Awareness Today, Hope for Tomorrow

On today’s episode, we revisit a previously recorded podcast featuring Dr. Hanna and other guests as they discuss the important topic of breast cancer awareness. Breast cancer is the most common cancer among American women, aside from skin cancer. Currently, the average lifetime risk of a woman in the United States developing breast cancer is about 13%, meaning there is a 1 in 8 chance she will develop the disease during her lifetime. Conversely, there is a 7 in 8 chance she will never develop breast cancer.

Breast cancer is also the second leading cause of cancer-related death among women, surpassed only by lung cancer. The likelihood of a woman dying from breast cancer is approximately 1 in 38, or about 2.6%. Encouragingly, breast cancer death rates among women declined by 40% between 1989 and 2016. Since 2007, death rates have remained stable for women younger than 50 while continuing to decrease among older women. These improvements are believed to result from earlier detection through screenings, increased public awareness, and advances in treatment options.

Transcript

SPEAKER_00 0:00

Hello, and thank you for listening to Soaring in Health and Wellness with Dr. Steve Wells. Dr. Wells is a chiropractic physician with a passion to help individuals reach new levels in health and wellness. He has been involved in the health and wellness field for over 30 years. Dr. Wells received his Bachelor of Science degree from Oral Roberts University in Tulsa, Oklahoma, with an emphasis in health and exercise science. He received his second Bachelor of Science degree in general sciences along with his Doctor of Chiropractic degree with honors from Palmer College of Chiropractic in Davenport, Iowa. Soaring in Health and Wellness is a tool to help educate individuals reach new levels in health and wellness and a passion to live with a sense of purpose and vitality. Dr. Wells and his guests, ranging from doctors from all areas of health care to educators, nurses, personal trainers, counselors, and pastors, will discuss and inform you on how to improve all dimensions of wellness from a biblical worldview perspective with one goal in mind: seeing you soar towards optimal health and wellness. If you're ready, let's get started with today's program with your host, Dr. Steve Wells.

SPEAKER_04 1:01

Welcome to another edition of Soaring in Health and Wellness. Today's guest are Dr. Stephen Hanna. Dr. Hannah is a medical doctor, family physician who has been practicing in Parksburg, West Virginia for over 30 years. We have Rennie Levitt, who has her Bachelor of Arts in Radiology Technology and is the director of cancer services. And we also have Renee Stevenson, who has her Bachelor of Science in Nursing, well as her master's degree in divinity. So welcome to the program. Thank you.

SPEAKER_02 1:29

Thanks for having us.

SPEAKER_04 1:30

All right. I tell you what, we're just going to start with Dr. Hannah. And Dr. Hannah, if you can tell a little bit about yourself, I know our listeners have heard you before on our previous podcast back last year when we were talking about general health and so forth. So if you can kind of refresh their memory for those who have not heard you and those who have heard you.

SPEAKER_01 1:45

Sure, it's good. It's good to be back again, Dr. Wells. And I've been here about 30 years. I'm at Cornerstone Healthcare, and my wife and I have three kids. I have a daughter who's going into medicine or medical school next year, and then I've got a computer nerd who will be a computer scientist. And then my seventh grader wants to go into acting, and he's playing Olaf in the upcoming performance of Frozen. So we've got a lot going on. I'd say one and your youngest son has his birthday today.

SPEAKER_04 2:10

That's right. Happy birthday, Andrew. Happy birthday, Andrew. Andrew. Andrew. All righty. Renee?

SPEAKER_03 2:17

I'm Renee Stevenson. I am have been a nurse for 25 years now. Most of my background has been in women's health, labor and delivery, OBGYN office, and I've been in the cancer center for four years now. So this is kind of a merger of all of my loves. So what basically what I'm doing is I'm the breast the navigator for breast health and helping the newly diagnosed breast cancer patients navigate through the system, helping them get anything that they need, making sure they understand their treatment plan, just actually being an extra ear for them to make sure that I can help them understand what the doctor is trying to tell them. All right, great. Well, welcome.

SPEAKER_02 2:54

Thank you.

SPEAKER_03 2:54

Ready?

SPEAKER_02 2:55

My name is Rainey Levin. I'm Director of Cancer Center at Camden. I've been with Camden my entire career. So I won't exactly say when that started, but it's been almost 30 years. And um, so I started out on staff and radiation oncology, moved into management, and then I'm into the director's role that I have now. So I've just kind of grown up in the cancer services at Camden. It is certainly my passion uh taking care of our cancer patients. It's it's definitely a privilege for us, those of us that are in cancer services. And uh just really proud of all of the things that we're able to do for the community through the WBU Cancer Institute.

SPEAKER_04 3:36

Well, I tell you what, well, we appreciate I appreciate all of you. And so thank you so much for helping us talk about a subject that is the in for the month of October, which is the National Awareness for Breast Cancer. And uh last week we had Dr. Bonnie Buckman and also we had Tony, and she uh was a breast health navigator through Stucker Cancer Society and so forth. So we're gonna continue our discussion uh today with that, and we want to go ahead and make sure that we kind of go over a little bit of the statistics. And so I'll just go ahead and have Rennie go ahead and give us a little bit of breast cancer, if if you could, that'd be great.

SPEAKER_02 4:13

I'll speak specifically uh towards uh for Camden, you know, what we see here in our community. We count our disease-specific sites in cancer registry at Camden, and there's a top five, and breast is always number two. It used to be number one, and then lung cancer in the last five years or so past breast for incidents. So in the cancer registry at Camden, we have about 650 to 700 cases that we look at every year, and of those, about 100 to 120 are breast. Now, as far as West Virginia incidents, per 100,000 women, we're looking at about 115 of those women are going to have breast cancer in our state. One thing that you know we do see a lot in our geographic area is a lot of the people that we see are advanced stage. Um, it's just a trend that we see here culturally. It's unfortunate, it's getting better, but that is uh what we do see. Now, overall, about one in eight women will get breast cancer in their lifetime. That can go up if your family risk factors uh would indicate that. The the type of risk factors that you don't have any control over that you're born with, those type of things can increase that uh quite a bit too. All righty.

