVE COPPING UP RIGHT NOW AND I OFTEN WILL START TO TALK RIGHT OFF WITH THAT TO GIVE THEM THAT CONFIDENCE.

SO WE ARE AT THAT POINT RIGHT NOW.

AND WE NOW HAVE HAD-- WE ARE APPROACHING ABOUT 30 OR 40 YEARS WHERE THE ANNUAL DEATHS FROM BREAST CANCER IN THE UNITED STATES HAVE BEEN GOING STRAIGHT DOWN.

SOME OF THAT IS FROM EARLY DETECTION FROM MORE PEOPLE BEING INVOLVED IN GETTING IMAGING STUDIES DONE, MAMMOGRAMS, ET CETERA.

BUT ALSO THE HUGE ADVANCES WE HAVE MADE IN TERMS OF TREATMENT TO PREVENT THE BREAST CANCER FROM COMING BACK AFTER IT HAS BEEN DIAGNOSED.

I THINK THAT'S SOMETHING OF CONFIDENCE.

I SAW RECENTLY A COMMENT THAT THERE IS, RIGHT NOW, ESTIMATED TO BE 3.8 MILLION BREAST CANCER SURVIVORS IN THE UNITED STATES RIGHT NOW.

AND THAT'S-- I USE THAT FOR MORALE FOR FOR THE REST OF OUR TEAM.

YOU KNOW WHAT?

WE ARE DOING SOMETHING GOOD HERE.

THAT'S A LOT OF WOMEN.

>> THAT SURE CHANGES THE DYNAMICS OF THE DISCUSSION, DOESN'T IT?

>> ABSOLUTELY.

>> BUT YOU'VE ALSO SAID THOUGH, THAT THE INCIDENTS-- >> YES.

>> IS GOING UP.

>> THE INCIDENTS IS GOING UP AND AGAIN, THE INS INCIDENTS IS GOING UP BUT SURVIVAL IS BETTER.

WE HAVE IMAGING NOW THAT IS FINDING CANCERS AT A MUCH SMALLER AMOUNT.

THAT MEANS FROM THE ORIGINAL MAMMOGRAPHY THAT WE DID IN THE 80S TO THE TWO DIMENSIONAL WE WERE DOING IN THE 90s AND NOW WE HAVE THIS THREE DIMENSIONAL IMAGING, WE FIND CANCERS THAT ARE MUCH, MUCH EARLIER.

MANY OF THEM ARE PRE-BRASHESSER COMMON BEING THE SO CALLED DUCTIL CARCINOMA FIND IN THE STUDIES.

SO THAT IS PART OF THE REASON.

NOW WE ALSO MAY BE HAVING A RISE BECAUSE OF THE CHANGE IN, YOU KNOW, DIET AND LIFESTYLE OVER THE PAST.

WE HAVE MORE PROBLEMS WITH OBESITY NOW WHICH IS AN UNEQUIVOCAL RISK ASSOCIATED WITH BREAST CANCER IN WOMEN.

WOMEN ARE LESS ACTIVE.

ANOTHER THING WE FOUND AS A SIGNIFICANT COMPONENT IS HAVING CHILDREN AT A LATER AGE IN PARTICULAR.

THE OPTIMAL TIME, AND IT'S A RISK FOR GET IS BREAST CANCER, IS EITHER NEVER HAVING CHILDREN OR HAVING CHILDREN AFTER AGE 30 AND OUR SOCIETY, THAT'S NOW THE CASE.

THE OTHER THICK IS THAT INCREASES RISK OF BREAST CANCER IS EARLY ON SET OF MENSTRUAL PERIODS.

WE HAVE GONE FROM 25 TO 30 YEARS AGO WHERE THE AVERAGE AGE WAS 12 AND 13 TO WHERE IT'S NOT UNCOMMON NOW IF YOU TALK TO A PEDIATRICIAN OR PEOPLE WHO HAVE YOUNGER CHILDREN, 9 AND 10 YEARS OLD IS COMMON.

