October 1, 2025 • 39 mins
When someone finishes a cancer treatment, it can feel like the end of the story. For many, it may just be the beginning–risk of recurrence looms, long-term medications (and their side effects) begin, and it’s hard to get your bearings. What do you really need to know?
In this candid conversation, Katie sits down with Dr. Lillian Smyth, Senior Vice President and Global Development Head for Breast Cancer at Eli Lilly and Company, and LaShae Rolle, a breast cancer survivor, public health researcher, and powerlifter. Together, they explore what life after breast cancer treatment really looks like: from follow-up care and managing side effects to navigating fears about recurrence and finding strength in advocacy.
This episode—created in partnership with Eli Lilly—is about more than medicine. It’s about empowerment: knowing your “normal,” asking the right questions, and embracing life following cancer treatment.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
We're partnering with Eli Lilly and Company for Breast Cancer
Awareness Month. A cancer diagnosis can impact every aspect of
someone's life, but they shouldn't face it alone. Research shows
that support and human connection play a significant role in
one's healing and mental health. That's why Lily is working
with patients, caregivers, and advocates to amplify voices, advanced treatment,
(00:27):
and empower the early and metastatic breast cancer community. Learn
more about how Lily is making a difference at Lily
dot com. Hi everyone, I'm Kitty Kuric and this is
next question. As many of you might know, I've been
through my own breast cancer journey and the one thing
(00:49):
I've learned is that the story doesn't necessarily stop when
treatment ends. In fact, for so many women, that's when
a whole new chapter begins. Today I'm talking with doctor
Lilly Smith, Senior Vice president and Global Development head for
breast Cancer at Eli Lilly and Company, as well as
breast cancer patient advocate and Lily partner Lecha Role. We're
(01:11):
talking about life after diagnosis and treatment. Why knowing your
body's normal is so critical, how to understand your risk
of recurrence, especially when diagnosed with early breast cancer that
does have a high risk of coming back, and what
it means to be your own advocate and follow up care.
Doctor Smith and Leshay, Welcome to both of you. I'm
(01:32):
so excited to be with you and have this important
conversation about breast cancer and really life after breast cancer treatment.
And doctor Smith, may I call you Lily?
Speaker 2 (01:42):
You may, of course.
Speaker 1 (01:43):
Let me start with you. I know you went into
oncology and then you decided to really focus on breast cancer.
What led you down this path? What was it about
breast cancer in particular that interested you?
Speaker 2 (01:56):
So you know, honestly, it was the patients that drew
me in. I mean, obviously, breast cancer predominantly affects women,
and I got the sense really early on in my
training that these were the women and the patients that
I wanted to look after. It just always felt like
critically important work. And then I would say, added to that,
the science pulled me in. Breast cancer is one of
(02:17):
the fastest moving feels in oncology, and the more I
treated patients, the more motivated I became to really try
and find new and improved ways to care for those patients. Ultimately,
I just wanted to be part of driving improved outcomes
for patients with this disease.
Speaker 1 (02:32):
Lche. I know that you share a lot of interest
with Lilian and that you were studying breast cancer prevention
and you were getting a PhD and still are in
public health when ironically you were diagnosed yourself with breast cancer.
Tell me about that, and that was I know, in
(02:55):
twenty twenty four, you were just twenty six years old.
Speaker 3 (02:57):
Liche, Yeah, I was young. So for me, basically, I
was in the middle of my PhD. Second year of
my PhD, and I thought, I'm doing cancer research, cancer
prevention in particular, and I felt a lump. I was like, hmm,
that's one of those things that I tell people might
be a risk factor. And I felt a little pain
(03:19):
in my breast and I was like, that's another red flag.
Speaker 4 (03:23):
And so I did with.
Speaker 3 (03:24):
What I hope many people do when they find that
something is wrong, they going to get checked out. So
I went to do a woman's health exam at the
student Health Center and they let me know that, hmm,
you have a lump there. Maybe it could be something
could not be most likely due to your age. It's
fibrus tissue. But they went and sent me off to
(03:45):
do a mamma gramina ultrasound anyway, and we all know
that story ended. They found that I did indeed have cancer.
And I credit me doing my PhD in this field
to finding that because I think had I been in
a different place in my life or not in this field,
I would not have been alarmed by those things, and
(04:05):
I maybe would not have known that that was something
that could be related to cancer. And so my biggest
thing that I tell people all the time is get
to know your body and what is your normal, so
that if something is wrong, you know to get checked.
Speaker 1 (04:18):
Well. Thank goodness, Lilian that Leche was studying this, knew
that this needed medical attention, did not blow it off
when and got it taken care of, but goodness she
would just she's twenty eight now, just twenty six years old.
We're seeing many more people, many more women getting diagnosed
(04:40):
with breast cancer at an earlier and earlier age, aren't
we We are?
Speaker 2 (04:45):
I mean, in fact, it has resulted in US sort
of adjusting the screening guidelines within the US to lower
that age to forty, where the recommendation is to have
yearly mammograms from that age, So there is no doubt
that younger age a diagnosis breast cancer is rising in incidents,
(05:06):
both globally and specifically within the US. So it's really
important that folks remain aware of that. And I think
telling stories like Ache is describing today is just hugely
important for everyone to understand the changes that are happening
out there.
Speaker 1 (05:20):
Because at her age, she was well below the guidelines
for getting screened, and yet you were aware enough to
notice a change in your body and Lechee, I really
admired the fact that you have shared your experience very publicly.
You've created a platform you talk about what happened to you.
(05:42):
Why has that been so important to you?
Speaker 3 (05:45):
It's been extremely important for me because at the time
when I was diagnosed, I went to Instagram, I went
all over the internet and I tried to find somebody
who was like me, that was sharing maybe some aspect,
not even the full story like I am. And I
couldn't find anyone. I couldn't find anyone my age, I
couldn't find anyone that looked like me. I couldn't find
(06:05):
anyone who was powerlifting.
Speaker 1 (06:08):
And yes, Bury the lead You're a power left. I'll
get to that.
Speaker 4 (06:12):
In a moment.
Speaker 3 (06:14):
Yes, And so what I wanted to do was I
wanted to create that person for other women who are
going to be diagnosed young, or who want to engage
in those activities, or or who have similarities to me.
And so that's why I want to share that, to
spread awareness and to have somebody who was out there
to be that person that I needed at the time.
Speaker 1 (06:35):
What kind of feedback have you gotten, Liche? Has it
been gratifying to see that you're striking a chord and
educating so many women who not only look like you,
but who don't look like you and need to be
aware of the symptoms of breast cancer, especially at an
early age.
Speaker 3 (06:52):
Yes, so it's been monumental. It's taken off much more
than I even thought. So initially I just posted that night.
I did want to share it with some people, and
I did want to make an impact, but it's made
much more of an impact than I could have ever
thought of, reaching people in different countries, like you said,
not just to look like me, everybody, and getting people
(07:14):
moving and people tagging me and saying I'm working out
today because I'm channeling my inner strong after cancer, and
I'm like, wow, this is incredible, And people are messaging
me saying they got their first mama around because they
realized that I was diagnosed so young and it actually
runs in their family and they weren't just getting screened
(07:35):
even though it runs in your family. And I'm sure
that many people can get screened because when you have
a genetic history, they do allow you to get it
covered and screened. And you know, I just A'm very
proud of what has happened, and I think that I
have no regrets.
Speaker 1 (07:53):
Well, I'm so proud of you that you have shared
your story, and I want to mention something because I
think sometimes family history is used as an excuse or
no family history, I should say, for not really pay
attention to many cancers, including breast cancer. And the fact
(08:15):
of the matter is Lilian that most women who are
diagnosed with breast cancer have no family history, right.
Speaker 2 (08:22):
Correct, entirely true, exactly. So I mean I think that
that's to your point. It's about understanding that you need
to know what normal is for your body and to
report any symptoms or red flags as you term them,
like new lumps, pains, issues. You really have to talk
to your doctor about them and don't dismiss them and think, oh, well,
(08:43):
this would never happen to me, or it doesn't.
