Hope in Diagnosis: Navigating Breast Cancer with Dr. Susan Schaffer Whiteman

According to the American Cancer Society, 1 in 8 women in the U.S. will be diagnosed with breast cancer in their lifetime. It is one of the most impactful and prevalent health challenges facing women today, highlighting the need for quality screening, diagnosis, and treatment.

On this episode of For the Love of Health, we're speaking with Dr. Susan Schaffer Whiteman, medical oncologist at ChristianaCare's Helen F. Graham Cancer Center & Research Institute. Dr. Schaffer Whiteman shares her expertise on how to catch breast cancer early, what the different breast cancer diagnoses actually mean, and how complementary therapies such as acupuncture and proper nutrition can ease treatment side effects. We also discuss the power of comprehensive cancer centers.

If this conversation helps you or someone you love feel more prepared and less alone, share it and subscribe for the next episode.

Susan Whelen Schaffer Whiteman, D.O., is a board-certified Medical Oncologist, Hematologist at ChristianaCare’s Helen F. Graham Cancer Center, specializing in breast and neurological cancers. She earned her medical degree from the Philadelphia College of Osteopathic Medicine and completed her training in Delaware, Virginia, and Arizona. Dr. Whiteman has held roles as an attending physician and medical director.

Links

• ChristianaCare Helen F. Graham Cancer Center & Research Institute
• ChristianaCare Breast Cancer Screening
• Breast Cancer Care at the Tatiana Copeland Breast Center
• American Cancer Society: Breast Cancer Facts & Figures

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Transcript

Why Symptoms Still Matter

SPEAKER_02 0:02

Anything that doesn't seem right to you, go get it evaluated.

SPEAKER_00 0:10

You're listening to For the Love of Health, a podcast about delivering care and creating health, brought to you by Christiana Care. Hello everyone, I'm Jason Tekarski.

SPEAKER_01 0:20

And I'm Megan McGurman. Welcome to For the Love of Health, brought to you by Christiana Care.

Prevalence And First Steps To Diagnosis

SPEAKER_00 0:25

According to the American Cancer Society, one in eight women in the U.S. will be diagnosed with breast cancer in their lifetime. It's one of the most impactful and prevalent health challenges facing women today.

What To Look For Beyond Mammograms

SPEAKER_01 0:35

To talk more about breast cancer diagnosis and screening, we've brought in Dr. Susan Schaefer-Weiteman, oncologist at Christiana Care's Helen F. Graham Cancer Center and Research Institute. Susan, thank you so much for being here today. Thank you for having me. We mentioned in the intro, one in eight women in the United States will be diagnosed with breast cancer in their lifetime. Talk to us about diagnosis before we dive into treatment. What is that diagnosis process like? And what should women who hear that statistic be on the lookout for in terms of symptoms that would bring them into an office like yours?

When A Negative Mammogram Misses Cancer

SPEAKER_02 1:11

Um, women are diagnosed with breast cancer by having a screening mammogram that is abnormal. Sometimes they feel a mass, sometimes they don't. Women are also diagnosed with breast cancer through self-exam, which means they are doing an exam and they are finding an abnormality of their own. And what could that be? That could be a mass that they feel. It could be breast asymmetry. One side is swollen, one side is not. It could be a dimpling or an asymmetry, or it could be redness, it could be a rash, it could be a mass that is under the arm. Often we tell women anything that doesn't seem right to you, go get it evaluated. There is also a situation where someone can have a mammogram and it can be normal when they have a mass on exam. So it is very important if a woman feels a mass, even if her mammogram is negative, mammograms can miss about 20% of breast cancers. It is very important to go get that evaluated.

When To Start Mammograms

SPEAKER_01 2:32

You mentioned the importance of finding those masses, doing those self-checks. Remind everyone what age should we be getting mammograms?

Understanding Breast Cancer Subtypes

SPEAKER_02 2:41

40 is the average age. Um, it does depend on someone's family history and specifics about an individual, but yes, in general, 40.