SPEAKER_01 5:43

Yeah, and I think it's really important. I commend you because this is, as you know, October is the breast cancer awareness month, and uh globally breast cancer is the number one cancer in the world, and it's actually the leading cause of cancer death in women in the world, which is a huge statement. Now, in the United States, it's the second most common cause of cancer death in women, but between 40 and 49, it's the leading cause of death. So I'm really glad you invite us to be here. You know, as doctors, uh, you and I often see people in various stages of illnesses, but one of the things you and I like to do is try to prevent suffering. And so when you look at the uh four main cancer groups and specifically breast cancer, there's a lot we can do to try to diagnose and prevent that suffering early.

SPEAKER_04 6:24

I tell you, there is uh there's a statistic. It says death rates from female breast cancer dropped 40 percent from 1989 to 2016. Since 2007, breast cancer death rates have been steady in women younger than 50, but have continued to decrease in older women. And Dr. Hannah, you know if I had talked uh earlier, so like that the decreases were believed to be a result of finding breast cancer earlier through screening, increased awareness, and better treatments. So that's why we're doing what we're doing today to bring out an awareness towards it. So we can, like you said, if we can have someone basically get a mammogram and to detect that and to save a life so forth, that is that's exactly well worth it. As far as the the survivors, they say 3.5 million breast cancer survivors in the United States includes women still being treated and those who have completed treatment. We know we talked earlier as far as a lot of people relate breast cancer to women, all right. But we also known from our last program that men get the breast cancer too. You mentioned earlier so forth, and feel free to just step in so forth.

SPEAKER_01 7:36

As far as the statistics with men as far as breast cancer, are there Yeah, and well, one of the main characteristics about men is that they get to the doctor even late. And when Rennie was mentioning that, in particular in West Virginia, women present often with more advanced breast cancer disease than the national average. And men in particular across the board present later because they don't come in as early. If it wasn't for our wives, most of us would never get to the doctor. And so men tend to be more in denial. And uh last year I had a man with breast cancer, he presented, and he was far advanced. I mean, I could feel it, I could actually just stick a needle in his breast in the office to diagnose the cancer. And I said, How long has this been here? And he said, Well, probably eight or nine months. And but he had a family to support, he had a family to feed, and he said, I just don't have time to take off. So men particularly need to be aware of their breasts and their bodies as as much as women do.

SPEAKER_04 8:34

Okay. I tell you, as far as the we mentioned this earlier, also, it's important to understand that most breast lumps are benign and not cancer malignant. Non cancerous breast tumors are abnormal gross, but they do not spread outside the breast. They are not life-threatening, but some types of benign breast lumps can increase a woman's risk of getting breast cancer. Any breast lump or change needs to be checked by a healthcare professional to determine if it's benign or malignant. You know, we and also I forgot to give out our sources, and a lot of the sources that I'm gazing today is from the cancer.org, the American Cancer Society, and boy, do they provide a lot of most recent and a wealth of lot of information about this topic so forth. So and you'd mentioned some other websites that might be good.

SPEAKER_01 9:26

One of the things I really like locally is the West Virginia Cancer Project, which looks at the cancer plan from 2016 to 2020. And so the West Virginia Cancer Plan, which Rennie is holding up a coffee for those of you watching on TV. And the other thing, um if you could maybe mention Coalition of Hope, which is another resource.

SPEAKER_02 9:50

Yes, the Mountains of Hope Cancer Coalition in West Virginia is a very active group of people. They invite all walks of life. You can be a patient, they encourage that, which has been really helpful in a lot of the studies that they've done and the initiatives that have been taken on. They really take the patient into consideration when they do that. It's an active group. You can get online for Mountains of Hope, West Virginia Cancer Coalition. I believe it's WV Mountainsofope.org. And you can look at the West Virginia Cancer Plan right on the website. You can look a lot at the initiatives that they have started. Dr. Hannah and I discussed earlier today some of the things that impressed me when I started being involved with the Cancer Coalition were a lot of the transportation rates. You know, they really look at what our cancer patients throughout the state go through. Some patients were driving one and a half hours each way for cancer treatment, depending on what and that might be every day of the week.

SPEAKER_05 10:54

Wow.

SPEAKER_02 10:54

They they also looked, of course, at some of the things that we see a lot of a lot of incidents of tobacco use, of obesity, things that really increase the cancer incidence, and then the presentation of stages, which is usually later. But all of that can be found. The mountains of hope is very active, they're still very active. We'll be working on another cancer plan. Of course, this one will be up next year. So we're looking at a lot of different things as well.

SPEAKER_04 11:21

So the percentage of decreasing cancer is definitely decreasing, right? I mean, 40% was back as we mentioned earlier, back in 2010 and so forth. But you still see that decline as far as the diagnosis of cancer, breast cancer decreasing, or just again, as far as the treatment in the more of the self-awareness type you know, as far as what do you you what do you find?

SPEAKER_02 11:47

Well, I think West Virginia is a little bit behind the times on those for the national trends. I wish we were up with everyone else, but for some reason we're just a little bit behind. But as far as those rates, they will continue to decrease because of the screening, because of the advanced treatment modalities. And I you know, it's kind of a little bit of a catch-22. The age you were mentioning, survivorship, that the percentage of people living with cancer is going to grow so quickly because the boomers are at that age group now where, you know, there's so many of them. They're at the age where a lot of cancers are diagnosed. So, you know, the survivorship numbers are going to go up too because of that population incidents. But yeah, it has a lot to do with screening and better treatments, all kinds of clinical trials that are going on.

SPEAKER_01 12:40

And yeah, I think if you look at the four big cancers, which are lung cancer, breast cancer, colon cancer, and prostate, those are the most common ones we see nationally. And in West Virginia, the overall rate of cure has improved 27 percent. That's really amazing. And for each of those lung, breast, colon, and prostate, there is a screening test for them. And so one of the things that we're all trying to do in this room is to get people to get screened earlier. And in West Virginia, for a lot of reasons, as Randy touched on, and and Renee and I will talk about, we don't get the percentage of screening that would really make a even bigger difference in our state and across the country.

SPEAKER_04 13:18

As far as breast cancer itself, how does it begin as far as we talked about as far as mutations to DNA? We were talking about the few different types of genes that were pretty most common. I know there are several other genes that can be mutated, but there's two that I think it's the B the BR the BREC or Yeah, the BRCA1 and BROCHA two.