Speaker 1 (08:45):
Run in my family, right because it didn't run in
Lache's family. Absolutely, Let's talk about the steps you need
to take after you're diagnosed, and just having experienced it
myself a few years years ago, the staging is critically important.
So can you help people understand who haven't gone through
(09:08):
what Leche and I have or don't have your background, Lilian,
what the difference is between early stage breast cancer and
metastatic breast cancer.
Speaker 2 (09:19):
Yeah, absolutely, so it's a critical distinction, and it's the
distinction that we make right at the time of diagnosis.
So early stage breast cancer is by far the most
common presentation, and that basically consists of breast cancer that
is confined to the breast or the local lymphnotes, and
the treatment intent for early breast cancer is cure. Typically
(09:42):
it consists of surgery first, so either a partial removal
of breast tissue or full removal of breast so.
Speaker 1 (09:49):
You're talking about a lumpa lump versus aspect.
Speaker 2 (09:52):
To me exactly, and then often that's followed by radiation
therapy and then in some cases chemotherapy or targeted therapy
like hormone therapies are offered. So that's early stage breast cancer.
Metastatic or advanced breast cancer is breast cancer that has
spread beyond the breast and local lymph node area to
(10:13):
a distant organ like long liver or bone, and the
treatment intent in that scenario is different. It is long
term treatment that is focusing on disease control and maintaining
quality of life for as long.
Speaker 1 (10:28):
As we can. That's why early detection is so critically
most important, because it is much easier to eradicate the
disease when it's caught early instead of just managing the.
Speaker 2 (10:40):
Disease correct andentarly.
Speaker 1 (10:42):
Absolutely, let's talk lche about life after treatment. Your breast
cancer was stage two B, so that meant lymph node
involvement correct.
Speaker 4 (10:56):
Yes, So I had lymph node involvement.
Speaker 1 (10:58):
So that meant you needed chemotherapy and you got a mestectomy.
Speaker 4 (11:03):
Yes.
Speaker 1 (11:04):
So first of all, how was that treatment for you?
Speaker 3 (11:09):
So for me, it honestly was it was a lot.
So being so young and having to have my breast removed,
it was just something I was not thinking about at all,
and it's something that's it feels so feminine, like it
feels like something that all women have. You have your breast.
(11:30):
That's one of the things that really sets us apart.
And so I had that removed and that was a
big thing. But then when I found out later that
it had spread all my lymph nodes because we were
still waiting for how many positive lymph nodes I had.
After surgery, found out I had to do chemo, and
you know when you hear the word chemo, it's very intimidating.
(11:50):
And so I had to do taxitair and cyclophosphamide that's
TC for four cycles and I lost all of my
hair and it was very, very emotional for me. But
you know, after I lost my hair, I was like, well,
that's it smooth sailing from hair. I was trying to
avoid losing my hair. That was the biggest thing. And
(12:12):
I just powered through it. And with the help of
my family and my dog. He was a big part.
He was a big part of my journey. I was
able to get through those two parts. And then I
had radiation after wood.
Speaker 1 (12:25):
And which can make you very tired.
Speaker 3 (12:28):
Oh yes, I had a lot of fatigue and there
was some mark, so it had some burning and discoloration
in that area. But just like chemotherapy, I got through it,
and I didn't stop doing anything throughout it. Throughout all
my treatment, I was still doing my PhD, I was
still working out, I was still living my life, and
(12:49):
I didn't let it stop me. So it might have
been hard, but you know what, I'm tougher than cancer.
Speaker 1 (12:55):
I think a lot of people focus on the treatment liche,
but there's also life after treatment, something that I think
patients aren't necessarily prepared for. Lillian, what do you tell
patients who are saying, Okay, I'm done about the things
they might experience once the treatment is actually over.
Speaker 2 (13:17):
Yeah, it's such an important question. So I would say,
once the upfront treatment of surgery, radiation, and chemotherapy is completed,
patients move into this active follow up schedule of follow
up visits. So typically what that looks like is they
will be seeing their clinician every three to four months
for the first two years, then it sort of moves
(13:39):
out every six to twelve months up until year five,
and then after that fifth year they're really just coming
in every year, And the purpose of those visits is
really a check in to see how are you doing,
do you have any worries or concerns, do you have
any symptoms that are new, have you any side effects
from treatment, or are you expect lear and seeing new
(14:00):
side effects from ongoing treatment. It's really an opportunity to
support those patients who are still on ongoing treatment because,
as you may know, many breast cancers are hormone receptor
positive and for those patients, they're recommended hormone therapy for
at least five years and sometimes up to ten years.
So it's actually really important to check in with those
(14:22):
patients and see how they're doing. Are you actually taking
your medication, how does that feel, do you have side effects?
And you know, the typical issues that we would be
discussing in clinic are things like sexual health, hot flashes,
bone health, and it's just really important that patients feel
comfortable to bring up these topics in the clinic. I
(14:43):
would say from an imaging perspective, their follow up usually
looks like a mammogram every year. We follow bone health
with a dexa scan every other year, and that's really
important for postmenopausal patients and patients who are on hormone therapy,
and then, as you mentioned history and genetics, if we
identify that a patient has a family history or an
(15:05):
increased risk a genetic risk, then we have to tailor
their treatment plan and their follow up appropriately. So I
guess I would say high level life sort of after
the upfront treatment really looks like staying very connected with
your care team, being proactive, and you know, for us
as providers, it's just about giving patients the tools to
(15:28):
live well so that all issues can be flagged early.
Speaker 1 (15:37):
We're partnering with Eli Lilly and Company for Breast Cancer
Awareness Month. A cancer diagnosis can impact every aspect of
someone's life, but they shouldn't face it alone. Research shows
that support and human connection play a significant role in
one's healing and mental health. That's why Lily is working
with patients, caregivers, and advocates to amplify voices, advanced treatment,
(16:01):
and empowered the early and metastatic breast cancer community. Learn
more about how Lily is making a difference at Lily
dot com. Lyche you have been a very vocal advocate
for your own follow up care. Tell us about that
(16:22):
and examples of how you have spoken up and made
your needs known to your healthcare providers.
Speaker 3 (16:31):
Yeah, so one of the biggest things I do is
I share with people on Instagram that if there's anything
wrong or you have any issues, make sure that you
tell your care team that because it's very important. Like
doctor said, you must, you know, keep your team informed.
And so for me, like doctor touched on a lot
(16:52):
of those things like hot flashes, etc. Because I'm also
hormone positive, there are a lot of things after cancer treatment,
and so for me, I just would share those things
with my doctor and I would let her know and
she would basically tailor a lot of those hormone therapies
and just help me have an overall much better experience.
(17:13):
And I've been able to maintain and stay on all
of the drugs and I'm in a good place. All
of my scans are clear and everything's going well. So
I would just say having that open line of communication
and just being aware that your body is still going
through a lot and trying to recover after treatment. I
would say that cancer patients, no matter what the type
(17:34):
of cancer, just know that your body went through a
lot and just be gentle with yourself and try to
build back.
Speaker 1 (17:41):
But I think you're so right. I mean, I think
it's so important for patients to talk to their physicians about, say,
the side effects of follow up care. For example, a
romantase inhibitors. Right, if you have hormone receptor positive breast cancer,
you have to take these inhibitors that basically suppress estrogen
(18:01):
because the cancer feeds on estrogen. Am I getting that
right there, Darley?
Speaker 4 (18:05):
Yes?
Speaker 1 (18:05):
And there are ways to mitigate some of the side
effects from taking those drugs, and a lot of women
do not take the drugs because of the side effects,
and it's really important to talk to your healthcare provider
about that so they can help you manage the side
effects and you still take the drugs.
Speaker 2 (18:22):
Absolutely, that's the message.
Speaker 1 (18:24):
How do you get women to feel comfortable and feel
like they're not bothering you by saying, hey, Lillian or
doctor Smith, you know I feel like hell because of this,
you know, follow up medication, and you know sex is
painful or my bones really hurt. I mean, there are
all kinds of things that sometimes come with that. And
(18:46):
how would you encourage women to be open and honest
and assertive about that without worrying that they're whining?
