♪ >> Tonight, breast cancer awareness and the fight to end the disease, it is all about early detection and examining yourself.

Personal stories of struggle, survival, and trial and the mission to educate everyone on this deadly disease and to teach us the key to saving lives.

We hear from the cancer expert on the ongoing shortage of chemo drugs affecting the nation.

A MetroFocus special starts right now.

♪ >> This is "MetroFocus," with Rafael Pi Roman, Jack Ford, and Jenna Flanagan.

MetroFocus is made possible by Filomen M. D'Agostino Foundation.

Bernard and Denise Schwartz.

The Ambrose Monell Foundation.

Estate of Roland Karlen.

Jenna: One in 8 women will be diagnosed with cancer, the genetic causes have not been known until now.

Researchers from around the world have discovered 72 previously unknown gene mutations that lead to the development of breast cancer.

Their findings may identify a small portion of women who are at times increased risk of developing the deadly disease.

There is hope in combating the illness.

For women living with it, it is a daily fight for life.

Unless you are survivor, there are things about breast cancer you cannot know or understand.

Joe London was diagnosed in 2014 and has taken the forefront in the fight against cancer, she is cancer free and ready to tell her story of survival, welcome to the program.

Joan: It is my pleasure to be with you.

Jenna: Of course, we are huge fans and so many people have followed your story from when you got your diagnosis.

Take me back to that moment, went through your mind when you heard those words?

Joan: I have done so many interviews with breast cancer experts, 1 in 8 women will be diagnosed with breast cancer in their lifetime.

I do not think I would be the 1 in 8.

I did not have a family history.

I was nonchalant about it.

I do not think I ever adjusted the information from all of the different cancer experts like it was going to affect me.

I was pretty shocked when I heard those words.

I had a clean, 3D mammogram that day.

I walked across the hall and had an ultrasound and heard those words.

You have cancer.

From the outset, I felt this compelling need to go out and educate women and let them hear my story so that they knew that they need to find out if they have very dense breasts.

You cannot tell it by your feeling.

It is something you point out in a mammogram.

I have been out on the speaking trail for the last three years ever since I was diagnosed trying to help empower women with information.

That is how at home with Joan came about.

It is a closed community where people can come in and educate themselves and soak up the information.

I believe if we share our stories, other people are.

I interviewed a lot of people.

Those interviews live on the website.

As well as interviews with oncologists and oncology nurses.

Jenna: That seems like something that is crucial for patients to have, a place where they can go to learn all of the questions we need to be asking and all of the different kind of therapies they can get.

Why is this so important for people to be able to be their own advocate?

Joan: Research is being done as such an amazing right, answers are coming down the pipe, new treatments are being made available.

It means that if you get this diagnosis, you are helping someone who got this diagnosis, you can get a couple of opinions.

Educate yourself.

Learn more about your specific disease.

In breast cancer for women, it is very complex.

It is not just one disease.

It is different in every woman.

It makes it much more difficult to study breast cancer and come up with answers.

The good news is that if you catch it early enough, breast cancer, you have a 99% chance that you will survive it.

At is amazing news for women today -- that is amazing news will be in today.

Women are afraid of the answer.

You should be afraid of dying.

To me, knowledge empowers us.

Certainly, in the health field, knowledge really empowers us.

Jenna: You feel that the conversation around breast cancer is changing?

We have seen some prominent young women, and talk about getting tested for the breast cancer gene.

A lot of people being open on social media about their journeys through treatment.

Do you feel as though that is helping with people who are dealing with this?

Joan: Absolutely.

It used to be that nobody talked about this.

A used to be that Dr. sometimes would not even tell a woman that she had breast cancer.

They did not want her to do with the anxiety and there was nothing she could do about it anyway.

Women would live with this shame because it was something that was wrong with your breasts.

It affects your femininity.

Or sensibility of yourself.

Thank goodness the times have changed.

Today, it is OK to talk about it.

There is an incredible sense of community among breast cancer survivors.

