In this powerful Breast Cancer Awareness Month rerun episode, we’re joined once again by renowned breast cancer oncologist Dr. Amy Comander to explore the vital connection between lifestyle medicine and breast cancer prevention, treatment, and survivorship.
Dr. Comander shares expert insights on how nutrition, exercise, stress management, and other evidence-based lifestyle changes can significantly reduce your risk of breast cancer, support recovery, and enhance long-term health outcomes.
Whether you're a patient, survivor, caregiver, or simply looking to take proactive steps toward better health, this episode offers practical, science-backed strategies for early detection, cancer prevention, and overall wellness. Tune in now to empower yourself with life-changing knowledge and actionable steps from one of the field’s leading voices.
Dr. Comander shares expert insights on how nutrition, exercise, stress management, and other evidence-based lifestyle changes can significantly reduce your risk of breast cancer, support recovery, and enhance long-term health outcomes.
Whether you're a patient, survivor, caregiver, or simply looking to take proactive steps toward better health, this episode offers practical, science-backed strategies for early detection, cancer prevention, and overall wellness. Tune in now to empower yourself with life-changing knowledge and actionable steps from one of the field’s leading voices.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hi everyone.
Speaker 2 (00:00):
My name is Haley and this is Laura and welcome
to the Body Pod.
Speaker 3 (00:10):
Hey.
Speaker 1 (00:11):
Everyone.
Speaker 2 (00:11):
On the episode of the Body Pod today, we are
actually rerunning doctor Amy Commander, who is a breast cancer oncologist,
and we thought this would be an appropriate time to
run it as it is Breast cancer Awareness Month, So
enjoy this rerun with doctor Amy Commander.
Speaker 1 (00:34):
Amy.
Speaker 2 (00:35):
We are thrilled to have you back for part two
and we are in Breast Cancer Awareness Month.
Speaker 3 (00:41):
Thank you so much. It's great to be back with you.
Speaker 2 (00:44):
Is this uh this is also menopause Awareness Month. I
feel like we should have broken those somebody should have
broken those up into different months because they're both like
heavy hitters.
Speaker 3 (00:54):
They deserve their own months. Yes sir, but hey, let's
just go women's health or just flat to raise awareness
and provide education. So that's awesome.
Speaker 2 (01:03):
Yes, great, And I was talking to last year at
this time, I was talking to doctor Jessica Shepherd, and
we were talking about how we need to have like
a color, you know, because breast cancer has like the
light pink, and then we were like, well, menopaus should
have a color.
Speaker 1 (01:18):
Clearly nothing happened. Maybe someone's named to.
Speaker 2 (01:20):
Color by now and I don't know, but anyhow, here
we are. So a few things that I wanted to
ask you kind of before we dive into this, you know,
lifestyle medicine, which is kind of our topic for today.
I'm fascinated by it. I love that the you know,
the greatest of the great are getting on board with
(01:43):
educating patients around this because I tell you, every time
I have someone on and obviously it has something to
do with lifestyle health nutrition, everyone is saying the same things.
Speaker 1 (01:56):
I'm like, okay, so.
Speaker 2 (01:57):
We see a pattern and you know, all of these things,
which doesn't it's not new information, but it's clearly we
have work to do from where, you know, to get
this into mainstream still, which we just maybe I just
hear it all the time. So I'm like, Okay, we're
saying the same things in every field, but there's still
(02:17):
a lot to learn.
Speaker 1 (02:18):
So that's really exciting.
Speaker 2 (02:21):
So I want to start with kind of some just
some basic facts. So we talked about the different kinds
of breast cancer last time.
Speaker 1 (02:30):
I was just reviewing.
Speaker 2 (02:31):
So one there's a one in eight chance of getting
breast cancer and there's over three hundred thousand cases a year.
Speaker 3 (02:40):
Yeah, so, thank you so much for inviting me back.
By the way, I love chatting with you both. And
I just want to say it is Breast Cancer Awareness Month,
but I like to call it breast cancer Action Month,
which what are we doing to actually raise awareness, make
it impact, help improve women's lives. So that is our
shared goal. Have to say that. But you're absolutely right.
(03:02):
For women living in the United States, we all have
a one in eight lifetime risk for development of breast cancer.
It is what it is, and some of us it
may be higher because of family history or other factors.
We can talk about that, and you're right. The statistics
from the American Cancer Society, which were recently updated, do
state that this year it is expected there about over
(03:24):
a little over three hundred thousand cases will be diagnosed
in the US of invasive cancer. That also includes doctal
carcinoma insight to which is essentially like a stage zero
breast cancer.
Speaker 1 (03:37):
Oh my goodness.
Speaker 2 (03:38):
I was actually shocked when we start to go over
like the risks. Is breastfeeding a risk?
Speaker 3 (03:45):
Actually, breastfeeding is protective. Breastfeeding is what I thought, Yeah,
decreases your risk.
Speaker 1 (03:51):
Okay, I must have read that wrong.
Speaker 2 (03:52):
Because I was like, wait, what great, but I don't
want someone.
Speaker 3 (04:00):
Obviously, we know so many women have a tough time
with breastfeeding, so again taking that away, don't beat yourself
up or feel bad. We know many women have challenges
with that, but it does actually decrease risk, so that's good,
not increase risk.
Speaker 2 (04:13):
Okay, I was like, wow, I shouldn't have stuck it
out the first run. My my youngest did not was
was all was all formula fed, and I mean he
was my easiest baby, so I have nothing to say.
Speaker 1 (04:27):
There, eat, best sleeper, all of that.
Speaker 2 (04:30):
But yeah, I was like, wait a second, Okay, got
that that fact straight. So as we look for these
risk factors, and obviously we know genetics is at the
top of the game, but what are the other risk
factors that that we're looking for when we're approaching this
this type of cancer.
Speaker 3 (04:51):
Great question, and I think it is good to highlight.
You're absolutely right, genetics is so important to think about
in family history. But actually in the US, of all
breast cancers diagnos in this country, only five to ten
percent our dudes had genes that we can currently test for.
In twenty twenty four, there may be another ten to
fifteen percent due to like familial factors, which maybe we
(05:15):
can't find the gene yet, maybe it's a few genes
working together that increase risk. But the majority of breast
cancers are not due to genes that we can test for.
So that's why I encourage everyone who listens to your
podcast to like, know your family history, make sure you're
on top of screening, and recognize that even if you
don't have a family history, unfortunately, you're still at risk.
(05:36):
So then we talk about other risk factors. Great question,
what are some factors that we can potentially change, which
are what we call modifiable risk factors, and what are
some factors that we can't change, you know, like our
age for example. You know, so we wish we could
change that one anyway, So exactly right, So thinking about
the non modifiable risk factors. Yeah, so being a woman
(06:00):
and increasing age are your biggest risk factors, so it
is what it is. And then thinking about when I
see a new patient, you know, we ask about other
risk factors related to exposure to hormones over the course
of a woman's lifetime, So we ask about what was
your age of menarchy when your period started? If a
(06:22):
woman's gone through menopause, what was her age of menopause.
If a woman's been pregnant, when did she have her
first full term pregnancy? How many pregnancies did she breastfeed?
Did she take you know, exogenous hormones? Like we asked
all of these questions. Did she have chest wall radiation
for any reason? Sadly, some people have a cancer diagnosis
at a young age and need radiation to their chest.
(06:43):
So these are all the questions that we ask someone
that are sort of these are like facts about someone's
medical history that potentially can influence risk. But then there's
the modifiable risk factors that we can all talk about
what can women do to help reduce risk? And those
refer to things like what is her exercise level, how
much alcohol does a person drink, what does her body weight?
(07:06):
Does she smoke? You know those types of factors. So
all of these come together to play a role in
a person's risk. So I hope that helps address her question.
Speaker 4 (07:15):
I have a question about the hormone the hormones, do
you see an increase in risk for anyone who's done IVF?
Like several rounds of IVF, so they are pumping all
of these hormones into their body.
Speaker 3 (07:29):
That's a great question. And certainly we know that many
women need to consider techniques such as IVF to pursue pregnancy.
And I would say, for the most part, the data,
you know, the data suggests that IVF is safe. So
I don't want someone who's thinking, oh my god, I
had IVF, I'm at such great risk. Like you know,
the modern techniques that are used for in feature fertilization
(07:52):
are felt to be safe. And I think if a
woman wants to pursue pregnancy, she should do that. And
if a woman does have a strong family history of
breast cancer or if she's had breast cancer, the reproductive
endocrinologist does take that into account and may use it
modify the protocol that they use. So if someone's had IVF,
it's okay. I guess that's what I would say.
Speaker 1 (08:14):
Well, I'm kind of interested in the if we.
Speaker 2 (08:18):
Look at obviously we're all aging, and when you ask
about like the age of monarchy and the age of menopause,
what does that like does a later menopause help or hurt?
Speaker 1 (08:32):
And does a later menarchy help or hurt?
Speaker 3 (08:35):
Right, So actually it's thinking about our bodies exposure to
hormones like estrogen is the number one over the course
of the lifetime. So actually earlier age of menarchy, so
having a period at eight or nine actually is a
greater risk factor for breast cancer later in life, and
a prolonged like a later age of menopause, so that's
(08:58):
more years of exposure to hormones that is a risk factor.
So we look at all of these factors into account.
It's not like they're just all pieces of the puzzle.
It's a puzzle that we're always trying to put together
when we're trying to help understand risk. But for an
individual patient, it's actually we don't really comment particularly on that.
It's just we ask these questions, but it's really it's
(09:20):
just good to understand what potentially contributes to risk.
Speaker 4 (09:27):
But breast cancer is the most preventable or one of
the most preventable cancers. Correct.
Speaker 3 (09:33):
Well, obviously, I wish we knew all the reasons, oh
why someone would get breast cancer. I mean, I saw
a patient yesterday and her forties, healthy exercises, takes good
care of herself, healthy body weight, eats healthy and unfortunately
she's in my office right So there's so many factories
don't understand. And I think that's just what's hard about
medicine in general, with any medical problem, whether that's cancer
(09:55):
or some other things that we infections, we get whatever,
you know, sometimes we don't fully understand all the risk
factors and why a person may get a certain diagnosis.