Speaker 2 (18:54):
Oh my god, Yes, I mean I think It starts
with just giving yourself permission to ask questions right and
lots of them, and start broad. You know, if you
don't understand what follow up looks like, ask the question,
what does my follow up look like? What should I
expect from these clinic visits? I mean, I always say
to patients before a clinic visit, just take a few
(19:15):
minutes to sit with yourself and think about how am
I feeling. You know, do I have any new symptoms?
Speaker 1 (19:20):
And write down? Write it down.
Speaker 2 (19:22):
That's exactly what I was going to say, right, Like,
make a note of your symptoms, your side effects, your questions,
your worries, your concerns, and just bring that in with
you into the clinic visit, because you know, often patients
are like a deer in a headlight right when they
arrive at the clinic visit. And I think it's important
for you as a patient to feel like you've used
your time well and that you leave that clinic visit
(19:44):
satisfied that you've gotten that opportunity to ask all of
those questions. And I will say I do think the
clinicians are genuinely of the mind that they want patients
to feel empowered to talk to them openly, and you know,
open and honest communication is a good This can improve
outcomes because it will keep patients on therapy longer.
Speaker 1 (20:04):
Let's talk about recurrence because obviously that's what you really
are trying to avoid for breast cancer patients. And how
do you determine the likelihood of recurrence? Today, breast cancer
doctors on coologists have all kinds of tools at their
disposal that they didn't have even ten years ago that
(20:25):
can help really determine the kind of care of breast
cancer patient gets. So let's talk about recurrence.
Speaker 2 (20:33):
Yeah, so recurrence is a term, or risk of recurrence
is a term that we use a lot, and really
what that means is the chance of the breast cancer
coming back after you've completed treatment. So we think about
risk of recurrence. When we're trying to estimate that risk,
we look at patient factors and we look at tumor factors.
(20:54):
So the things we consider in patient factors are, you know,
agent diagnosis that's critically important, is there a family history?
And then the tumor factors that we're especially interested in
are how big is that tumor, has the tumor spread
to the local lymph, nodes, what is the grade of
that tumor, which is really just a pathologist way of
(21:15):
describing how different that cancer cell looks to normal cells.
And then we look at the tumor biology. So you
mentioned the estrogen receptor, so we stain the breast tumor
tissue for the estrogen receptor and for the herto receptor,
and if a patient is found to be positive for
those receptors, that information tells us that we should consider
(21:37):
a specific type of targeted therapy for those patients. I
would say that we also, as you mentioned, have lots
of new tools, so we sometimes use validated risk scores,
which basically pool all of that information together. We use
genomic tests, and all of these information factors essentially give
(21:59):
us a more acise estimate of risk. Once we understand
what that risk of recurrence is, then we can tailor
the treatment plan. We can decide with the patient whether
chemotherapy or targeted therapy like hormone therapy is needed. I
would say it's important to recognize that talking about risk
of recurrence is not about creating fear. It is about
(22:22):
ensuring that patients are getting the right treatment plan that
is individualized to their situation. So you know, information is power.
That's the reality.
Speaker 1 (22:32):
Amen to that, sister, And I am so thrilled that
doctors like yourself have this whole panoply of tools now
that can be really evaluated in concert and help a
patient navigate and determine the course of treatment. And Leche
(22:54):
miss PhD and public health. You know somebody who really
understands whose specialty is cancer prevention. How did these tools
help you navigate your own treatment and life after treatment?
Speaker 4 (23:09):
Oh?
Speaker 3 (23:09):
It helped me a lot. It helped me understand more
about what was going on because a lot of the
things that from the patient perspective, you just confuse and
you don't know what's going on.
Speaker 1 (23:20):
Right, that's a lot to kind of digest all that
stuff that Lilian was.
Speaker 3 (23:23):
Talking about, Right, You're like, what, like imagine if you
know just nothing not right? What is ER positive? What
is PR positive? And what is a mama print? And
an oncode type?
Speaker 4 (23:38):
What is RAT?
Speaker 3 (23:39):
And so for me being able to break those things
down read studies, it helped me a lot with my treatment.
For example, with my surgery, I had a unilateral mastectomy,
so only one side the brast that was affected was
removed because studies have found that there was no benefit
to doing a bilateral mastectomy, and so together with me
(24:00):
and my surgeon, we decided on just removing the disease tissue.
And so me being able to break that down and
read things as an epidemiologist and understand statistics, it helped
me a lot.
Speaker 4 (24:12):
And so then also.
Speaker 3 (24:14):
Being able to look at the oncotype and mamma print
results that I got, I was able to look at
my risk of recurrence and so I saw, Okay, if
I take on aroma taste inhibitor or something similar to that,
my risk goes down by this much. If I have chemo,
my risk goes down by this much, if I have radiation.
And so because of that, I think that's one of
(24:35):
the reasons I ended up opting for everything, give me
everything to make sure this does not come back, particularly
because of my age, because just because I'm younger, I'm
going to be around longer, So inherently I'm going to
have an increased risk just because of the mere fact
that I'm younger. So I wanted to have my best
bet of never seeing this disease again, and so it
(24:58):
helped me a lot with that, and then also doing
a lot of the complimentary treatment, so being able to
lessen my stress, eat more fruits and vegetables, and following
some of those guidelines, working out, and just working together
with some of my mentors.
Speaker 4 (25:14):
It was just great.
Speaker 1 (25:16):
You know, we talked about treatment and follow up after
your initial treatment, but one of the things I didn't
ask you about, Leche was some of the sort of
psychological and physical challenges that one faces after breast cancer
treatment as they continue on this path. And as somebody
(25:39):
who is a powerlifter, which what does that mean exactly?
You just lift super heavyweights? Is that the deal?
Speaker 3 (25:46):
Yeah, So with powerlifting, it's three lifts, So it's squat,
bench press, and dad lift, and so it's the CUMU
lift total of those three lifts, and so you try
to lift as much as you can for one lift.
Then you have three attempts in a competition. So, yes,
how did you get into that? By the way, So
I played college basketball and during the training we would
(26:09):
do a lot of lifting in the gym to strengthen up,
and I noticed, wow, I'm pretty strong.
Speaker 4 (26:14):
I'm strong, and then a lot of the people around me.
Speaker 3 (26:17):
And so once I completed playing college basketball, I said, oh,
I'm just I'm not going to just sit around and
do nothing. I need to work out and do something.
And I wanted to compete as well, because I'm a competitor.
I've been competing my whole life. And so I said, okay,
this is the best of both worlds. I can work
out and not do too much running and stuff, because
(26:38):
all that running was it was a lot with powerlifting,
and I can compete, and so then that's what I did.
Speaker 1 (26:45):
So I'm thinking about you as a powerlifter and somebody
who is a competitor and loves doing that. And you
get a mastectomy, right, which often affects your mobility and
also your energy. Love, so that was something that you
had to overcome following your treatment. What was that like?
Speaker 3 (27:07):
It was very difficult, mainly because I just it's like
a block.
Speaker 4 (27:12):
It was a mental block.
Speaker 3 (27:14):
It's like, you know, that area is removed. How am
I gonna listen?
Speaker 1 (27:18):
I'm sure it accepted, right, You're just physically how much
you could move your arm right for a while.
Speaker 4 (27:25):
In the beginning.
Speaker 3 (27:26):
Yes, so about a month after my mastectomy, I had
full range of motion only because I did a lot
of prehab. I met with a physical therapist, and due
to my background working in lifestyle medicine oncology, I just
knew the blueprint and what to do and I prepared
for it. So I think a month turnaround is just
(27:47):
insane when I look back at it. But for me, yeah,
it was. It was a period of time where I
did not have that mobility or the strength. But at
the time I reached chemotherapy, I was bench pressing two
hundred and fifty then bounds.
Speaker 1 (28:02):
So that's amazing. I mean, Lilyan in many ways, Leche
is such an ideal patient because she had a deep
understanding of cancer, cancer prevention, she did prehab, rehab, so
she gets like a gold star in every category. But
a lot of people don't have this understanding of cancer.
(28:22):
Why do you think conversations like this are so important?