SPEAKER_00 2:51

Breast cancer isn't just one disease. There are many different varieties of it. One we hear a lot about, maybe people don't understand the difference is triple negative, for example. So can you give us some ideas of what these different terms are, the different varieties of breast cancer there are?

The New HER2-Low Category

SPEAKER_02 3:08

Yeah, absolutely. So the types of breast cancer are based on pathology, and there are markers on the breast cancer cells. Three in specific. There are estrogen markers, progesterone markers, and HER2 markers. Based on these markers, we categorize the breast cancer. And the most common type of breast cancer is estrogen positive, HER2 negative, about 70%. And that type of breast cancer generally has the best prognosis. Triple negative, as you said, is another type of breast cancer. It is estrogen negative, progesterone negative, and HER2 negative. So one, two, three markers, triple negative. That type of breast cancer can often affect younger women. It can often be more aggressive and it can often spread more quickly. The third type of breast cancer is a category called HER2, and you can have HER2 positive breast cancer, and you can have estrogen positive, estrogen negative, and HER2-positive breast cancer. One of our newest subtypes, if you will, is a category called HER2 Low type breast cancer. So you can have a three plus kind of standard HER2-positive breast cancer. And then on pathology, you can have markers that are a one plus or a two plus. And that is kind of a new category of breast cancer called HER2Low. Identifying that helps us with treatment options.

Research Drives Evolving Classifications

SPEAKER_01 4:56

How do you find a new type of breast cancer? How does that come to be?

SPEAKER_02 5:01

Through research, through pathology analysis and research, and sometimes translational research, sometimes basic research. Yeah.

SPEAKER_01 5:13

So as the types evolve and as research advances, I would assume treatment also advances. How would you describe that change over the last decade or so?

Genomic Testing And Chemo Decisions

What Personalization Really Looks Like

SPEAKER_02 5:23

I have been around long enough to see a few decades. So absolutely breast cancer treatment options have changed over the years. And I would say for the better. You got chemo or you didn't. And now breast cancer treatment is very personalized and very targeted. And we do specific analysis with genomic testing and things like that to figure out if a patient has a low-risk cancer or a high risk cancer. And based on that information, we determine the need for chemotherapy. And it's a very good thing because if you have a low-risk cancer and you don't need chemotherapy, that's a great thing to know.

SPEAKER_01 6:24

You mentioned it's very personalized. How does that work and why is that so important for someone going through treatment?

SPEAKER_02 6:32

Personalized means that we use a lot of information and data to make a decision about a patient's treatment. It takes into account an individual's characteristics, their age, their health, their actual personal preferences for treatment. And then it pairs that with our pathology or our biologic data, the estergen and progesterone and HERTINU. And when we have all that data, we personalize it to create a treatment plan that is very specific for an individual and not just a common pathway, but a personal plan.

SPEAKER_00 7:26

Acupuncture, nutrition management. How has that developed over time?

Acupuncture, Nutrition, And Side Effects

SPEAKER_02 7:31

Yeah, one of my favorite topics. I do like how the field has advanced over time with the availability of complementary medicine. So complementary medicine is, you know, practices and treatments that go along with standard of care. So a patient will have chemo, and then they will have the option of an offering such as massage or yoga or acupuncture, quite often used. They can choose to use these things to help with side effects of treatment. So example, acupuncture, we use often in women who have nausea. It can help with that. It can also help with neuropathy. And there are many times when I'm with a patient and I'm like, well, I can give you a drug for neuropathy to help with that side effect, or we can try acupuncture and see if that helps to alleviate that symptom. So complimentary therapies can help with side effects of treatment, anxiety, stress, a lot of things. And it gives patients alternatives to medicines for medicine.

SPEAKER_01 8:53

In the 20 plus years that you've been working with breast cancer, have you seen these patients evolve as well? You know, when you first started and it was kind of chemo or nothing, and now it's all these potential treatments as well as acupuncture. Are you seeing just the quality of life improve in these patients?