SPEAKER_01 13:38

And Renee is going to talk about uh genetic testing here in a few minutes. But yeah, most of the time it's a mutation caused by uh the DNA in a cell in the breast. As you know, the genetic is probably five to ten percent, which is significant as far as watching that. But whatever happens to cause a mutation, and there are certainly environmental factors, cultural factors, obesity, a lot of things that contribute, including our lifestyle. But uh when it starts, it starts very small, and usually we can go ahead and pick it up if we screen early enough, and that's that's a big thing.

SPEAKER_04 14:11

Right. I see as far as some of the risk factors. We had talked about this earlier and so forth, but I think it's very good to go ahead and discuss some of the risk factors. So, Renee?

SPEAKER_03 14:22

Okay. Obviously, being female is one of the main risk factors. Um, you can't change increasing age. If you do have a genetic mutation, so if there's a lot of family history, getting genetic testing done is something that you may want to consider. If you've used a lot of hormone replacement therapy for a long-term use, any family history of breast cancer, a personal history of a breast cancer, or the like you were talking about earlier, the non-cancerous condition such as the fibrocystic breast. If you've ever had treatment with radiation to your breast or chest for some other reason, believe it or not, alcohol intake, obesity, not being physically active, not getting enough sleep, having a your first period at a later age, starting menopause at at a later age.

SPEAKER_04 15:15

As far as to go back to that, as far as the later menopause, like that, and also starting menopause earlier. A lot of times, as far as the they believe that it's the estrogen, longer years of being estrogen, since a lot of this breast cancer is it seems to be estrogen, is the related most factor. Is that correct?

SPEAKER_01 15:35

Yes, and actually, when you talk about obesity, we used to think for years that our fat just sat there in our belly or in our hips and was inert, but now we know it's biological active and produces a lot of hormones, one of which is estrogen. And so obesity does have a direct correlation not just with breast cancer, but with other cancers because of the inflammatory processes that are occurring in our fat. So another reason to get rid of that.

SPEAKER_04 16:00

I'd say as far as the I was kind of looking here as far as race and ethnicity and so forth. They say basically overall white women are slightly more likely to develop breast cancer than African American women. Although the gap between them has been closely in the recent years, and women under age 45, breast cancer is more common in African American women. African American women also are more likely to die from breast cancer at any age. Asian, Hispanic, and Native American women have a lower risk of developing and dying from breast cancer. So, I mean, race also seems to play a factor as a risk factor as well.

SPEAKER_01 16:35

Aaron Ross Powell, Jr. It certainly does. And the thing about race, it is very sad, both because if you look at the issues of race and the issues of poverty, if you look at rur rural Appalachia, and I'm talking about Appalachia in Kentucky, Ohio, Virginia, and West Virginia, those people have a lot higher disease progression when they present because of problems with access. And it's really true, too, in the African African American society, because those people often live in a situation where either because of unemployment or economy or lack of access or lack of health insurance, they just do not get screened as well. And so those people also often present too late to really have an effective cure. Would you agree with that?

SPEAKER_02 17:15

Yeah. Yes, that that makes complete sense. You know, it has a lot to do with geographical area where people kind of, you know, a commute community together will have, you know, a like mind. And so that does make sense. Uh if you know the incidences and how they would react to things. Access is huge. Access is one of the biggest factors for treatment and compliance and basically just whether or not you show up at all to see your doctor.

SPEAKER_01 17:47

And education has a lot to do too. There's some really good studies that show that the higher level of education you have, the more likely you are to get screened for any particular cancer, but it's particularly true in breast cancer. And it's certainly West Virginia, you know, I I saw a statistic where the level of high school graduation is going up, which bodes well for a lot of things. But the people who have a higher education tend to present more and get treatment more quickly.

SPEAKER_04 18:13

I tell you, you know, as far as the risk factors, you know, we've talked a little bit about things that we can't control, and I don't want to beat a drum, stuff like that. But as far as the things, and it's kind of it's kind of like I was telling you, Sarge, that silver lining. You know, it's only like three to five percent that actually is genetic and so forth. So it seems like a lot of things, you know, it could be related to lifestyle.

SPEAKER_05 18:32

Yes.

SPEAKER_04 18:33

You know, as far as of course you know that West Virginia is definitely, as we discussed earlier in the program a year ago, that uh we're not the healthiest. We're we'd lead the the nation in as far as obesity, we'd lead the nation in as far as diabetes. And I'm sure we're probably up there as far as with cancer possibility. Is that correct? That's correct, yeah.

SPEAKER_02 18:54

You know, and generally, uh all those things that you mentioned and all the other ones that normally go hand in hand, that's the handful of things that are really gonna cause you problems with everything. So if you're not gonna have a cancer incidence, you're probably gonna have a cardiac incidence, or you're gonna end up having a stroke, or you're gonna have diabetes, or you know, they all just tie so so nicely together. And it just is such a motivation for all of us to stay active, stay healthy, you know, do do a little bit of exercise, watch what you're eating, don't smoke, don't drink, you know, get a lot of sleep, do the do the things that, you know, the things that you really know you should be doing. Right.

SPEAKER_01 19:38

And and whether we can control those factors or or not, we can all get screened. And so that's the thing, no matter where your background is, environmentally or culturally, or uh as far as genetically, we all have the same opportunity to get screened and have our patients screens.

SPEAKER_04 20:00

Are there guidelines that they put out as far as they recommend?

SPEAKER_02 20:04

They do have recommendations, but they are that. They're a recommendation. 45 is is a the common one that you'll hear for four mammograms. However, this is where your relationship with your primary care provider is key. Because personally, I'll just speak for myself. My family has a lot of breast cancer. My mom's one of four sisters in her family. She's the only one of the four that has not had breast cancer. One of them has had two different primaries. So for me, when I talk with my primary care physician, we started screening for for me very early. And that's a that's a conversation you really need to consciously have with your provider. And that's the expert. That's the person that's that's kind of the stoplight for you, anyway, as far as let's do this, let's do this, let's start that. They'll know your history, they'll know your risk factors, and they'll factor in your family history to come up with that date. And I'm sure you do that every day. That's right.

SPEAKER_01 21:09

And it it threw it through people for a loop several years ago when the recommendations were changed on the frequency of mammograms, and it had a lot to do with the age of people screening, and mammograms are very accurate, 85 to 90 percent. And the other thing, certainly, if you have a primary relative, a mother or sister that has breast cancer, then I think those people particularly it's helpful to have genetic screening. I I like to see what Renee says about genetic screening and women, because that's one of her areas of expertise in communication.