And I'm really asking both of you in the public
sphere for people to feel less afraid for breast cancer
and really all cancers to be less stigmatized. Why do
you think this is so valuable for someone who doesn't
(28:42):
have Lchee's background, your background, or even my background.
Speaker 2 (28:46):
It's such a good point. I mean, I think that
at a minimum, it gives folks a language to even
talk about, right, because all of these terms that we're using,
you know, if you're not dealing with cancer care or
you don't know someone who has been affected by cancer,
it's alien concepts talking about tumor size and grade and receptors.
(29:06):
So I think that the more and more that the
community can understand and have an awareness of what's going
on with respect to cancer, it's just a good thing.
Speaker 4 (29:17):
You know.
Speaker 2 (29:17):
It's not that we want to normalize, but in some
ways you sort of do because it's part of life,
and it's really understanding that if you have a problem,
go to a physician, get yourself checked out. You know.
I think giving information to the community is just always valuable.
It's never a bad thing.
Speaker 1 (29:36):
Lache, I know that, as I said, you have been
able to translate your academic understanding of cancer as well
as your personal understanding of cancer to all kinds of people.
Why do you think that's so valuable in terms of
(29:56):
sharing your journey with complete strangers by the way, yeah.
Speaker 3 (30:01):
I think it's very important because you need somebody out
there to look up to and who's going through a
similar thing. We all need that support person. We all
need that person to saying Oh, but she went through
the same thing, and she can do it, maybe I
can do it. And I think you also need people
who understand what's going on to break it down in
(30:22):
the language you could understand.
Speaker 1 (30:23):
I was going to say, I think you need someone
to translate all this science and no offense. Lilian, you're it.
You're really good at explaining. But a lot of doctors
and scientists are so used to kind of talking about
something at this level, they're not very good at dumbing
it down because they're so smart basically, And I think,
(30:47):
you know, for you to do that, Lche is so
helpful for people.
Speaker 3 (30:52):
Yes, I think it's a big benefit to to public
health and public health training. What they teach us is
you have to find ways to break down for any
disease messages out of fifth grade level so that everybody,
no matter what, they can understand. And so that's something
I already had with my training, was that you have
to be able to give messages in small bursts because
(31:13):
people might not want to pay attention for as long
and just let them know the key things. And so
with early breast cancer detection, the biggest thing that I
try to send a message about is if you get
screened early. So when you look at the American Cancer
Society and you look at some of the things they have,
if you get screened, then you find it early, you
have a high likely or a high chance of being around.
(31:35):
So you know it shouldn't be that scared and see
nice people like doctor Smith. She'll get you in a
good physician.
Speaker 1 (31:43):
And I applaud you for so many things lche that
you were doing. I think you're taking a personal challenge
and I'm sure what was a very frightening experience, and
you're using it to really help other people, which I
think is very therapeutic. It was certainly therapeutic for me
when I lost my husband a calling cancer, and really
(32:05):
therapeutic when I experienced breast cancer myself to be able
to share what I learned to other people. But I
also so appreciate the fact that you're participating in some
studies that will really help doctors like Lilian understand some
(32:25):
of the biology of this disease. Tell us about that.
Speaker 3 (32:30):
Yeah, So I thought it was extremely important because one
of the things we tend to look at is genetic mutations,
and for me, when I did the test to the
comprehensive test. There were no genetic mutations that I had
linked to anti cancers, not just breast cancer.
Speaker 1 (32:45):
Not known genetics takes about to get.
Speaker 3 (32:48):
To and so what I did was I donated my
tissue because right now at UM they're doing studies.
Speaker 1 (32:54):
Where they're University of Miami and oh yes.
Speaker 3 (32:56):
At University of Miami, they're doing studies where they're looking
at people of West African genetic ancestry, which I happen
to be a part of, and they're looking at our
tumor biology to see if there's another gene that we're
unaware of on other genetic factors.
Speaker 4 (33:11):
And so that's one of the things.
Speaker 3 (33:13):
Maybe down the line there might be a reason I
got this because right now we don't know none of
the known risk factors. I have none of those, So
no faunily history. I exercise ate, right, all those nice things,
never smoked, don't drink nothing, And so you know, I
want to pay it forward because me as a researcher,
(33:34):
I want to get data. I want people to participate,
and so I want to be a part of pushing
the science forward. And I think it's so important because
it helps not only you but others. And if you
participate in clinical trials, you get more appointments, you get
to see your doctor, you get extended care. Who doesn't
want that.
Speaker 1 (33:54):
It is really important that the data represents a broad
swath of human biology, isn't it.
Speaker 2 (34:03):
It's incredibly important And Lashaye and I were chatting about
this before the recording. It is just unbelievably amazing to
advocate for improving research and breast cancer clinical trial participation.
I mean, we are going to learn so much more
if we all work together, contribute tissue samples, participate in
(34:24):
clinical trials. It's how we learn, it's how we advance
the field. And I just commend you for doing that
because someone will benefit from that. It really that's how
it works.
Speaker 1 (34:35):
Yes, what is the most important thing for both of
you to leave patients or just people who are perfectly healthy?
What do you want them to know after watching this?
What are sort of the top line messages you would
like to impart.
Speaker 3 (34:54):
One of the biggest things I'd like to impart is
that if for some reason you do get cancer, it's
not a death sentence and you can be like me.
You can go through treatment and you can be cancer free.
You can look quote unquote normal like nothing ever happened
to you lift four hundred and eight pounds for your
(35:14):
last chemotherapy treatment, and yeah, you can just live an
amazing life. And also just be aware of your body.
Get to know your body, if it's one thing you
learn from this session and watching us here, get to
know what is your normal and if you see something wrong,
get it checked.
Speaker 1 (35:34):
And what about you, Lilyan, Especially for people once their
treatment is complete, what do you want those people watching
to understand?
Speaker 2 (35:42):
Yes, I have a very similar message to Lache there
is life after breast cancer. Most patients who were diagnosed
with early breast cancer, once they've completed treatment, this becomes
something in their rear viewmer it is very unlikely to
be an issue for them again. And I think that
that's a piece of information that isn't out there, and
(36:03):
I would like to emphasize that. I would also say,
you know, we've touched on this. For the patients who
are hormone receptor positive who've been recommended hormone therapy, do
try to stick with it. I know it's hard. We
know that adherents can be hard. We know that patients
often struggle to even admit to their provider that they're
(36:23):
struggling with the side effects. But I would say, if
you are struggling, speak up, speak to your doctor, because
there are ways that we can help. There are other
options that we consider, so I think that's an important message.
And then I would say, you know, it's like all
of us. Try to do as best you can. Exercise,
eat well, reduce alcohol, avoid.
Speaker 1 (36:45):
Smoking, and just get back to living your life well.
This has been such an important conversation. Lyche, I'm so
grateful for you talking about this and sharing your story.
And doctor Smith, Lillian, I'm so grateful for your dedication
to all your patients and to breast cancer research. I
(37:09):
applaud you and all your fellow clinicians and scientists. You
are my heroes and I've added you to my list too.
Speaker 4 (37:17):
Oh, thank you so much. You're ready on my list.
Speaker 1 (37:22):
Thanks so much to both of you. Really appreciate thanks
for having me.
Speaker 4 (37:25):
Thank you so much. Thank you.
Speaker 1 (37:27):
All conversations like this remind us that breast cancer isn't
just about diagnosis and treatment. It's about what comes after
and how we can empower patients to feel informed, supported
and hopeful every step of the way. I'm grateful to
Eli Lilly for making these important discussions possible, and for
their ongoing commitment to advancing science and amplifying patient voices.
(37:51):
And to all of you listening and watching, remember you
are your own best advocate. Pay attention to your body,
stay informed, and take care of yourself and the people
you love. Thanks for listening everyone. If you have a
question for me, a subject you want us to cover,
or you want to share your thoughts about how you
(38:12):
navigate this crazy world, reach out send me a DM
on Instagram. I would love to hear from you. Next
Question is a production 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.
(38:38):
For more information about today's episode, or to sign up
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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
(39:00):
favorite shows. We're partnering with Eli Lilly and Company for
Breast Cancer Awareness Month. A cancer diagnosis can impact every
aspect of someone's life, but they shouldn't face it alone.
