October 9, 2024 • 60 mins
In this special live recording of Next Question in New York City at the Paley Center for Media, Katie Couric enters her "Comfort Zone" for a powerful conversation in honor of Breast Cancer Awareness Month, in partnership with comfort footwear brand, Easy Spirit! Katie shares her personal experience as a breast cancer survivor alongside the surgeon who treated her, renowned breast cancer researcher Dr. Lisa Newman. They are joined by Sharon Joseph, CEO of the Boys and Girls Club of Harlem, who is currently undergoing treatment for breast cancer herself. Together, they discuss their personal journeys, the importance of early detection, and the groundbreaking research funded by Marc Fisher’s Easy Spirit.
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Speaker 1 (00:00):
Hi everyone, it's Katiekuric. If you're looking for smart, comfortable
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(00:22):
with the code next twenty. Hi everyone, I'm Katikuric and
this is Next Question. Welcome everyone to this live taping
of Next Question with me Katiekuric. I am very excited
(00:43):
to be having this important conversation produced in partnership with
Easy Spirit here at the Pailey Center for Media in
New York City in honor Breast Cancer Awareness Month. And
in our audience are lots of breast cancer survivors, people
who may be in treatment right now, and people who
are trying to raise money and awareness for this disease. This,
(01:07):
of course, is a topic that is very near and
dear to my heart. Literally, as some of you might
know and some of you listeners out there, I was
diagnosed with stage one A breast cancer in twenty twenty two.
I had spent the previous twenty four years as a
cancer advocate after losing my husband when he was forty
(01:28):
two years old to colon cancer, going as far as
getting a colonoscopy on the Today Show, because let's face it,
nothing says good morning like showing your calling on national
television at seven thirty am. Then a number of years later,
(01:49):
after a mammogram and a breast ultrasound, I went from
advocate to patient myself. I was really grateful through my
breast cancer journey to have access us to incredible care.
And one of our guests today is actually my rest surgeon,
doctor Lisa Newman, who held my hand and gave me
(02:09):
a ton of confidence and reassurance throughout the entire process.
I cannot say enough nice things about Lisa, who said
I could call her Lisa.
Speaker 2 (02:21):
An easy spirit.
Speaker 1 (02:23):
I am very grateful they've been able to help fund
some of doctor Newman's critically important life saving research. The
two of us are joined by another one of doctor
Newman's patients. It's like a little Lisa Newman fanclick very much.
Sharon Joseph. Sharon is the CEO of Boys and Girls
(02:44):
Club of Harlem and is still in the middle of
her treatment. So thank you both so much for joining
us today. And since this is a live podcast, I
think it's okay to ask you all to give these
ladies around ubform and our hope is that so many
(03:09):
women will listen to this podcast, So I hope you'll
spread the word because we hope to impart a lot
of important, as I said, life saving information to everyone listening.
So I think, Sharon, many of us our media thought
after being diagnosed, is I have cancer?
Speaker 2 (03:30):
Now what?
Speaker 1 (03:31):
And I'm hoping that today's conversation will shed some light
not only on the physical changes and treatment that you undergo,
but the mental and emotional toll it can also have
on you. You were diagnosed earlier this year, Sharon, tell me
about that day and how you felt hearing the news.
Speaker 3 (03:54):
Needless to say, I was shocked. I don't know what
I thought a cancer pation looked like, but I didn't
you looked like me, which is such an arrogant assumption.
I had watched my mother have breast cancer and metastasized
her brain. I'd taken a BRACA test and it came
back negative, so I really thought I was clear. So
(04:18):
I knew I had dense bress, and I consistently had
my mammograms, and ironically, they had told me that I
couldn't get my mammogram until November December of this year,
and I advocated for having it earlier and I wound
up having it on Mother's Day. And I remember joking around, going,
this is the best Mother's Day gift I can give myself.
I didn't realize how true that statement was going to become.
(04:40):
And I always have a mammogram and ultra sound together.
And so I was on my way to church and
they kept bringing me back into the room and I'm like, hey, guys,
what's going on here? I gotta go, And then they
said we found something and I wasn't surprised. I have
dense bress. And then they sent me for a buyof
see and then I was joking around there too, still thinking,
(05:04):
you know, this is just what happens when you have
dense breass. And then I got the news. And when
I got it, I was shocked, but I was also like, going, okay, mom,
this is you right telling me now. You make your
own decisions. You were judgmental, but mind, let's see how
you handle this. And I remember my radiologist. I had
(05:26):
asked her for her help. I said, well, where do
I start? I need a good recommendation of a doctor.
And she said, the best one I know is doctor
Lisa Numan. And She's like, she's really busy, but I'm gonna,
you know, tell her about you and you call her.
And I called her, and from the very first moment
I met her, I was like wow, but I was emotional.
(05:47):
I went from being a little overwhelmed to then jumping
into a problem solving mode. Okay, this is a problem.
What am I going to do? What steps am I
going to take? And realizing that I wasn't going to
do this by myself, and thinking about all the people
that I needed to be here for, like my daughter,
(06:08):
a daughter's and wondering, okay, what do I do? I'm strong,
I can do this, but you're alone, you're sad, you're mad,
You're going why me? And then there's a why not me?
And how are we going to turn this around? That
I'm not a victim, I'm a victor, And how am
(06:30):
I going to use this to bless somebody else? And
that's how we started this journey.
Speaker 2 (06:34):
That's beautiful.
Speaker 1 (06:35):
Actually, Karen A couple of questions. So my understanding was
your mom kept her breast cancer diagnosis a secret that
when you were helping her and driving her to the
doctor's office or driving her to the hospital, she never
(06:59):
came out and said to you, Sharon, this is what
is going on.
Speaker 2 (07:04):
Tell me about that. I left my mother.
Speaker 3 (07:09):
My mother, and I think I inherited too, this kind
of strong woman persona that many of us in this
room probably also have. And we're Caribbean, and so it's
not only strong woman persona, but it's keep it to yourself.
And maybe she thought she was also protecting me, but
she said, I have a procedure and I said where,
because I'm nosy. She told me it was all the
way downtown and she was going to take two buses
(07:30):
and a train and I said, no way, Mom, I said,
what's the procedure? She said, do don't worry about it.
I'm okay. And so I literally drove my mother down
and she got out the car, and I started calling
all my relatives, including my relatives in the Caribbean, and
I'm like, Mommy's having a procedure and I don't know
what this is. Do you know what this is? And
(07:51):
finally someone said, we think your mom has breast cancer
and she's doing something about it.
Speaker 2 (07:57):
And that was it. You never discussed it with her.
Speaker 3 (08:00):
I went upstairs and found her in the room, and
when she was coming out and I'm like, mom, she's like,
I'm fine, what happened today? Oh, don't worry.
Speaker 1 (08:16):
That's so interesting. You know, culturally, it sounds like there's
still a lot of secrecy surrounding cancer diagnosis, And when
you think about it, it's not all that's surprising, because
I think it's really within the last gosh, maybe twenty
five years, and it's hard to remember how people just
(08:40):
didn't discuss cancer and they were sort of embarrassed or
secretive about it. And then, as Sharon mentioned, culturally for
some black women, it's still like that. Can you describe
what you've seen among your patient population with that trend
(09:02):
or the women you've been studying?
Speaker 4 (09:04):
Yeah? Thanksana.
Speaker 5 (09:05):
First of all, your story sharing is just incredible. Thank
you for sharing it is so so very powerful.
Speaker 4 (09:11):
Appreciate it.
Speaker 5 (09:12):
But it is true that unfortunately, many women do feel
this stigma associated with a breast cancer diagnosis. And I
can remember in my own family similaria is a lot
of the reluctance to say the word I can call
my mom talking about the Big Sea. It was as
if saying the word was somehow going to make it
(09:36):
real and ignoring it was going to make the problem
going go away. And one of the organizations that I
work with quite a bit, the Sisters Network, Incorporated, which
is an African American breast cancer survivor's organization, a national organization.
Their logo is to stop the silence, specifically to counteract
that pervasive impression that you shouldn't talk about breast can answer.
(10:00):
We are empowering ourselves if we talk about the diagnosis
and we share with each other how to protect ourselves
against the threat of breast cancer. And we do have
so many ways that we can protect ourselves. Between screening, treatment,
survivorship medalities, we can protect ourselves against this disease.
Speaker 1 (10:19):
And just talking about it is so critically important. I
remember reading in The Emperor of All Maladies. I might
have mentioned this to you before, Lisa, by Siddartha Mukherjee.
It's a great book. You want to pull a surprise.
It's about the history of cancer. It's fascinating and in
the nineteen fifties when women who had breast cancer were
looking for a support group. I think the New York
(10:42):
Times wouldn't allow them to put in the classifies that
they were looking for other breast cancer patients. They would
have to say looking for women who have been diagnosed
with cancer of the chest cavity, because they didn't want
to write the word breast, which is just so unbelievable.
And that was in the nineteen fifties. So we have
(11:04):
come a long way, but clearly not far enough when
it comes to bringing this topic out into the open.
And when I heard Sharon's story, I was like, Wow,
she actually is one of those women who has done
everything right because she knows she has dense breast. Forty
(11:25):
two percent of women over the age of forty have
dense breast, and we're going to talk about that some
more in a moment. But because of that, she got
a mammogram and an ultrasound, which was your usual routine
every year or every two years, or every year I guess, right.
Speaker 3 (11:42):
A year, almost every six months if I could.
Speaker 1 (11:44):
Really And was it because of the family history that
you got both of them or how.
Speaker 2 (11:49):
Did you find out?
Speaker 1 (11:50):
By the way, this is going to be very instructive
because so many women don't really know about dense breass.
How did you find out you had dense breass?
Speaker 3 (11:59):
Really through my doc when we talked about it. I
had had a benign syst in my left breast and
we've been monitoring that. And again because my mother's breast
cancer atasthtsized to her brain, I was very very aggressive
about trying to make sure I had my mammograms and
ultrasounds both on the same day so that I could
(12:22):
constantly test, and also doing self checks. So I was
very religious about them.
Speaker 1 (12:27):
That's wonderful because first of all, just so everyone knows,
and Lisa should be saying this, but I'm like the
dense breast lunatic now because I have dense breasts. And
number one, if you have dense breast, you have a
higher risk of being diagnosed with breast cancer. Number Two,
(12:48):
a mammogram alone can't necessarily tell if you have any
kind of abnormality. So I have all at and like
people feel their breasts and they're kind of lumpy and
big or they're whatever, and they think.
Speaker 2 (13:03):
Oh, I have dense press.
Speaker 1 (13:04):
You can only find out through a mammogram if you
actually have dense press and as I said, nearly half
of women over the age of forty fall into this category.
And so you really need additional screening and we're going to.
Speaker 2 (13:18):
Talk about that.
Speaker 1 (13:19):
Well, why don't we just talk about that now, because Lisa,
it's very upsetting to me A that so many women
don't know that. And the FDA changed their rule requiring
women to be notified that they have dense press and
it all has to be done in the same language now, right,
that was I think done in the spring of last year,
(13:41):
put into effect maybe in September.
Speaker 2 (13:44):
Actually it became icial rules. Thank you. I've got all
these experts in audience. I should just have asked you all.
Speaker 1 (13:51):
But anyway, you know, Sharon knew this already, but so
many women don't. How can we spread the word A
that you need to find out if you have dense
breasts and be about additional screening and see insurance companies
need to pay for additional screening.
Speaker 2 (14:09):
It's so unfair and so wrong.
Speaker 5 (14:13):
Yeah, so you stated the main issues perfectly as you
always do, Katie.
Speaker 2 (14:18):
Oh, thank you, Lisa, but.
Speaker 4 (14:22):
It's so true. But yeah, you're right.
Speaker 5 (14:24):
The Foot and Drug Administration of enacted policies such that
all mimography units have to now report on breast density
to patients that are undergoing mamographic evaluation, and it became
official for all states just a couple of weeks ago,
So that.
Speaker 4 (14:40):
Is a wonderful advance.
