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.