SPEAKER_03 21:45

So I guess we can go ahead and talk about that.

SPEAKER_04 21:47

Yeah, I think it'd be a great time.

SPEAKER_03 21:48

Let's talk about that. There's actually a new recommendation by our breast surgeons that every woman that is diagnosed with breast cancer have the genetic testing, regardless of her family history. So we are trying to tell. Test every breast cancer patient now for genetics. So it's something that we've just recently started in the last few months. And genetics is changing. You know, it used to be we only looked for the BRCA1 and BRCA2 on our breast patients. Now there's a whole panel that they look for. So they're detecting more and more genes that can believe be related to breast and other cancers as well. A lot of them are affect more than one type of cancer. So if you have a breast cancer and you test positive, we need to be watching you for something like ovarian or pancreatic. Or if a a woman has BRCA1 or BRCA2, we need to be looking to see if her sons have inherited because they could end up with prostate cancer. So it truly does affect the whole family. One of the things with genetic testing is usually the genetic mutations that cause cancer happen at a younger age. So when you have a family history, but they're older aged people, most likely that's not going to be something that's genetic. But we are still trying to catch everybody just because we want to make sure we're not missing it. Because as I said before, genetic testing's been around about 25 years. It's new for medicine. We're still learning a lot. New things happen all the time. And new treatments are coming out from the clinical trials based on these genetic mutations. Right.

SPEAKER_02 23:19

One of the other things that I think is so important about genetic testing, just in general, is with that information, there really comes a burden of knowing. So you have to be prepared as a facility to not only offer the genetic testing to the patients that are appropriate to be tested, but you have to be able to follow up on those findings. So if a woman is positive for something and then her daughter subsequently has to make that decision too. Okay, so my mom is positive, what do I do? And if the daughter who doesn't have a breast cancer test and then she's positive, what does she do with that information? So it's a responsibility, it's a huge responsibility that we have as healthcare providers to not only provide the testing and the data, but we have to follow up and support those patients with okay, now what? Now what do I do with this information? And we don't want to scare people. It's more of this, this is your knowledge. So here's what we recommend you do. Maybe it's just you're more in you're more frequent with your screenings, or you keep up with your physician a little bit more often. But you have to be able to provide that support on the back end.

SPEAKER_01 24:37

And I think one of the best examples of uh genetic testing that our listeners would probably be aware of is Angelina Jolie, who several years ago had genetic testing. She has the Broco 1 gene, and she was very public and has written a lot about this, but her mother had both breast cancer and ovarian cancer. So she, of course, was a setup, and so her oncologist told her that she had an 87% chance of having breast cancer. So without a diagnosis of breast cancer, she elected to have a prophylactic bilateral mastectomy. And she said the peace of mind I have was enormous after watching my mother go through this. And so that's not for everybody, but that's one thing that can sometimes be helpful. And so that's how genetic testing really can help. The other thing is that reconstructive surgery is so advanced now that for women both who have surgery for treatment of their breast cancer, or as she did, prophylactic mastectomy, being an actress, she's obviously very concerned she was able to have reconstructive surgery and achieve what she felt was a ability to function in her career.

SPEAKER_04 25:38

Right. You can either you can either deny or you don't have to answer the question so forth. And the reason I I'm asking you just because you're you're living that. You know, you have close relatives that have breast cancer. So what is Rennie doing? Are you you know, because you know you're in charge of that whole entire cancer complex, you know.

SPEAKER_02 26:03

Yeah. So what I'm doing personally, since my mother is the one who thankfully has not had any breast cancer, and actually, my the two of my aunts that have had breast cancer recently, one was very, very young, they both tested negative. They had the genetic testing. So as far as I'm concerned for myself right now, that's not going to be something that I'm gonna do. I'm not gonna have the genetic testing because what the information I have from my own family wouldn't indicate for me to have that. Now, if my mom would end up with a breast cancer, which hopefully she she doesn't, but if she would, I would probably go down that path. But at this point, I I'm not going to do that. But my annual exams with my physician are very thorough. I don't miss my screening mammogram. I do it's it's somewhat controversial right now for self-breast exams, but I am a believer in that. So personally, I do that every month and just I've taken ownership of myself.

SPEAKER_05 27:10

Right.

SPEAKER_02 27:11

And I do my I have an older sister and she feels the very same way. We're kind of a push.

SPEAKER_04 27:16

Well, that's you know, that that's key. Knowing knowing your body. Yes, you know, looking for changes. And I I want to basically go over some of the signs and symptoms of breast cancer. So if you could help us out with that, that would be excellent.

SPEAKER_03 27:33

Sure. Like Randy was saying, get to know your own breast if there's any change whatsoever that you need to let somebody know. You could have a nipple discharge, you could have dimpling, inverted nipple. Some people have seen the lumps just by looking at it. Just feeling anything abnormal. A lot of times there's not pain associated with it. There can be, but not not all the time. But if there's any change at all, if your breasts look the same and then suddenly they look different, just make sure that you let your doctor know. A lot of times, with especially younger women, we have denser breasts, and that's hard for stuff to pick up on mammograms. So that's why we're going to a lot of people getting breast MRIs, especially if they've been a problem and they're either too young, they don't recommend doing mammograms under certain ages because the breasts are too dense. So the breast MRIs will actually detect more in that in that population. Right.

SPEAKER_04 28:34

As far as Dr.

SPEAKER_01 28:35

Hannon, do you need to add anything to that? Yeah, I'd like to mention because self-breast exam was extremely a point of emphasis 15 years ago. And what we have found is it's still very important for women to do that. One study, the Canadian breast cancer study, showed that they were effective in picking up breast cancers. But the average breast exam in that study lasted 10 minutes. So the physician was examining the woman. And if you think of your own breast examine as a woman, or we rarely spend that much time either personally or as a physician. And so the analogy I like to use, knowing your breasts and your body is very important and being alert for any changes. But when we started looking at lung cancer screenings for people who smoke, which is the biggest killer in our state and uh in our country, we thought, well, the best way to screen for lung cancer would be to get a chest x-ray. It makes sense. But what we found out is that we could not identify the small nodules of lung cancer early enough on the chest x-ray to make a difference. So what we do now, what we recommend to everybody who smokes or has a history of smoking, is a CAT scan, low-dose radiation CAT scan, because that will pick up small nodules, two to three to four to six millimeters, where if they do have a cancerous appearance, we can get rid of them and save someone's life. So equivocantly in breast cancer, self-breast exam, while it can pick up a lot of things, does not usually or often pick up those very, very small nodules that we could get rid of and treat and thereby cure someone. So a breast exam is very, very important. Mammograms are actually even more sophisticated as far as picking up those little things, and that's one of the reasons why with the increase in mammogram screening, we've been able to pick up cancers early enough to treat and cure.