Speaker 5 (14:41):
However, women are then left with having to sort out
what do I do next now that I've been told
that my mammogram shows breast density. I would recommend that
you speak to your radiologist, Sharon did. Speak to your
healthcare provider, because there are options in terms of addition
enhanced breast imaging, such as breast ultrasound.
Speaker 4 (15:03):
Some women will need breast MRI.
Speaker 5 (15:06):
There are innovative ways of performing mammograms, such as contrast
enhanced mimography, and these modalities can sometimes help improve the
ability to evaluate the mammogram. As you also correctly stated,
having that breast density not only makes a regular routine
mammogram more difficult to interpret, but it's a risk factor
(15:27):
indicating that you're att more likely to develop breast cancer
in the future. So speak with your healthcare provider if
you are told that you have dense breast find out
what your options are and make sure that these options
and issues are documented, because the way that they're documented
can influence whether or not your insurance plan will reimburse
will pay for the additional testing business.
Speaker 1 (15:49):
I know that in some states it's required that they
pay insurance for additional screening. I interviewed somebody in Ohio
I think you were on the podcast with her actually,
who really fought to have insurance pay for additional screening
because she was diagnosed with stage four breast cancer. They
(16:10):
kept missing it on the mammogram. So I really admire
her and the women in other states have worked to
make this happen.
Speaker 3 (16:18):
I'll also say that even though I got the mammogram
and the ultrasound, the MRI showed more. Yeah, So if
we had just left it to the mammogram and the ultrasound,
it would have only shown a very small portion. The
MRI showed that there was a lot more than they
initially thought. So that's additionally why it's important.
Speaker 1 (16:38):
Yeah, but I think wouldn't a standard of care be
if someone like Sharon presented with something suspicious on both
the mammogram and the breast ultrasound, she would almost automatically
be given an MRI to kind of validate the findings.
Speaker 2 (16:53):
Or am I crazy?
Speaker 5 (16:55):
Now, that is often the strategy, But the decision about
MRIs in the base of a breast cancer diagnosis is
definitely a nuanced, challenging decision to make, but often it
is very, very helpful. Breast MRI is absolutely valuable in
women that have known breast cancer predisposition such as a
strong family history, a known genetic susceptibility, mutation carriers such
(17:20):
as a BRCA mutation, women that have had prior therapeutic
radiation to the chest wall.
Speaker 4 (17:26):
These are all markers.
Speaker 5 (17:27):
Of women that will benefit from MRI in addition to
MAMMOGRAHAM to early detect a new breast cancer.
Speaker 1 (17:34):
You know, I know that women, white women, and black
women are diagnosed at the same rate with breast cancer,
but black women have a forty percent higher mortality rate.
I discovered this when you were treating me for my
breast cancer, and it was so disconcerting. Can you explain
(17:56):
why this is the case.
Speaker 5 (17:58):
Yeah, well, there are a lot of reasons at which
I am happy to discuss, But first of all, I
just have to say I was so struck in getting
to know you through your treatment experience, how passionate you
became about addressing breast cancer disparities and learning about breast
cancer disparities. This woman, as she's getting ready to start
(18:18):
her breast cancer surgery, she's talking about how she wants
to use her experience to advocate for women so that
all women have access to the treatment options that she
was able to avail herself of.
Speaker 4 (18:31):
It's still mind volve them.
Speaker 5 (18:32):
To me, how gracious you are, how you think of everybody?
Speaker 1 (18:36):
Were getting me to sleep, you know, making me count
for ten backwards, and I was like, you guys, it's terrible.
Speaker 2 (18:46):
So many women.
Speaker 1 (18:47):
Well, you know, I felt so lucky that I had
the good fortune and honestly the financial wherewithal an insurance
coverage to get the very best treatment available. And I
couldn't stop thinking what would I have done if I
had had to wait to get my lump back to me,
(19:09):
if I had to wait to get my mammogram, if
my doctor didn't automatically give me a breast ultrasound every
time I was checked. And you know, your health should
not be determined by your zip code or your bank account,
and it so often is. And that's why I am
so passionate about not only giving the people the information
(19:31):
they need, but supporting them because it's just unfair that
a person of means is a survivor and a person
who doesn't have means is often not. And it's just
the inequities are maddening to me. Well, and I'm going
to talk about your research in a second, but let's
(19:54):
talk about the reasons that Black women have a forty
percent higher mortality. Some of it has to do with
their breast density, right, and some of it has to
do with access.
Speaker 2 (20:07):
Can you just talk about that, Lisa.
Speaker 5 (20:09):
There are many complex reasons explaining these breast cancer disparities
that you described, and indeed, breast cancer mortality rates death
rates are forty percent higher in African American women compared
to White American women. Now, the incidents rates actually used
to be lower for breast cancer and Black women compared
to white women, but there's been a disproportion so interesting incidence,
(20:31):
so that now the rates are equal. But we've had
this widening of the mortality gap, and it's because of
a lot of different factors. The disproportionately high prevalence of
socioeconomic disadvantages in the African American community, higher poverty rates,
higher rates of being uninsured or under insured, all of
(20:53):
these factors definitely contribute to delays and breast cancer diagnosis,
delays in completing treatment, and this will result in higher
mortality rates.
Speaker 1 (21:02):
So poverty, but it's also these social determinants of going on.
Speaker 5 (21:07):
Yes, yeah, so we still unfortunately continue to see discriminatory
patterns in the healthcare system. African American women are less
likely to be offered genetic testing, African American women are
less likely to have mimmography in the highest quality centers,
and African American women are less likely to be offered
(21:27):
cutting edge breast cancer treatments, such as in the setting
of clinical trials and clinical research. So we definitely have
to address all of those inequities in the healthcare system,
number one, if we're going to achieve.
Speaker 4 (21:41):
Breast health equity.
Speaker 5 (21:43):
But there are other factors, and there are several characteristics
that describe the breast cancer burden of the African American community,
indicating that there are tumor biology factors that we need
to understand through research. African American women are more likely
to be diagnosed with breast cancer at younger ages. We
are more likely to have biologically aggressive tumors called triple
(22:05):
negative breast cancers and male breast cancer is actually more
common in the African American community. So my own research
actually looks at studying the breast cancer burden of women
in different regions of the continent of Africa, and we've
learned that women from West Africa, which is the homeland
for the ancestors of most African Americans, the triple negative
(22:28):
breast cancers are most common in that part of the continent,
and it's because of specific genetic variants that developed in
the ancestors of West Africans related to having to develop
resistance to infectious.
Speaker 4 (22:42):
Diseases like malaria.
Speaker 5 (22:44):
But these variants have downstream consequences on the breast tissue
immune landscape such that it predisposes to the breast to
developing these triple negative breast cancers. So these international research
programs will actually teach us about the genetic root cause
of aggressive tumors like triple negative breast cancer, and it'll
(23:04):
teach us how to prevent and treat these tumors better.
Speaker 1 (23:07):
The research you're doing is so interesting, So are you
taking different populations globally and looking at sort of there
or are you focus mostly on the continent of Africa.
Speaker 5 (23:21):
We are definitely expanding more globally. We have several partners
now in different regions of Africa, because Africa is a
huge continent, tremendous diversity in terms of lifestyle, culture and genetics,
because it's the founder homeland for all of human kind.
Of course, so we do study breast cancer in East Africa,
(23:42):
West Africa, Central Africa, but we are also expanding to
study the breast cancer burden in Mexico and in South America.
These genetics of ancestry definitely play a role in susceptibility
for different patterns of the disease, and we have to
look at all of these internationally dis patient populations to
truly understand the root causes of cancer comprehensibly.
Speaker 2 (24:05):
So basically, all breasts are not created equal.
Speaker 4 (24:09):
I mean very true.
Speaker 2 (24:10):
It's true, and I'm talking at.
Speaker 1 (24:12):
A cellular level right and at a genetic level. At
Easy Spirit, they know comfort isn't just about footwear. It's
about empowering women to take action in their lives. That's
(24:35):
why this Breast Cancer Awareness Month, I'm proud to support
their Move for Pink initiative, helping to drive real change
for women everywhere.
Speaker 4 (24:43):
For the third year in a row.
Speaker 1 (24:45):
Easy Spirit has been giving back, donating a portion of
proceeds from their limited edition sneakers to support doctor Lisa
Newman's groundbreaking breast cancer research. I know firsthand how important
this work is. I've actually had my own journey with
breast cancer, and doctor Newman was my doctor. Easy Spirit
being a part of this important conversation helps shine a
(25:07):
light on how women can mobilize to drive change and
ultimately find a cure. I move for my health, for
my family, and for all the women out there who
are fighting their own battles. Walking, running, even a quick stroll.
It's how I stay motivated, stay strong, and stay connected
to what matters. Easy Spirit makes it easy for me
(25:28):
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They're truly designed for the way we live. Easy Spirit
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(25:50):
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easy spirit, you're taking a step in the right direction
for breast cancer research too. Another thing, I was curious
(26:19):
if some of the social determinants of health, you know,
like higher smoking rates or obesity rates, or the fact
that there are so many food deserts and the intersection
sadly of poverty and race, if that is also contributing
to not only access to healthcare and to preventative screening,
(26:42):
but also is that having an impact on the specific
cellular activity in breasts.
Speaker 2 (26:51):
Does that make sense?
Speaker 5 (26:52):
Oh, you stated it perfectly. It is so true. That's
absolutely correct. Environment definitely plays a role in breast cancer.
And there is a very large, exciting, growing body of
research looking at how certain neighborhood characteristics related to poverty
related to nutritional insecurity and food deserts. These characteristics are
(27:13):
not only associated with obesity rates, which is another risk
factor for getting breast cancer, but these neighborhood characteristics are
also inherently related to likelihood of developing certain breast cancer patterns.
Speaker 1 (27:26):
And also another problem I know is getting women of
color in clinical trials, right, I mean, it's hard enough
to get anyone in clinical trials, but particularly challenging for
the black community to participate. Why has that been so challenging, Lisa.
Speaker 5 (27:46):
Again, Katie, for so many complex reasons. They're destinately the
medical communityificant distrust.
Speaker 4 (27:53):
Yes, and for appropriate reasons.
Speaker 5 (27:55):
In the past, there have been horrific abuses in clinical
research tex Tuskegee, the Tuskegee experience, and so rightfully, many individuals,
especially from communities of color, are suspicious of clinical research.
But we can absolve the medical professional community from responsibility either.
(28:16):
There are actually many studies showing that one of the
biggest barriers to an African American cancer patient participating in
the clinical trial is the absence of the physician offering
a clinical trial to that patient. Some physicians just don't
want to take the time to explain the clinical trial.
(28:38):
Some physicians are fearful that bringing up a clinical trial
will somehow alienate the patient and generate more is distrust.
Speaker 4 (28:46):
But we have to get over that.
Speaker 5 (28:48):
Clinical trials are part of standard of care and we
have to offer them to everybody.
Speaker 1 (28:54):
The other thing I know that you care deeply about
is to have more black doctors, because I think people
feel often more comfortable when their doctor has a similar
experience than they do, and that is actually increasing, but
not at a fast enough rate, is it.
Speaker 4 (29:14):
Yeah, that is so true.
Speaker 5 (29:16):
Just as we need better gender balances in the healthcare
professional community, we also need more diversity in the healthcare workforce.
Speaker 4 (29:26):
And I do think that it's true that many.
Speaker 5 (29:28):
Patients want to have a match in terms of not
only the gender, but often the race, ethnicity of their
position to their own experiences and identity.
Speaker 4 (29:38):
But the patient population.
Speaker 5 (29:40):
Overall, I think will have greater trust in the healthcare
system if they see a healthcare system that reflects their
neighborhoods and their communities.
Speaker 1 (29:49):
Sharon, is that one of the reasons that going to
doctor Newman appealed to you? Did you feel more of
a connection with a woman of color as your surgeon?
She's okay, no, I'm curious.
Speaker 2 (30:03):
I mean, did that enter into it at all?