Speaker 4 (10:04):
Well, and environmental takes a big role in this, right.
Speaker 3 (10:09):
Yeah, we're learning more and more about environmental factors and
cancer risk and you know, thinking about things like air
pollution and I hate to say it, our food environment
when we think about you know, our exposure to ultra
process foods, particularly here in the US with our sad
diet diet. I both are writing education about that. So
(10:35):
you know, there's lots of environmental factors that potentially are
planker worle too, plastics too, we're learning more and more
about that.
Speaker 2 (10:41):
Does the USA have higher breast cancer rates than other countries.
Speaker 3 (10:48):
Well, breast cancer is the most common cancer diagnosis in
women now worldwide, so in developed nations in particular, breast
cancer is still you know, after skin cancer or when
I say skin cancer, you know including like basil cell
scave of cell, and melanoma. But like you know, basil
cell and screen to sell. Those types of skin cancers
are obviously very common, but breast cancer is really the
(11:11):
second most common type of breast cancer, and it is
really worldwide the number one cancer, and you know, so
I think that's important for people to recognize too.
Speaker 1 (11:20):
Yeah.
Speaker 4 (11:22):
Wow, what have you seen a correlation to your dental health,
like the health of your gums and in relation to
breast cancer or infection or cancer of any kind.
Speaker 3 (11:40):
Yeah, that's such an interesting question thinking about oral health
and cancer risk. Oh, I'm not particularly aware of a
risk of breast cancer per se, but I do think
if you think about it, I mean oral health. Are
we also thinking about our microbiome, which certainly is in
all aspects of our gi track, including our mouth and
all going. Yeah, so, you know, I think we're that's
(12:02):
an emerging field, like learning about the gut microbiome and
certainly risks for many chronic diseases, including cancer. So I
wonder in the next ten years if we're going to
learn more about that. So, but it's such a exciting
breast cancer. Yeah, it's very exciting.
Speaker 1 (12:19):
Yeah.
Speaker 2 (12:19):
I love the whole gut microbiome. I mean, everyone's kind
of coming to the party for it, but it's it's
just like in its infancy. I mean, we're just really
scratching the surface of how that plays a part in everything.
So I read this on one of your I don't know,
in a blog or either listen to it in a podcast,
(12:40):
but forty percent of the risk factors for breast cancer
are lifestyle related.
Speaker 1 (12:45):
I mean that's almost half.
Speaker 3 (12:47):
It's huge. So yeah, so reputable organizations like the American
Cancer Society, American Institute of Cancer Research, you know, when
you look at large population data and try to understand
contributing risk factors for breast cancer and other cancers, it
is felt that up to forty percent may actually be
due to lifestyle factors. So these are risk factors that
(13:12):
we can control. And so I think it's really important
to highlight this and actually a great resource which is
on the American Institute of Cancer Research's website AICR dot org.
They have they list this figure with like the top
ten recommendations for cancer prevention, and these are all lifestyle related.
(13:34):
So what can each of us do? What can we
do to take action to hopefully lower our risk of cancer?
And I'm happy to talk about those and a lot
of it is stuff we've already talked about, but I
think it's really important for us to be aware that
our lifestyle does potentially play a significant role in risk
for cancer.
Speaker 1 (13:53):
Well that's just alone.
Speaker 2 (13:54):
I mean, I'm like, if I have a forty percent
less chance of getting breast cancer or any type of
cancer just from my lifestyle, that's like, you know, good,
good bets that if you're kind of on the fence
of like, well I may you know, I may know.
I know that substance abuse or you know, alcohol intake
(14:16):
and smoking is probably not great. Well, we all know
it's not great, But like if somebody were kind of
on a borderline there, it would be really easy if
I heard these statistics to be like, all right, how
important is this and how important it's going to be
in fifteen twenty years, you know, if I keep going
at the rate. We all have our vices, and it
(14:38):
can be different things for different different women. But let's
talk about those areas of the lifestyle medicine and how
we are helping, you know, prevent but then also helping
you know, with the cancer survivorship after and really seeing
how that goes with your patients once they have come
(14:59):
through breast cancer treatment and what that looks like.
Speaker 3 (15:02):
The American Institute of Cancer Researchers recommendations. The first one
is being at a healthy body weight. We can, by
the way, go into greater detail on all of these.
We know that's a challenging one. Being physically active. Thank
you for all the work you do to help us
with that. But that is beif when we think about
cancer risk reduction. And then thinking about our diet, and
there are many recommendations eating a diet rich and fresh
(15:26):
fruits and vegetables, fruit lagoons, beans, whole grains so important.
Limiting the ultra processed foods that are so prevalent in
our diet, the fast foods, all these things out here
that we're exposed to in our environment here in the US,
which are things we need to cut down on. Limiting
red meat consumption and really eliminating a lot of these
(15:50):
processed meats that we consume. And then thinking about limiting
consumption of these sugar sweetened beverages. I know we all
love to go to Starbucks, but like being mindful of
what you're ordering there is so important. And then of
course alcohol is key, limiting alcohol consumption. And then the
last two are really focusing on you know, supplements unfortunately
(16:11):
do not prevent cancer. We can talk a whole thing
about that, and then breastfeeding is protective. So those are
all listed on the a I see our website, and
these are all steps we can all take to help
optimize our health in terms of our lifestyle to reduce
risk of cancer. And they're also important for cancer survivors.
So to follow these particular recommendations as well.
Speaker 1 (16:33):
It's it's tough.
Speaker 2 (16:34):
We just had a nutritionist on that lives in New Zealand,
and you know, she was like, our environment is just
not set up for success. And I'm like, well, I've
been to New Zealand and it's way better than.
Speaker 1 (16:46):
What we're dealing with in America.
Speaker 2 (16:50):
So true all of these things, and I feel like,
you know, where a lot of women may be like yeah, yeah, yeah,
we get you know, we get the message. We get
the message, but you know, it's also hard. I see
the other side, working one on one with women and
in these groups where you know, the healthy relationships and
the poor sleep and the stress. It's like, yeah, great,
(17:13):
I don't want to have any of those things, but
I have them. Yeah, And that's where it gets a
little bit trickier to really work on that, because that
not only helps with obviously reduction of cancer risk, but
that helps with body composition and that helps with you know,
our lifestyle there and how we're going to either lose
(17:33):
weight or gain muscle. I mean, so it really comes
full circle with everything that we do. So what do
you tell your patients when you know they're struggling with
any of these issues that are harder to tackle.
Speaker 3 (17:50):
Right, I mean, you reaise such important points. Oh my goodness,
you're absolutely right. I'm just gonna When I first wanted
to start some type of lifestyle medicine based program and
for my patients with breast cancer, I actually wanted to
just you know, think about let's talk about the diet
and the exercise, and but you're so right. There are
so many components of our lifestyle, which is really what
lifestyle medicine focuses on, that are key when we think
(18:13):
about that, as you do in your programs too, Like again,
restoreative sleep so important. So many of us struggle with
that thinking about social connection the community, and you do
that so beautifully with your programs, and I love that
that is so key to help anyone affect behavior change.
Limiting risky substances such as alcohol. We could talk more
(18:35):
about that. That's a tough one, but we really should
focus on that since it is unfortunately a risk factor
for cancer as well. And then talking about stress management,
which you just alluded to, which is a challenge for
so many of us, in particular women. We're juggling so
many balls at the same time, and so we really
need to address that too. And so all of these
(18:55):
factors social connection, you know, I just highlight that again.
I think it's so important and sometimes overlooks. So all
of these factors are absolutely key to help us optimize
our health. And really, like where do you start? And
I think like what you would probably say, it's just
pick one thing to start on. Yeah, say that's sleep,
or let's say it's trying to get more protein in
your diet. Maybe just for breakfast, start with breakfast. But like,
(19:18):
just pick one thing because you obviously can't tackle it
all at the same time.
Speaker 2 (19:23):
M h, Well, what would you say is too much?
How much is too much of alcohol? Because that's going
to be the question.
Speaker 1 (19:29):
I feel like.
Speaker 2 (19:30):
We live in this lat last decade where you know,
and especially since COVID, where we started having like women
started having like these wine online wine parties, and you know,
it's pretty much alcohol is at every almost every event
that you go to for adults.
Speaker 1 (19:51):
Anyway.
Speaker 2 (19:51):
That just reminds me of a Seinfeld episode where George
is trying to bring pepsi and he's like, why can't
I bring pepsi?
Speaker 1 (19:57):
Because we're adults, George. So I mean, it's kind of
just like.
Speaker 2 (20:04):
It's like it embedded into our all of our activities
in our social life. But there is this pull kind
of pulling back over the last I've seen it a
lot over the last couple of years and still very
new of like these you know, non alcoholic clubs opening
and a lot of mocktails on the you know.
Speaker 1 (20:25):
So I feel like there is this kind of trend shifting.
Speaker 2 (20:29):
Where have we been using this for a crutch a
little bit for some women?
Speaker 1 (20:34):
So what would you say?
Speaker 2 (20:35):
And I try to tell people like, Okay, well, it's
not like you have to eliminate everything. It's you know,
everyone thinks they have to come in. Okay, I can
have no, I can't have sugar anymore, I can't drink,
Like this is going to be the you know, great
fun life for me for the rest of the you
know second ever, you know, second part of my life.
Speaker 1 (20:52):
But how much is too much? Or is there any
guidelines there?