I never used to totally get it, I saw these events with everybody wearing pink, but now I do.

Now I understand the strength and the compassion that is waiting there for you if it is your time to go down that path.

I am part of that.

You find yourself on the other a life-threatening disease as a survivor, I think it is an natural instinct to say let me survive, thanks!

I will put my hand and help the next person through.

Jenna: One of the most challenging things with any kind of cancer diagnosis is the daunting gauntlet of what comes next.

Treatments, where do you go?

Who do you get your opinions from?

Having a place where people can go and talk about that sounds so crucially important for the patient's on mental health!

Joan: I have been in people's living room for the past several decades!

Jenna: You are a familiar, friendly face!

Joan: That plays a part in this though, they consume information from me and a little bit of a different wave, woman to woman, friend to friend.

I was in your living room, with your family.

I think that is part of it.

I am passionate about this endeavor of mind to go out and educate.

Not just women, but anyone dealing with any cancer diagnosis.

The at home with Joan campaign pulls in storytelling.

That is what I have made my living doing.

Telling people stories.

It is very natural that they have me go out and interview people fighting cancer and surviving cancer from all over the United States.

We represent everybody.

Jenna: Listen, on behalf of women and even men, thank you for being that person to come forward and make sure that others know what to ask and how to ask and we can go for the information.

Joan: I hope everybody joins me at home with Joan and becomes a part of our community.

Jenna: Thank you!

♪ Jenna: October is breast Cancer awareness month and he is a protective statistic.

If breast cancer is caught early the five year survival rate is almost 100%.

One of the survivors is musician Sheryl Crow, with no family history or significant risk factors, she was diagnosed at just 44 years old.

She joins us now from Nashville along with OB/GYN and immense health expert Dr. Jessica Sheppard.

Welcome to you both.

I want to start with you, and ask given that you had no traditional red flags in regards to breast cancer, what was that like when you first got the diagnosis confirmed?

Sheryl: I was in shock.

I think for someone who is very healthy and who takes care of themselves and has no family history, was diligent about getting mammography exams.

It was a very eye-opening experience.

Everything normal came to a screeching halt.

I am 13 years out.

I have enjoyed the dubious honor of being the poster child of early detection.

I celebrate that and embrace that.

My story is the story of your cure.

Until there is a cure, early detection is our greatest weapon.

I like to utilize my profile to talk to women who follow me who have been fans for years.

They are mothers and daughters and grandmothers and will encourage them to advocate for their own health and be diligent at the age of 40 of getting their yearly mammogram.

Jenna: I want to turn to you and ask because there is also a troubling statistic that goes along with breast cancer awareness and that is that women of color are more likely to die from the disease.

Why is that?

Jessica: There are multiple reasons why that can happen.

I'm glad that up.

For African-American women, when you look at the statistic for breast cancer, or Caucasian women are diagnosed, when you look at triple negative cancer, more Black women are diagnosed which is harder to treat, but what goes into that is that when we look at the statistics for African-American women, they are diagnosed later on and so, Cheryl was alluding to early detected.

-- action.

That should transcend into the African-American community, that should transcend into the African-American community.

Hope that mission -- message resonates for everybody who is listening.

Jenna: So many women are taught to do self-breast exams in the shower.

This is making sure you get the mammogram.

Where are the first steps specifically for women who perhaps do not have the financial resources to have that specialty Dr. or to be able to go?

What are the first steps they should be taking?

Jessica: When we look at Medicaid or Medicare, annual woman visits starting at the age of 40 and mammogram falls into that is cancer screening category and should be covered by those types of insurances.

For women who do not have insurance coverage, there are organizations who devote their resources to get mammograms to women who do not have access to that.

Whether that be through hospital proximity or an insurance issue.

I feel that we have a long way to go, but we do have resources for women who do not have access to care or do not have insurance.

Jenna: Want to turn back to Sheryl Crow and ask you spoke a little bit earlier about having, -- leading a healthy life.

Are there any additional steps you are taking to keep yourself cancer free?

Sheryl: when you put into your body is tantamount.