Research shows that support and human connection play a significant
role in one's healing and mental health. That's why Lily
(39:21):
is working with patients, caregivers, and advocates to amplify voices,
advanced treatment, and empower the early and metastatic breast cancer community.
Learn more about how Lily is making a difference at
lily dot com.
We're partnering with Eli Lilly and Company for Breast Cancer
Awareness Month. A cancer diagnosis can impact every aspect of
someone's life, but they shouldn't face it alone. Research shows
that support and human connection play a significant role in
one's healing and mental health. That's why Lily is working
with patients, caregivers, and advocates to amplify voices, advanced treatment,
(00:27):
and empower the early and metastatic breast cancer community. Learn
more about how Lily is making a difference at Lily
dot com. Hi everyone, I'm Kitty Kuric and this is
next question. As many of you might know, I've been
through my own breast cancer journey and the one thing
(00:49):
I've learned is that the story doesn't necessarily stop when
treatment ends. In fact, for so many women, that's when
a whole new chapter begins. Today I'm talking with doctor
Lilly Smith, Senior Vice president and Global Development head for
breast Cancer at Eli Lilly and Company, as well as
breast cancer patient advocate and Lily partner Lecha Role. We're
(01:11):
talking about life after diagnosis and treatment. Why knowing your
body's normal is so critical, how to understand your risk
of recurrence, especially when diagnosed with early breast cancer that
does have a high risk of coming back, and what
it means to be your own advocate and follow up care.
Doctor Smith and Leshay, Welcome to both of you. I'm
(01:32):
so excited to be with you and have this important
conversation about breast cancer and really life after breast cancer treatment.
And doctor Smith, may I call you Lily?
Speaker 2 (01:42):
You may, of course.
Speaker 1 (01:43):
Let me start with you. I know you went into
oncology and then you decided to really focus on breast cancer.
What led you down this path? What was it about
breast cancer in particular that interested you?
Speaker 2 (01:56):
So you know, honestly, it was the patients that drew
me in. I mean, obviously, breast cancer predominantly affects women,
and I got the sense really early on in my
training that these were the women and the patients that
I wanted to look after. It just always felt like
critically important work. And then I would say, added to that,
the science pulled me in. Breast cancer is one of
(02:17):
the fastest moving feels in oncology, and the more I
treated patients, the more motivated I became to really try
and find new and improved ways to care for those patients. Ultimately,
I just wanted to be part of driving improved outcomes
for patients with this disease.
Speaker 1 (02:32):
Lche. I know that you share a lot of interest
with Lilian and that you were studying breast cancer prevention
and you were getting a PhD and still are in
public health when ironically you were diagnosed yourself with breast cancer.
Tell me about that, and that was I know, in
(02:55):
twenty twenty four, you were just twenty six years old.
Speaker 3 (02:57):
Liche, Yeah, I was young. So for me, basically, I
was in the middle of my PhD. Second year of
my PhD, and I thought, I'm doing cancer research, cancer
prevention in particular, and I felt a lump. I was like, hmm,
that's one of those things that I tell people might
be a risk factor. And I felt a little pain
(03:19):
in my breast and I was like, that's another red flag.
Speaker 4 (03:23):
And so I did with.
Speaker 3 (03:24):
What I hope many people do when they find that
something is wrong, they going to get checked out. So
I went to do a woman's health exam at the
student Health Center and they let me know that, hmm,
you have a lump there. Maybe it could be something
could not be most likely due to your age. It's
fibrus tissue. But they went and sent me off to
(03:45):
do a mamma gramina ultrasound anyway, and we all know
that story ended. They found that I did indeed have cancer.
And I credit me doing my PhD in this field
to finding that because I think had I been in
a different place in my life or not in this field,
I would not have been alarmed by those things, and
(04:05):
I maybe would not have known that that was something
that could be related to cancer. And so my biggest
thing that I tell people all the time is get
to know your body and what is your normal, so
that if something is wrong, you know to get checked.
Speaker 1 (04:18):
Well. Thank goodness, Lilian that Leche was studying this, knew
that this needed medical attention, did not blow it off
when and got it taken care of, but goodness she
would just she's twenty eight now, just twenty six years old.
We're seeing many more people, many more women getting diagnosed
(04:40):
with breast cancer at an earlier and earlier age, aren't
we We are?
Speaker 2 (04:45):
I mean, in fact, it has resulted in US sort
of adjusting the screening guidelines within the US to lower
that age to forty, where the recommendation is to have
yearly mammograms from that age, So there is no doubt
that younger age a diagnosis breast cancer is rising in incidents,
(05:06):
both globally and specifically within the US. So it's really
important that folks remain aware of that. And I think
telling stories like Ache is describing today is just hugely
important for everyone to understand the changes that are happening
out there.
Speaker 1 (05:20):
Because at her age, she was well below the guidelines
for getting screened, and yet you were aware enough to
notice a change in your body and Lechee, I really
admired the fact that you have shared your experience very publicly.
You've created a platform you talk about what happened to you.
(05:42):
Why has that been so important to you?
Speaker 3 (05:45):
It's been extremely important for me because at the time
when I was diagnosed, I went to Instagram, I went
all over the internet and I tried to find somebody
who was like me, that was sharing maybe some aspect,
not even the full story like I am. And I
couldn't find anyone. I couldn't find anyone my age, I
couldn't find anyone that looked like me. I couldn't find
(06:05):
anyone who was powerlifting.
Speaker 1 (06:08):
And yes, Bury the lead You're a power left. I'll
get to that.
Speaker 4 (06:12):
In a moment.
Speaker 3 (06:14):
Yes, And so what I wanted to do was I
wanted to create that person for other women who are
going to be diagnosed young, or who want to engage
in those activities, or or who have similarities to me.
And so that's why I want to share that, to
spread awareness and to have somebody who was out there
to be that person that I needed at the time.
Speaker 1 (06:35):
What kind of feedback have you gotten, Liche? Has it
been gratifying to see that you're striking a chord and
educating so many women who not only look like you,
but who don't look like you and need to be
aware of the symptoms of breast cancer, especially at an
early age.
Speaker 3 (06:52):
Yes, so it's been monumental. It's taken off much more
than I even thought. So initially I just posted that night.
I did want to share it with some people, and
I did want to make an impact, but it's made
much more of an impact than I could have ever
thought of, reaching people in different countries, like you said,
not just to look like me, everybody, and getting people
(07:14):
moving and people tagging me and saying I'm working out
today because I'm channeling my inner strong after cancer, and
I'm like, wow, this is incredible, And people are messaging
me saying they got their first mama around because they
realized that I was diagnosed so young and it actually
runs in their family and they weren't just getting screened
(07:35):
even though it runs in your family. And I'm sure
that many people can get screened because when you have
a genetic history, they do allow you to get it
covered and screened. And you know, I just A'm very
proud of what has happened, and I think that I
have no regrets.
Speaker 1 (07:53):
Well, I'm so proud of you that you have shared
your story, and I want to mention something because I
think sometimes family history is used as an excuse or
no family history, I should say, for not really pay
attention to many cancers, including breast cancer. And the fact
(08:15):
of the matter is Lilian that most women who are
diagnosed with breast cancer have no family history, right.
Speaker 2 (08:22):
Correct, entirely true, exactly. So I mean I think that
that's to your point. It's about understanding that you need
to know what normal is for your body and to
report any symptoms or red flags as you term them,
like new lumps, pains, issues. You really have to talk
to your doctor about them and don't dismiss them and think, oh, well,
(08:43):
this would never happen to me, or it doesn't.
Speaker 1 (08:45):
Run in my family, right because it didn't run in
Lache's family. Absolutely, Let's talk about the steps you need
to take after you're diagnosed, and just having experienced it
myself a few years years ago, the staging is critically important.
So can you help people understand who haven't gone through
(09:08):
what Leche and I have or don't have your background, Lilian,
what the difference is between early stage breast cancer and
metastatic breast cancer.