Speaker 3 (20:56):
Yes, such an important and timely question since it is
US Cancer Awareness Month or Action Month. And actually just
recently another baive organization, the American Association of Cancer Research AACR,
another reputable organization, came out with this Cancer Progress Support
for twenty twenty four and it did really highlight not
(21:17):
to be a downer, but that alcohol is a significant
risk factor for six different types of cancer, including breast cancer,
and also highlighted that over fifty percent of Americans are
not even aware that alcohol, unfortunately is a risk factor
for cancer. And we think about women you mentioned, like
you know, certainly for the pandemic, and people socializing you know,
(21:39):
even zoom alcohol parties things like that, Like you know,
so many women are so focused, like you know, on
like eating organically and getting the exercise, but maybe drink
two or three glasses of wine to night and don't
even think of anything of it. So I think it's
important that we spread the message that alcohol is a
cancer risk factor. It is what it is. So I'm
going to cite one recommendation from an another organization. I
(22:01):
like the AICR Worterity Reference American Institute of Cancer Research.
You can drink, but just think before you drink. Why
are you having that glass of wine? So I'll just
share it a personal example. The other night, I was
at a special dinner at an Italian restaurant honoring a
colleague who unfortunately is leaving our hospital for another opportunity.
(22:22):
And we were all celebrating and there's a glass of
red wine being poured for everyone, and I was like,
I'm going to have this glass of red wine. I'm
celebrating my colleague. It's a special occasion and so I
enjoyed it. But would I do that like every single
night when I'm at home having dinner. No, I don't
think that's a good idea. So, especially for women, we
really do need to be mindful of our alcohol intakes.
(22:42):
So I think that's a really important message that we
can spread through this podcast today.
Speaker 4 (22:49):
Yeah, that's a good tip to be mindful. Yeah, and
why do I need to get a second glass? Do
I really need a second glass? And I love Haley
that you mentioned mocktails. They are having a moment and
there's so many like fun mocktails out there.
Speaker 3 (23:06):
Like I'll be honest, I have not really made one yet,
but like I'm always inspired when I see someone showing
how they make their mocktail. I'm like, oh, that looks
really good. I should make that.
Speaker 1 (23:16):
Yeah. Yeah, it's nice to have options there.
Speaker 2 (23:19):
But you know, I've been seeing a theme in again,
just from this week in the podcast that we filmed
and the nutrition course, where we've talked a lot about
disassociation and really how women especially have gotten to this
point where we just like disassociate. We don't even subconsciously
(23:42):
maybe even you know, think about pouring the drink at night,
or eating the extra food or something of we're you know,
we're living in this high stress. We're trying to do
all the right things, and usually there is something obvious
that I always say, if I, you know, if me
or even you could go and be a ghost in
someone's house for twenty four hours and watch everything that
(24:05):
they did, it would probably be easy to spot, but
they might not even know what because we're just like
robotic a lot of the time, especially when we're so busy,
that these things are just getting missed because we're not present,
and it's really hard to be present when we have
everything going on all the time.
Speaker 3 (24:26):
I totally agree, and that's why I think. I just
think about the programs you offer, which I'm so fortunate
to be involved with right now. The power of the community,
Like if you have obviously you're not going to have
someone in your house with you all the time saying
do you really need to eat those chocolate chips right now?
But like you know, the community support. I mean, we
can provide all the education about every health and wellness
(24:48):
topic in the world and make it as evidence based
and amazing as possible. But if we are not also
focusing on what are the steps we need to do
to help an individual make these behavior change is like
eat more fruits and vegetables, eat more protein in her diet,
strength train three or four times a week, whatever it
might be. You know, we are not going to make progress.
(25:09):
So that is really hard. As a doctor, I can
tell you was I taught, like how do you coach
your patient on behavior change? Like I wasn't really taught
the coaching strategies that you have that expertise, and I
think I've actually learned some of it along the way
since then, but I will say that is so important,
so the coaching piece and the community piece to help
people make these changes because it is really hard, especially
(25:30):
when we have so much going on.
Speaker 4 (25:33):
I'm so glad you bring up social health because I
think it's something that is not talked about enough, and
I really think that social skills are off balance. And
I mean, it's a proven fact that social connection helps
you live longer for sure, and living a healthier and
happier life creates longevity too. I just have to commend
(25:57):
you that I was so impressed with this time we
interviewed you, that you really focused on asking your client
about their lifestyle, because I find that a lot of
doctors it's okay, you have this, this is X is wrong,
and this is what we do to correct it, and
(26:17):
they're not examining and taking a glimpse of the whole
big picture. And I just I am so glad that
you are doing this, and I just have to commend you.
Speaker 3 (26:30):
Thank you so much, and I agree that we all
need to have There is this like a buzzword now
and the literature it's called like whole person care, and
it's like this new thing like take care of the
whole patient ask about her lifestyle, how she's sleeping, how
she eating, how she exercising. To me, I'm like, how
haven't we been doing this? Like this should be like
very bread and butter medicine. One oh one. And it's
(26:51):
interesting that you say that, Laura, I guess I hate
to say it, not first of all, to defend my colleagues.
We are very limited in time and really it and
it's just a fact. And also I will say when
it comes to the lifestyle piece, a lot of us
we're not really educated in medical school, residency, fellowship, whatever
about all these lifestyle factors to the degree that we
(27:13):
feel super comfortable talking and counseling our patients about it.
So these are all things that I think are going
to change. But you raise some really important points that
as a medical field, you know, we're wondering. It's great
that we can work with a wonderful team, but we
also need to be doing a better job addressing all
of these concerns for our patients. Yeah.
Speaker 2 (27:31):
Absolutely, Well, if we look at a patient after treatment,
so say that they are kind of in recovery, they're
in a recovery period, and you know you're coaching them
what does the return to exercise look like? Now, obviously
I would treat it to someone who had any surgery
(27:53):
or injury or a long time off of fitness regular movement,
But are they there are any things that you would
stay away from? Obviously I'm thinking anything test related.
Speaker 1 (28:07):
But what does that look like for.
Speaker 2 (28:08):
Women that maybe out there that Because I get asked
all the time like do you have a breast cancer
kind of recovery program of where to start? And it's
just made me pause and think about the importance of that.
And I know that you offer something as well, so
let's dive into that.
Speaker 3 (28:27):
Yes, so such an important question, because I promise you
I talk about exercise with all of my patients. Any
of them are listening, they know I do, and I've
shared your amazing program and I will continue to do
so too. So exercise is absolutely important for women with
a history of breast cancer. In fact, studies show that
doing regular exercise, and we can talk about what those
(28:49):
basic guidelines are can help reduce risk of recurrence and
improve outcome from breast cancer. So right there, exercise can
improve an woman outcome from her breast cancer. So that
is the most important thing. Right when it comes to
treating my patients and helping them optimize their health, well
being and well being. So what are the basic guidelines? Again,
(29:12):
let's just start with the basics, and it really is
similar to what the CDC would recommend for all Americans
on one hundred and fifty minutes of moderate aerobic activity
each week or seventy five minutes of more vigorous activity.
But let's just focus on the one hundred and fifty number,
and that could be walking, jogging, cycling, kayaking, vacuuming, zoomba,
(29:34):
whatever that may be. And two sessions of strength training.
I know it's not a lot, but two sessions is right,
very good. Yeah, but I will tell you, and you
know this from your work, like the majority of people
do not meet those criteria, and certainly when we think
about the cancer survivor population, the majority do not meet
(29:55):
those very basic guidelines. So that is where I often
start with a patient of cour of course, probably like
you do with the people you work with, like where
are you starting from? What are you doing at this time?
What are you comfortable with? And really for me, it's
helping my patient. Maybe she's going to start with walking.
Like I actually said this to a patient yesterday, we
set a smart goal together, Maybe you can walk for
(30:16):
fifteen minutes three times this week and see how you do.
Because she's someone who doesn't exercise at all, So start
with that and then gradually introduce more aerobic activity, introduce
the strength training, and you do raise really great questions.
What if a woman just had to mastect me, like,
what are her limitations? What can she do? When can
(30:36):
she start lifting weights? What is safe for her? What's
a warning sign? And I will tell you I'm very
fortunate where I work to work with physical therapists who
have specific training in how to work with women who
have had a history of breast cancer. But I will
tell you that many studies show that lifting weights is
safe and very much important for our patient population for
(31:00):
all the reasons you talk about muscle mass, bone health,
metabolic health. Can go on and on, and there is
a condition called lymph edema where a woman can have
swelling of her arm on the side where she had
her breast cancer, especially if she had many lymph notes
removed in her surgery or if she had radiation on
that side, and exercise does not increase the risk of
(31:22):
lymph DMA can actually help it. So it is we
do get into some of the technical aspects of how
a woman should be assessed, etc. But in general, exercise
is good and beneficial and she'ld be strongly encouraged for everyone.
Speaker 2 (31:36):
Yes, and I just want to plug this and I
feel like I've been plugging it and I'm like a
broken record, but I'm going to say it again. I
think as women when they're coming into the field, because
I have obviously all levels, but the ones that are
really beginner, like they've received the message, they're ready to go.
There's so much information out there that's good information that's
(31:59):
throwing at them, but that we peel back and just
be like, it doesn't matter what you start with, Like
just start. Don't worry about the guidelines for optimal body
composition or optimal fitness or taking you know yourself to
this high level. Yes we can, we can program that
(32:20):
over time, but we start with just like what makes
you happy, what gets you out the door. I mean,
none of those should ever be discounted. And then it's like, well,
once you're there, now, do you want to add something?
Is there something else we can add there? But the
the you know, exercise in general there's a lot of specifics,
(32:41):
but I want women to know that, like you start
with what you can do and what you can manage,
and it doesn't it's it's it's meaningless of what you
know an someone else is recommending on their journey or
what's optimal. If for you, this is what is making youill,
okay and be active and do that. So anyhow, I
(33:05):
mean there's a place for everyone. There is a place
for everyone, and it's usually the very beginners that are
very timid and just feel like, you know, they don't
have the confidence yet to really get get out there
and do a lot of things. So they should be
doing just the bare minimum of what they can that
they feel comfortable with.
Speaker 1 (33:23):
So let's talk about your.