Speaker 3 (30:08):
Yes? But more importantly what entered into and she didn't know,
was that I did research on her. I went online,
and when I saw that her study what she was doing,
I thought, wow, not only is she a woman of color,
but also, you know, let's be honest, she is the
lead person in her field at her hospital, so her
(30:29):
expertise was important to me. The fact that she was
doing research around this was important to me. But that
wasn't enough for me. So I went to some other
doctors at other hospitals. And then, funny enough, gender is
important because when I went to the male doctor at
a very nice hospital, instead of telling me I had
dense bruss, he kept telling you, I had complex br us.
(30:51):
And a woman doesn't want to know she has complex
for us.
Speaker 1 (30:54):
Okay, I don't know, nice and a little nicer than
I was as a woman who gets called complicated.
Speaker 3 (31:03):
I was like, okay, now my breast complicated too, So
I was kind of taking that issue. But he didn't
handle me with the same care that doctor Newman handled me.
And then what was interesting was that he also was
specializing in the same type of research, but for Jewish women,
and I thought, wow, that's amazing, and I really appreciated
(31:23):
that he was doing that. But I was like, well,
he's specializing in Jewish women, and I've just talked to
a woman who's a woman who's handling me with a
lot of care and compassion. She has the expertise, and
more importantly, she is doing research about women like myself.
Speaker 4 (31:40):
So where do I go? It seems easy enough, and
I already.
Speaker 3 (31:44):
Knew I was going to her, but I just wanted
a second opinion. And then her peers in the industry
kept telling me she was amazing, so she didn't even
have to tell me she was amazing. Her peers in
the industry at the other hospitals were like, well, if
you're not going to go with us, she is one
of the best in the industry.
Speaker 1 (32:02):
So I'm curious, Lisa, and why you decided. I mean,
first of all, you're a brilliant person. You could study
whatever you wanted. I'm sure, why did you decide to
really investigate the disparities in white women and women of
color when it came to breast cancer.
Speaker 2 (32:21):
What was it?
Speaker 1 (32:23):
Did you have an aha moment? Did you treat somebody,
did you read the statistics? What made you think I
need to dig deeper into this.
Speaker 5 (32:32):
It was actually a little bit of everything you just described.
But before I get into that, I just want to
thank both of you for your comments, and I also
want to specifically give a shout out to Sharon for
the way she kept it so real with me. She
did her homework and investigated other centers and then she
came back and told me what she liked about my
program and what she didn't like about my program.
Speaker 4 (32:53):
She was very honest about things that we needed to
work on.
Speaker 5 (32:57):
Well, I'm not even going to say what they were,
because I've correct to everything that she told me about it.
But for me, it was a long journey to coming
to where my career is today and back. I won't
say how long ago, but it was more than twenty
years ago. When I was first starting on my career,
I was a general surgeon taking care of a lot
(33:19):
of different types of surgical problems, and back then we
didn't have an appreciation for the types of race related
differences in breast cancer burden that you described today, and
those are very well documented today, but that back then
we didn't understand them very well. We didn't understand the
fact that breast cancer is actually comprised of a whole
(33:41):
spectrum of different subtypes, and we just didn't understand why
some breast cancers were more poorly controlled than others. And
my general surgery practice was based in Brooklyn, New York, where,
of course we have a beautiful and robustly diverse patient population,
and every day I was struck in my own practice
(34:02):
by how my black breast cancer patients were being diagnosed
at younger ages. They were often diagnosed with bulkier tumors,
and they were developing recurrences of their breast cancer more frequently.
And so I decided to pursue additional training and research
so that I could have a dedicated career studying breast
cancer and dedicated to surgical management of the disease. So
(34:26):
that twenty year journey twenty plus your journey actually has
evolved into this international breast cancer research and a lot
of research looking at the genetics of the disease.
Speaker 1 (34:37):
I know that it's true in the case of calling cancer,
that younger and younger people are being diagnosed, which is
really upsetting people in their twenties and thirties and forties.
You know, you have to get a screening, colonoscopy or
some kind of calling screening at age forty five because
(34:58):
of these numbers, they lowered the age for your first screening.
And I'm curious if this is true for breast cancer,
and if you have any idea why younger and younger
people seem to be getting diagnosed with these diseases.
Speaker 4 (35:17):
Well, you are again correct.
Speaker 5 (35:19):
We are seeing a similar pattern in breast cancer as
what you described in colon cancer, with higher and increasing
population based incidence rates of breast cancer in younger women,
women that are still in the pre menopausal age ranges.
We don't completely understand the explanations, but we are assuming
at this point in time that it's related to a
(35:42):
constellation of factors. Diet, lifestyle, environmental exposures, obesity rates are
unfortunately on the rise in the United States, and all
of these factors, in addition to our genetics, we'll be
playing a role in.
Speaker 1 (35:56):
I wonder when you say environmental factors, I feel like it.
You know, it's frustrating to me because we've seen these
numbers for a few years now, and I've talked to
a lot of scientists because of stand Up to Cancer
and my own cancer activism, and some say it might
be the over prescription of antibiotics. Other people say maybe
(36:21):
process foods. We're hearing a lot about alcohol consumption and cancer.
I think a big study just came out about that
and how closely linked they are. When do you think
we're going to And I wonder about pesticides, and I
wonder about these forever chemicals. What are they called p fasts?
Is that what they're called? Anybody, come on audience, P
(36:45):
fast right, pfas I guess, And everything from leggings to
you know, rubber mats and all kinds of household products.
Speaker 2 (36:57):
When do you think, I know, it's.
Speaker 1 (36:58):
Really hard at semiologists struggle with this, But when do
you think we'll have a better idea about why this
is happening because it has such a huge impact on
screening recommendations and overall awareness for a younger population.
Speaker 5 (37:15):
Yeah, these are incredibly difficult questions to address, and yes,
epidemiologists are continuing to struggle with them. It is correct
that excessive and increasing rates of alcohol consumption on a
daily basis will increase breast cancer risk. Obesity increases breast
(37:35):
cancer risk. Leading a sedentary lifestyle with the lack of
adequate exercise on a daily basis, All of those patterns
will increase breast cancer risk. The things that do not
seem to affect breast cancer risk would be wearing a
brazier or not wearing a brazier, or different types of
brazil If.
Speaker 2 (37:53):
People think that really has an impact.
Speaker 5 (37:56):
It seems to cycle like every couple of years. There
are these yet on the internet about risk of braziers
and breast cancer risk, but yet non association.
Speaker 2 (38:06):
Yeah, but sometimes when.
Speaker 1 (38:07):
I used to take walks, I would stick my iPhone
and my bra and then I kind of wondered, Oh,
I wondered if that actually had an impact on my
breast cancer.
Speaker 2 (38:17):
Do you think it did?
Speaker 4 (38:19):
I don't think so.
Speaker 3 (38:20):
I do not think so. But I asked you about
the diet. Ho I think I asked you about my dietoke.
I was like, drinking twenty years of di coke? Did
that lead to my breast cancer?
Speaker 2 (38:29):
But you never?
Speaker 1 (38:30):
I mean, I think what's what the problem is. There's
you know, people fill in the lack of knowledge with
with uh, you know, ideas and speculation, and I think
we really need to focus on that.
Speaker 2 (38:45):
Are people studying this.
Speaker 5 (38:47):
They are very aggressively, but it's so difficult to get
a consistent and definitive handle on the answers because so
many of these factors are poorly recalled by individuals. They're
poorly documented, so it's difficult to accurately assess the quantity
of different dietary components, the exposures to different pesticides, right,
(39:14):
things that are in the environment.
Speaker 1 (39:16):
You believe in breast cancer clusters, you know, where you
see a lot of breast cancer like Long Island by
the way. Yes, that is that there have been reported
a lot of cases in certain geographic areas or in neighborhoods,
and you know, but it's never quite proven. And is
(39:36):
that something that you think warrants more study.
Speaker 5 (39:41):
Yeah, absolutely warrants more study. And the clusters are very real.
It becomes difficult to tease out though why those clusters
occur because neighborhoods exist with people living in the same
environment for so many different reasons. Families like to live
together if they have certain lifestyles in common, or cultures
(40:02):
in common, race ethnicities often want to be in the
same neighborhood with each other. So there are just so
many factors that go behind the reasons why a neighborhood
is characterized by one pattern versus a different pattern.
Speaker 1 (40:17):
But it does make you wonder, like is there an
environmental fact as way here? Is it like a certain
kind of plant maybe nearby that or pesticides anyway, It's
as I said, it's a lot of speculation. Let's focus
on for the remaining time we have on the best
way to prevent breast cancer and the best way to
(40:39):
prevent a recurrence of breast cancer, because I think both
of those are so important. We're all wearing our nice, comfortable,
easy spirit shoes, and that makes me want to ask
you about exercise and the role of being a physical
activity in terms of not only breast cancer, but a
(41:01):
whole host of diseases.
Speaker 4 (41:03):
Yeah.
Speaker 5 (41:04):
Yeah, exercise and continuing to move, being on the move
is good for the mind, body, and soul, and it
very definitely is valuable in preventing breast cancer and in
having a better outcome if you have been diagnosed with
breast cancer. Now, I don't want women and breast cancer
(41:25):
survivors to feel that everything is on their shoulders and
in terms of preventing a recurrence of a breast cancer
or preventing it from being diagnosed altogether, because some things
are simply out of our control. But absolutely we can
provide ourselves some protection against a breast cancer diagnosis with
a healthy lifestyle, balanced diet, and continuing to be screened.
(41:51):
Because there is no doubt about it that early detection
of a breast cancer, regardless of the breast cancer subtype,
early detection of that breast cancer is a huge factor
in likelihood of successful treatment, and if a breast cancer
has been diagnosed, a woman has to be vigilant about
her breast evaluation for both breasts for the rest of
(42:13):
her life. She not only could develop a recurrence of
the breast cancer in that breast or in other parts
of the body, but.
Speaker 4 (42:19):
She can develop a whole new breast cancer. And it
always breaks my heart when.
Speaker 5 (42:23):
I hear breast cancer patients say that they just didn't
realize that they have to be on the lookout for
a new cancer developing.
Speaker 4 (42:32):
There's a Lenser's key.
Speaker 1 (42:33):
Yeah, there's exercise, and there's exercise, like for me taking
a nice walk around Central Park and looking at all
the people and the squirrels and the birds. But how
like how intense should your exercise be? Because I think
there's a big spectrum right from lazy to intense. Right,
(42:57):
So do you have to really get your heart rate up?
And can you give us some advice on that, Lisa,
or is it kind of out of your well.
Speaker 5 (43:08):
I don't think that you have to be manic about
your exercise regimen, but making sure that you walk regularly
throughout the day, take a flight, or two upstairs every day.
Speaker 4 (43:25):
That will help.
Speaker 1 (43:26):
And if you break a sweat, it's a good thing, right.
I don't like very sweat straightforward parameter. Okay, let's just
talk quickly about diet and alcohol and sort of what
you recommend. Should I not be eating bacon because it
is my favorite food, it is my very favorite food.
Speaker 2 (43:45):
Well, it's all about balance, because I don't.
Speaker 3 (43:49):
Want to hear the answer to that one. I love bacon. Oh,
but I'm good. I took off both of us, so
I'm good.
Speaker 1 (43:55):
Bacon is probably not good for a lot of different things.
Speaker 5 (43:58):
But yeah, it's all about balance in life and not
overdoing it with any type of food on a daily basis,
but especially fried foods, things like and fatty foods.
Speaker 4 (44:10):
You don't want to overdo those on a daily basis.
Same with alcohol.
Speaker 5 (44:13):
There are some cardiovascular benefits to some alcohol intake, but
more than a couple of glasses on a daily basis
is going to be bad for a number of different
health issues, including breast cancer. Risk of diet that has
a lot of fresh fruits and vegetables in it is
excellent fiber. Fiber isn't a fiber? Yeah, yeah, And in general,
(44:39):
all of the dietary patterns that are good for cardiovascular
health are good for breast health.
Speaker 1 (44:45):
Let me ask you about genetic testing because I feel
like a lot of people don't get genetic testing. They
think it's too expensive or they think, you know, honestly,
they sort of don't want to know. So who is
genetic testing right for? And what would you tell your
patients or anyone listening to our conversation about genetic testing.
Speaker 5 (45:10):
Well, fortunately, the costs of genetic testing have plummeted since
the Supreme Court ruling in twenty thirteen opening up genetic
testing to be performed by a number of different companies.