Speaker 2 (09:19):
Yeah, absolutely, so it's a critical distinction, and it's the
distinction that we make right at the time of diagnosis.
So early stage breast cancer is by far the most
common presentation, and that basically consists of breast cancer that
is confined to the breast or the local lymphnotes, and
the treatment intent for early breast cancer is cure. Typically
(09:42):
it consists of surgery first, so either a partial removal
of breast tissue or full removal of breast so.
Speaker 1 (09:49):
You're talking about a lumpa lump versus aspect.
Speaker 2 (09:52):
To me exactly, and then often that's followed by radiation
therapy and then in some cases chemotherapy or targeted therapy
like hormone therapies are offered. So that's early stage breast cancer.
Metastatic or advanced breast cancer is breast cancer that has
spread beyond the breast and local lymph node area to
(10:13):
a distant organ like long liver or bone, and the
treatment intent in that scenario is different. It is long
term treatment that is focusing on disease control and maintaining
quality of life for as long.
Speaker 1 (10:28):
As we can. That's why early detection is so critically
most important, because it is much easier to eradicate the
disease when it's caught early instead of just managing the.
Speaker 2 (10:40):
Disease correct andentarly.
Speaker 1 (10:42):
Absolutely, let's talk lche about life after treatment. Your breast
cancer was stage two B, so that meant lymph node
involvement correct.
Speaker 4 (10:56):
Yes, So I had lymph node involvement.
Speaker 1 (10:58):
So that meant you needed chemotherapy and you got a mestectomy.
Speaker 4 (11:03):
Yes.
Speaker 1 (11:04):
So first of all, how was that treatment for you?
Speaker 3 (11:09):
So for me, it honestly was it was a lot.
So being so young and having to have my breast removed,
it was just something I was not thinking about at all,
and it's something that's it feels so feminine, like it
feels like something that all women have. You have your breast.
(11:30):
That's one of the things that really sets us apart.
And so I had that removed and that was a
big thing. But then when I found out later that
it had spread all my lymph nodes because we were
still waiting for how many positive lymph nodes I had.
After surgery, found out I had to do chemo, and
you know when you hear the word chemo, it's very intimidating.
(11:50):
And so I had to do taxitair and cyclophosphamide that's
TC for four cycles and I lost all of my
hair and it was very, very emotional for me. But
you know, after I lost my hair, I was like, well,
that's it smooth sailing from hair. I was trying to
avoid losing my hair. That was the biggest thing. And
(12:12):
I just powered through it. And with the help of
my family and my dog. He was a big part.
He was a big part of my journey. I was
able to get through those two parts. And then I
had radiation after wood.
Speaker 1 (12:25):
And which can make you very tired.
Speaker 3 (12:28):
Oh yes, I had a lot of fatigue and there
was some mark, so it had some burning and discoloration
in that area. But just like chemotherapy, I got through it,
and I didn't stop doing anything throughout it. Throughout all
my treatment, I was still doing my PhD, I was
still working out, I was still living my life, and
(12:49):
I didn't let it stop me. So it might have
been hard, but you know what, I'm tougher than cancer.
Speaker 1 (12:55):
I think a lot of people focus on the treatment liche,
but there's also life after treatment, something that I think
patients aren't necessarily prepared for. Lillian, what do you tell
patients who are saying, Okay, I'm done about the things
they might experience once the treatment is actually over.
Speaker 2 (13:17):
Yeah, it's such an important question. So I would say,
once the upfront treatment of surgery, radiation, and chemotherapy is completed,
patients move into this active follow up schedule of follow
up visits. So typically what that looks like is they
will be seeing their clinician every three to four months
for the first two years, then it sort of moves
(13:39):
out every six to twelve months up until year five,
and then after that fifth year they're really just coming
in every year, And the purpose of those visits is
really a check in to see how are you doing,
do you have any worries or concerns, do you have
any symptoms that are new, have you any side effects
from treatment, or are you expect lear and seeing new
(14:00):
side effects from ongoing treatment. It's really an opportunity to
support those patients who are still on ongoing treatment because,
as you may know, many breast cancers are hormone receptor
positive and for those patients, they're recommended hormone therapy for
at least five years and sometimes up to ten years.
So it's actually really important to check in with those
(14:22):
patients and see how they're doing. Are you actually taking
your medication, how does that feel, do you have side effects?
And you know, the typical issues that we would be
discussing in clinic are things like sexual health, hot flashes,
bone health, and it's just really important that patients feel
comfortable to bring up these topics in the clinic. I
(14:43):
would say from an imaging perspective, their follow up usually
looks like a mammogram every year. We follow bone health
with a dexa scan every other year, and that's really
important for postmenopausal patients and patients who are on hormone therapy,
and then, as you mentioned history and genetics, if we
identify that a patient has a family history or an
(15:05):
increased risk a genetic risk, then we have to tailor
their treatment plan and their follow up appropriately. So I
guess I would say high level life sort of after
the upfront treatment really looks like staying very connected with
your care team, being proactive, and you know, for us
as providers, it's just about giving patients the tools to
(15:28):
live well so that all issues can be flagged early.
Speaker 1 (15:37):
We're partnering with Eli Lilly and Company for Breast Cancer
Awareness Month. A cancer diagnosis can impact every aspect of
someone's life, but they shouldn't face it alone. Research shows
that support and human connection play a significant role in
one's healing and mental health. That's why Lily is working
with patients, caregivers, and advocates to amplify voices, advanced treatment,
(16:01):
and empowered the early and metastatic breast cancer community. Learn
more about how Lily is making a difference at Lily
dot com. Lyche you have been a very vocal advocate
for your own follow up care. Tell us about that
(16:22):
and examples of how you have spoken up and made
your needs known to your healthcare providers.
Speaker 3 (16:31):
Yeah, so one of the biggest things I do is
I share with people on Instagram that if there's anything
wrong or you have any issues, make sure that you
tell your care team that because it's very important. Like
doctor said, you must, you know, keep your team informed.
And so for me, like doctor touched on a lot
(16:52):
of those things like hot flashes, etc. Because I'm also
hormone positive, there are a lot of things after cancer treatment,
and so for me, I just would share those things
with my doctor and I would let her know and
she would basically tailor a lot of those hormone therapies
and just help me have an overall much better experience.
(17:13):
And I've been able to maintain and stay on all
of the drugs and I'm in a good place. All
of my scans are clear and everything's going well. So
I would just say having that open line of communication
and just being aware that your body is still going
through a lot and trying to recover after treatment. I
would say that cancer patients, no matter what the type
(17:34):
of cancer, just know that your body went through a
lot and just be gentle with yourself and try to
build back.
Speaker 1 (17:41):
But I think you're so right. I mean, I think
it's so important for patients to talk to their physicians about, say,
the side effects of follow up care. For example, a
romantase inhibitors. Right, if you have hormone receptor positive breast cancer,
you have to take these inhibitors that basically suppress estrogen
(18:01):
because the cancer feeds on estrogen. Am I getting that
right there, Darley?
Speaker 4 (18:05):
Yes?
Speaker 1 (18:05):
And there are ways to mitigate some of the side
effects from taking those drugs, and a lot of women
do not take the drugs because of the side effects,
and it's really important to talk to your healthcare provider
about that so they can help you manage the side
effects and you still take the drugs.
Speaker 2 (18:22):
Absolutely, that's the message.
Speaker 1 (18:24):
How do you get women to feel comfortable and feel
like they're not bothering you by saying, hey, Lillian or
doctor Smith, you know I feel like hell because of this,
you know, follow up medication, and you know sex is
painful or my bones really hurt. I mean, there are
all kinds of things that sometimes come with that. And
(18:46):
how would you encourage women to be open and honest
and assertive about that without worrying that they're whining?
Speaker 2 (18:54):
Oh my god, Yes, I mean I think It starts
with just giving yourself permission to ask questions right and
lots of them, and start broad. You know, if you
don't understand what follow up looks like, ask the question,
what does my follow up look like? What should I
expect from these clinic visits? I mean, I always say
to patients before a clinic visit, just take a few
(19:15):
minutes to sit with yourself and think about how am
I feeling. You know, do I have any new symptoms?