SPEAKER_03 30:20

I wish you could see the the necklace that I have that I actually take to our health fairs. It has different sizes of lumps. And the biggest lump, what would you say? That would be about four sonometers across, is what a woman who is not used to doing self-breast exams would be able to detect in her breast. And then there's a smaller one for women who do them regularly. And then there's one, or assuming that one was one, the biggest one is when they don't do it regularly. There's some that do them occasionally, and there's this little bit smaller, a little bit smaller if you do them regularly. And for your first mammogram, it could take something probably about the size of the end of your pinky. But if you get your annual mammograms, it's very tiny. It's almost a little bit larger than the the head of a pen that they can detect on annual mammograms. So that is very important that they get those regularly just so they can catch any changes.

SPEAKER_02 31:18

It is, and the other thing that, and don't put it off because the whole idea of a screening mammogram or screening anything is to establish a baseline. So you the earlier you establish your baseline, each year they're comparing the one from the year before. So when there is a minor change, even if it's the tiniest little thing, it's going to be easily identifiable because you had the baseline. So as he was saying for the low dose CT scamper, lung cancer, same exact thing. I mean, people would take advantage of that, talk to their primary care about that, it's going to save a lot of lives and it's going to get things a lot earlier because, as we have said before, we're seeing cancers way too late. We're seeing them too late of a stage. If we would have seen them a few months before, a year before, or whenever, you know, that's the difference between a cure and a palliative treatment path for somebody.

unknown 32:16

Yeah.

SPEAKER_01 32:16

It's important. A lot of people have fear of mammograms because they are not the most comfortable thing. One of my favorite lines is if you want to prepare for a mammogram, you go out on the garage floor naked, lay down on the cold floor, and let the car run over your breast. And that'll get you prepared. But having said that, one of the things that's scary is that when you have a mammogram and then you get called back and we said, Well, we see something suspicious, and that that can be some of the most frightening couple days. And so what we've done now, and most institutions will allow the radiologist to go ahead and do an ultrasound or do a compression film while the woman is there if they see something normal. The other thing we've been much more proactive on and all across the country is sending women letters that tells them what grade or stage their mammogram was. We call that birad detection. And sometimes if you see a birad four or five, that can be very scary scary. And so Renee does that. She's in charge of that for our institution. So I'm going to have her elaborate a little bit on what those letters mean that you may get in the mail following a mammogram.

SPEAKER_03 33:27

So we actually have a report that comes to the nurse navigator for all the birads four and fives. And basically those are the ones suspicious or likely cancer. So they would come to us. And basically, what we do with that list, and I don't call the patients, that's up to their physician to let them know what's going on. But I can call the primary care physician and see if there's any way that I can assist getting this patient scheduled with the coordination of care. Can we get their ultrasound? Can we get their biopsy scheduled? What can I do to help you get things moving for this patient so that they can be treated quicker?

SPEAKER_02 34:03

What we have found is even though the BIRADS letters are awesome to send to people, a lot of times they don't understand them. So when they get a letter sent to their home and they've had a mammogram, all they see is, oh my gosh, I've got a letter from the hospital and they're it's terrifying. So we've tried to really take ownership of the ones that that will need further navigation. And certainly if anyone has any questions, they can always call. But the radiologists are so good when they're reading these mammograms, putting these grades on there. So the primary care physician, obviously, they're going to know what to do. But these reports will say, I recommend an ultrasound guida biopsy. I recommend a stereotactic biopsy. I recommend this. I recommend that. And so it's really helping us move that forward very quickly when there is something of concern.

SPEAKER_04 34:59

All righty. My table, we're going to go ahead and take a break, and when we come back, we'll continue our discussion on breast cancer awareness.

SPEAKER_00 35:05

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SPEAKER_04 35:26

Welcome back to Soaring Health and Wellness on our today's discussion as far as breast cancer awareness. We were basically just finished up uh receiving that bi read letter. So once you receive that birad letter, stage four or five, what's the next step?

SPEAKER_01 35:40

Right. And that has to be one of the scariest things for women or anybody who gets a presumptive diagnosis of cancer. And so the next thing that happens is that you'll get called by your primary care doctor, whomever that would be, usually who ordered the mammogram. And they categorize cancer by a system called TNM, which stands for tumor, node, and metastasis. And so everybody who has a cancer is classified into one of these things, which makes it a national and international standard. So the tumor, the T stands for the size of the tumor, the N stands for whether or not there's a lymph node involvement, and the M stands for whether or not there's metastasis at the time of the presentation. So the nice thing is that most treatment across our country is standardized. And so if you go to the Mayo Clinic or you go to MD Anderson or you go to Ohio or Mariette or Parkersburg, you're probably going to get the same recommendations for the early treatment of non-invasive carcinoma, which is reassuring. But usually the radiologist will recommend when he looks at the X-ray, the mammogram, whether or not the lesion can be biopsied by needles. And so usually an ultrasound guided biopsy is enough to make the diagnosis in a large percentage of cases. And then once that is done, usually then you have a multidisciplinary team, where usually made up of an oncologist, medical, and radiation and the surgeon. And just wanted to mention that treatment options, particularly surgeons, have really improved. So now we have what's called breast conservation surgery, also known as a lumpectomy, where if the lump is a certain size or the mass is a certain size, it can be totally excised with preservation of the breasts, which is nice cosmetically. And then certainly if the size of the tumor or the lymph nodes that are sampled are greater than that, then we often can go to mastectomy. But I want to pass it over to Renee because one of her jobs is to get these people coordinated and into a system where they become family and get better care.

SPEAKER_03 37:40

Okay. So I meet most of the patients when they come into the medical oncology office. But even before that, we actually have a breast tumor board or a breast conference where we meet, and the breast surgeons are there, the medical oncologists are there, the radiation oncologist are there, and the genetics person, the clinical trial person, all of the whole team is there discussing those particular patients so we can get a plan of care in mind for what we're going to do with them.