The prices have plummeted, and we have large scale panels
for genes that can be evaluated to look for hereditary
susceptibility for a variety of different cancers, not only breast cancer,
(45:34):
but we can identify hereditary predisposition for ovarian cancer, colon cancer, melanoma. Now,
there are some people who believe that everybody should be
genetically tested, at least for certain genes when they reach
adult life. We haven't quite gotten to the point where
that is broadly available to the general population. At this
(45:57):
point in time, the United States and Services Task Force
does recommend that anybody with Oshkenazi Jewish background should consider
getting tested for specific BRCA mutations once they reach age thirty,
because there's a very high risk.
Speaker 1 (46:13):
For your risk of breast and ovarian goes up to
eighty percent if you'r BRACK a positive right.
Speaker 5 (46:18):
Exactly, That is so true if you do have a
strong family history of breast cancer ovarian cancer, I mean
multiple relatives with either of those cancers. If there are
any men in your family with breast cancer, if you
have in your extended family tree many individuals diagnosed with
even other cancers such as coerectol or melanoma, those would
(46:42):
all be features indicating that you should consider getting genetic
testing done. If there's a bilateral breast cancer in the family,
breast cancer being diagnosed at younger ages, for women that
are themselves diagnosed with breast cancer at young ages, or
triple negative breast cancers, these are all so features indicating
that you might be more likely to have hereditary predisposition.
(47:05):
Now I am a breast surgeon, The American Society of
Breast Surgeons advocates in favor of all women who've been
diagnosed with breast cancer, regardless of age, racial ethnic background,
regardless of their pattern of breast cancer. If they are
diagnosed with breast cancer, they should be offered genetic testing.
And so I do offer genetic testing to all of
my patients.
Speaker 1 (47:25):
I would like to make another argument for genetic testing though,
if I may, I do you know I think what
people don't understand is the vast majority of cancers involve
no family history. I think it's something like seventy eight
or eighty percent of calling cancer cases. And I know
(47:47):
a lot about this because my husband have no family history. Similarly,
the majority of breast cancer cases have no family history.
So isn't it smart before you get diagnosed to see
if you have any genetic mutations that may make you
at greater risk for any of these cancers so you
(48:11):
can schedule your screenings accordingly, So you might have to
be more vigilant. For example, I had genetic testing, I
believe it or not, have a higher risk of colling
cancer slightly because I have some genetic mutation and new
mutations are being discovered all the time.
Speaker 2 (48:29):
So to me, it's kind of.
Speaker 1 (48:30):
A no brainer to say, well, boy, I better not
forget to get my colling cancer, screening my colonoscopy or
my colon guard, whatever I choose to do.
Speaker 2 (48:40):
So isn't that a good argument?
Speaker 1 (48:42):
I remember, by the way, my parents were late for
their colonoscopies or whatever, and I was like, you guys
know how embarrassing it would be for me if you've
got diagnosed with calling cancer.
Speaker 2 (48:51):
Come on, anyway, it's all about me.
Speaker 1 (48:56):
So why wouldn't people recommend screening before they get diagnosed
with something so they can be armed with better information
that could potentially save their lives.
Speaker 5 (49:08):
Ye, you are correct again, genetic testing a way.
Speaker 4 (49:12):
Yes you are. In my book, you already are, but correct.
Speaker 5 (49:18):
Genetic testing can save lives, and it does save lives
as we learn more about it. People who have hereditary
predisposition for different cancers can detect those cancers earlier with
enhanced screening. Some of these genetic markers serve as markers
for specific treatments that will be necessary if a cancer
is diagnosed, and we have good ways of preventing different cancers.
(49:42):
Individuals that are at higher risk for ovarian cancer if
they remove their ovaries, that is a wonderful way to
prevent ovarian cancer. And it's been shown to have survival advantages.
People that are at high risk for breast cancer are
candidates often to take special medication that can prevent breast cancer.
Speaker 1 (50:01):
Or you know, to even make lifestyle changes, right. You know,
if you know that, you can say I'm going to
make sure I'm really vigilant about my diet and exercise.
Speaker 3 (50:11):
But I will say as someone who I did the test,
I did the genetic testing and came back negative the
first time, So I don't want people to get comfortable
to take it and it comes back negative.
Speaker 2 (50:21):
Like I do a false sense gave me a false.
Speaker 3 (50:23):
It did, and then I took it again once I
did find out, but this time I took a full panel, right,
So when you take it, take the full panel. And
I did it the second time not for me, but
my daughter, right because I needed to know and make
sure my daughter had as much family history as she
could possibly have. So I would definitely encourage everyone to
(50:44):
have it. And when you have it, take the full panel,
because now we've discovered that I have some unknown genetic
and that we're going to need more people to do
genetic testing so we can figure out what my own
known and I'm at risk for right.
Speaker 1 (50:58):
You know, you mentioned Sharon so beautifully at the beginning
of this conversation that you're trying to serve others and
help your community understand the importance of early detection about
getting screened. And I'm curious, how are you doing that,
because it's so important that women of color that we
(51:21):
reach out to them and make sure they know where
to go to get screened, make sure they know where
to go if they're uninsured or underinsured or insured, you know,
And I'm curious what you think are the most effective
ways to reach women.
Speaker 3 (51:38):
Well, I mean, first, it starts with the conversation. So
like my mother, I was also very very private, and
when I discovered I had breast cancer, I actually, for
the first time my life decided to be public and
so I started sharing with everyone. Then I had breast
cancer and well, my doctor was my treatment. My daughter
created a WhatsApp communication because I didn't how to do
(52:00):
it with all my friends and telling them to get mammograms.
Before my surgery, I had a bye bye Boobs party
and I invited men and women to come to say
bye bye to my twins, but also to once again
talk about the importance of early detection.
Speaker 4 (52:17):
And making it less.
Speaker 3 (52:20):
Scary for folks. And everyone knew that my mom had
allowed hers to metastasize and what it caused me, and
so what they felt was like Wow. I had people
go get their mammograms and make appointments. I also run
a boys and girls club, so I have lots of
thousands of families there. So we are now having community
days where we're bringing in health professionals to talk about diabetes,
(52:44):
breast cancer, asking the American Cancer to bring the van
so we can do free screenings because a lot of
our parents are living the poverty line. And I know
for a fact that my father also died from cancer,
and both my mother and my father did not necessarily
go to the best places and didn't get the best device,
and they listened only to one doctor who wasn't necessarily
(53:06):
giving them the best device. And so I think sometimes
as African Americans were scared and we live by fear.
And so I also am a minister in a church,
and so I talk about it in the church.
Speaker 1 (53:18):
I was going to say, Black churches to me, would
be a great place to spread the word.
Speaker 2 (53:23):
Maybe you could travel around to a bunch of.
Speaker 3 (53:26):
So I've been motivational speaking on this topic, and it's
really about the fact that and when I said it
at church, all these older women came up to me, go,
I had breast cancer, And I'm like, I've been sent
up here, y'all to tell me, Like I was trying
to figure out if I get a tattoo, no nipples,
all these things I had questions about, and y'all sitting
(53:47):
here and y'all knew I was having a double mis actomy.
Speaker 2 (53:49):
You don't want to tell me.
Speaker 3 (53:51):
But I think that the more I've been comfortable with
it and I've been sharing, I had surgery yesterday, by
the way, but I'm telling every I'm on the ones app.
Speaker 2 (54:02):
I'm not only.
Speaker 3 (54:02):
Instagram because I don't know how to do social media,
but I'm sharing, And I think taking the stigma out
of it, taking the fear out of it not being.
Speaker 1 (54:12):
And also having a sense of humor clean breaks I
think that breaks the ice for people.
Speaker 3 (54:19):
It really does, because I told everyone I had to
have emergency surgery yesterday, and I told everyone's because I
only had cancer in my right breast and my left
breast was fine, So my left breast got mad at
me for cutting it off. And then I wound up
getting an affection, so I had to take take care
of it yesterday. So but I have decided that I'm
going to laugh and I am going to enjoy it,
(54:40):
but I'm going to share, and I'm going to ask
people to go get their mammograms. I'm going to ask
them to have opinions, to do the research, do their homework,
get the genetic testing. And also, don't be afraid to
share with your children. They've got a note too, You've
you know, like I think sometimes with parents we want
to love them and protect them and keep it to ourselves,
but we owe them to talk to them and to
(55:02):
share in our journey.
Speaker 2 (55:05):
Before we go.
Speaker 1 (55:06):
I want to ask you one question, Lisa, about the future,
because I've been reading obviously a lot about AI. Who
hasn't and now with the expanded use of AI when
it comes to things like screening and pathology, etc.
Speaker 2 (55:21):
It's very exciting.
Speaker 1 (55:23):
I know that I read that AI can make early
detection easier and that it can even be used to
predict who might actually be diagnosed with breast cancer before
they even exhibit any symptoms, which is mind boggling to me.
(55:43):
Can you talk a little bit about how you see
the role of AI changing your field.
Speaker 4 (55:49):
Oh, it's the enormous, Katie.
Speaker 5 (55:52):
Yes, AI holds great promise in being able to improve
breast cancer outcomes. And as you mentioned with mammograms for example,
wouldn't it be incredible if, based upon a screening mammogram
and a woman that's totally healthy, if we could predict
the thirteen percent of the women in this country that
are destined to develop breast cancer and then prevent.
Speaker 4 (56:14):
The cancer from developing in them.
Speaker 5 (56:16):
And this is the promise of the artificial intelligence algorithms.
Now we're not quite there yet, but that is the
direction that we're going in. And artificial intelligence big data
algorithms are very useful in being able to evaluate and
read pathology biopsy specimens. But just as AI holds incredible promise,
(56:38):
it also holds great risks and if we don't do
it right, we're going to worsen the disparities that already exist.
If we develop these AI algorithms based upon data from
limited populations skinny women, women that are more affluent, women
with only European ancest we're going to be very limited
(57:03):
in what we can learn from these algorithms and we're
going to worsen some of the disparities that already exist.
Speaker 2 (57:08):
That's such an important point.
Speaker 1 (57:09):
Do you think that the tech world is mindful of
that as they start developing these tools, because I feel
like the word is out that these disparities exist and
that the large language models, whatever you call them, really
have to include a diverse population.
Speaker 4 (57:29):
Yeah.
Speaker 5 (57:30):
I hope that they are robustly aware of these risks,
but I'm not too sure because unfortunately, they often end
up relying upon data sets that already exist, and these
pre existing data sets are frequently very limited in the
individuals that have contributed data. So we have to be
(57:51):
working together to generate new data sets that are more
broadly inclusive of women that live in different environments, the
women that consume different types of diets, women that have
different ancestral backgrounds.
Speaker 4 (58:04):
These data sets have to be generated de novo.
Speaker 2 (58:07):
Yeah, such a good point.
Speaker 1 (58:08):
Well, Sharon Joseph and doctor Lisa Newman, you both are
such rock stars. Thank you so much for such an
important informative conversation about breast cancer for Breast Cancer Awareness Month.
Thank you for the research you're doing, Sharon, thank you
for your advocacy, and everyone here. Thank you for being
(58:29):
a part of this conversation. I hope you'll go out
and spread the word to all of your friends and
family members.
Speaker 2 (58:35):
So thank you, thank you, and thank.
Speaker 4 (58:38):
You for being so fabulous. Your sake so many lives.
Speaker 5 (58:43):
Katie, just by being who you are.