To eat healthy, it is important to exercise, the body functions at a higher level if we are exercising at least 30 minutes a day.

One of the things that was interesting about my diagnosis is that 13 years ago we did not have the technology advancements we have now.

I was basically relegated to the technology.

I was told to come back in six months.

Rather than waiting my doctor said let us not wait.

Something happened in six months if it is something.

One of the great things that we are able to enjoy is the 3D technology where we are able to see indents, the difference between density and something that might turn out to be cancer.

We are encouraging women to not only be diligent about getting a mammogram but ask your doctor or go to a 3D near me online and look at the website and find out where the closest genius 3D exam is.

We are seeing far less false positives and a better rate of early detection with 3D and 2D.

-- than 2d.

Jenna: I want to ask more quick question, if you had a girlfriend who had a positive test, what would you tell her?

Jessica: I applaud her forgetting the testing that she needs and we can move forward and find treatment for her.

Sheryl: your entire community is diagnosed.

Those people who love you, your friends, children, your parents, your significant other.

To try to just keep things as normal as possible while your going through treatment.

Put yourself first.

Give voice to what is that you need or do not need.

To just keep your eyes open and see how at the end of it how your life is enhanced.

Do not miss the big lessons.

Jenna: Wise words.

Thank you for joining us!

For more information on the genius exam and where you can find one that our website at MetroFocus -- at our website at MetroFocus.org.

>> Drug shortages have made chemotherapy difficult to get.

Chemotherapy is in short supply and that is leaving hospitals and doctors with difficult decisions on how to treat patients including the possibility of delaying treatment and rationing doses in some cases.

In New York, these types of shortages are taking a toll on patients and physicians.

We look at what is behind the shortages and what be done to correct the problem.

We turn to a professor of gynecology and obstetrics at John Hopkins Hospital and President-elect of the society of gynecologic oncology.

Welcome, and thank you for joining us.

Amanda: he went for having me.

>> Will get two more specifics.

To set the stage for the conversation, give us a sense of how widespread these footages are?

>> To put things into perspective, the issue of drug shortages in the U.S. is a chronic problem that has existed for more than a decade.

Specifically, prescription, generic injectable drug shortages.

However, what we know that they can occur for a variety of reasons, manufacturing, or labor issues or inability to secure raw materials, what is problematic that is happening in the current era is we are seeing an increase in the number of drugs that are undergoing shortage.

In my field of oncology, for lifesaving chemotherapy drugs, we are seeing that this class of agents is often in the top five of drugs that are in consistent shortage in the United States.

As of this week, the FDA and the American Society of Hospital pharmacists report that we have 15 indispensable chemotherapy drugs that are currently in shortage.

We know that based on national surveys that have been conducted from the Desir network that is an alliance of academic cancer centers across the U.S., this is a serious nationwide problem with our society in oncology survey with oncologists in more than 40 states and in Washington DC reported shortages of at least one or more of these drugs at their institutions.

National conference of cancer work survey suggests that for those institutions that responded, 93% reporting a shortage of at least one of these critical chemotherapy drugs.

>> For most people this sounds legally counterintuitive.

Most people, I suspect, would think if you are talking about lifesaving drugs, they will be our priority.

They would not be the ones we are excusing shortages of.

Why, why are these drugs who are so integral to saving lives, where we sing shortages of them?

Amanda: that is an excellent question and these are among the most important medicines that we use as oncologists to save and extend lives.

The drugs that are in shortage or actually used in more than 100 treatments, or children, I treat many cancers, leukemia, bladder, the list goes on and on.

It is a public health care crisis.

Would have the reasons for that is that the most -- one of the reasons for this is that generic formulations are manufactured often by very few companies.

There is a lot of market instability right now with the manufacturing of these drugs.

One of the reasons for that is that generic drugs do not bring in a lot of revenue for manufacturing companies and other facilities.

Is difficult for these organizations to invest in production of the drugs because they do not produce revenue.

The second is that there is a lot of market consolidation that is because of the poor revenue stream.