SPEAKER_02 38:08

Even during that, if I can interject, the radiologist is there to review all of the imaging studies, and the pathologist attends as well to go over any pathology slides that have been taken from any biopsies. So this really is the complete comprehensive multidisciplinary team coming together to the table, case by case, looking at every single patient to devise the best plan for them.

SPEAKER_04 38:36

Wow. That's awesome. That's right.

SPEAKER_03 38:38

And then when they come into the medical oncology office, a lot of times, you know, they've already got their biopsy back, so we know what we're dealing with. And then he will sit down and talk with them what type of plan that they need, depending on what stage they're in, the size of their tumor, if it's spread to the lymph nodes, if it's estrogen or progesterone positive, HER2 positive, because all of that will change the treatment plan. If there is the HER2 is positive, there's something called her septin that we can give that attacks that HER2 protein to help reduce that and helps um treat that type of cancer. If there's if it's estrogen and progesterone receptor positive, tamoxifen or aromatase inhibitors like aromidex can be used to treat those. That reduces the chance of reoccurrence in those that the surgery has already removed the cancer, or it can be used in metastatic disease to treat the patients that have cancer outside of their breast. Let's see. Whether or not we need to use chemo. Is if we've only got the first biopsy back and we're looking forward to surgery, do we need to do neoadjuvant chemotherapy, which is before the surgery, to try to shrink the tumor down to a better size so that surgery is more effective? Do we, if we've already had the surgery, adjuvant chemotherapy, which means after the surgery, to try to tr to prevent either it from coming back or if there's still some cells left to treat those cells. We also do genomic testing, the onka type DX score, where we send off part of the tumor tissue to look at uh 21 different genes to see what the recurrence rate is for that patient, if the aromatase inhibitors will help, if radiation will help. It kind of gives us an idea of all of that, but we need to wait for the node status to come back first because if you've got the more at risk you are, the more nodes that are involved, but you're going to do more treatment anyway. Okay. The chemo the physician will talk about what type of chemotherapy if it's needed. Most of the time for our breast cancer patients, they look at what's called AC and Taxol, ADR mycin, cyclophosphamide, and taxol. Or he could use cytotoxin and taxeter for our metastatic patients. He may want to look at forgetta or something else. So it all just depends on what your status is, where you are, as to what type of therapy they choose. And then going back to what we were talking about earlier, the genetics. If you're BRCA1, BRCA2 positive, there are now PARP inhibitors out there. It's immunotherapy, things that will actually take advantage of the damage in your DNA to help prevent those cancer cells from spreading.

SPEAKER_01 41:18

Right. And uh go ahead and tell us about so a lot of times with the lumpectomy, for instance, in which the tumor is removed, women require radiation to make sure they got so why don't you spent your whole career doing that and supervising that, Rennie? Why don't you tell our listeners about that?

SPEAKER_02 41:33

I will. There are there are many uses for radiation therapy with breast cancers. Most of the time it is the patients that have had breast conservation surgery of the lumpectomy, as you mentioned. And then their treatments are tailored basically to the outcome of their surgery. And it's normally after chemotherapy. When we would do that, radiation is not usually used as a just the only treatment. It's always used in con in conjunction with another type of treatment. Most patients usually end up with all three. They'll get surgery and then they'll go to chemo and then they'll end up in radiation. But there's a few different ways that radiation can be administered. Most of it is what's called external beam, and that's like a very powerful X-ray. Normally patients will come a Monday through Friday for six to seven weeks to complete that type of a therapy. There is a hypofractionated therapy that in the recent years has become a little more popular for certain patients with very early stage disease. It's uh just an accelerated plan. So more dose is given over a shorter period of time or a higher dose each day. It ends up being the same in the end. There are other things that can be offered for radiation therapy. There's an interoperative procedure that can be done in larger institutions for patients with breast cancer and also what we call brachytherapy, which is where you take an actual radioactive source of some kind. Normally they're little tiny seeds of radioactive material that are placed inside of the breast through catheters and other means to treat from the inside out. The statistic that I looked on, Astro, which is the radiation, the association for the professional site for radiotherapy, is 80% of all patients will live past 10 years. So that's kind of the way you look at cancer survival is five years and then 10 years. So we're talking about really great, really great rates and effectiveness. Yeah.

SPEAKER_01 43:49

And as Renee said, the multidisciplinary is a key because it's a team approach and and so we talk about surgery and chemotherapy, we talk about the mind, body, and spirit. All of us in this room coming from a position of faith that's very important in our lives. And so a lot of times when something as dramatic as cancer happens to us, it brings us face to face with our mortality, and we make some decisions, and we actually our relationships change. Sometimes they intensify. And so it's an opportunity also to get in touch with people and our spiritual faith that we may not have been, both as a source of comfort and a source of curing, too. There's a wonderful book, Dr. Bernie Siegel, who's an oncologist at Yale, many years ago wrote one of my favorite books. It's called Love, Medicine and Miracles. And I recommend all my patients that who have cancer get it because he talks about the mind and the body and the spirit connection and the fact that there's so much positive to uh integrate in your faith as a healing source. One of the great stories he tells is a woman who was getting chemotherapy, and every day she got the chemo, she went out, her husband was in the car at the curb, and he would have a paper bag. So when she got in, she would throw up into the paper bag. And so every day that went on. And so one day she got into the car and she opened up the paper bag, and there were a dozen red roses in there.

SPEAKER_05 45:13

Oh wow.

SPEAKER_01 45:14

And so she sat down and she never threw up again the rest of her treatment. And so the integration of our you know psycho-spiritual nature is is really, really good. And I don't know, you can per speak to what what you and we all feel is part of the uh uh our faith being such a big contributor to our health.

SPEAKER_04 45:32

You know, you had mentioned uh statistics also shows where faith is a big important part of actually longevity. And so that's that's really neat the way it all ties together. As far as some of the things is you know, I want to get back to Rennie and so forth. As far as, you know, we've we talked and I don't want to spend a lot of time on this, but you know, we talked about the ultrasound, we talked about the mammogram, we talked about the MRI. Are there other diagnostic studies that are coming through the pipeline as far as that are a little bit more specific? And Dr. Hannah or uh Renee, if you know the information and what you think that as far as it's becoming more technology, newer technology?