IT'S NOT AS CLEAR AS YOU MIGHT THINK.

>> I WOULD LIKE TO LOOK AT THE DIETARY THINGS.

THAT'S ONE OF THE MANY THINGS.

>> WHEN YOU TALK ABOUT THE EARLY ONSET OF MENSES AND THE LATER TIME WHEN WOMEN ARE HAVING CHILDREN, IS THAT-- IS THE FACT THAT THERE IS AN UNINTERRUPTED PERIOD WHERE WOMEN ARE HAVING THEIR CYCLES,... >> UNINTERRUPTED WITH CONTINUAL FEEDING OF HORMONES EITHER FOR A LONGER DURATION OF TIME OR NOT THE DISRUPTION DURING PREGNANCY.

>> >> DO BIRTH CONTROL PILLS IMPACT THAT.

>> ORIGINALLY THEY DID THROUGH THE 70s AND 80s BECAUSE AT THAT TIME THEY HAD HIGH DOSED ESTROGEN IN THEM.

THE ONCE NOW THE CONSENSUS IS AND DATA SEEMS TO SUGGEST THAT THERE IS PROBABLY NO SIGNIFICANT INCREASED RISK JUST WITH THAT ALONE.

>> YOU MENTIONED THE RISK FACTORS FOR DEVELOPING BREAST CANCER WHAT CAN WE DO TO DECREASE THE RISK?

THE RISK OF DEVELOPING BREAST CANCER?

>> WELL CERTAINLY IT'S ESTIMATED SOME MODELS HAVE SUGGESTED THAT PERHAPS 25 TO 30% OF PATIENTS OF OBESITY WE HAVE IN OUR PATIENTS.

SOME STUDIES HAVE SUGGESTED ANOTHER RISK FACTOR IS CERTAINLY BY WEIGHT AND ONE EXAMPLE I REMEMBER USING ON THE TOP OF MY TONGUE IS IF A WOMAN HAS A BODY MASS INDEX THAT IS 30, IF SHE CAN GO TO 25, THAT CUTS THE RISK BY 20%.

THAT IS A WOMAN THAT IS ABOUT 5'4" GOING FROM 175 TO 150 POUNDS.

NOT EASY BUT THAT CAN BE, JUST BY ITSELF, CAN BE A SIGNIFICANT RISK REDUCER.

A NUMBER OF REAT WELL RETROSPECTIVE STUDIES BUT IT'S NOT RIG RES-- RIGOROUS, THE RECOMMENDATION IS I THINK 150 HOURS PER WEEK OR SO, ROUGHLY-- MINUTES PER WEEK SO ROUGHLY 20-25 MINUTES.

SO IF YOU HAVE AN EXERCISE MACHINE, A TREAD MILL GETS YOUR HEART RATE GOING, THAT INDEPENDENTLY IS A RISK REDUCTION.

>> IS THAT TIED INTO OBESITY DO YOU THINK?

>> IT APPEARS TO BE INDEPENDENT IF YOU LOOK AT BOTH.

>> YOU TALKED ABOUT BREAST CANCER IN MEN HAVING A GREATER ASSOCIATION WITH BEING INHERITED WHAT ABOUT THE INHERITANCE IN WOMEN.

WHAT DO THEY NEED TO WATCH OUT FOR?

>> INHERITED BREAST CANCER THAT WE CAN ACTUALLY DO THE GENETIC TESTING IDENTIFIED AS BEING HIGH RISK, IS PROBABLY STILL ONLY ABOUT FOUR OR 5% OF ALL BREAST CANCER.

>> 4 OR 5%?

>> WE ESTIMATE THAT PROBABLY DOUBLE THAT IS HEREDITARY.

WE JUST DON'T HAVE THE GENE PROFILES WHERE WE HAVE IDENTIFIED IT.

SO ALL OF US IN THE BREAST MEDICAL ONCOLOGY WILL HAVE A PATIENT, A PATIENT I HAD TODAY, THREE SIBLINGS ALL DIAGNOSED UNDER AGE 60 AND SHE WAS DIAGNOSED AT 55.