Very few companies, sometimes one or two companies produce the raw materials that are needed under the active ingredients in these drugs or what are two or three companies that are the primary manufacturers of these leading lifesaving generic chemotherapy drugs that we use to help treat patients every day.

Jack: I want to get into this question of what do we do about all of this?

Included raising awareness.

Let us talk about specifics.

We are talking about these dramatic shortages.

However doctors then responding -- how are doctors responding?

Amanda: this is devastating for oncologists because we live to help our patients live better, longer lives and not have access to the most important medicines we use to help patients is unacceptable.

It is even more devastating for patients.

This is high-stakes for them!

There is a number of strategies that we are using on the oncology side that I can talk about.

One of the initiatives I have been involved with in the society of gynecologic oncology and other societies including the foundation for women's cancer and others are working together to develop mitigation strategies.

Some of the things we are doing across the country at all oncology pharmacies is we are looking at opportunities to preserve the drug supply that we have and get more mileage out of it or more patients.

With using special pharmacy techniques that allow us to not waste a single drop of chemotherapy and use those drugs as responsibly as possible across the most patients possible.

Some of the things required include rounding the vials down to the nearest no size or using multiple files in the treatment of multiple patients.

If you have a few drops in a vile, you can use it to treat the next patient.

These are critical strategies that oncology and oncologists are using at this time.

We are also developing alternative drug guidelines.

We are using best available evidence from rigorous clinical trials in order to develop recommendations for oncologists so that if one or more of these drugs are not available, we are creating new drug guidelines that will enable our physicians and health care providers to take care of patients in the best way with other standard of care drugs.

In many cases, the alternative substitutions that are being recommended will be just as effective as the standard of care drugs that are in shortage but they have trade-offs.

They may have more toxicity or side effects they of the drug city -- than the drugs in shortage.

This is a temporary strategy.

Jack: You mentioned how precarious the situation is.

I was going to ask you what the consequences are for patients?

You talk about that right now.

Let us talk now about the consequences were physicians?

This is a personal question.

This is what you do.

This piece came about because of a conversation with my daughter, a doctor who has been on this program before who had recommended that I reach out for you and she is a gynecologist at Riverview Medical Center.

She was certainly deeply concerned about this.

I know you are too.

What are you suggesting to physicians?

Especially through the organizations?

What are you saying your members about how they handle this professionally and personally?

Amanda: to her for asking that question.

Our patients or our singular focus -- are our singular focus.

We are devastated.

We are also taking action.

We are creating better opportunities for patients that we could have ever imagined.

-- than we could have ever imagined.

Hosted webinars to help them with developing oncology policies at other institutions, putting them in contact with the foundations that might be able to help them get access to drugs.

Institutions do not have a drug available, we are also providing education and supportive services for our members through webinars.

How to have difficult conversations with patients.

How to support your own motives and having conversations that oncologists do have with the patient.

-- what to have with a patient.

We talk about what is going on and what is going on the ground with their institutions and how we can best support them in that.

The advocacy arm which is led by Gardner his working on the patient -- is working on the patient advocacy side.

How do we help them also get access to drugs?

Work with their oncologists to receive best care?

We also have an open survey that we submitted across advocates to understand their feelings and what their thoughts are.

So they can come to the table with us, the advocacy piece, the advocacy piece is with the FDA.

Directly with Capitol Hill legislators and drug manufacturers in group purchasing organizations.

We want to have a seat at this table to develop long-term solutions so that this never happens again.

This is not sustainable for this to keep happening.

Lives are going to be affected if we do not get a handle on this quickly.

Also, I just mitigate a short-term, public cap long-term solutions -- not just mitigate, but create long-term solutions.

>> MetroFocus is made possible by the Joan Ganz Cooney Fund Filomen M. D'Agostino Foundation Barbara Hope Zuckerberg, Jody and John Arnhold, Dr. Robert C. and Tina Sohn Foundation, The Ambrose Monell Foundation, Estate of Roland Karlen.