Speaker 1 (58:56):
Thanks for listening everyone. If you have a question for me,
object you want us to cover, or you want to
share your thoughts about how you navigate this crazy world
reach out. You can leave a short message at six
oh nine five P one two five five five, or
you can send me a DM on Instagram. I would
love to hear from you. Next Question is a production
(59:18):
of iHeartMedia and Katie Couric Media. The executive producers are Me,
Katie Kuric, and Courtney Ltz. Our supervising producer is Ryan Martz,
and our producers are Adriana Fazzio and Meredith Barnes. Julian
Weller composed our theme music. For more information about today's episode,
(59:38):
or to sign up for my newsletter wake Up Call,
go to the description in the podcast app or visit
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wherever you listen to your favorite shows. Hi everyone, it's
(01:00:02):
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with the code next twenty. Hi everyone, I'm Katikuric and
this is Next Question. Welcome everyone to this live taping
of Next Question with me Katiekuric. I am very excited
(00:43):
to be having this important conversation produced in partnership with
Easy Spirit here at the Pailey Center for Media in
New York City in honor Breast Cancer Awareness Month. And
in our audience are lots of breast cancer survivors, people
who may be in treatment right now, and people who
are trying to raise money and awareness for this disease. This,
(01:07):
of course, is a topic that is very near and
dear to my heart. Literally, as some of you might
know and some of you listeners out there, I was
diagnosed with stage one A breast cancer in twenty twenty two.
I had spent the previous twenty four years as a
cancer advocate after losing my husband when he was forty
(01:28):
two years old to colon cancer, going as far as
getting a colonoscopy on the Today Show, because let's face it,
nothing says good morning like showing your calling on national
television at seven thirty am. Then a number of years later,
(01:49):
after a mammogram and a breast ultrasound, I went from
advocate to patient myself. I was really grateful through my
breast cancer journey to have access us to incredible care.
And one of our guests today is actually my rest surgeon,
doctor Lisa Newman, who held my hand and gave me
(02:09):
a ton of confidence and reassurance throughout the entire process.
I cannot say enough nice things about Lisa, who said
I could call her Lisa.
Speaker 2 (02:21):
An easy spirit.
Speaker 1 (02:23):
I am very grateful they've been able to help fund
some of doctor Newman's critically important life saving research. The
two of us are joined by another one of doctor
Newman's patients. It's like a little Lisa Newman fanclick very much.
Sharon Joseph. Sharon is the CEO of Boys and Girls
(02:44):
Club of Harlem and is still in the middle of
her treatment. So thank you both so much for joining
us today. And since this is a live podcast, I
think it's okay to ask you all to give these
ladies around ubform and our hope is that so many
(03:09):
women will listen to this podcast, So I hope you'll
spread the word because we hope to impart a lot
of important, as I said, life saving information to everyone listening.
So I think, Sharon, many of us our media thought
after being diagnosed, is I have cancer?
Speaker 2 (03:30):
Now what?
Speaker 1 (03:31):
And I'm hoping that today's conversation will shed some light
not only on the physical changes and treatment that you undergo,
but the mental and emotional toll it can also have
on you. You were diagnosed earlier this year, Sharon, tell me
about that day and how you felt hearing the news.
Speaker 3 (03:54):
Needless to say, I was shocked. I don't know what
I thought a cancer pation looked like, but I didn't
you looked like me, which is such an arrogant assumption.
I had watched my mother have breast cancer and metastasized
her brain. I'd taken a BRACA test and it came
back negative, so I really thought I was clear. So
(04:18):
I knew I had dense bress, and I consistently had
my mammograms, and ironically, they had told me that I
couldn't get my mammogram until November December of this year,
and I advocated for having it earlier and I wound
up having it on Mother's Day. And I remember joking around, going,
this is the best Mother's Day gift I can give myself.
I didn't realize how true that statement was going to become.
(04:40):
And I always have a mammogram and ultra sound together.
And so I was on my way to church and
they kept bringing me back into the room and I'm like, hey, guys,
what's going on here? I gotta go, And then they
said we found something and I wasn't surprised. I have
dense bress. And then they sent me for a buyof
see and then I was joking around there too, still thinking,
(05:04):
you know, this is just what happens when you have
dense breass. And then I got the news. And when
I got it, I was shocked, but I was also like, going, okay, mom,
this is you right telling me now. You make your
own decisions. You were judgmental, but mind, let's see how
you handle this. And I remember my radiologist. I had
(05:26):
asked her for her help. I said, well, where do
I start? I need a good recommendation of a doctor.
And she said, the best one I know is doctor
Lisa Numan. And She's like, she's really busy, but I'm gonna,
you know, tell her about you and you call her.
And I called her, and from the very first moment
I met her, I was like wow, but I was emotional.
(05:47):
I went from being a little overwhelmed to then jumping
into a problem solving mode. Okay, this is a problem.
What am I going to do? What steps am I
going to take? And realizing that I wasn't going to
do this by myself, and thinking about all the people
that I needed to be here for, like my daughter,
(06:08):
a daughter's and wondering, okay, what do I do? I'm strong,
I can do this, but you're alone, you're sad, you're mad,
You're going why me? And then there's a why not me?
And how are we going to turn this around? That
I'm not a victim, I'm a victor, And how am
(06:30):
I going to use this to bless somebody else? And
that's how we started this journey.
Speaker 2 (06:34):
That's beautiful.
Speaker 1 (06:35):
Actually, Karen A couple of questions. So my understanding was
your mom kept her breast cancer diagnosis a secret that
when you were helping her and driving her to the
doctor's office or driving her to the hospital, she never
(06:59):
came out and said to you, Sharon, this is what
is going on.
Speaker 2 (07:04):
Tell me about that. I left my mother.
Speaker 3 (07:09):
My mother, and I think I inherited too, this kind
of strong woman persona that many of us in this
room probably also have. And we're Caribbean, and so it's
not only strong woman persona, but it's keep it to yourself.
And maybe she thought she was also protecting me, but
she said, I have a procedure and I said where,
because I'm nosy. She told me it was all the
way downtown and she was going to take two buses
(07:30):
and a train and I said, no way, Mom, I said,
what's the procedure? She said, do don't worry about it.
I'm okay. And so I literally drove my mother down
and she got out the car, and I started calling
all my relatives, including my relatives in the Caribbean, and
I'm like, Mommy's having a procedure and I don't know
what this is. Do you know what this is? And
(07:51):
finally someone said, we think your mom has breast cancer
and she's doing something about it.
Speaker 2 (07:57):
And that was it. You never discussed it with her.
Speaker 3 (08:00):
I went upstairs and found her in the room, and
when she was coming out and I'm like, mom, she's like,
I'm fine, what happened today? Oh, don't worry.
Speaker 1 (08:16):
That's so interesting. You know, culturally, it sounds like there's
still a lot of secrecy surrounding cancer diagnosis, And when
you think about it, it's not all that's surprising, because
I think it's really within the last gosh, maybe twenty
five years, and it's hard to remember how people just
(08:40):
didn't discuss cancer and they were sort of embarrassed or
secretive about it. And then, as Sharon mentioned, culturally for
some black women, it's still like that. Can you describe
what you've seen among your patient population with that trend
(09:02):
or the women you've been studying?
Speaker 4 (09:04):
Yeah? Thanksana.
Speaker 5 (09:05):
First of all, your story sharing is just incredible. Thank
you for sharing it is so so very powerful.
Speaker 4 (09:11):
Appreciate it.
Speaker 5 (09:12):
But it is true that unfortunately, many women do feel
this stigma associated with a breast cancer diagnosis. And I
can remember in my own family similaria is a lot
of the reluctance to say the word I can call
my mom talking about the Big Sea. It was as
if saying the word was somehow going to make it
(09:36):
real and ignoring it was going to make the problem
going go away. And one of the organizations that I
work with quite a bit, the Sisters Network, Incorporated, which
is an African American breast cancer survivor's organization, a national organization.
Their logo is to stop the silence, specifically to counteract
that pervasive impression that you shouldn't talk about breast can answer.
(10:00):
We are empowering ourselves if we talk about the diagnosis
and we share with each other how to protect ourselves
against the threat of breast cancer. And we do have
so many ways that we can protect ourselves. Between screening, treatment,
survivorship medalities, we can protect ourselves against this disease.
Speaker 1 (10:19):
And just talking about it is so critically important. I
remember reading in The Emperor of All Maladies. I might
have mentioned this to you before, Lisa, by Siddartha Mukherjee.
It's a great book. You want to pull a surprise.
It's about the history of cancer. It's fascinating and in
the nineteen fifties when women who had breast cancer were
looking for a support group. I think the New York
(10:42):
Times wouldn't allow them to put in the classifies that
they were looking for other breast cancer patients. They would
have to say looking for women who have been diagnosed
with cancer of the chest cavity, because they didn't want
to write the word breast, which is just so unbelievable.
And that was in the nineteen fifties. So we have
(11:04):
come a long way, but clearly not far enough when
it comes to bringing this topic out into the open.
And when I heard Sharon's story, I was like, Wow,
she actually is one of those women who has done
everything right because she knows she has dense breast. Forty
(11:25):
two percent of women over the age of forty have
dense breast, and we're going to talk about that some
more in a moment. But because of that, she got
a mammogram and an ultrasound, which was your usual routine
every year or every two years, or every year I guess, right.
Speaker 3 (11:42):
A year, almost every six months if I could.
Speaker 1 (11:44):
Really And was it because of the family history that
you got both of them or how.
Speaker 2 (11:49):
Did you find out?
Speaker 1 (11:50):
By the way, this is going to be very instructive
because so many women don't really know about dense breass.
How did you find out you had dense breass?
Speaker 3 (11:59):
Really through my doc when we talked about it. I
had had a benign syst in my left breast and
we've been monitoring that. And again because my mother's breast
cancer atasthtsized to her brain, I was very very aggressive
about trying to make sure I had my mammograms and
ultrasounds both on the same day so that I could
(12:22):
constantly test, and also doing self checks. So I was
very religious about them.
Speaker 1 (12:27):
That's wonderful because first of all, just so everyone knows,
and Lisa should be saying this, but I'm like the
dense breast lunatic now because I have dense breasts. And
number one, if you have dense breast, you have a
higher risk of being diagnosed with breast cancer. Number Two,
(12:48):
a mammogram alone can't necessarily tell if you have any
kind of abnormality. So I have all at and like
people feel their breasts and they're kind of lumpy and
big or they're whatever, and they think.
Speaker 2 (13:03):
Oh, I have dense press.
Speaker 1 (13:04):
You can only find out through a mammogram if you
actually have dense press and as I said, nearly half
of women over the age of forty fall into this category.
And so you really need additional screening and we're going to.
Speaker 2 (13:18):
Talk about that.
Speaker 1 (13:19):
Well, why don't we just talk about that now, because Lisa,
it's very upsetting to me A that so many women
don't know that. And the FDA changed their rule requiring
women to be notified that they have dense press and
it all has to be done in the same language now, right,
that was I think done in the spring of last year,
(13:41):
put into effect maybe in September.
Speaker 2 (13:44):
Actually it became icial rules. Thank you. I've got all
these experts in audience. I should just have asked you all.
Speaker 1 (13:51):
But anyway, you know, Sharon knew this already, but so
many women don't. How can we spread the word A
that you need to find out if you have dense
breasts and be about additional screening and see insurance companies
need to pay for additional screening.
Speaker 2 (14:09):
It's so unfair and so wrong.
Speaker 5 (14:13):
Yeah, so you stated the main issues perfectly as you
always do, Katie.
Speaker 2 (14:18):
Oh, thank you, Lisa, but.
Speaker 4 (14:22):
It's so true. But yeah, you're right.
Speaker 5 (14:24):
The Foot and Drug Administration of enacted policies such that
all mimography units have to now report on breast density
to patients that are undergoing mamographic evaluation, and it became
official for all states just a couple of weeks ago,
So that.
Speaker 4 (14:40):
Is a wonderful advance.
Speaker 5 (14:41):
However, women are then left with having to sort out
what do I do next now that I've been told
that my mammogram shows breast density. I would recommend that
you speak to your radiologist, Sharon did. Speak to your
healthcare provider, because there are options in terms of addition
enhanced breast imaging, such as breast ultrasound.
Speaker 4 (15:03):
Some women will need breast MRI.
Speaker 5 (15:06):
There are innovative ways of performing mammograms, such as contrast
enhanced mimography, and these modalities can sometimes help improve the
ability to evaluate the mammogram. As you also correctly stated,
having that breast density not only makes a regular routine
mammogram more difficult to interpret, but it's a risk factor
(15:27):
indicating that you're att more likely to develop breast cancer
in the future. So speak with your healthcare provider if
you are told that you have dense breast find out
what your options are and make sure that these options
and issues are documented, because the way that they're documented
can influence whether or not your insurance plan will reimburse
will pay for the additional testing business.