ALMOST HAS TO BE HEREDITARY.

WE DID A 36 GENE PROFILE ON HER AND FOUND NOTHING.

WE WILL BE MOVING ALONG WITH THAT.

WE'LL FIND THOSE IN THE FUTURE.

>> SO THAT HISTORY IS NOT AS IMPORTANT AS MANY OF US MAY HAVE THOUGHT THAT IT MIGHT BE?

>> IT IS.

AND INDEPENDENT WE STILL WOULD MARK THOSE PATIENTS OF BEING AT HIGH RISK WITH A VERY STRONG FAMILY HISTORY IN TERMS OF PERHAPS CHANGING THE IMAGING PLANS AND HOW WE FOLLOW THEM AND PARTICULAR WILL I HOPE PRIMARY CARE DOCTORS ARE EMPHASIZING THINGS THEY CAN DO TO REDUCE THE RISK OF GETTING BREAST CANCER.

>> I WANT TO TALK ABOUT A SUBJECT THAT HAS ABSOLUTELY NO CONTROVERSY SOARVETTED WITH IT AND THAT'S-- ASSOCIATED WITH THAT AND THAT'S SCREENING.

>> WE COULD DO THE WHOLE SHOW ON SCREENING.

>> OKAY, SO LET'S GO THROUGH A COUPLE THINGS FIRST.

TELL ME ABOUT WHERE ARE WE WITH-- THEN I WANT YOU TO TELL ME THE RECOMMENDATION.

BREAST SELF EXAMINATION USED TO BE PUSHED FOR EVERYBODY TO DO THAT.

WHERE ARE WE?

>> I THINK MANY OF THE VIEWERS, THE WOMEN IN PARTICULAR, WILL REMEMBER GOING TO STATE FAIRS GOING TO DOCTORS OFFICES, THERE WOULD BE THOSE LITTLE THINGS YOU COULD HOOK UP ON YOUR SHOWER THAT WOULD SHOW YOU HOW TO DO THE BREAST EXAM AND IF YOU NOTICE YOU DON'T SEE THOSE ANYMORE.

>> RIGHT.

>> AND THERE WAS ACTUALLY A CLINICAL TRIAL DONE, I BELIEVE IT WAS IN EUROPE.

AND THE WOMEN WERE SPLIT INTO GROUPS HER THEY GOT A LITTLE BOOKLET HOW TO EXAMINE THEIR BREASTS AND THE OTHERS HAD TO GO TO TWO MULTIPLE HOUR SESSIONS TO BE TAUGHT WITH MODELINGS THAT HAD BREAST MASSES IN IT AND THE END POINT OF THE STUDY WOULD HAVE BEEN, IF IT ACTUALLY WORKED, THAT EXTRA TEACHING THERE SHOULD BE EARLIER STAGE BREAST CANCER IF THEY DEVELOP BRANCHESSER BECAUSE THEY'VE FOUND IT EARLY.

THE STUDY WAS A BUST.

AND I THINK THE WAY I INTERPRET IT AND ALL OF US INTERPRETED IT, YOU DON'T NEED TO DO SOMETHING FORMAL BUT GOOD BODY AWARENESS.

ALL OF US WHEN WE ARE WASHING OURSELVES, CHANGING CLOTHES, IF YOU SEE OR FEEL SOMETHING, JUST IN YOUR NORMAL CARE, MAYBE GIVE IT A WEEK OR TWO BUT IF IT IS NOT GETTING BETTER, YOU NEED TO SEE SOMEBODY.

THAT'S THE WAY TO INTERPRET IT.

>> NOT SO MUCH-- MAMMOGRAPHY, WHERE ARE WE NOW?

>> THAT'S THE MORE CONTROVERSIAL ONE.

THAT COULD GO ON FOR HOURS AND HOURS.

THE MAIN CONTROVERSY HAS BEEN DO WE START AT 40 OR 50?

I THINK A LOT OF THAT IS CONFUSION TO PATIENTS.