SPEAKER_02 46:15

Technology advances, I think, ten years a day. I like to say sometimes. Truly, I think all of the imaging modalities are looking at ways that they can better evaluate all body parts, um, breast included. But the leaps and bounds that come with uh breast imaging and specifically mammogram, which is what I would personally recommend. There are indications for MRI, and of course, Dr. Han is the doctor, so let him say to, you know, don't take a recommendation from me. But from what I see, also in my personal opinion, the mammogram needs to stay the primary source of the imaging. Now there are advancements in that equipment. You know, there's digital imaging, and then there's 3D, there's 4D, there's all kinds of things that they're doing with that. But a lot of times, you know, it's it's not really just the imaging, it's the expertise behind who's looking at it and is it done in the right in the right frequency in the right manner, and all of that. The breast MRI was a great addition. There are some tomotherapy studies or tomo studies that people are are having done.

SPEAKER_01 47:30

But other than that, yeah, and I think and I think uh here again we say no one imaging is perfect. Everybody, you know, you you hope for 85 to 90 percent accuracy and diagnosis on mammograms, which is about what we have, but often you need ultrasound, or this is a case if someone has, as Renee said, especially dense breast or problematic area or two areas that overlap, MRI is very good. And of course, as Rennie said, the two and the 3D tomosynthesis machines are in the future and here here now.

SPEAKER_04 48:03

I'd tell you what, as far as some of the lifestyle changes that we can do to help prevent our risk factors from breast cancer, so I'll go ahead and start with Dr. Hannah.

SPEAKER_01 48:15

Yeah, I think that's a and I I really loved last session when you had Dr. Bonnie on, and I I really resonated with what she said about the Dr. WSAFE, because those characteristics of lifestyle changes are enormous. And one of the things we all have a hard time is if you give someone an option for treatment of a disease and you say, Would you rather have six months of lifestyle changes or surgery, unfortunately, most people in our society will say, I'll take the surgery, get it over, I don't have to change anything. So there's a thing called blue zones in the in the world where they've gone around and they've looked and they have identified seven areas in the world where people live well into their hundreds and are very vigorously active at 80 and 90, and they all have the same characteristics. And one is that they are very active, they move naturally, you know, they don't ride cars around. The other thing is that they have a purpose in life. The other thing is they know how to relieve stress. They take naps, they pray, they meditate, they have parties, things that we don't do. The other thing which is very interesting is a plant-based diet. And I know Dr. Bonnie mentioned this, and one of the hardest things we have to do in our society is to get people to change their diets. It's very hard. Here again, unemployment, economy. I remember when one of the famous chefs came to Huntington and talked about plants and foods. There was an elementary class where no one had ever seen a tomato before. So when I talked to some of my diabetics, I gave them a lecture. I said, you know, you could really go on this diet and really change your lifestyle. And this man did. He went home, came back three months, and he said, This is great. My A1C is under control, my blood sugar is under control, but I have to give it up because I hate fruits and vegetables. And so most of us grow up, and if a lot of times the fruits and vegetables we had were boiled Brussels sprouts or boiled beans, and so it doesn't have to be this way as far as our plant-based diet. In fact, I my wife and I have been taking some cooking classes at the Marietta Hospital, and they have one for oncology and they have one for diabetes, and so it's a fun way. We call that our date night, trying to increase our repertoire. The other thing, as we mentioned, is that these seven blue zones, which are lifestyle changes, they all have a sense of community of faith. And there's really good studies out there now medically that shows that if you are in a community of faith, your average life expectancy will be extended four to fourteen years. But what other lifestyle changes do you think would be helpful when you look at breast cancer?

SPEAKER_02 50:41

First thing that I think of are the things that it's our choices every day, the smoking and and alcohol specifically. I mean, you just I wish people could really wrap their minds around what smoking is doing to their bodies and and how that's affecting the mortality of our population, especially in this state. So that's all that always comes to mind to me. But another lifestyle is is being self-aware and taking ownership of your health. And that's a lifestyle. Some people don't want to think about it. But those of us in healthcare, we think about it all the time. So I think that's another that's another way to live is to be very self-aware and to, you know, be your own be your own advocate. As far as your health goes.

SPEAKER_03 51:32

I like to tell people that knowledge is power. You may you may not want to know what your genetic results are, but the more you know, the more you can do to try to prevent something or to help your family members.

SPEAKER_01 51:44

That's right. And I think a lot of us uh growing up over the last several decades have a fear of going to the hospital, a fear particularly of cancer and cancer treatments, because it's changed so dramatically. But I I had an 86-year-old woman come in last year and she had a lump in her breast, really the size uh of a uh baseball. And I said, You have to have had that there for months. And she goes, Yes, but I was afraid to do anything about it. Uh and I've had other people very tragically say, you know, my dad had cancer, and of course it was a different type than breast cancer, and he said he would not have gone through chemo if he had it to do over. So therefore, I'm not going to do it. Um and this person treated it with diet alone, which is an important part of treatment, but that's not the only thing. And the results, unfortunately, were very sorrowful. So part of it is that having enough faith in the medical system and your primary care team and your multidisciplinary team to say, yes, I'm going to go get this taken care of. I'm going to do it fine. And one one of my friends says, you just need 20 seconds of courage to go ahead and say, Yes, I'd like to go ahead and have that mammogram.

SPEAKER_02 52:47

To be brave. And when you think about it, especially today's medicine, there's advancements all the time. We probably don't even know a fraction of the things that are going to be here next year. We haven't even heard heard yet how awesome the advancements are going to be, you know, in the next 10 years. So that's the other thing that we need to keep in mind, especially when you talk about someone who doesn't doesn't want to address their problem because of what their dad or their grandfather went through. The advancements that have happened in that time, in that generation, are tremendous. And the things that people had to go through 10 years ago, you know, sometimes it's the same, but a lot of times, even if it's the same maybe it's the same chemotherapy that's pretty harsh. We have so many other things now to help manage those side effects that it makes a huge difference. It really makes a big difference. So I would just I would I would recommend that anyone starting out with a diagnosis start just with themselves and not project what they've heard or or seen or witnessed in anyone else and just go from there.