Empowerment Through Food Choices

Why Care At Helen F. Graham

SPEAKER_02 9:11

Yes. And I think understanding of availability of complementary therapies is also much greater than it used to be. When I first started training in regular med school, sadly, you don't get much training in complementary therapies and very little in nutrition. And now there are integrative medicine programs. I did an integrative medicine fellowship um about four or five years ago. And I did it because women were asking me to help them with supplements and you know, what kinds of therapies can I do? And I had to go back and take training to learn more about how to help them with these therapies. And it was actually really great. And nutrition is one that we get asked a lot about what can I eat? What shouldn't I eat? You know, there's no one answer for everyone because people are different and they have different food preferences, but we often will say things like, How about a plant-based whole food diet? Or how about food as medicine rather than a whole handful of supplements? And I think that it helps patients to realize that they have some control over things in their cancer treatment when they're like, okay, I'm going to eat fruits and vegetables every day, and I'm going to have control over how I'm going to be healthier by the diet that I have. And that empowers them.

SPEAKER_00 10:50

The treatments that we've been discussing thus far are all available here at Christiana Care through the Helen F. Graham Cancer Center and Research Institute. How does Christiana Care's treatments and offerings compare to other cancer centers?

Research, Genetics, And Navigation

Mental Health Support In Cancer Care

SPEAKER_02 11:05

I would absolutely say ahead of the game. The Helen F. Graham Center is, you know, a state-of-the-art facility, comprehensive cancer center. Patients absolutely would benefit going to Helen F. Graham. Why? I think there are many reasons actually. Intelligent, up-to-date, compassionate doctors would be top on the list. And then I would say research is highly supported, you know, at the cancer center, both translational research and clinical research. And research is so necessary in the cancer field. It is how we learn, it is how we grow, it is how we create new treatments. And so to be committed to research is makes a huge difference. We have geneticists who are fabulous and meet with patients and talk about their family history and their genes and their testing and allow them to be a part of understanding what it means for them, not just someone doing a genetic test, but why does this matter? It's very important. We have navigators. Lots of times patients have a new diagnosis and lots of tests and things that they have to do. And our navigators will absolutely hold their hand, direct them, help them get tests, help them get studied and set up. And that is a little bit of a relief, I think, to the patients when they have a someone helping them and tracking them and keeping up with other tests and stuff. One of the big ones, the mental health. I always tell patients, I mean, anxiety and depression is everywhere anyway. But when you have cancer, it's doubled. To have a department that focuses on the mental health of cancer patients is providing extra care and comfort and resources for patients that absolutely need it.

SPEAKER_01 13:14

There certainly may be someone who is listening to this who was just diagnosed or has a family member who was just diagnosed with breast cancer. What is your message to those who are looking for answers or looking for, you know, hope and healing?

Hope, Self-Care, And Self-Advocacy

SPEAKER_02 13:29

Medically, I would probably say find a center like we just talked about, but one with oncologists that are willing to listen and take the time to understand who you are and what you want out of therapy. Um, a cancer center that has research, has access to clinical trials. What advice would I give to someone emotionally? For women, I think it's very interesting. I would say, take care of yourself. Self-care is so important. And I find that so many of my women are like, I, you know, I've spent my whole life taking care of everybody else. And I'm like, yeah, that's done. It's time to take care of yourself. And I think that hits home a lot. And I will tell my women, you know, don't be afraid. Ask for what you want. Ask for what you need. Your doctor needs to listen to you, and that's important.

SPEAKER_01 14:29

Susan, thank you so much for your time.

SPEAKER_02 14:31

Thank you for having me.

SPEAKER_00 14:34

Check out the show notes for this episode for more information on cancer treatment and screening at the Christiana Care Helen F. Graham Cancer Center and Research Institute.

SPEAKER_01 14:41

And you can keep up with For the Love of Health on social media. Just search Christiana Care on your favorite social platform.

SPEAKER_00 14:47

We'll be back in two weeks with another great conversation.

SPEAKER_01 14:49

Until then, thanks for joining us for the love of health.