UNEQUIVOCALLY WORLDWIDE CONSENSUS THERE IS A BENEFIT OVER AGE 50.

PROBABLY STOPPING AT AGE 70 TO 75 UNLESS THERE IS A FAMILY HISTORY OR PRIOR HISTORY OF CANCER.

>> SUMMING IF NOTHING IS EVER FOUND.

>> SO THE CONTROVERSY IN THE 40-YEAR-OLDS IS THE MAMMOGRAPHY IS MUCH MORE DIFFICULT TO INTERPRET BECAUSE THE BREAST TISSUE IN YOUNGER WOMEN IS THICKER, MORE DENSE, DIFFICULT TO DETERMINE WHAT IS POSITIVE AND WHAT IS NEGATIVE.

I MENTION THE LOW RISK BETWEEN YOUR 40th AND 50th BIRTHDAY OF GETTING BREAST CANCER IS 1.5%.

IF YOU DO A MAMMOGRAM ON EVERY 40-YEAR-OLD FOR 10 CONSECUTIVE YEARS UNTIL THEIR 50th BIRTHDAY, MOST OF THE WOMEN WILL HAVE ONE, POSSIBLY MORE CALL BACKS OR BIOPSIES AND THERE IS STRESS WITH THAT.

THAT'S NOT HAVING TO WAIT TO COME BACK TWO WEEKS TO GET THE SECOND STUDY DONE AND THEN THREE WEEKS AFTER THAT FOR A BIOPSY.

AND THEN TWO WEEKS FOR THAT TO COME BACK.

THAT'S A DOWNSIDE.

AND WHAT ISN'T CLEAR IN THE DATA IS HOUSING VOUCHER LONG-TERM BENEFIT WE GET TO THAT.

THE IMPACT ON GETTING EARLIER STAGE BREAST CANCER AND THE DATA IS MIXED.

IN OUR FRIENDS OVERSEAS IN EUROPE, AND THEIR SOCIALIZED MEDICAL SYSTEMS, THEY WON'T PAY FOR ANYTHING OVER 50.

BUT I THINK WHEN WOMEN GET BETWEEN 40 AND 50, IF YOU HAVE A FAMILY HISTORY, ABSOLUTELY.

CAN YOU WAIT UNTIL 50 WITH NO FAMILY HISTORY AND TRY TO FOCUS ON THE DIET AND LIFESTYLE ISSUES?

THAT'S A REASONABLE DECISION AND SOMETHING THEY WILL ALWAYS SAY BEFORE YOU READ ABOUT IT THAT THE DOCTOR SHOULD TALK ABOUT IT WITH THE PATIENT.

THE POOR PRIMARY CARE PHYSICIAN AND GYNECOLOGIST HAVE LONG AND BUSY DAYS TO GO OVER THAT IN FINE DETAIL BUT I THINK THAT'S THE MORE WAY TO PUT IT.

>> WHAT ABOUT DOING ULTRASOUND?

>> WELL, THE THING WITH ULTRASOUND, JUST RECENTLY THEY HAVE TECHNOLOGY NOT READILY VEILABLE AND MAYBE NOT NECESSARY THAT CAN BE DO A WHOLE BODY ULTRASOUND.

OTHERWISE IT'S SOMEONE WHO HAS TOLD ME SIMILAR TO USING YOUR SCISSORS AND TRYING TO CUT YOUR FRONT LAWN.

THERE ISN'T ONE THAT CAN DO THE WHOLE BREAST.

IT'S JUST GOING...

IT'S USED WHEN THEY FIND SOMETHING ABNORMAL IN A MAMMOGRAM.

IMMEDIATELY LOOK AT THE AREA WITH ULTRASOUND BECAUSE YOU KNOW EXACTLY WHERE IT IS.

AND THEN IF IT'S ABNORMAL, DETERMINE THAT'S A CYST THAT KONK TAINS FLUID, CERTAINLY NOT CANCER OR THAT ONE REALLY NEEDS TO BE BISHOPED, LET'S-- BOINSED MENT LET'S SCHEDULE IT TODAY OR TOMORROW.