Speaker 1 (15:49):
I know that in some states it's required that they
pay insurance for additional screening. I interviewed somebody in Ohio
I think you were on the podcast with her actually,
who really fought to have insurance pay for additional screening
because she was diagnosed with stage four breast cancer. They
(16:10):
kept missing it on the mammogram. So I really admire
her and the women in other states have worked to
make this happen.
Speaker 3 (16:18):
I'll also say that even though I got the mammogram
and the ultrasound, the MRI showed more. Yeah, So if
we had just left it to the mammogram and the ultrasound,
it would have only shown a very small portion. The
MRI showed that there was a lot more than they
initially thought. So that's additionally why it's important.
Speaker 1 (16:38):
Yeah, but I think wouldn't a standard of care be
if someone like Sharon presented with something suspicious on both
the mammogram and the breast ultrasound, she would almost automatically
be given an MRI to kind of validate the findings.
Speaker 2 (16:53):
Or am I crazy?
Speaker 5 (16:55):
Now, that is often the strategy, But the decision about
MRIs in the base of a breast cancer diagnosis is
definitely a nuanced, challenging decision to make, but often it
is very, very helpful. Breast MRI is absolutely valuable in
women that have known breast cancer predisposition such as a
strong family history, a known genetic susceptibility, mutation carriers such
(17:20):
as a BRCA mutation, women that have had prior therapeutic
radiation to the chest wall.
Speaker 4 (17:26):
These are all markers.
Speaker 5 (17:27):
Of women that will benefit from MRI in addition to
MAMMOGRAHAM to early detect a new breast cancer.
Speaker 1 (17:34):
You know, I know that women, white women, and black
women are diagnosed at the same rate with breast cancer,
but black women have a forty percent higher mortality rate.
I discovered this when you were treating me for my
breast cancer, and it was so disconcerting. Can you explain
(17:56):
why this is the case.
Speaker 5 (17:58):
Yeah, well, there are a lot of reasons at which
I am happy to discuss, But first of all, I
just have to say I was so struck in getting
to know you through your treatment experience, how passionate you
became about addressing breast cancer disparities and learning about breast
cancer disparities. This woman, as she's getting ready to start
(18:18):
her breast cancer surgery, she's talking about how she wants
to use her experience to advocate for women so that
all women have access to the treatment options that she
was able to avail herself of.
Speaker 4 (18:31):
It's still mind volve them.
Speaker 5 (18:32):
To me, how gracious you are, how you think of everybody?
Speaker 1 (18:36):
Were getting me to sleep, you know, making me count
for ten backwards, and I was like, you guys, it's terrible.
Speaker 2 (18:46):
So many women.
Speaker 1 (18:47):
Well, you know, I felt so lucky that I had
the good fortune and honestly the financial wherewithal an insurance
coverage to get the very best treatment available. And I
couldn't stop thinking what would I have done if I
had had to wait to get my lump back to me,
(19:09):
if I had to wait to get my mammogram, if
my doctor didn't automatically give me a breast ultrasound every
time I was checked. And you know, your health should
not be determined by your zip code or your bank account,
and it so often is. And that's why I am
so passionate about not only giving the people the information
(19:31):
they need, but supporting them because it's just unfair that
a person of means is a survivor and a person
who doesn't have means is often not. And it's just
the inequities are maddening to me. Well, and I'm going
to talk about your research in a second, but let's
(19:54):
talk about the reasons that Black women have a forty
percent higher mortality. Some of it has to do with
their breast density, right, and some of it has to
do with access.
Speaker 2 (20:07):
Can you just talk about that, Lisa.
Speaker 5 (20:09):
There are many complex reasons explaining these breast cancer disparities
that you described, and indeed, breast cancer mortality rates death
rates are forty percent higher in African American women compared
to White American women. Now, the incidents rates actually used
to be lower for breast cancer and Black women compared
to white women, but there's been a disproportion so interesting incidence,
(20:31):
so that now the rates are equal. But we've had
this widening of the mortality gap, and it's because of
a lot of different factors. The disproportionately high prevalence of
socioeconomic disadvantages in the African American community, higher poverty rates,
higher rates of being uninsured or under insured, all of
(20:53):
these factors definitely contribute to delays and breast cancer diagnosis,
delays in completing treatment, and this will result in higher
mortality rates.
Speaker 1 (21:02):
So poverty, but it's also these social determinants of going on.
Speaker 5 (21:07):
Yes, yeah, so we still unfortunately continue to see discriminatory
patterns in the healthcare system. African American women are less
likely to be offered genetic testing, African American women are
less likely to have mimmography in the highest quality centers,
and African American women are less likely to be offered
(21:27):
cutting edge breast cancer treatments, such as in the setting
of clinical trials and clinical research. So we definitely have
to address all of those inequities in the healthcare system,
number one, if we're going to achieve.
Speaker 4 (21:41):
Breast health equity.
Speaker 5 (21:43):
But there are other factors, and there are several characteristics
that describe the breast cancer burden of the African American community,
indicating that there are tumor biology factors that we need
to understand through research. African American women are more likely
to be diagnosed with breast cancer at younger ages. We
are more likely to have biologically aggressive tumors called triple
(22:05):
negative breast cancers and male breast cancer is actually more
common in the African American community. So my own research
actually looks at studying the breast cancer burden of women
in different regions of the continent of Africa, and we've
learned that women from West Africa, which is the homeland
for the ancestors of most African Americans, the triple negative
(22:28):
breast cancers are most common in that part of the continent,
and it's because of specific genetic variants that developed in
the ancestors of West Africans related to having to develop
resistance to infectious.
Speaker 4 (22:42):
Diseases like malaria.
Speaker 5 (22:44):
But these variants have downstream consequences on the breast tissue
immune landscape such that it predisposes to the breast to
developing these triple negative breast cancers. So these international research
programs will actually teach us about the genetic root cause
of aggressive tumors like triple negative breast cancer, and it'll
(23:04):
teach us how to prevent and treat these tumors better.
Speaker 1 (23:07):
The research you're doing is so interesting, So are you
taking different populations globally and looking at sort of there
or are you focus mostly on the continent of Africa.
Speaker 5 (23:21):
We are definitely expanding more globally. We have several partners
now in different regions of Africa, because Africa is a
huge continent, tremendous diversity in terms of lifestyle, culture and genetics,
because it's the founder homeland for all of human kind.
Of course, so we do study breast cancer in East Africa,
(23:42):
West Africa, Central Africa, but we are also expanding to
study the breast cancer burden in Mexico and in South America.
These genetics of ancestry definitely play a role in susceptibility
for different patterns of the disease, and we have to
look at all of these internationally dis patient populations to
truly understand the root causes of cancer comprehensibly.
Speaker 2 (24:05):
So basically, all breasts are not created equal.
Speaker 4 (24:09):
I mean very true.
Speaker 2 (24:10):
It's true, and I'm talking at.
Speaker 1 (24:12):
A cellular level right and at a genetic level. At
Easy Spirit, they know comfort isn't just about footwear. It's
about empowering women to take action in their lives. That's
(24:35):
why this Breast Cancer Awareness Month, I'm proud to support
their Move for Pink initiative, helping to drive real change
for women everywhere.
Speaker 4 (24:43):
For the third year in a row.
Speaker 1 (24:45):
Easy Spirit has been giving back, donating a portion of
proceeds from their limited edition sneakers to support doctor Lisa
Newman's groundbreaking breast cancer research. I know firsthand how important
this work is. I've actually had my own journey with
breast cancer, and doctor Newman was my doctor. Easy Spirit
being a part of this important conversation helps shine a
(25:07):
light on how women can mobilize to drive change and
ultimately find a cure. I move for my health, for
my family, and for all the women out there who
are fighting their own battles. Walking, running, even a quick stroll.
It's how I stay motivated, stay strong, and stay connected
to what matters. Easy Spirit makes it easy for me
(25:28):
to keep moving with sizes and styles for every woman.
They're truly designed for the way we live. Easy Spirit
is the original comfort footwear brand, proudly designing women's footwear
that's comfortable, right out of the box and made to
keep you moving. Easy Spirit understands every woman has her
own unique needs, her own unique footprint. That's why they
(25:50):
offer solutions like extended sizes and wits, orthoughtic friendly silhouettes,
arch support, and much more like their Move for Pink
initiative Cancer Awareness Month. When you step into comfort with
easy spirit, you're taking a step in the right direction
for breast cancer research too. Another thing, I was curious
(26:19):
if some of the social determinants of health, you know,
like higher smoking rates or obesity rates, or the fact
that there are so many food deserts and the intersection
sadly of poverty and race, if that is also contributing
to not only access to healthcare and to preventative screening,
(26:42):
but also is that having an impact on the specific
cellular activity in breasts.
Speaker 2 (26:51):
Does that make sense?
Speaker 5 (26:52):
Oh, you stated it perfectly. It is so true. That's
absolutely correct. Environment definitely plays a role in breast cancer.
And there is a very large, exciting, growing body of
research looking at how certain neighborhood characteristics related to poverty
related to nutritional insecurity and food deserts. These characteristics are
(27:13):
not only associated with obesity rates, which is another risk
factor for getting breast cancer, but these neighborhood characteristics are
also inherently related to likelihood of developing certain breast cancer patterns.
Speaker 1 (27:26):
And also another problem I know is getting women of
color in clinical trials, right, I mean, it's hard enough
to get anyone in clinical trials, but particularly challenging for
the black community to participate. Why has that been so challenging, Lisa.
Speaker 5 (27:46):
Again, Katie, for so many complex reasons. They're destinately the
medical communityificant distrust.
Speaker 4 (27:53):
Yes, and for appropriate reasons.
Speaker 5 (27:55):
In the past, there have been horrific abuses in clinical
research tex Tuskegee, the Tuskegee experience, and so rightfully, many individuals,
especially from communities of color, are suspicious of clinical research.
But we can absolve the medical professional community from responsibility either.
(28:16):
There are actually many studies showing that one of the
biggest barriers to an African American cancer patient participating in
the clinical trial is the absence of the physician offering
a clinical trial to that patient. Some physicians just don't
want to take the time to explain the clinical trial.
(28:38):
Some physicians are fearful that bringing up a clinical trial
will somehow alienate the patient and generate more is distrust.
Speaker 4 (28:46):
But we have to get over that.
Speaker 5 (28:48):
Clinical trials are part of standard of care and we
have to offer them to everybody.
Speaker 1 (28:54):
The other thing I know that you care deeply about
is to have more black doctors, because I think people
feel often more comfortable when their doctor has a similar
experience than they do, and that is actually increasing, but
not at a fast enough rate, is it.
Speaker 4 (29:14):
Yeah, that is so true.
Speaker 5 (29:16):
Just as we need better gender balances in the healthcare
professional community, we also need more diversity in the healthcare workforce.
Speaker 4 (29:26):
And I do think that it's true that many.
Speaker 5 (29:28):
Patients want to have a match in terms of not
only the gender, but often the race, ethnicity of their
position to their own experiences and identity.
Speaker 4 (29:38):
But the patient population.
Speaker 5 (29:40):
Overall, I think will have greater trust in the healthcare
system if they see a healthcare system that reflects their
neighborhoods and their communities.
Speaker 1 (29:49):
Sharon, is that one of the reasons that going to
doctor Newman appealed to you? Did you feel more of
a connection with a woman of color as your surgeon?
She's okay, no, I'm curious.
Speaker 2 (30:03):
I mean, did that enter into it at all?
Speaker 3 (30:08):
Yes? But more importantly what entered into and she didn't know,
was that I did research on her. I went online,
and when I saw that her study what she was doing,
I thought, wow, not only is she a woman of color,
but also, you know, let's be honest, she is the
lead person in her field at her hospital, so her
(30:29):
expertise was important to me. The fact that she was
doing research around this was important to me. But that
wasn't enough for me. So I went to some other
doctors at other hospitals. And then, funny enough, gender is
important because when I went to the male doctor at
a very nice hospital, instead of telling me I had
dense bruss, he kept telling you, I had complex br us.