Speaker 2 (33:27):
Path to the path? What is path to pavement? Something
in pavement? I actually have a book. I didn't know
you had a book.
Speaker 3 (33:41):
But actually I want to say one thing because it's
actually in the beginning of this book and it's totally
related to what you just said. And you're welcome to
use this quote. It's not my quote. It's from like
this Chinese philosopher Lao Zoo. But the journey of a
thousand Miles begins with a single step. So I love
what you just said. Just love the first step is
(34:02):
so key. So I love that you just talked about
how the beginners struggles so much. Just take that first step.
So yeah, paving the path to wellness. So this is
a wonderful collaboration that began with my colleague, doctor Beth Frady's.
Speaker 1 (34:16):
Five years ago.
Speaker 3 (34:17):
It's like hard for me to fully wrap my head
around really five years that's gone by really fast. But
it's a lifestyle medicine based survivorship program for women with
breast cancer who really want to learn about what we've
been talking about, the evidence based recommendations in terms of nutrition,
physical activity, sleep, stress management, all of these topics after
(34:38):
diagnosis of breast cancer. So we meet virtually and each
week and go over each of these topics in great
detail and also work together in the community setting to
help people make these behavior changes. And it's really been
such a wonderful undertaking. And we've also talked about the
power of community and that's been such a key benefit
of this program as well.
Speaker 4 (35:00):
But this program is for people that have breast cancer
and then are learn living with it afterwards, like after
they got there.
Speaker 3 (35:08):
I'm offering is specifically for breast cancer survivors and thrivers.
They like to call themselves that, and I love that.
But I will tell you that doctor Frady's when she
first came up with this program, she was offering it
to stroke survivors who at a hospital called Spaulding Rehabilitation Hospital,
which is here in Boston at Philly with Harvard Medical School.
(35:28):
So she was first offering the program there, and I
met with her many years ago to learn about lifestyle medicine,
and then we adapted this program and I started offering
specifically for women with breast cancer. But I know doctor
Fradi's and colleagues, we actually have a nonprofit and we're
hoping to bring this program to lots of populations, not
just women with breast cancer. But my passion, of course
(35:50):
is helping the breast cancer survivor community, and that's that's
really my why.
Speaker 1 (35:55):
I love that. So you're a vegan, right.
Speaker 3 (36:00):
I would say I've been having some salmon like once
in a while to get my omega threes in, but
like I do otherwise follow very much on plant predominant diet,
I call it that. But yeah, I was realizing I
needed to find some ways to in my omega threes,
which we know are so good for our crediovascular health.
Speaker 4 (36:19):
How long have you been vegan?
Speaker 3 (36:21):
Well, I mean I go back and forth. Right now,
I'm not totally vegan, I should say I'm but gosh,
when the d become like essentially vegetarian a long time ago,
I don't even remember. That's honestly the truth. Like, I
don't even remember. I guess my daughter was nine because
she she became a vegetarian at that time too, so
I can do the math. So she's now, so it
(36:41):
was eight years ago. Hell does she know? She camps
on the bandwagon too.
Speaker 1 (36:48):
Yeah, that's great.
Speaker 2 (36:48):
Well, I like how you talk about the plant based
diet here, and this is where it's going to be
like okay, well we hear protein, and even with the
importance of protein, that's never going away, or I don't
foresee it ever going away. But if we look at
the importance of that, it's hard for some women who
(37:08):
start to change their diet. And then it's really protein,
you know, muscle like a muscle centric approach, which is
a lot of protein to support the training, but then
a lot of the good fruits and vegetables might get
lost in the mix because we're so pro protein. So
do you have any advice on that, because you know,
(37:30):
ideally we're all getting the thirty fruits and vegetables in
a week and we're all having the right number of protein.
But I mean, in like real world, it's freaking hard.
Speaker 3 (37:42):
It is. In fact, my colleague and I shout out
to my colleague, chef Laura Client, we taught a culinary
medicine cooking class on Wednesday to a group of women
with breast cancer, and we tried to do some education
about nutrition along the way. We talked about our favorite topic,
got microbiome, protein, fiber, and we did really talk about
(38:03):
the challenge of getting in those thirty plants, getting in
your protein. So one of the things we made was
this soup with lentils. Lentils are pretty awesome, by the way.
My colleague Cheflara showed there's like five different types of lentils,
all these different colors. I don't even know if you know,
there's black lentils, yellow lentils. I was like blown away.
I'm like, I need to go buy all of these
(38:23):
pretty lentils because packed with protein, Like one cup of
lentils has like eighteen grams of protein and they're packed
with fiber, so you're getting fiber and protein when you
have lentils, which are so yummy in a soup or
you can put them in a salad, so many things
you can do. So that was a tip and trick
we did share with our group because we all need
to get at least thirty grams of fiber a day
(38:46):
and most of us are not getting that either, not streggle.
We talked about this.
Speaker 2 (38:51):
It's important, very important, and that's that's the hard transition
is like that's what I see with women that go
into like a fat loss.
Speaker 3 (39:00):
You know.
Speaker 2 (39:01):
Course with me is is the fiber takes the hit
because the plant and vegetables, like all of the plants
take a hit. And so if we're just like it
really is, it seems like it's simple information, have a
lot of variety of fruits and vege and like have protein.
We're like, okay, cool, but it's really hard to get
(39:22):
all of those balances.
Speaker 1 (39:23):
But again, start somewhere.
Speaker 2 (39:25):
If you're eating three vegetables a week, the same ones,
then maybe out of fourth. I mean that's how I'm
doing it, because it's it's tricky to do it, especially
when you're in limited time.
Speaker 3 (39:35):
You know, Yes, I definitely agree, it's tricky, and that's
why I love that. There's also you have this wonderful
community so people can support each other and share ideas
with each other in strategies.
Speaker 2 (39:45):
Yeah, I love that. And you know, we're running out
of time here. I'm so sad. I feel like, where
does the time go? We can't have been talking for
forty minutes.
Speaker 4 (39:56):
I know I just saw the same thing, but I
do want to just touch on one thing because it
does breast cancer awareness. One, just to remind people, so screening,
you're supposed to get a mammogram once a year, correct.
Speaker 3 (40:11):
Correct, And aren't recommendations starting at age forty unless you
have a strong family history or other significant rest factors,
and then you would talk with your doctor about potentially
starting earlier. But a woman of average risk should be
starting at age forty and doing it every year.
Speaker 4 (40:28):
What do you think of the Pronovo scan? Am I
saying it correctly? The full body Pronova scan?
Speaker 3 (40:38):
If you're referring to like, I'm not sure specifically about
that particular one, but if you're thinking about full body, yeah,
the ovagen like that. Again, I do not recommend testing
like that because I will tell you anytime you order
as a doctor, anytime I order a scan on any patient,
I have to have a good reason why am I
doing this? Because often there are incidental findings and what
(41:00):
does that mean? Something you will find that you were
not looking for, and now you're going to go down
that rabbit hole of chasing it and it may or
may not turn out to be anything of clinical significance.
I'll give a common example, and I know we're short
on time. Lung nodules. Lots of us have lung nodules.
They're usually super tiny, five millimeters. You see it on
someone's scan, you're going to follow it. So now she's
(41:22):
getting a scan maybe initially every six months for one
or two years to make sure they're stable and nothing
growing or whatever. But now that patient is getting all
these extra scans and extra exposure to radiation that she did.
So I am not a fan of doing scans on
people when you don't have a really good reason why
you're doing it. Okay, that's great advice.
Speaker 4 (41:41):
I just wanted to ask, Yes, that's we're in this,
but mammograms, yes.
Speaker 2 (41:47):
Yeah, oh, that's I didn't even think about that, but
that's I'm going to do the regular one that is
not as fun, but at least it's it's not cause
of me to get other scan. Is there anything new
since we talked to you last about six months ago
in the breast cancer treatment world, Any new information that
you can share or something that you found interesting.
Speaker 3 (42:11):
Oh gosh, in the breast cancer world, their things are
always evolving, always changing. That's why my job is very
exciting because there's always new research studies with new treatments
and new findings that are being released. And I'll just
think of one that is super interesting. Recently, at my hospital,
we had a retreat to actually focus on the role
(42:32):
of artificial intelligence in cancer care. And that's obviously a
feel in your field too. That's really taking off the
power of these tools to enhance whether it's health and
wellness or maybe in the breast cancer field, helping us
identify cancers earlier on mammograms using all these really cool
AI algorithms. I do not claim to be an expert
(42:53):
on this, but it's super interesting. So that's an area
that I think we're going to really see takeoff in
the next few.
Speaker 2 (42:58):
Years AI get in or Get Out. I just watched
that at Tesla with my son this morning. He's like, Mom,
look at these robots. You can you know you're gonna
be able to buy one in twenty twenty six, And like,
I feel like that's we're in Halloween.
Speaker 1 (43:13):
My son loves animatronics.
Speaker 2 (43:14):
I feel like it's an animatronic walking around the house.
I don't think I'm comfortable with with that quite yet,
but you know, I guess you know.
Speaker 1 (43:23):
The AI world is is.
Speaker 2 (43:25):
It's not going away, so it's it's quite interesting on
all spectrums there, but fascinating information. I think I love
the lifestyle approach and I love that there's so much
power in lifestyle medicine and that it's kind of getting
into the main medical stream and getting talked about because
(43:47):
it really is. We're all working together for someone's health.
I mean, and there's lots of participants in a client's
journey that you know, we all we all benefiting each
other by helping out with our specific area and so
there's lots of good.
Speaker 1 (44:03):
It's an exciting time to live for surely.
Speaker 3 (44:05):
I have to agree with you one hundred percent.
Speaker 2 (44:08):
So Amy, can you tell us about is your book available.
I didn't know that there was an actual book same.
I'm like, we got to get the book.
Speaker 3 (44:18):
So this is a wonderful workbook that I was fortunate
to collaborate with with doctor Beth Frady's and doctor Michelle Tollison.