>> MRI IS SOMETHING THAT HAS GAININGED VALUE I WOULD IMAGINE.

>> YES.

>> AND JUST LIKE THE THREE DIMENSIONAL MAMMOGRAM, WHICH WE HAVE EVERYWHERE IN THE STATE AT MOST OF THE CENTERS RIGHT NOW, MORE SENSITIVE AT PICK THINGS UP BUT LIKE MRI, ALSO HAS HIGHER PROBLEMS WITH FALSE POSITIVES.

>> I SEE.

>> AND MRI SCANS, THERE IS A NEW TECHNOLOGY THAT IS GOING TO BE SHORTER, QUICKER AND EASIER BUT STANDARD ONE RIGHT NOW, IT'S KIND OF BURDENSOME.

VERY UNCOMFORTABLE, YOU LAY ON YOUR STOMACH AND YOUR BREAST HANGS BELOW THE MACHINE.

HAS AN INJECTION THAT GOES WITH IT.

AND CERTAINLY IN THE PATIENTS THAT ARE THE GENETIC CARRIERS IF YOU ARE A FAMILY MEMBER THAT IS A FAMILY CARRIER, THE PATIENTS THAT HAVE VERY DENSE BREASTS WHERE THE RADIOLOGIST SAYS I CAN'T INTERPRET THIS BREAST IN THIS COMPLICATED PATIENT, THAT'S WHERE IT FITS.

>> GOTCHA.

SO THE RECOMMENDATION THEN IS STARTING AT AGE 50 FOR THE AVERAGE RISK INDIVIDUAL HAVING THE MAMMOGRAM.

>> YES.

AND IF A WOMAN CHOOSES, WE STILL , INSURANCE WILL PAY FOR IT.

I THINK THE PRECAUTION IS THE FALSE POSITIVE PROBLEM.

THE VERY LOW RISK, AND IF YOU SPREAD 1.2% OVER 10 YEARS OF GETTING BREAST CANCER BETWEEN YOUR 40th AND 50th BIRTHDAY, EACH YEAR IT'S ONE IN A THOUSAND OR MORE.

AS OPPOSED... EVERY INCREMENTAL 10 YEAR IT'S GOING UP AND THE IMAGING IS EASIER TO FIND AND WORKS BETTER.

>> SO IT'S A WIN-WIN.

>> SO WOVE' GONE A LONG WAY IN TERMS OF SURGICAL TREATMENT TAKING OFF THE ENTIRE CHEST WALL, TO TAKING OFF THE MUSCLE IN THE BREAST, TO EVEN NOW JUST DOING A LUMPECTOMY.

SO THINGS HAVE CHANGED SURGICALLY WISE.

TELL ME WHAT IS NEW WITH CHEMOTHERAPY AND HOW THAT IS IMPACTING WHAT IS DONE NOW?

>> GEE, IT'S JUST HARD TO KNOW WHERE TO START.

THE MOST COMMON BREAST CANCER IS BREAST CANCER THAT IS HORMONE DRIVEN.

HORMONE RECEPTOR POSITIVE ESTROGEN AND PROJEST RIN POSITIVE.

THE SAME RECEPTORS ON THE MILK DUCT CELLS AND WE HAD WELL DONE METICULOUSLY MULTI-THOUSAND PATIENT CLINICAL TRIAL IN THE EARLY STAGE PATIENTS THAT ALL OF THEM NEEDED AN ANTIESTROGEN PILL AND CHEMOTHERAPY AND THE PRACTICAL PROBLEM WE HAD WITH THAT IS THE BENEFIT OF THE CHEMOTHERAPY WAS ONLY IN FIVE OR 6% OF THE PATIENTS SO WE WOULD HAVE TO GIVE CHEMOTHERAPY TO 100 WOMEN TO GET BENEFIT IN THREE OR FOUR OF THEM AND I HAVE NO IDEA WHO THEY WERE.