(30:51):
And a woman doesn't want to know she has complex
for us.
Speaker 1 (30:54):
Okay, I don't know, nice and a little nicer than
I was as a woman who gets called complicated.
Speaker 3 (31:03):
I was like, okay, now my breast complicated too, So
I was kind of taking that issue. But he didn't
handle me with the same care that doctor Newman handled me.
And then what was interesting was that he also was
specializing in the same type of research, but for Jewish women,
and I thought, wow, that's amazing, and I really appreciated
(31:23):
that he was doing that. But I was like, well,
he's specializing in Jewish women, and I've just talked to
a woman who's a woman who's handling me with a
lot of care and compassion. She has the expertise, and
more importantly, she is doing research about women like myself.
Speaker 4 (31:40):
So where do I go? It seems easy enough, and
I already.
Speaker 3 (31:44):
Knew I was going to her, but I just wanted
a second opinion. And then her peers in the industry
kept telling me she was amazing, so she didn't even
have to tell me she was amazing. Her peers in
the industry at the other hospitals were like, well, if
you're not going to go with us, she is one
of the best in the industry.
Speaker 1 (32:02):
So I'm curious, Lisa, and why you decided. I mean,
first of all, you're a brilliant person. You could study
whatever you wanted. I'm sure, why did you decide to
really investigate the disparities in white women and women of
color when it came to breast cancer.
Speaker 2 (32:21):
What was it?
Speaker 1 (32:23):
Did you have an aha moment? Did you treat somebody,
did you read the statistics? What made you think I
need to dig deeper into this.
Speaker 5 (32:32):
It was actually a little bit of everything you just described.
But before I get into that, I just want to
thank both of you for your comments, and I also
want to specifically give a shout out to Sharon for
the way she kept it so real with me. She
did her homework and investigated other centers and then she
came back and told me what she liked about my
program and what she didn't like about my program.
Speaker 4 (32:53):
She was very honest about things that we needed to
work on.
Speaker 5 (32:57):
Well, I'm not even going to say what they were,
because I've correct to everything that she told me about it.
But for me, it was a long journey to coming
to where my career is today and back. I won't
say how long ago, but it was more than twenty
years ago. When I was first starting on my career,
I was a general surgeon taking care of a lot
(33:19):
of different types of surgical problems, and back then we
didn't have an appreciation for the types of race related
differences in breast cancer burden that you described today, and
those are very well documented today, but that back then
we didn't understand them very well. We didn't understand the
fact that breast cancer is actually comprised of a whole
(33:41):
spectrum of different subtypes, and we just didn't understand why
some breast cancers were more poorly controlled than others. And
my general surgery practice was based in Brooklyn, New York, where,
of course we have a beautiful and robustly diverse patient population,
and every day I was struck in my own practice
(34:02):
by how my black breast cancer patients were being diagnosed
at younger ages. They were often diagnosed with bulkier tumors,
and they were developing recurrences of their breast cancer more frequently.
And so I decided to pursue additional training and research
so that I could have a dedicated career studying breast
cancer and dedicated to surgical management of the disease. So
(34:26):
that twenty year journey twenty plus your journey actually has
evolved into this international breast cancer research and a lot
of research looking at the genetics of the disease.
Speaker 1 (34:37):
I know that it's true in the case of calling cancer,
that younger and younger people are being diagnosed, which is
really upsetting people in their twenties and thirties and forties.
You know, you have to get a screening, colonoscopy or
some kind of calling screening at age forty five because
(34:58):
of these numbers, they lowered the age for your first screening.
And I'm curious if this is true for breast cancer,
and if you have any idea why younger and younger
people seem to be getting diagnosed with these diseases.
Speaker 4 (35:17):
Well, you are again correct.
Speaker 5 (35:19):
We are seeing a similar pattern in breast cancer as
what you described in colon cancer, with higher and increasing
population based incidence rates of breast cancer in younger women,
women that are still in the pre menopausal age ranges.
We don't completely understand the explanations, but we are assuming
at this point in time that it's related to a
(35:42):
constellation of factors. Diet, lifestyle, environmental exposures, obesity rates are
unfortunately on the rise in the United States, and all
of these factors, in addition to our genetics, we'll be
playing a role in.
Speaker 1 (35:56):
I wonder when you say environmental factors, I feel like it.
You know, it's frustrating to me because we've seen these
numbers for a few years now, and I've talked to
a lot of scientists because of stand Up to Cancer
and my own cancer activism, and some say it might
be the over prescription of antibiotics. Other people say maybe
(36:21):
process foods. We're hearing a lot about alcohol consumption and cancer.
I think a big study just came out about that
and how closely linked they are. When do you think
we're going to And I wonder about pesticides, and I
wonder about these forever chemicals. What are they called p fasts?
Is that what they're called? Anybody, come on audience, P
(36:45):
fast right, pfas I guess, And everything from leggings to
you know, rubber mats and all kinds of household products.
Speaker 2 (36:57):
When do you think, I know, it's.
Speaker 1 (36:58):
Really hard at semiologists struggle with this, But when do
you think we'll have a better idea about why this
is happening because it has such a huge impact on
screening recommendations and overall awareness for a younger population.
Speaker 5 (37:15):
Yeah, these are incredibly difficult questions to address, and yes,
epidemiologists are continuing to struggle with them. It is correct
that excessive and increasing rates of alcohol consumption on a
daily basis will increase breast cancer risk. Obesity increases breast
(37:35):
cancer risk. Leading a sedentary lifestyle with the lack of
adequate exercise on a daily basis, All of those patterns
will increase breast cancer risk. The things that do not
seem to affect breast cancer risk would be wearing a
brazier or not wearing a brazier, or different types of
brazil If.
Speaker 2 (37:53):
People think that really has an impact.
Speaker 5 (37:56):
It seems to cycle like every couple of years. There
are these yet on the internet about risk of braziers
and breast cancer risk, but yet non association.
Speaker 2 (38:06):
Yeah, but sometimes when.
Speaker 1 (38:07):
I used to take walks, I would stick my iPhone
and my bra and then I kind of wondered, Oh,
I wondered if that actually had an impact on my
breast cancer.
Speaker 2 (38:17):
Do you think it did?
Speaker 4 (38:19):
I don't think so.
Speaker 3 (38:20):
I do not think so. But I asked you about
the diet. Ho I think I asked you about my dietoke.
I was like, drinking twenty years of di coke? Did
that lead to my breast cancer?
Speaker 2 (38:29):
But you never?
Speaker 1 (38:30):
I mean, I think what's what the problem is. There's
you know, people fill in the lack of knowledge with
with uh, you know, ideas and speculation, and I think
we really need to focus on that.
Speaker 2 (38:45):
Are people studying this.
Speaker 5 (38:47):
They are very aggressively, but it's so difficult to get
a consistent and definitive handle on the answers because so
many of these factors are poorly recalled by individuals. They're
poorly documented, so it's difficult to accurately assess the quantity
of different dietary components, the exposures to different pesticides, right,
(39:14):
things that are in the environment.
Speaker 1 (39:16):
You believe in breast cancer clusters, you know, where you
see a lot of breast cancer like Long Island by
the way. Yes, that is that there have been reported
a lot of cases in certain geographic areas or in neighborhoods,
and you know, but it's never quite proven. And is
(39:36):
that something that you think warrants more study.
Speaker 5 (39:41):
Yeah, absolutely warrants more study. And the clusters are very real.
It becomes difficult to tease out though why those clusters
occur because neighborhoods exist with people living in the same
environment for so many different reasons. Families like to live
together if they have certain lifestyles in common, or cultures
(40:02):
in common, race ethnicities often want to be in the
same neighborhood with each other. So there are just so
many factors that go behind the reasons why a neighborhood
is characterized by one pattern versus a different pattern.
Speaker 1 (40:17):
But it does make you wonder, like is there an
environmental fact as way here? Is it like a certain
kind of plant maybe nearby that or pesticides anyway, It's
as I said, it's a lot of speculation. Let's focus
on for the remaining time we have on the best
way to prevent breast cancer and the best way to
(40:39):
prevent a recurrence of breast cancer, because I think both
of those are so important. We're all wearing our nice, comfortable,
easy spirit shoes, and that makes me want to ask
you about exercise and the role of being a physical
activity in terms of not only breast cancer, but a
(41:01):
whole host of diseases.
Speaker 4 (41:03):
Yeah.
Speaker 5 (41:04):
Yeah, exercise and continuing to move, being on the move
is good for the mind, body, and soul, and it
very definitely is valuable in preventing breast cancer and in
having a better outcome if you have been diagnosed with
breast cancer. Now, I don't want women and breast cancer
(41:25):
survivors to feel that everything is on their shoulders and
in terms of preventing a recurrence of a breast cancer
or preventing it from being diagnosed altogether, because some things
are simply out of our control. But absolutely we can
provide ourselves some protection against a breast cancer diagnosis with
a healthy lifestyle, balanced diet, and continuing to be screened.
(41:51):
Because there is no doubt about it that early detection
of a breast cancer, regardless of the breast cancer subtype,
early detection of that breast cancer is a huge factor
in likelihood of successful treatment, and if a breast cancer
has been diagnosed, a woman has to be vigilant about
her breast evaluation for both breasts for the rest of
(42:13):
her life. She not only could develop a recurrence of
the breast cancer in that breast or in other parts
of the body, but.
Speaker 4 (42:19):
She can develop a whole new breast cancer. And it
always breaks my heart when.
Speaker 5 (42:23):
I hear breast cancer patients say that they just didn't
realize that they have to be on the lookout for
a new cancer developing.
Speaker 4 (42:32):
There's a Lenser's key.
Speaker 1 (42:33):
Yeah, there's exercise, and there's exercise, like for me taking
a nice walk around Central Park and looking at all
the people and the squirrels and the birds. But how
like how intense should your exercise be? Because I think
there's a big spectrum right from lazy to intense. Right,
(42:57):
So do you have to really get your heart rate up?
And can you give us some advice on that, Lisa,
or is it kind of out of your well.
Speaker 5 (43:08):
I don't think that you have to be manic about
your exercise regimen, but making sure that you walk regularly
throughout the day, take a flight, or two upstairs every day.
Speaker 4 (43:25):
That will help.
Speaker 1 (43:26):
And if you break a sweat, it's a good thing, right.
I don't like very sweat straightforward parameter. Okay, let's just
talk quickly about diet and alcohol and sort of what
you recommend. Should I not be eating bacon because it
is my favorite food, it is my very favorite food.
Speaker 2 (43:45):
Well, it's all about balance, because I don't.
Speaker 3 (43:49):
Want to hear the answer to that one. I love bacon. Oh,
but I'm good. I took off both of us, so
I'm good.
Speaker 1 (43:55):
Bacon is probably not good for a lot of different things.
Speaker 5 (43:58):
But yeah, it's all about balance in life and not
overdoing it with any type of food on a daily basis,
but especially fried foods, things like and fatty foods.
Speaker 4 (44:10):
You don't want to overdo those on a daily basis.
Same with alcohol.
Speaker 5 (44:13):
There are some cardiovascular benefits to some alcohol intake, but
more than a couple of glasses on a daily basis
is going to be bad for a number of different
health issues, including breast cancer. Risk of diet that has
a lot of fresh fruits and vegetables in it is
excellent fiber. Fiber isn't a fiber? Yeah, yeah, And in general,
(44:39):
all of the dietary patterns that are good for cardiovascular
health are good for breast health.
Speaker 1 (44:45):
Let me ask you about genetic testing because I feel
like a lot of people don't get genetic testing. They
think it's too expensive or they think, you know, honestly,
they sort of don't want to know. So who is
genetic testing right for? And what would you tell your
patients or anyone listening to our conversation about genetic testing.
Speaker 5 (45:10):
Well, fortunately, the costs of genetic testing have plummeted since
the Supreme Court ruling in twenty thirteen opening up genetic
testing to be performed by a number of different companies.