Speaker 1 (19:20):
And write down? Write it down.
Speaker 2 (19:22):
That's exactly what I was going to say, right, Like,
make a note of your symptoms, your side effects, your questions,
your worries, your concerns, and just bring that in with
you into the clinic visit, because you know, often patients
are like a deer in a headlight right when they
arrive at the clinic visit. And I think it's important
for you as a patient to feel like you've used
your time well and that you leave that clinic visit
(19:44):
satisfied that you've gotten that opportunity to ask all of
those questions. And I will say I do think the
clinicians are genuinely of the mind that they want patients
to feel empowered to talk to them openly, and you know,
open and honest communication is a good This can improve
outcomes because it will keep patients on therapy longer.
Speaker 1 (20:04):
Let's talk about recurrence because obviously that's what you really
are trying to avoid for breast cancer patients. And how
do you determine the likelihood of recurrence? Today, breast cancer
doctors on coologists have all kinds of tools at their
disposal that they didn't have even ten years ago that
(20:25):
can help really determine the kind of care of breast
cancer patient gets. So let's talk about recurrence.
Speaker 2 (20:33):
Yeah, so recurrence is a term, or risk of recurrence
is a term that we use a lot, and really
what that means is the chance of the breast cancer
coming back after you've completed treatment. So we think about
risk of recurrence. When we're trying to estimate that risk,
we look at patient factors and we look at tumor factors.
(20:54):
So the things we consider in patient factors are, you know,
agent diagnosis that's critically important, is there a family history?
And then the tumor factors that we're especially interested in
are how big is that tumor, has the tumor spread
to the local lymph, nodes, what is the grade of
that tumor, which is really just a pathologist way of
(21:15):
describing how different that cancer cell looks to normal cells.
And then we look at the tumor biology. So you
mentioned the estrogen receptor, so we stain the breast tumor
tissue for the estrogen receptor and for the herto receptor,
and if a patient is found to be positive for
those receptors, that information tells us that we should consider
(21:37):
a specific type of targeted therapy for those patients. I
would say that we also, as you mentioned, have lots
of new tools, so we sometimes use validated risk scores,
which basically pool all of that information together. We use
genomic tests, and all of these information factors essentially give
(21:59):
us a more acise estimate of risk. Once we understand
what that risk of recurrence is, then we can tailor
the treatment plan. We can decide with the patient whether
chemotherapy or targeted therapy like hormone therapy is needed. I
would say it's important to recognize that talking about risk
of recurrence is not about creating fear. It is about
(22:22):
ensuring that patients are getting the right treatment plan that
is individualized to their situation. So you know, information is power.
That's the reality.
Speaker 1 (22:32):
Amen to that, sister, And I am so thrilled that
doctors like yourself have this whole panoply of tools now
that can be really evaluated in concert and help a
patient navigate and determine the course of treatment. And Leche
(22:54):
miss PhD and public health. You know somebody who really
understands whose specialty is cancer prevention. How did these tools
help you navigate your own treatment and life after treatment?
Speaker 4 (23:09):
Oh?
Speaker 3 (23:09):
It helped me a lot. It helped me understand more
about what was going on because a lot of the
things that from the patient perspective, you just confuse and
you don't know what's going on.
Speaker 1 (23:20):
Right, that's a lot to kind of digest all that
stuff that Lilian was.
Speaker 3 (23:23):
Talking about, Right, You're like, what, like imagine if you
know just nothing not right? What is ER positive? What
is PR positive? And what is a mama print? And
an oncode type?
Speaker 4 (23:38):
What is RAT?
Speaker 3 (23:39):
And so for me being able to break those things
down read studies, it helped me a lot with my treatment.
For example, with my surgery, I had a unilateral mastectomy,
so only one side the brast that was affected was
removed because studies have found that there was no benefit
to doing a bilateral mastectomy, and so together with me
(24:00):
and my surgeon, we decided on just removing the disease tissue.
And so me being able to break that down and
read things as an epidemiologist and understand statistics, it helped
me a lot.
Speaker 4 (24:12):
And so then also.
Speaker 3 (24:14):
Being able to look at the oncotype and mamma print
results that I got, I was able to look at
my risk of recurrence and so I saw, Okay, if
I take on aroma taste inhibitor or something similar to that,
my risk goes down by this much. If I have chemo,
my risk goes down by this much, if I have radiation.
And so because of that, I think that's one of
(24:35):
the reasons I ended up opting for everything, give me
everything to make sure this does not come back, particularly
because of my age, because just because I'm younger, I'm
going to be around longer, So inherently I'm going to
have an increased risk just because of the mere fact
that I'm younger. So I wanted to have my best
bet of never seeing this disease again, and so it
(24:58):
helped me a lot with that, and then also doing
a lot of the complimentary treatment, so being able to
lessen my stress, eat more fruits and vegetables, and following
some of those guidelines, working out, and just working together
with some of my mentors.
Speaker 4 (25:14):
It was just great.
Speaker 1 (25:16):
You know, we talked about treatment and follow up after
your initial treatment, but one of the things I didn't
ask you about, Leche was some of the sort of
psychological and physical challenges that one faces after breast cancer
treatment as they continue on this path. And as somebody
(25:39):
who is a powerlifter, which what does that mean exactly?
You just lift super heavyweights? Is that the deal?
Speaker 3 (25:46):
Yeah, So with powerlifting, it's three lifts, So it's squat,
bench press, and dad lift, and so it's the CUMU
lift total of those three lifts, and so you try
to lift as much as you can for one lift.
Then you have three attempts in a competition. So, yes,
how did you get into that? By the way, So
I played college basketball and during the training we would
(26:09):
do a lot of lifting in the gym to strengthen up,
and I noticed, wow, I'm pretty strong.
Speaker 4 (26:14):
I'm strong, and then a lot of the people around me.
Speaker 3 (26:17):
And so once I completed playing college basketball, I said, oh,
I'm just I'm not going to just sit around and
do nothing. I need to work out and do something.
And I wanted to compete as well, because I'm a competitor.
I've been competing my whole life. And so I said, okay,
this is the best of both worlds. I can work
out and not do too much running and stuff, because
(26:38):
all that running was it was a lot with powerlifting,
and I can compete, and so then that's what I did.
Speaker 1 (26:45):
So I'm thinking about you as a powerlifter and somebody
who is a competitor and loves doing that. And you
get a mastectomy, right, which often affects your mobility and
also your energy. Love, so that was something that you
had to overcome following your treatment. What was that like?
Speaker 3 (27:07):
It was very difficult, mainly because I just it's like
a block.
Speaker 4 (27:12):
It was a mental block.
Speaker 3 (27:14):
It's like, you know, that area is removed. How am
I gonna listen?
Speaker 1 (27:18):
I'm sure it accepted, right, You're just physically how much
you could move your arm right for a while.
Speaker 4 (27:25):
In the beginning.
Speaker 3 (27:26):
Yes, so about a month after my mastectomy, I had
full range of motion only because I did a lot
of prehab. I met with a physical therapist, and due
to my background working in lifestyle medicine oncology, I just
knew the blueprint and what to do and I prepared
for it. So I think a month turnaround is just
(27:47):
insane when I look back at it. But for me, yeah,
it was. It was a period of time where I
did not have that mobility or the strength. But at
the time I reached chemotherapy, I was bench pressing two
hundred and fifty then bounds.
Speaker 1 (28:02):
So that's amazing. I mean, Lilyan in many ways, Leche
is such an ideal patient because she had a deep
understanding of cancer, cancer prevention, she did prehab, rehab, so
she gets like a gold star in every category. But
a lot of people don't have this understanding of cancer.
(28:22):
Why do you think conversations like this are so important?
And I'm really asking both of you in the public
sphere for people to feel less afraid for breast cancer
and really all cancers to be less stigmatized. Why do
you think this is so valuable for someone who doesn't
(28:42):
have Lchee's background, your background, or even my background.
Speaker 2 (28:46):
It's such a good point. I mean, I think that
at a minimum, it gives folks a language to even
talk about, right, because all of these terms that we're using,
you know, if you're not dealing with cancer care or
you don't know someone who has been affected by cancer,
it's alien concepts talking about tumor size and grade and receptors.