AND WE NOW HAVE THESE GENE OPENNIC STUDIES-- GENOMIC STUDIES THAT WE CAN SEND THE TUMOR SPECIMEN OFF AFTER SURGERY AND THEY VERY ACCURATELY TELL US WHO THAT SMALL PERCENTAGE THAT NEED CHEMOTHERAPY.

AND IN MY CAREER IN BREAST CANCER, WHAT A BREAKTHROUGH.

HUNDREDS AND THOUSANDS OF WOMEN THAT DON'T NEED CHEMOTHERAPY NOW BECAUSE WE HAVE BEEN ABLE TO DETERMINE THAT.

AND IN EACH STEP OF TREATMENT, THAT'S WHAT WE ARE LOOKING FOR.

AND THE CEERP THAT WE GIVE RIGHT NOW THE CHEMOTHERAPY WE GIVE RIGHT NOW, THE MOST COMMON REGIMENS IS A FOUR DRUG, FOUR DOSES, ONE DOSE EVERY THREE WEEKS, NOT A NAUSEA VOMITING INDUCING DRUG.

I HAVE WOMEN THAT WORK FULL TIME , SOMETIMES COME IN ON FRIDAY AFTERNOON FOR THAT.

NOW SOME OF THEM, THE LESS COMMON SO CALLED TRIPLE NEGATIVE BREAST CANCER POSITIVE, A LITTLE BIT DIFFERENT BUT THE MOST COMMON REGIMEN, IF WE NEED IT AND IN MANY CASES I CAN SORT THROUGH THIS AND FIGURE OUT THAT THEY DON'T NEED IT, SO THAT'S ALSO BEEN A BIG BREAKTHROUGH.

BUT THE OTHER CHEMOTHERAPY REGIMENS WE USE ARE MUCH DIFFERENT ALSO.

ONE OF THE COMMON DRUGS WE HAVE HAD THAT IS STILL VERY IMPORTANT IN THESE MUCH HIGHER RISK PATIENTS IS A DRUG PREVIOUSLY KNOWN.

AND IT WAS A DRUG THAT BACK EARLY IN MY CAREER, WHEN OUR ANTINAUSEA MAINTAINEDS WERE NOT GOOD, IT WAS TCIALG.

AND WE HAVE INCREMENTALLY OVER THE LAST 10 TO 15 YEARS ARE A LITTLE BIT BETTER BUT STILL NOT GREAT.

WE INTERESTING THINGS THAT COME UP IN OUR RESEARCH, THEY DISCOVERED AN ANTIPSYCHOTIC DRUG THAT HAS BEEN AROUND SINCE THE 90s, IF YOU GAVE THAT, VERSE THE STUDY GIVING THE OLD ANTI-MEDICS ESSENTIALLY NO NAUSEA AND VOMITING AND WITH JUST TAKING IT FOUR DAYS AFTER EACH TREATMENT, SO IT HAS TURNED EVEN THE MORE DIFFICULT CHEMOTHERAPY INTO MUCH MORE TOLERABLE, JUST WITH LITTLE SUBTLE THINGS.

WE HAVE MAREIK INTERVENTIONS BUT THE SUGGEST SUBTLE THINGS ARE EXCITING AND I USUALLY HAVE TO EXPLAIN MY WAY THROUGH THAT.

PATIENTS ARE ASKING ABOUT THE NAUSEA AND VOMITING BECAUSE THEY KNEW SOMEBODY WHO THEY GREW UP WITH, THEIR NEIGHBOR, SOMEBODY THEY WENT TO CHURCH WITH, AND THAT DOESN'T HAPPEN ANYMORE.

WE TRY TO AVOID CHEMOTHERAPY IF WE CAN.

>> TELL ME ABOUT THIS ANTIBODY DRUG CONJUGANTS.

>> EARLY IN MY MEDICAL ONCOLOGY CAREER AND WE EVEN IN THAT PERIOD OF TIME, WE WERE CURING LYMPHOMA AND LUKE LIEU QEEMIA-- LEUKEMIA.