SPEAKER_04 53:57

I tell you, I just basically was looking at some issues as far as exercise, and it shows that research studies of physical activity for cancer patients have shown physiological and psychological benefits of regular activity. Research studies with breast cancer patients have mainly incorporated aerobic training rather than resistance exercise as the exercise modality. As we have mentioned earlier, that high levels of estrogens have been implicated in the development and growth of breast cancer. One postulated mechanism for the beneficial effects of aerobic activity for women at high risk for breast cancer relates to the estrogen lowering effects of this form of exercise and the concurrent reduction in breast cancer recurrence and new diagnosis. And that's from D.A. Cosmin, which exercise lowers estrogen and progestion levels in premenopausal women at high risk of breast cancer from the Journal of Applied Physiology. And following menopause, fat cells, not the ovaries, are the main source of estrogen, and regular aerobic activity provides an important means to control body weight. Breast cancer patients who are physically active and less overweight have a greater chance of surviving the disease. And that comes from M. Hammer, the impact of physical activity on all cause mortality in men and women after a cancer diagnosis. So we can see the benefits of exercise as far as not only do you feel better mentally, you know, which is very key, but also it helps lower those estrogen levels and so forth. So again, spirit, mind, and body all work together.

SPEAKER_02 55:28

Absolutely. Patients do better. The better their attitude and the better their outlook. Renee and I see it every day. You could have the same exact patient with the same exact diagnosis and prognosis, and then one is feeling like they're doomed, and the other one is like, I'm gonna beat this. And you will have a very different response from those people.

SPEAKER_04 55:52

Yeah, Dr. Bonnie had mentioned that last week with her vibrant wellness center she has and so forth. Well, what I always like to do at the end of our program is kind of like ask each one of you if you have a golden nugget, all right, there's someone out there that's going through this disease, a family member, you know, and you know the the the news is devastating so forth. So what can we give them? What hope that's what we provide for them, is giving them a sense of hope so forth. So we'll go ahead and start with Rennie.

SPEAKER_02 56:23

Okay. What I would say, and especially if there's someone out there that's listening, that's trying to decide whether or not to pursue getting something checked, or if they're worried about something, your healthcare team is not only a group of professional people that know how to do hospital stuff. You're gonna find a group of people that really have your best interest at heart. And there are people like Renee, there are navigators, nurses, physicians that really, really care about you as an individual and want you to be well. So I would encourage everyone to keep up with their annual visits, with their physicians, keep up with their screenings, and if you're worried about it, please talk to somebody. Please let somebody know and initiate your own your own care. I mean, you've got to take ownership of it, and you've got to be sure to be your own champion when it comes to your health care. Right.

SPEAKER_03 57:25

One of the things we touched on before was the attitude. I've seen it over and over again. Patients that come in with a great attitude to do better. I have this one patient in particular that I'm thinking of that she went out and got her own support care team through her church.

SPEAKER_04 57:43

Wow.

SPEAKER_03 57:44

She had about eight people that were praying for her, fixing meals with her, doing things with her, and just uplifting her constantly. And she has done phenomenal.

SPEAKER_01 57:53

Wow, that's super.

unknown 57:54

Dr.

SPEAKER_01 57:55

Hale? Yeah, so I had I had a patient with breast cancer, and she said, you know, now that I've come to get through this and survive it, I realize there's certain people I don't want in my life anymore because they're negative, and one of them is my husband. And so that that was a that was a tough stressor. But this is a golden channel. Yeah, but that's yeah, that's not the golden chicken nugget. But what I would say is that there's always hope. And I think that even in cases that are far advanced, so the newer drugs, the immunotherapies, the modalities of care, there's always some hope. And the other thing we didn't talk about, which obviously not everybody survives breast cancer, and so hospice has come a long way. And so here again you talk about another great multidisciplinary team that has your back spiritually and medically, and they've they've they've come light years as way as well. So I I always recommend that at the case where sometimes it looks like it may not end as well as we'd like. And then I would just leave and say that from a faith perspective, we're all healed already. And so that's the ul the ultimate thing. So I revert back to that and and say thanks, thanks be to God who heals us all the time in every way.

SPEAKER_04 59:06

Amen. Rennie. As far as if somebody's out there who wants to get some more information, you know, how do they get in contact with the Cancer System Center at Okay.

SPEAKER_02 59:18

CamdenClark.org will take you to the website and then all of the contact information is on there. And then Renee, if you'll go ahead and give your extension, that'll be. I mean, it just call the hospital and ask for any of us, and we will get you.

SPEAKER_03 59:46

And I will be happy to help you any way that I can. Alrighty. And there's one more thing that I wanted to say if that's okay. You go right ahead. I was actually in a room with a patient not too long ago and it with one of our medical oncologists. And before the physician left the room, she stopped our our doctor and said, I just want you to know that you, as my physician, I am praying for you.

SPEAKER_04 1:00:07

Wow.

SPEAKER_03 1:00:08

She said, I know it's not all in your hands. I know who the great physician is, but I have learned that I need to pray for my providers. So I am praying for you and lifting you up that you will be given the right decisions for me.

SPEAKER_04 1:00:19

Well, that's nice to know, isn't it? Wow. I tell you. Again, I'd like to thank our guests, Brene Stevenson, Rennie Levitt, and Dr. Stephen Hannett, for being on our program today. Again, our program is always as good as our guests, and you guys are excellent. And again, I appreciate what you do in a community and the knowledge that you brought to our listeners. And for those who are basically want to listen to a podcast that they may not have heard or listen to Dr. Bonnie Buckman or other podcasts and related to the health and wellness basically you can go to equalsway ministries.org and select listen to podcast. Until then, keep advancing towards optimal health and wellness.

SPEAKER_00 1:00:58

Thank you for listening to Sorian Health and Wellness with Dr. Steve Wells and his guests. We would like to thank our sponsor, Mountaineer Chiropractic. For more information, go online to MountaineerCairo.com. If you'd like to be a sponsor or help support Sorian Health and Wellness Podcast, please go to the web at Eaglesway Ministries.org and select the patron page in the top menu bar. If you or your business or church would like Dr. Steve Wells to speak at your church, special event or conference, please go online to Eaglesways Ministries.org and select contact on the menu bar or send an email to Eaglesway Ministries at gmail.com or call 304-485-6589. Until next time, think of Isaiah chapter 40, verses 29 through 31. He gives strength to the weary and increases in the power of the weak. Even youths grow tired and weary, and young men stumble and fall. Those who hope in the Lord will renew their strength. They will soar in wings like eagles. They will run and not grow weary, they will walk and not be faint.