It's called Paving the Path to Wellness Workbook. It is
on Amazon or on the publisher's site healthy learning dot com.
And by the way, the proceeds do not go to
meet They go to our nonprofit called Paving Wellness, and
(44:39):
that's Paving Wellness dot org. But bottom line is, this
is a great workbook that goes with our program. And
I am working on one focused on breast cancer, and
we also have one already written by my amazing colleague,
doctor Tollison. She was the first author focused on menopause.
And by the way, you would love it. It's all
about it's somewhere over there, but it's focused on lifestyle
(45:05):
strategies to optimize our health during menopause, which is something
that you're already an expert on. So but I think
you would love it because a lot that she does
focus a lot, We focus a lot about everything, but
certainly exercise is key in that too.
Speaker 1 (45:17):
All right, I'm getting it. I feel like I order
more books from podcasts.
Speaker 3 (45:23):
Let I know. It's going to be a gift for me.
I'm sending it to you, so oh, I helping all
I am sending it to you, so I will do
that because you will absolutely love it.
Speaker 2 (45:33):
Oh, I'm so excited. Well, thank you so much for
your time, doctor Commander. We is always just a special
treat to have you, especially during the month of breast
cancer awareness and menopause month as well, so we kind
of tackle two big women's health yes, women's health. So
thank you so much for your time and we will
(45:54):
catch up with you soon.
Speaker 3 (45:56):
Thank you so much for the opportunity, and thanks for
all the amazing work you do.
Speaker 1 (46:00):
Thanks for listening everyone.
Speaker 4 (46:01):
If you enjoyed this episode, please consider giving us a
five star rating and sharing the body Pod with your friends.
Hi everyone.
Speaker 2 (00:00):
My name is Haley and this is Laura and welcome
to the Body Pod.
Speaker 3 (00:10):
Hey.
Speaker 1 (00:11):
Everyone.
Speaker 2 (00:11):
On the episode of the Body Pod today, we are
actually rerunning doctor Amy Commander, who is a breast cancer oncologist,
and we thought this would be an appropriate time to
run it as it is Breast cancer Awareness Month, So
enjoy this rerun with doctor Amy Commander.
Speaker 1 (00:34):
Amy.
Speaker 2 (00:35):
We are thrilled to have you back for part two
and we are in Breast Cancer Awareness Month.
Speaker 3 (00:41):
Thank you so much. It's great to be back with you.
Speaker 2 (00:44):
Is this uh this is also menopause Awareness Month. I
feel like we should have broken those somebody should have
broken those up into different months because they're both like
heavy hitters.
Speaker 3 (00:54):
They deserve their own months. Yes sir, but hey, let's
just go women's health or just flat to raise awareness
and provide education. So that's awesome.
Speaker 2 (01:03):
Yes, great, And I was talking to last year at
this time, I was talking to doctor Jessica Shepherd, and
we were talking about how we need to have like
a color, you know, because breast cancer has like the
light pink, and then we were like, well, menopaus should
have a color.
Speaker 1 (01:18):
Clearly nothing happened. Maybe someone's named to.
Speaker 2 (01:20):
Color by now and I don't know, but anyhow, here
we are. So a few things that I wanted to
ask you kind of before we dive into this, you know,
lifestyle medicine, which is kind of our topic for today.
I'm fascinated by it. I love that the you know,
the greatest of the great are getting on board with
(01:43):
educating patients around this because I tell you, every time
I have someone on and obviously it has something to
do with lifestyle health nutrition, everyone is saying the same things.
Speaker 1 (01:56):
I'm like, okay, so.
Speaker 2 (01:57):
We see a pattern and you know, all of these things,
which doesn't it's not new information, but it's clearly we
have work to do from where, you know, to get
this into mainstream still, which we just maybe I just
hear it all the time. So I'm like, Okay, we're
saying the same things in every field, but there's still
(02:17):
a lot to learn.
Speaker 1 (02:18):
So that's really exciting.
Speaker 2 (02:21):
So I want to start with kind of some just
some basic facts. So we talked about the different kinds
of breast cancer last time.
Speaker 1 (02:30):
I was just reviewing.
Speaker 2 (02:31):
So one there's a one in eight chance of getting
breast cancer and there's over three hundred thousand cases a year.
Speaker 3 (02:40):
Yeah, so, thank you so much for inviting me back.
By the way, I love chatting with you both. And
I just want to say it is Breast Cancer Awareness Month,
but I like to call it breast cancer Action Month,
which what are we doing to actually raise awareness, make
it impact, help improve women's lives. So that is our
shared goal. Have to say that. But you're absolutely right.
(03:02):
For women living in the United States, we all have
a one in eight lifetime risk for development of breast cancer.
It is what it is, and some of us it
may be higher because of family history or other factors.
We can talk about that, and you're right. The statistics
from the American Cancer Society, which were recently updated, do
state that this year it is expected there about over
(03:24):
a little over three hundred thousand cases will be diagnosed
in the US of invasive cancer. That also includes doctal
carcinoma insight to which is essentially like a stage zero
breast cancer.
Speaker 1 (03:37):
Oh my goodness.
Speaker 2 (03:38):
I was actually shocked when we start to go over
like the risks. Is breastfeeding a risk?
Speaker 3 (03:45):
Actually, breastfeeding is protective. Breastfeeding is what I thought, Yeah,
decreases your risk.
Speaker 1 (03:51):
Okay, I must have read that wrong.
Speaker 2 (03:52):
Because I was like, wait, what great, but I don't
want someone.
Speaker 3 (04:00):
Obviously, we know so many women have a tough time
with breastfeeding, so again taking that away, don't beat yourself
up or feel bad. We know many women have challenges
with that, but it does actually decrease risk, so that's good,
not increase risk.
Speaker 2 (04:13):
Okay, I was like, wow, I shouldn't have stuck it
out the first run. My my youngest did not was
was all was all formula fed, and I mean he
was my easiest baby, so I have nothing to say.
Speaker 1 (04:27):
There, eat, best sleeper, all of that.
Speaker 2 (04:30):
But yeah, I was like, wait a second, Okay, got
that that fact straight. So as we look for these
risk factors, and obviously we know genetics is at the
top of the game, but what are the other risk
factors that that we're looking for when we're approaching this
this type of cancer.
Speaker 3 (04:51):
Great question, and I think it is good to highlight.
You're absolutely right, genetics is so important to think about
in family history. But actually in the US, of all
breast cancers diagnos in this country, only five to ten
percent our dudes had genes that we can currently test for.
In twenty twenty four, there may be another ten to
fifteen percent due to like familial factors, which maybe we
(05:15):
can't find the gene yet, maybe it's a few genes
working together that increase risk. But the majority of breast
cancers are not due to genes that we can test for.
So that's why I encourage everyone who listens to your
podcast to like, know your family history, make sure you're
on top of screening, and recognize that even if you
don't have a family history, unfortunately, you're still at risk.
(05:36):
So then we talk about other risk factors. Great question,
what are some factors that we can potentially change, which
are what we call modifiable risk factors, and what are
some factors that we can't change, you know, like our
age for example. You know, so we wish we could
change that one anyway, So exactly right, So thinking about
the non modifiable risk factors. Yeah, so being a woman
(06:00):
and increasing age are your biggest risk factors, so it
is what it is. And then thinking about when I
see a new patient, you know, we ask about other
risk factors related to exposure to hormones over the course
of a woman's lifetime, So we ask about what was
your age of menarchy when your period started? If a
(06:22):
woman's gone through menopause, what was her age of menopause.
If a woman's been pregnant, when did she have her
first full term pregnancy? How many pregnancies did she breastfeed?
Did she take you know, exogenous hormones? Like we asked
all of these questions. Did she have chest wall radiation
for any reason? Sadly, some people have a cancer diagnosis
at a young age and need radiation to their chest.
(06:43):
So these are all the questions that we ask someone
that are sort of these are like facts about someone's
medical history that potentially can influence risk. But then there's
the modifiable risk factors that we can all talk about
what can women do to help reduce risk? And those
refer to things like what is her exercise level, how
much alcohol does a person drink, what does her body weight?
(07:06):
Does she smoke? You know those types of factors. So
all of these come together to play a role in
a person's risk. So I hope that helps address her question.
Speaker 4 (07:15):
I have a question about the hormone the hormones, do
you see an increase in risk for anyone who's done IVF?
Like several rounds of IVF, so they are pumping all
of these hormones into their body.
Speaker 3 (07:29):
That's a great question. And certainly we know that many
women need to consider techniques such as IVF to pursue pregnancy.
And I would say, for the most part, the data,
you know, the data suggests that IVF is safe. So
I don't want someone who's thinking, oh my god, I
had IVF, I'm at such great risk. Like you know,
the modern techniques that are used for in feature fertilization
(07:52):
are felt to be safe. And I think if a
woman wants to pursue pregnancy, she should do that. And
if a woman does have a strong family history of
breast cancer or if she's had breast cancer, the reproductive
endocrinologist does take that into account and may use it
modify the protocol that they use. So if someone's had IVF,
it's okay. I guess that's what I would say.
Speaker 1 (08:14):
Well, I'm kind of interested in the if we.
Speaker 2 (08:18):
Look at obviously we're all aging, and when you ask
about like the age of monarchy and the age of menopause,
what does that like does a later menopause help or hurt?
Speaker 1 (08:32):
And does a later menarchy help or hurt?
Speaker 3 (08:35):
Right, So actually it's thinking about our bodies exposure to
hormones like estrogen is the number one over the course
of the lifetime. So actually earlier age of menarchy, so
having a period at eight or nine actually is a
greater risk factor for breast cancer later in life, and
a prolonged like a later age of menopause, so that's
(08:58):
more years of exposure to hormones that is a risk factor.
So we look at all of these factors into account.
It's not like they're just all pieces of the puzzle.
It's a puzzle that we're always trying to put together
when we're trying to help understand risk. But for an
individual patient, it's actually we don't really comment particularly on that.