WE GIVE THIS DRUG COMBINATION, WE MAKE THESE PATIENTS VERY, VERY SICK.

OFTEN WITH THE POTENTIAL FOR TOXICITY TO MAJOR ORGANS.

IF I DAY COULD EVER COME, WHY CAN'T WE FIGURE OUT A WAY TO DELIVER THE CANCER DRUG TO THE CANCER RATHER THAN CIRCULATING IT TO THE BODY.

SO THROUGH THE ABSOLUTE YOU KNOW, MIRACLES OF RESEARCH, AND THIS IS A HOT ITEM IN THE WHOLE WORLD OF ONCOLOGY VERY IMPORTANT IN BREAST CANCER, IS YOU CAN GET A MONOCLONAL ANTIBODY LIKE WE AFTER WE GET AN INFECTION, EVERYBODY GETS A COLD IN THE FAMILY BUT YOU DON'T BECAUSE HAVE YOU THE ANTIBODY OR YOU WHY GIVEN AN FLU OR COVID VACCINE, AND THEY HAVE BEEN ABLE TO HOOK CANCER TREATMENT DRUGS INTO THE MONOCLONAL ANTIBODY, SEARCHING THE BODY LOOKING FOR THE TARGET, A CHARACTERISTIC THE CANCER HAS HAT IT CAN ATTACH TO, IT INTERNALIZES THE DRUG AND JUST TREATS THE CANCER ALMOST EXCLUSIVELY.

IT ALLOWS US TO USE DRUGS THAT WERE VERY GOOD IN THE LABORATORY IN BREAST CANCER BUT WE WEREN'T ABLE TO GIVE IT TO THE PATIENT BECAUSE THE DOSE NEEDED TO GET INTO THE BODY WAS FATAL.

BUT WE CAN DELIVER IT RIGHT NOW TO THE CANCER.

AND THIS IS A HOT ITEM GOING FORWARD AT ALL OF CANCER.

BUT SORT OF LIKE A DREAM COME TRUE.

THE OLD TROJAN HORSE STORY IS THE WAY IT FITS.

>> SO YOU ACTUALLY HAVE THE CHEMOTHERAPY ATTACHED TO THE ANTIBODY THAT WILL FIND THE CANCER CELL BECAUSE THEY'RE SO MUCH DIFFERENT.

>> PRIMARILY.

>> DIFFERENT FROM NORMAL CELLS AND THIS THE ANTIBODY WILL PICK UP THAT DIFFERENCE.

>> AND THEY'RE CUSTOMIZED TO THE INDIVIDUALIZED.

>> GO AHEAD.

SO, YOU KNOW, THE HUGE TECHNOLOGY HERE IS TO PUT IT, WHO MAKES AND HAS RESEARCHED AND PUT THE LINK TOGETHER.

YOU HAVE TO HAVE A CANCER DRUG THAT THAT IS POTENTIALLY VERY DANGEROUS ATTACHED MICROSCOPICALLY TO AN ANTIBODY, IT HAS TO BE ABLE TO CIRCULATE THROUGH THE BODY WITHOUT BREAKING OFF OR IT WOULD CAUSE OTHER PROBLEM AND ONLY WHEN IT GETS TO THE CANCER CELLS TAKEN IN BY THE CANCER CELL, THEN IT KILLS THE CANCER CELL REALLY GOING TO BE THE FUTURE FOR SOLID TUMORS.

>> CAN YOU ATTACH RAICT MATERIALS TO THAT.

>> THAT WOULD BE SOMETHING IN THE FUTURE.

>> YOU USED TRIPLE NEGATIVE.

WE HEAR THIS THROWN AROUND.

WHAT IS THAT?

THE TRIPLING-- IS ESTROGEN AND PROJEST RIN.

THEY'RE NOT DRIVEN BY ESTROGEN, THEY DON'T HAVE A UNIQUE PROTEIN ON THEIR SURFACE.

IT IS ABOUT 10 OR 15% OF BREAST CANCER PATIENTS RIGHT NOW.