(29:06):
So I think that the more and more that the
community can understand and have an awareness of what's going
on with respect to cancer, it's just a good thing.
Speaker 4 (29:17):
You know.
Speaker 2 (29:17):
It's not that we want to normalize, but in some
ways you sort of do because it's part of life,
and it's really understanding that if you have a problem,
go to a physician, get yourself checked out. You know.
I think giving information to the community is just always valuable.
It's never a bad thing.
Speaker 1 (29:36):
Lache, I know that, as I said, you have been
able to translate your academic understanding of cancer as well
as your personal understanding of cancer to all kinds of people.
Why do you think that's so valuable in terms of
(29:56):
sharing your journey with complete strangers by the way, yeah.
Speaker 3 (30:01):
I think it's very important because you need somebody out
there to look up to and who's going through a
similar thing. We all need that support person. We all
need that person to saying Oh, but she went through
the same thing, and she can do it, maybe I
can do it. And I think you also need people
who understand what's going on to break it down in
(30:22):
the language you could understand.
Speaker 1 (30:23):
I was going to say, I think you need someone
to translate all this science and no offense. Lilian, you're it.
You're really good at explaining. But a lot of doctors
and scientists are so used to kind of talking about
something at this level, they're not very good at dumbing
it down because they're so smart basically, And I think,
(30:47):
you know, for you to do that, Lche is so
helpful for people.
Speaker 3 (30:52):
Yes, I think it's a big benefit to to public
health and public health training. What they teach us is
you have to find ways to break down for any
disease messages out of fifth grade level so that everybody,
no matter what, they can understand. And so that's something
I already had with my training, was that you have
to be able to give messages in small bursts because
(31:13):
people might not want to pay attention for as long
and just let them know the key things. And so
with early breast cancer detection, the biggest thing that I
try to send a message about is if you get
screened early. So when you look at the American Cancer
Society and you look at some of the things they have,
if you get screened, then you find it early, you
have a high likely or a high chance of being around.
(31:35):
So you know it shouldn't be that scared and see
nice people like doctor Smith. She'll get you in a
good physician.
Speaker 1 (31:43):
And I applaud you for so many things lche that
you were doing. I think you're taking a personal challenge
and I'm sure what was a very frightening experience, and
you're using it to really help other people, which I
think is very therapeutic. It was certainly therapeutic for me
when I lost my husband a calling cancer, and really
(32:05):
therapeutic when I experienced breast cancer myself to be able
to share what I learned to other people. But I
also so appreciate the fact that you're participating in some
studies that will really help doctors like Lilian understand some
(32:25):
of the biology of this disease. Tell us about that.
Speaker 3 (32:30):
Yeah, So I thought it was extremely important because one
of the things we tend to look at is genetic mutations,
and for me, when I did the test to the
comprehensive test. There were no genetic mutations that I had
linked to anti cancers, not just breast cancer.
Speaker 1 (32:45):
Not known genetics takes about to get.
Speaker 3 (32:48):
To and so what I did was I donated my
tissue because right now at UM they're doing studies.
Speaker 1 (32:54):
Where they're University of Miami and oh yes.
Speaker 3 (32:56):
At University of Miami, they're doing studies where they're looking
at people of West African genetic ancestry, which I happen
to be a part of, and they're looking at our
tumor biology to see if there's another gene that we're
unaware of on other genetic factors.
Speaker 4 (33:11):
And so that's one of the things.
Speaker 3 (33:13):
Maybe down the line there might be a reason I
got this because right now we don't know none of
the known risk factors. I have none of those, So
no faunily history. I exercise ate, right, all those nice things,
never smoked, don't drink nothing, And so you know, I
want to pay it forward because me as a researcher,
(33:34):
I want to get data. I want people to participate,
and so I want to be a part of pushing
the science forward. And I think it's so important because
it helps not only you but others. And if you
participate in clinical trials, you get more appointments, you get
to see your doctor, you get extended care. Who doesn't
want that.
Speaker 1 (33:54):
It is really important that the data represents a broad
swath of human biology, isn't it.
Speaker 2 (34:03):
It's incredibly important And Lashaye and I were chatting about
this before the recording. It is just unbelievably amazing to
advocate for improving research and breast cancer clinical trial participation.
I mean, we are going to learn so much more
if we all work together, contribute tissue samples, participate in
(34:24):
clinical trials. It's how we learn, it's how we advance
the field. And I just commend you for doing that
because someone will benefit from that. It really that's how
it works.
Speaker 1 (34:35):
Yes, what is the most important thing for both of
you to leave patients or just people who are perfectly healthy?
What do you want them to know after watching this?
What are sort of the top line messages you would
like to impart.
Speaker 3 (34:54):
One of the biggest things I'd like to impart is
that if for some reason you do get cancer, it's
not a death sentence and you can be like me.
You can go through treatment and you can be cancer free.
You can look quote unquote normal like nothing ever happened
to you lift four hundred and eight pounds for your
(35:14):
last chemotherapy treatment, and yeah, you can just live an
amazing life. And also just be aware of your body.
Get to know your body, if it's one thing you
learn from this session and watching us here, get to
know what is your normal and if you see something wrong,
get it checked.
Speaker 1 (35:34):
And what about you, Lilyan, Especially for people once their
treatment is complete, what do you want those people watching
to understand?
Speaker 2 (35:42):
Yes, I have a very similar message to Lache there
is life after breast cancer. Most patients who were diagnosed
with early breast cancer, once they've completed treatment, this becomes
something in their rear viewmer it is very unlikely to
be an issue for them again. And I think that
that's a piece of information that isn't out there, and
(36:03):
I would like to emphasize that. I would also say,
you know, we've touched on this. For the patients who
are hormone receptor positive who've been recommended hormone therapy, do
try to stick with it. I know it's hard. We
know that adherents can be hard. We know that patients
often struggle to even admit to their provider that they're
(36:23):
struggling with the side effects. But I would say, if
you are struggling, speak up, speak to your doctor, because
there are ways that we can help. There are other
options that we consider, so I think that's an important message.
And then I would say, you know, it's like all
of us. Try to do as best you can. Exercise,
eat well, reduce alcohol, avoid.
Speaker 1 (36:45):
Smoking, and just get back to living your life well.
This has been such an important conversation. Lyche, I'm so
grateful for you talking about this and sharing your story.
And doctor Smith, Lillian, I'm so grateful for your dedication
to all your patients and to breast cancer research. I
(37:09):
applaud you and all your fellow clinicians and scientists. You
are my heroes and I've added you to my list too.
Speaker 4 (37:17):
Oh, thank you so much. You're ready on my list.
Speaker 1 (37:22):
Thanks so much to both of you. Really appreciate thanks
for having me.
Speaker 4 (37:25):
Thank you so much. Thank you.
Speaker 1 (37:27):
All conversations like this remind us that breast cancer isn't
just about diagnosis and treatment. It's about what comes after
and how we can empower patients to feel informed, supported
and hopeful every step of the way. I'm grateful to
Eli Lilly for making these important discussions possible, and for
their ongoing commitment to advancing science and amplifying patient voices.
(37:51):
And to all of you listening and watching, remember you
are your own best advocate. Pay attention to your body,
stay informed, and take care of yourself and the people
you love. Thanks for listening everyone. If you have a
question for me, a subject you want us to cover,
or you want to share your thoughts about how you
(38:12):
navigate this crazy world, reach out send me a DM
on Instagram. I would love to hear from you. Next
Question is a production 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.
(38:38):
For more information about today's episode, 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
(39:00):
favorite shows. We're partnering with Eli Lilly and Company for
Breast Cancer Awareness Month. A cancer diagnosis can impact every
aspect of someone's life, but they shouldn't face it alone.
Research shows that support and human connection play a significant
role in one's healing and mental health. That's why Lily
(39:21):
is working with patients, caregivers, and advocates to amplify voices,
advanced treatment, and empower the early and metastatic breast cancer community.
Learn more about how Lily is making a difference at
lily dot com.
Host
Katie Couric
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