It's just we ask these questions, but it's really it's
(09:20):
just good to understand what potentially contributes to risk.
Speaker 4 (09:27):
But breast cancer is the most preventable or one of
the most preventable cancers. Correct.
Speaker 3 (09:33):
Well, obviously, I wish we knew all the reasons, oh
why someone would get breast cancer. I mean, I saw
a patient yesterday and her forties, healthy exercises, takes good
care of herself, healthy body weight, eats healthy and unfortunately
she's in my office right So there's so many factories
don't understand. And I think that's just what's hard about
medicine in general, with any medical problem, whether that's cancer
(09:55):
or some other things that we infections, we get whatever,
you know, sometimes we don't fully understand all the risk
factors and why a person may get a certain diagnosis.
Speaker 4 (10:04):
Well, and environmental takes a big role in this, right.
Speaker 3 (10:09):
Yeah, we're learning more and more about environmental factors and
cancer risk and you know, thinking about things like air
pollution and I hate to say it, our food environment
when we think about you know, our exposure to ultra
process foods, particularly here in the US with our sad
diet diet. I both are writing education about that. So
(10:35):
you know, there's lots of environmental factors that potentially are
planker worle too, plastics too, we're learning more and more
about that.
Speaker 2 (10:41):
Does the USA have higher breast cancer rates than other countries.
Speaker 3 (10:48):
Well, breast cancer is the most common cancer diagnosis in
women now worldwide, so in developed nations in particular, breast
cancer is still you know, after skin cancer or when
I say skin cancer, you know including like basil cell
scave of cell, and melanoma. But like you know, basil
cell and screen to sell. Those types of skin cancers
are obviously very common, but breast cancer is really the
(11:11):
second most common type of breast cancer, and it is
really worldwide the number one cancer, and you know, so
I think that's important for people to recognize too.
Speaker 1 (11:20):
Yeah.
Speaker 4 (11:22):
Wow, what have you seen a correlation to your dental health,
like the health of your gums and in relation to
breast cancer or infection or cancer of any kind.
Speaker 3 (11:40):
Yeah, that's such an interesting question thinking about oral health
and cancer risk. Oh, I'm not particularly aware of a
risk of breast cancer per se, but I do think
if you think about it, I mean oral health. Are
we also thinking about our microbiome, which certainly is in
all aspects of our gi track, including our mouth and
all going. Yeah, so, you know, I think we're that's
(12:02):
an emerging field, like learning about the gut microbiome and
certainly risks for many chronic diseases, including cancer. So I
wonder in the next ten years if we're going to
learn more about that. So, but it's such a exciting
breast cancer. Yeah, it's very exciting.
Speaker 1 (12:19):
Yeah.
Speaker 2 (12:19):
I love the whole gut microbiome. I mean, everyone's kind
of coming to the party for it, but it's it's
just like in its infancy. I mean, we're just really
scratching the surface of how that plays a part in everything.
So I read this on one of your I don't know,
in a blog or either listen to it in a podcast,
(12:40):
but forty percent of the risk factors for breast cancer
are lifestyle related.
Speaker 1 (12:45):
I mean that's almost half.
Speaker 3 (12:47):
It's huge. So yeah, so reputable organizations like the American
Cancer Society, American Institute of Cancer Research, you know, when
you look at large population data and try to understand
contributing risk factors for breast cancer and other cancers, it
is felt that up to forty percent may actually be
due to lifestyle factors. So these are risk factors that
(13:12):
we can control. And so I think it's really important
to highlight this and actually a great resource which is
on the American Institute of Cancer Research's website AICR dot org.
They have they list this figure with like the top
ten recommendations for cancer prevention, and these are all lifestyle related.
(13:34):
So what can each of us do? What can we
do to take action to hopefully lower our risk of cancer?
And I'm happy to talk about those and a lot
of it is stuff we've already talked about, but I
think it's really important for us to be aware that
our lifestyle does potentially play a significant role in risk
for cancer.
Speaker 1 (13:53):
Well that's just alone.
Speaker 2 (13:54):
I mean, I'm like, if I have a forty percent
less chance of getting breast cancer or any type of
cancer just from my lifestyle, that's like, you know, good,
good bets that if you're kind of on the fence
of like, well I may you know, I may know.
I know that substance abuse or you know, alcohol intake
(14:16):
and smoking is probably not great. Well, we all know
it's not great, But like if somebody were kind of
on a borderline there, it would be really easy if
I heard these statistics to be like, all right, how
important is this and how important it's going to be
in fifteen twenty years, you know, if I keep going
at the rate. We all have our vices, and it
(14:38):
can be different things for different different women. But let's
talk about those areas of the lifestyle medicine and how
we are helping, you know, prevent but then also helping
you know, with the cancer survivorship after and really seeing
how that goes with your patients once they have come
(14:59):
through breast cancer treatment and what that looks like.
Speaker 3 (15:02):
The American Institute of Cancer Researchers recommendations. The first one
is being at a healthy body weight. We can, by
the way, go into greater detail on all of these.
We know that's a challenging one. Being physically active. Thank
you for all the work you do to help us
with that. But that is beif when we think about
cancer risk reduction. And then thinking about our diet, and
there are many recommendations eating a diet rich and fresh
(15:26):
fruits and vegetables, fruit lagoons, beans, whole grains so important.
Limiting the ultra processed foods that are so prevalent in
our diet, the fast foods, all these things out here
that we're exposed to in our environment here in the US,
which are things we need to cut down on. Limiting
red meat consumption and really eliminating a lot of these
(15:50):
processed meats that we consume. And then thinking about limiting
consumption of these sugar sweetened beverages. I know we all
love to go to Starbucks, but like being mindful of
what you're ordering there is so important. And then of
course alcohol is key, limiting alcohol consumption. And then the
last two are really focusing on you know, supplements unfortunately
(16:11):
do not prevent cancer. We can talk a whole thing
about that, and then breastfeeding is protective. So those are
all listed on the a I see our website, and
these are all steps we can all take to help
optimize our health in terms of our lifestyle to reduce
risk of cancer. And they're also important for cancer survivors.
So to follow these particular recommendations as well.
Speaker 1 (16:33):
It's it's tough.
Speaker 2 (16:34):
We just had a nutritionist on that lives in New Zealand,
and you know, she was like, our environment is just
not set up for success. And I'm like, well, I've
been to New Zealand and it's way better than.
Speaker 1 (16:46):
What we're dealing with in America.
Speaker 2 (16:50):
So true all of these things, and I feel like,
you know, where a lot of women may be like yeah, yeah, yeah,
we get you know, we get the message. We get
the message, but you know, it's also hard. I see
the other side, working one on one with women and
in these groups where you know, the healthy relationships and
the poor sleep and the stress. It's like, yeah, great,
(17:13):
I don't want to have any of those things, but
I have them. Yeah, And that's where it gets a
little bit trickier to really work on that, because that
not only helps with obviously reduction of cancer risk, but
that helps with body composition and that helps with you know,
our lifestyle there and how we're going to either lose
(17:33):
weight or gain muscle. I mean, so it really comes
full circle with everything that we do. So what do
you tell your patients when you know they're struggling with
any of these issues that are harder to tackle.
Speaker 3 (17:50):
Right, I mean, you reaise such important points. Oh my goodness,
you're absolutely right. I'm just gonna When I first wanted
to start some type of lifestyle medicine based program and
for my patients with breast cancer, I actually wanted to
just you know, think about let's talk about the diet
and the exercise, and but you're so right. There are
so many components of our lifestyle, which is really what
lifestyle medicine focuses on, that are key when we think
(18:13):
about that, as you do in your programs too, Like again,
restoreative sleep so important. So many of us struggle with
that thinking about social connection the community, and you do
that so beautifully with your programs, and I love that
that is so key to help anyone affect behavior change.
Limiting risky substances such as alcohol. We could talk more
(18:35):
about that. That's a tough one, but we really should
focus on that since it is unfortunately a risk factor
for cancer as well. And then talking about stress management,
which you just alluded to, which is a challenge for
so many of us, in particular women. We're juggling so
many balls at the same time, and so we really
need to address that too. And so all of these
(18:55):
factors social connection, you know, I just highlight that again.
I think it's so important and sometimes overlooks. So all
of these factors are absolutely key to help us optimize
our health. And really, like where do you start? And
I think like what you would probably say, it's just
pick one thing to start on. Yeah, say that's sleep,
or let's say it's trying to get more protein in
your diet. Maybe just for breakfast, start with breakfast. But like,
(19:18):
just pick one thing because you obviously can't tackle it
all at the same time.
Speaker 2 (19:23):
M h, Well, what would you say is too much?
How much is too much of alcohol? Because that's going
to be the question.
Speaker 1 (19:29):
I feel like.
Speaker 2 (19:30):
We live in this lat last decade where you know,
and especially since COVID, where we started having like women
started having like these wine online wine parties, and you know,
it's pretty much alcohol is at every almost every event
that you go to for adults.
Speaker 1 (19:51):
Anyway.
Speaker 2 (19:51):
That just reminds me of a Seinfeld episode where George
is trying to bring pepsi and he's like, why can't
I bring pepsi?
Speaker 1 (19:57):
Because we're adults, George. So I mean, it's kind of
just like.
Speaker 2 (20:04):
It's like it embedded into our all of our activities
in our social life. But there is this pull kind
of pulling back over the last I've seen it a
lot over the last couple of years and still very
new of like these you know, non alcoholic clubs opening
and a lot of mocktails on the you know.
Speaker 1 (20:25):
So I feel like there is this kind of trend shifting.
Speaker 2 (20:29):
Where have we been using this for a crutch a
little bit for some women?
Speaker 1 (20:34):
So what would you say?
Speaker 2 (20:35):
And I try to tell people like, Okay, well, it's
not like you have to eliminate everything. It's you know,
everyone thinks they have to come in. Okay, I can
have no, I can't have sugar anymore, I can't drink,
Like this is going to be the you know, great
fun life for me for the rest of the you
know second ever, you know, second part of my life.