The prices have plummeted, and we have large scale panels
for genes that can be evaluated to look for hereditary
susceptibility for a variety of different cancers, not only breast cancer,
(45:34):
but we can identify hereditary predisposition for ovarian cancer, colon cancer, melanoma. Now,
there are some people who believe that everybody should be
genetically tested, at least for certain genes when they reach
adult life. We haven't quite gotten to the point where
that is broadly available to the general population. At this
(45:57):
point in time, the United States and Services Task Force
does recommend that anybody with Oshkenazi Jewish background should consider
getting tested for specific BRCA mutations once they reach age thirty,
because there's a very high risk.
Speaker 1 (46:13):
For your risk of breast and ovarian goes up to
eighty percent if you'r BRACK a positive right.
Speaker 5 (46:18):
Exactly, That is so true if you do have a
strong family history of breast cancer ovarian cancer, I mean
multiple relatives with either of those cancers. If there are
any men in your family with breast cancer, if you
have in your extended family tree many individuals diagnosed with
even other cancers such as coerectol or melanoma, those would
(46:42):
all be features indicating that you should consider getting genetic
testing done. If there's a bilateral breast cancer in the family,
breast cancer being diagnosed at younger ages, for women that
are themselves diagnosed with breast cancer at young ages, or
triple negative breast cancers, these are all so features indicating
that you might be more likely to have hereditary predisposition.
(47:05):
Now I am a breast surgeon, The American Society of
Breast Surgeons advocates in favor of all women who've been
diagnosed with breast cancer, regardless of age, racial ethnic background,
regardless of their pattern of breast cancer. If they are
diagnosed with breast cancer, they should be offered genetic testing.
And so I do offer genetic testing to all of
my patients.
Speaker 1 (47:25):
I would like to make another argument for genetic testing though,
if I may, I do you know I think what
people don't understand is the vast majority of cancers involve
no family history. I think it's something like seventy eight
or eighty percent of calling cancer cases. And I know
(47:47):
a lot about this because my husband have no family history. Similarly,
the majority of breast cancer cases have no family history.
So isn't it smart before you get diagnosed to see
if you have any genetic mutations that may make you
at greater risk for any of these cancers so you
(48:11):
can schedule your screenings accordingly, So you might have to
be more vigilant. For example, I had genetic testing, I
believe it or not, have a higher risk of colling
cancer slightly because I have some genetic mutation and new
mutations are being discovered all the time.
Speaker 2 (48:29):
So to me, it's kind of.
Speaker 1 (48:30):
A no brainer to say, well, boy, I better not
forget to get my colling cancer, screening my colonoscopy or
my colon guard, whatever I choose to do.
Speaker 2 (48:40):
So isn't that a good argument?
Speaker 1 (48:42):
I remember, by the way, my parents were late for
their colonoscopies or whatever, and I was like, you guys
know how embarrassing it would be for me if you've
got diagnosed with calling cancer.
Speaker 2 (48:51):
Come on, anyway, it's all about me.
Speaker 1 (48:56):
So why wouldn't people recommend screening before they get diagnosed
with something so they can be armed with better information
that could potentially save their lives.
Speaker 5 (49:08):
Ye, you are correct again, genetic testing a way.
Speaker 4 (49:12):
Yes you are. In my book, you already are, but correct.
Speaker 5 (49:18):
Genetic testing can save lives, and it does save lives
as we learn more about it. People who have hereditary
predisposition for different cancers can detect those cancers earlier with
enhanced screening. Some of these genetic markers serve as markers
for specific treatments that will be necessary if a cancer
is diagnosed, and we have good ways of preventing different cancers.
(49:42):
Individuals that are at higher risk for ovarian cancer if
they remove their ovaries, that is a wonderful way to
prevent ovarian cancer. And it's been shown to have survival advantages.
People that are at high risk for breast cancer are
candidates often to take special medication that can prevent breast cancer.
Speaker 1 (50:01):
Or you know, to even make lifestyle changes, right. You know,
if you know that, you can say I'm going to
make sure I'm really vigilant about my diet and exercise.
Speaker 3 (50:11):
But I will say as someone who I did the test,
I did the genetic testing and came back negative the
first time, So I don't want people to get comfortable
to take it and it comes back negative.
Speaker 2 (50:21):
Like I do a false sense gave me a false.
Speaker 3 (50:23):
It did, and then I took it again once I
did find out, but this time I took a full panel, right,
So when you take it, take the full panel. And
I did it the second time not for me, but
my daughter, right because I needed to know and make
sure my daughter had as much family history as she
could possibly have. So I would definitely encourage everyone to
(50:44):
have it. And when you have it, take the full panel,
because now we've discovered that I have some unknown genetic
and that we're going to need more people to do
genetic testing so we can figure out what my own
known and I'm at risk for right.
Speaker 1 (50:58):
You know, you mentioned Sharon so beautifully at the beginning
of this conversation that you're trying to serve others and
help your community understand the importance of early detection about
getting screened. And I'm curious, how are you doing that,
because it's so important that women of color that we
(51:21):
reach out to them and make sure they know where
to go to get screened, make sure they know where
to go if they're uninsured or underinsured or insured, you know,
And I'm curious what you think are the most effective
ways to reach women.
Speaker 3 (51:38):
Well, I mean, first, it starts with the conversation. So
like my mother, I was also very very private, and
when I discovered I had breast cancer, I actually, for
the first time my life decided to be public and
so I started sharing with everyone. Then I had breast
cancer and well, my doctor was my treatment. My daughter
created a WhatsApp communication because I didn't how to do
(52:00):
it with all my friends and telling them to get mammograms.
Before my surgery, I had a bye bye Boobs party
and I invited men and women to come to say
bye bye to my twins, but also to once again
talk about the importance of early detection.
Speaker 4 (52:17):
And making it less.
Speaker 3 (52:20):
Scary for folks. And everyone knew that my mom had
allowed hers to metastasize and what it caused me, and
so what they felt was like Wow. I had people
go get their mammograms and make appointments. I also run
a boys and girls club, so I have lots of
thousands of families there. So we are now having community
days where we're bringing in health professionals to talk about diabetes,
(52:44):
breast cancer, asking the American Cancer to bring the van
so we can do free screenings because a lot of
our parents are living the poverty line. And I know
for a fact that my father also died from cancer,
and both my mother and my father did not necessarily
go to the best places and didn't get the best device,
and they listened only to one doctor who wasn't necessarily
(53:06):
giving them the best device. And so I think sometimes
as African Americans were scared and we live by fear.
And so I also am a minister in a church,
and so I talk about it in the church.
Speaker 1 (53:18):
I was going to say, Black churches to me, would
be a great place to spread the word.
Speaker 2 (53:23):
Maybe you could travel around to a bunch of.
Speaker 3 (53:26):
So I've been motivational speaking on this topic, and it's
really about the fact that and when I said it
at church, all these older women came up to me, go,
I had breast cancer, And I'm like, I've been sent
up here, y'all to tell me, Like I was trying
to figure out if I get a tattoo, no nipples,
all these things I had questions about, and y'all sitting
(53:47):
here and y'all knew I was having a double mis actomy.
Speaker 2 (53:49):
You don't want to tell me.
Speaker 3 (53:51):
But I think that the more I've been comfortable with
it and I've been sharing, I had surgery yesterday, by
the way, but I'm telling every I'm on the ones app.
Speaker 2 (54:02):
I'm not only.
Speaker 3 (54:02):
Instagram because I don't know how to do social media,
but I'm sharing, And I think taking the stigma out
of it, taking the fear out of it not being.
Speaker 1 (54:12):
And also having a sense of humor clean breaks I
think that breaks the ice for people.
Speaker 3 (54:19):
It really does, because I told everyone I had to
have emergency surgery yesterday, and I told everyone's because I
only had cancer in my right breast and my left
breast was fine, So my left breast got mad at
me for cutting it off. And then I wound up
getting an affection, so I had to take take care
of it yesterday. So but I have decided that I'm
going to laugh and I am going to enjoy it,
(54:40):
but I'm going to share, and I'm going to ask
people to go get their mammograms. I'm going to ask
them to have opinions, to do the research, do their homework,
get the genetic testing. And also, don't be afraid to
share with your children. They've got a note too, You've
you know, like I think sometimes with parents we want
to love them and protect them and keep it to ourselves,
but we owe them to talk to them and to
(55:02):
share in our journey.
Speaker 2 (55:05):
Before we go.
Speaker 1 (55:06):
I want to ask you one question, Lisa, about the future,
because I've been reading obviously a lot about AI. Who
hasn't and now with the expanded use of AI when
it comes to things like screening and pathology, etc.
Speaker 2 (55:21):
It's very exciting.
Speaker 1 (55:23):
I know that I read that AI can make early
detection easier and that it can even be used to
predict who might actually be diagnosed with breast cancer before
they even exhibit any symptoms, which is mind boggling to me.
(55:43):
Can you talk a little bit about how you see
the role of AI changing your field.
Speaker 4 (55:49):
Oh, it's the enormous, Katie.
Speaker 5 (55:52):
Yes, AI holds great promise in being able to improve
breast cancer outcomes. And as you mentioned with mammograms for example,
wouldn't it be incredible if, based upon a screening mammogram
and a woman that's totally healthy, if we could predict
the thirteen percent of the women in this country that
are destined to develop breast cancer and then prevent.
Speaker 4 (56:14):
The cancer from developing in them.
Speaker 5 (56:16):
And this is the promise of the artificial intelligence algorithms.
Now we're not quite there yet, but that is the
direction that we're going in. And artificial intelligence big data
algorithms are very useful in being able to evaluate and
read pathology biopsy specimens. But just as AI holds incredible promise,
(56:38):
it also holds great risks and if we don't do
it right, we're going to worsen the disparities that already exist.
If we develop these AI algorithms based upon data from
limited populations skinny women, women that are more affluent, women
with only European ancest we're going to be very limited
(57:03):
in what we can learn from these algorithms and we're
going to worsen some of the disparities that already exist.
Speaker 2 (57:08):
That's such an important point.
Speaker 1 (57:09):
Do you think that the tech world is mindful of
that as they start developing these tools, because I feel
like the word is out that these disparities exist and
that the large language models, whatever you call them, really
have to include a diverse population.
Speaker 4 (57:29):
Yeah.
Speaker 5 (57:30):
I hope that they are robustly aware of these risks,
but I'm not too sure because unfortunately, they often end
up relying upon data sets that already exist, and these
pre existing data sets are frequently very limited in the
individuals that have contributed data. So we have to be
(57:51):
working together to generate new data sets that are more
broadly inclusive of women that live in different environments, the
women that consume different types of diets, women that have
different ancestral backgrounds.
Speaker 4 (58:04):
These data sets have to be generated de novo.
Speaker 2 (58:07):
Yeah, such a good point.
Speaker 1 (58:08):
Well, Sharon Joseph and doctor Lisa Newman, you both are
such rock stars. Thank you so much for such an
important informative conversation about breast cancer for Breast Cancer Awareness Month.
Thank you for the research you're doing, Sharon, thank you
for your advocacy, and everyone here. Thank you for being
(58:29):
a part of this conversation. I hope you'll go out
and spread the word to all of your friends and
family members.
Speaker 2 (58:35):
So thank you, thank you, and thank.
Speaker 4 (58:38):
You for being so fabulous. Your sake so many lives.
Speaker 5 (58:43):
Katie, just by being who you are.
Speaker 1 (58:56):
Thanks for listening everyone. If you have a question for me,
object you want us to cover, or you want to
share your thoughts about how you navigate this crazy world
reach out. You can leave a short message at six
oh nine five P one two five five five, or
you can send me a DM on Instagram. I would
love to hear from you. Next Question is a production
(59:18):
of iHeartMedia and Katie Couric Media. The executive producers are Me,
Katie Kuric, and Courtney Ltz. Our supervising producer is Ryan Martz,
and our producers are Adriana Fazzio and Meredith Barnes. Julian
Weller composed our theme music. For more information about today's episode,
(59:38):
or to sign up for my newsletter wake Up Call,
go to the description in the podcast app or visit
us at Katiecuric dot com. You can also find me
on Instagram and all my social media channels. For more
podcasts from iHeartRadio, visit the iHeartRadio app, Apple Podcasts, or
wherever you listen to your favorite shows. Hi everyone, it's
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