THE MOST DANGEROUS THING, EARLY STAGE TRIPLE STAGE NEGATIVE BREAST CANCER PROPER USE OF RADIATION AND THE DRUGS WE HAVE INCLUDING WHAT ARE COMING IN ARE THESE ANTIBODY DRUG CONJUG ANTS RIGHT NOW.

EEK USE SURGERY FOR THE NOTORIOUS PREVIOUSLY NOTORIOUS BREAST CANCER.

ABOUT HALF OF THE PATIENTS AT THE TIME OF THE SURGERY, THEY CAN'T FIND ANY TUMOR.

IF IT WAS IN THE LYMPH NODES IT'S GONE.

THAT'S HOW EFFECTIVE THEY ARE.

SO WE ARE MAKING STRIDES.

>> WE HAVE ABOUT A MINUTE TO GO WHAT ARE THE THREE BIG THINGS WE MISUNDERSTAND ABOUT BREAST CANCER THAT WE SHOULD GET RIGHT ONE THING IS ONE THING WE MIRS UNDERSTAND IN TERMS OF THOSE MEDICAL ONCOLOGY WORLD THAT IT IS TREATABLE AND THE VAST MAJORITY OF PATIENTS ARE CURED.

AND GOING, IF IT'S TERRIBLE OF COURSE, IT'S GOING TO DISRUPT TIME WITH YOUR FAMILY, MAYBE DISRUPT WORK FOR SOME TREATMENTS BUT OVERALL, WE DO VERY WELL WITH IT OTHER MISUNDERSTANDINGS IS WE NEED TO FIND SOMETHING BETTER FOR IMAGING.

NOWHERE IN THE WORLD IN MEDICINE DO WE HAVE SOMETHING LIKE WE HAVE WITH MAMMOGRAPHY WHERE SO MANY FALSE POSITIVE.

THEY LOOK LIKE NORMAL TISCH TISSUE BECAUSE THEY BROUGHT IT TO DRI DOCTOR AND THE DOCTOR THINK WE NEED TO BIOPSY THAT SOMEWHERE.

IT'S SOMETHING MISUNDERSTOOD THAT MAMMOGRAPHY IS PERFECT.

>> SHORT ANSWER, WHAT IS THE THIRD THING.

>> THE THIRD THING IS THIS TARGETED TREATMENT TO INDIVIDUAL CHARACTERISTICS.

>> THAT IS THE MOST FASCINATING THING.

>> VERY, VERY EXCITING.

>> JEFF, I WANT TO THANK YOU FOR BEING WITH US.

WONDERFUL TO BE HERE.

>> WONDERFUL.

YOU GAVE US SOME GREAT INFORMATION.

I WANT TO THANK EVERYONE ELSE WHO WAS WATCHING.

THANK YOU FOR BEING WITH US BECAUSE WHILE WE HAVE MANY ANSWERS REGARDING BREAST CANCER, THERE IS STILL MUCH TO KNOW, HOWEVER, THERE HAS BEEN GREAT PROGRESS IN THE TREATMENT OF BREAST CANCER AND IMPROVEMENTS IN THE QUANTITY AND QUALITY OF LIFE FOR THE BREAST CANCER PATIENT.

IT IS IMPORTANT TO GET AN EARLY DIAGNOSIS AND GET TREATMENT THAT IS SPECIFIC FOR THE TYPE OF CANCER THAT YOU HAVE.

I THINK THAT WE HAVE SEEN THE BENEFITS OF THAT.

IF YOU WISH TO WATCH THIS SHOW AGAIN OR ARCHIVED VERSION OF PAST SHOWS, GO TO KET.ORG/HEALTH.

IF YOU HAVE A QUESTION OR COMMENT, PLEASE GIVE IS A CALL OR REACH US AT KYHEALTH AT ket.org.

IF YOU HAVE A QUESTION ABOUT BREAST CANCER, TALK TO YOUR PRIMARY HEALTH PROVIDER.

JEFF, THANK YOU.

>> YOU ARE WELCOME.