Speaker 1 (20:52):
But how much is too much? Or is there any
guidelines there?
Speaker 3 (20:56):
Yes, such an important and timely question since it is
US Cancer Awareness Month or Action Month. And actually just
recently another baive organization, the American Association of Cancer Research AACR,
another reputable organization, came out with this Cancer Progress Support
for twenty twenty four and it did really highlight not
(21:17):
to be a downer, but that alcohol is a significant
risk factor for six different types of cancer, including breast cancer,
and also highlighted that over fifty percent of Americans are
not even aware that alcohol, unfortunately is a risk factor
for cancer. And we think about women you mentioned, like
you know, certainly for the pandemic, and people socializing you know,
(21:39):
even zoom alcohol parties things like that, Like you know,
so many women are so focused, like you know, on
like eating organically and getting the exercise, but maybe drink
two or three glasses of wine to night and don't
even think of anything of it. So I think it's
important that we spread the message that alcohol is a
cancer risk factor. It is what it is. So I'm
going to cite one recommendation from an another organization. I
(22:01):
like the AICR Worterity Reference American Institute of Cancer Research.
You can drink, but just think before you drink. Why
are you having that glass of wine? So I'll just
share it a personal example. The other night, I was
at a special dinner at an Italian restaurant honoring a
colleague who unfortunately is leaving our hospital for another opportunity.
(22:22):
And we were all celebrating and there's a glass of
red wine being poured for everyone, and I was like,
I'm going to have this glass of red wine. I'm
celebrating my colleague. It's a special occasion and so I
enjoyed it. But would I do that like every single
night when I'm at home having dinner. No, I don't
think that's a good idea. So, especially for women, we
really do need to be mindful of our alcohol intakes.
(22:42):
So I think that's a really important message that we
can spread through this podcast today.
Speaker 4 (22:49):
Yeah, that's a good tip to be mindful. Yeah, and
why do I need to get a second glass? Do
I really need a second glass? And I love Haley
that you mentioned mocktails. They are having a moment and
there's so many like fun mocktails out there.
Speaker 3 (23:06):
Like I'll be honest, I have not really made one yet,
but like I'm always inspired when I see someone showing
how they make their mocktail. I'm like, oh, that looks
really good. I should make that.
Speaker 1 (23:16):
Yeah. Yeah, it's nice to have options there.
Speaker 2 (23:19):
But you know, I've been seeing a theme in again,
just from this week in the podcast that we filmed
and the nutrition course, where we've talked a lot about
disassociation and really how women especially have gotten to this
point where we just like disassociate. We don't even subconsciously
(23:42):
maybe even you know, think about pouring the drink at night,
or eating the extra food or something of we're you know,
we're living in this high stress. We're trying to do
all the right things, and usually there is something obvious
that I always say, if I, you know, if me
or even you could go and be a ghost in
someone's house for twenty four hours and watch everything that
(24:05):
they did, it would probably be easy to spot, but
they might not even know what because we're just like
robotic a lot of the time, especially when we're so busy,
that these things are just getting missed because we're not present,
and it's really hard to be present when we have
everything going on all the time.
Speaker 3 (24:26):
I totally agree, and that's why I think. I just
think about the programs you offer, which I'm so fortunate
to be involved with right now. The power of the community,
Like if you have obviously you're not going to have
someone in your house with you all the time saying
do you really need to eat those chocolate chips right now?
But like you know, the community support. I mean, we
can provide all the education about every health and wellness
(24:48):
topic in the world and make it as evidence based
and amazing as possible. But if we are not also
focusing on what are the steps we need to do
to help an individual make these behavior change is like
eat more fruits and vegetables, eat more protein in her diet,
strength train three or four times a week, whatever it
might be. You know, we are not going to make progress.
(25:09):
So that is really hard. As a doctor, I can
tell you was I taught, like how do you coach
your patient on behavior change? Like I wasn't really taught
the coaching strategies that you have that expertise, and I
think I've actually learned some of it along the way
since then, but I will say that is so important,
so the coaching piece and the community piece to help
people make these changes because it is really hard, especially
(25:30):
when we have so much going on.
Speaker 4 (25:33):
I'm so glad you bring up social health because I
think it's something that is not talked about enough, and
I really think that social skills are off balance. And
I mean, it's a proven fact that social connection helps
you live longer for sure, and living a healthier and
happier life creates longevity too. I just have to commend
(25:57):
you that I was so impressed with this time we
interviewed you, that you really focused on asking your client
about their lifestyle, because I find that a lot of
doctors it's okay, you have this, this is X is wrong,
and this is what we do to correct it, and
(26:17):
they're not examining and taking a glimpse of the whole
big picture. And I just I am so glad that
you are doing this, and I just have to commend you.
Speaker 3 (26:30):
Thank you so much, and I agree that we all
need to have There is this like a buzzword now
and the literature it's called like whole person care, and
it's like this new thing like take care of the
whole patient ask about her lifestyle, how she's sleeping, how
she eating, how she exercising. To me, I'm like, how
haven't we been doing this? Like this should be like
very bread and butter medicine. One oh one. And it's
(26:51):
interesting that you say that, Laura, I guess I hate
to say it, not first of all, to defend my colleagues.
We are very limited in time and really it and
it's just a fact. And also I will say when
it comes to the lifestyle piece, a lot of us
we're not really educated in medical school, residency, fellowship, whatever
about all these lifestyle factors to the degree that we
(27:13):
feel super comfortable talking and counseling our patients about it.
So these are all things that I think are going
to change. But you raise some really important points that
as a medical field, you know, we're wondering. It's great
that we can work with a wonderful team, but we
also need to be doing a better job addressing all
of these concerns for our patients. Yeah.
Speaker 2 (27:31):
Absolutely, Well, if we look at a patient after treatment,
so say that they are kind of in recovery, they're
in a recovery period, and you know you're coaching them
what does the return to exercise look like? Now, obviously
I would treat it to someone who had any surgery
(27:53):
or injury or a long time off of fitness regular movement,
But are they there are any things that you would
stay away from? Obviously I'm thinking anything test related.
Speaker 1 (28:07):
But what does that look like for.
Speaker 2 (28:08):
Women that maybe out there that Because I get asked
all the time like do you have a breast cancer
kind of recovery program of where to start? And it's
just made me pause and think about the importance of that.
And I know that you offer something as well, so
let's dive into that.
Speaker 3 (28:27):
Yes, so such an important question, because I promise you
I talk about exercise with all of my patients. Any
of them are listening, they know I do, and I've
shared your amazing program and I will continue to do
so too. So exercise is absolutely important for women with
a history of breast cancer. In fact, studies show that
doing regular exercise, and we can talk about what those
(28:49):
basic guidelines are can help reduce risk of recurrence and
improve outcome from breast cancer. So right there, exercise can
improve an woman outcome from her breast cancer. So that
is the most important thing. Right when it comes to
treating my patients and helping them optimize their health, well
being and well being. So what are the basic guidelines? Again,
(29:12):
let's just start with the basics, and it really is
similar to what the CDC would recommend for all Americans
on one hundred and fifty minutes of moderate aerobic activity
each week or seventy five minutes of more vigorous activity.
But let's just focus on the one hundred and fifty number,
and that could be walking, jogging, cycling, kayaking, vacuuming, zoomba,
(29:34):
whatever that may be. And two sessions of strength training.
I know it's not a lot, but two sessions is right,
very good. Yeah, but I will tell you, and you
know this from your work, like the majority of people
do not meet those criteria, and certainly when we think
about the cancer survivor population, the majority do not meet
(29:55):
those very basic guidelines. So that is where I often
start with a patient of cour of course, probably like
you do with the people you work with, like where
are you starting from? What are you doing at this time?
What are you comfortable with? And really for me, it's
helping my patient. Maybe she's going to start with walking.
Like I actually said this to a patient yesterday, we
set a smart goal together, Maybe you can walk for
(30:16):
fifteen minutes three times this week and see how you do.
Because she's someone who doesn't exercise at all, So start
with that and then gradually introduce more aerobic activity, introduce
the strength training, and you do raise really great questions.
What if a woman just had to mastect me, like,
what are her limitations? What can she do? When can
(30:36):
she start lifting weights? What is safe for her? What's
a warning sign? And I will tell you I'm very
fortunate where I work to work with physical therapists who
have specific training in how to work with women who
have had a history of breast cancer. But I will
tell you that many studies show that lifting weights is
safe and very much important for our patient population for
(31:00):
all the reasons you talk about muscle mass, bone health,
metabolic health. Can go on and on, and there is
a condition called lymph edema where a woman can have
swelling of her arm on the side where she had
her breast cancer, especially if she had many lymph notes
removed in her surgery or if she had radiation on
that side, and exercise does not increase the risk of
(31:22):
lymph DMA can actually help it. So it is we
do get into some of the technical aspects of how
a woman should be assessed, etc. But in general, exercise
is good and beneficial and she'ld be strongly encouraged for everyone.
Speaker 2 (31:36):
Yes, and I just want to plug this and I
feel like I've been plugging it and I'm like a
broken record, but I'm going to say it again. I
think as women when they're coming into the field, because
I have obviously all levels, but the ones that are
really beginner, like they've received the message, they're ready to go.
There's so much information out there that's good information that's
(31:59):
throwing at them, but that we peel back and just
be like, it doesn't matter what you start with, Like
just start. Don't worry about the guidelines for optimal body
composition or optimal fitness or taking you know yourself to
this high level. Yes we can, we can program that
(32:20):
over time, but we start with just like what makes
you happy, what gets you out the door. I mean,
none of those should ever be discounted. And then it's like, well,
once you're there, now, do you want to add something?
Is there something else we can add there? But the
the you know, exercise in general there's a lot of specifics,
(32:41):
but I want women to know that, like you start
with what you can do and what you can manage,
and it doesn't it's it's it's meaningless of what you
know an someone else is recommending on their journey or
what's optimal. If for you, this is what is making youill,
okay and be active and do that. So anyhow, I
(33:05):
mean there's a place for everyone. There is a place
for everyone, and it's usually the very beginners that are
very timid and just feel like, you know, they don't
have the confidence yet to really get get out there
and do a lot of things. So they should be
doing just the bare minimum of what they can that
they feel comfortable with.
Speaker 1 (33:23):
So let's talk about your.
Speaker 2 (33:27):
Path to the path? What is path to pavement? Something
in pavement? I actually have a book. I didn't know
you had a book.
Speaker 3 (33:41):
But actually I want to say one thing because it's
actually in the beginning of this book and it's totally
related to what you just said. And you're welcome to
use this quote. It's not my quote. It's from like
this Chinese philosopher Lao Zoo. But the journey of a
thousand Miles begins with a single step. So I love
what you just said. Just love the first step is
(34:02):
so key. So I love that you just talked about
how the beginners struggles so much. Just take that first step.
So yeah, paving the path to wellness. So this is
a wonderful collaboration that began with my colleague, doctor Beth Frady's.
Speaker 1 (34:16):
Five years ago.
Speaker 3 (34:17):
It's like hard for me to fully wrap my head
around really five years that's gone by really fast. But
it's a lifestyle medicine based survivorship program for women with
breast cancer who really want to learn about what we've
been talking about, the evidence based recommendations in terms of nutrition,
physical activity, sleep, stress management, all of these topics after
(34:38):
diagnosis of breast cancer. So we meet virtually and each
week and go over each of these topics in great
detail and also work together in the community setting to
help people make these behavior changes. And it's really been
such a wonderful undertaking. And we've also talked about the
power of community and that's been such a key benefit
of this program as well.
Speaker 4 (35:00):
But this program is for people that have breast cancer
and then are learn living with it afterwards, like after
they got there.
Speaker 3 (35:08):
I'm offering is specifically for breast cancer survivors and thrivers.
They like to call themselves that, and I love that.
But I will tell you that doctor Frady's when she
first came up with this program, she was offering it
to stroke survivors who at a hospital called Spaulding Rehabilitation Hospital,
which is here in Boston at Philly with Harvard Medical School.
(35:28):
So she was first offering the program there, and I
met with her many years ago to learn about lifestyle medicine,
and then we adapted this program and I started offering
specifically for women with breast cancer. But I know doctor
Fradi's and colleagues, we actually have a nonprofit and we're
hoping to bring this program to lots of populations, not
just women with breast cancer. But my passion, of course
(35:50):
is helping the breast cancer survivor community, and that's that's
really my why.
Speaker 1 (35:55):
I love that. So you're a vegan, right.
Speaker 3 (36:00):
I would say I've been having some salmon like once
in a while to get my omega threes in, but
like I do otherwise follow very much on plant predominant diet,
I call it that. But yeah, I was realizing I
needed to find some ways to in my omega threes,
which we know are so good for our crediovascular health.
Speaker 4 (36:19):
How long have you been vegan?
Speaker 3 (36:21):
Well, I mean I go back and forth. Right now,
I'm not totally vegan, I should say I'm but gosh,
when the d become like essentially vegetarian a long time ago,
I don't even remember. That's honestly the truth. Like, I
don't even remember. I guess my daughter was nine because
she she became a vegetarian at that time too, so
I can do the math. So she's now, so it
(36:41):
was eight years ago. Hell does she know? She camps
on the bandwagon too.
Speaker 1 (36:48):
Yeah, that's great.
Speaker 2 (36:48):
Well, I like how you talk about the plant based
diet here, and this is where it's going to be
like okay, well we hear protein, and even with the
importance of protein, that's never going away, or I don't
foresee it ever going away. But if we look at
the importance of that, it's hard for some women who
(37:08):
start to change their diet. And then it's really protein,
you know, muscle like a muscle centric approach, which is
a lot of protein to support the training, but then
a lot of the good fruits and vegetables might get
lost in the mix because we're so pro protein. So
do you have any advice on that, because you know,
(37:30):
ideally we're all getting the thirty fruits and vegetables in
a week and we're all having the right number of protein.
But I mean, in like real world, it's freaking hard.
Speaker 3 (37:42):
It is. In fact, my colleague and I shout out
to my colleague, chef Laura Client, we taught a culinary
medicine cooking class on Wednesday to a group of women
with breast cancer, and we tried to do some education
about nutrition along the way. We talked about our favorite topic,
got microbiome, protein, fiber, and we did really talk about
(38:03):
the challenge of getting in those thirty plants, getting in
your protein. So one of the things we made was
this soup with lentils. Lentils are pretty awesome, by the way.
My colleague Cheflara showed there's like five different types of lentils,
all these different colors. I don't even know if you know,
there's black lentils, yellow lentils. I was like blown away.
I'm like, I need to go buy all of these
(38:23):
pretty lentils because packed with protein, Like one cup of
lentils has like eighteen grams of protein and they're packed
with fiber, so you're getting fiber and protein when you
have lentils, which are so yummy in a soup or
you can put them in a salad, so many things
you can do. So that was a tip and trick
we did share with our group because we all need
to get at least thirty grams of fiber a day
(38:46):
and most of us are not getting that either, not streggle.
We talked about this.
Speaker 2 (38:51):
It's important, very important, and that's that's the hard transition
is like that's what I see with women that go
into like a fat loss.
Speaker 3 (39:00):
You know.
Speaker 2 (39:01):
Course with me is is the fiber takes the hit
because the plant and vegetables, like all of the plants
take a hit. And so if we're just like it
really is, it seems like it's simple information, have a
lot of variety of fruits and vege and like have protein.
We're like, okay, cool, but it's really hard to get
(39:22):
all of those balances.
Speaker 1 (39:23):
But again, start somewhere.
Speaker 2 (39:25):
If you're eating three vegetables a week, the same ones,
then maybe out of fourth. I mean that's how I'm
doing it, because it's it's tricky to do it, especially
when you're in limited time.
Speaker 3 (39:35):
You know, Yes, I definitely agree, it's tricky, and that's
why I love that. There's also you have this wonderful
community so people can support each other and share ideas
with each other in strategies.
Speaker 2 (39:45):
Yeah, I love that. And you know, we're running out
of time here. I'm so sad. I feel like, where
does the time go? We can't have been talking for
forty minutes.
Speaker 4 (39:56):
I know I just saw the same thing, but I
do want to just touch on one thing because it
does breast cancer awareness. One, just to remind people, so screening,
you're supposed to get a mammogram once a year, correct.
Speaker 3 (40:11):
Correct, And aren't recommendations starting at age forty unless you
have a strong family history or other significant rest factors,
and then you would talk with your doctor about potentially
starting earlier. But a woman of average risk should be
starting at age forty and doing it every year.
Speaker 4 (40:28):
What do you think of the Pronovo scan? Am I
saying it correctly? The full body Pronova scan?
Speaker 3 (40:38):
If you're referring to like, I'm not sure specifically about
that particular one, but if you're thinking about full body, yeah,
the ovagen like that. Again, I do not recommend testing
like that because I will tell you anytime you order
as a doctor, anytime I order a scan on any patient,
I have to have a good reason why am I
doing this? Because often there are incidental findings and what
(41:00):
does that mean? Something you will find that you were
not looking for, and now you're going to go down
that rabbit hole of chasing it and it may or
may not turn out to be anything of clinical significance.
I'll give a common example, and I know we're short
on time. Lung nodules. Lots of us have lung nodules.
They're usually super tiny, five millimeters. You see it on
someone's scan, you're going to follow it. So now she's
(41:22):
getting a scan maybe initially every six months for one
or two years to make sure they're stable and nothing
growing or whatever. But now that patient is getting all
these extra scans and extra exposure to radiation that she did.
So I am not a fan of doing scans on
people when you don't have a really good reason why
you're doing it. Okay, that's great advice.
Speaker 4 (41:41):
I just wanted to ask, Yes, that's we're in this,
but mammograms, yes.
Speaker 2 (41:47):
Yeah, oh, that's I didn't even think about that, but
that's I'm going to do the regular one that is
not as fun, but at least it's it's not cause
of me to get other scan. Is there anything new
since we talked to you last about six months ago
in the breast cancer treatment world, Any new information that
you can share or something that you found interesting.
Speaker 3 (42:11):
Oh gosh, in the breast cancer world, their things are
always evolving, always changing. That's why my job is very
exciting because there's always new research studies with new treatments
and new findings that are being released. And I'll just
think of one that is super interesting. Recently, at my hospital,
we had a retreat to actually focus on the role
(42:32):
of artificial intelligence in cancer care. And that's obviously a
feel in your field too. That's really taking off the
power of these tools to enhance whether it's health and
wellness or maybe in the breast cancer field, helping us
identify cancers earlier on mammograms using all these really cool
AI algorithms. I do not claim to be an expert
(42:53):
on this, but it's super interesting. So that's an area
that I think we're going to really see takeoff in
the next few.
Speaker 2 (42:58):
Years AI get in or Get Out. I just watched
that at Tesla with my son this morning. He's like, Mom,
look at these robots. You can you know you're gonna
be able to buy one in twenty twenty six, And like,
I feel like that's we're in Halloween.
Speaker 1 (43:13):
My son loves animatronics.
Speaker 2 (43:14):
I feel like it's an animatronic walking around the house.
I don't think I'm comfortable with with that quite yet,
but you know, I guess you know.
Speaker 1 (43:23):
The AI world is is.
Speaker 2 (43:25):
It's not going away, so it's it's quite interesting on
all spectrums there, but fascinating information. I think I love
the lifestyle approach and I love that there's so much
power in lifestyle medicine and that it's kind of getting
into the main medical stream and getting talked about because
(43:47):
it really is. We're all working together for someone's health.
I mean, and there's lots of participants in a client's
journey that you know, we all we all benefiting each
other by helping out with our specific area and so
there's lots of good.
Speaker 1 (44:03):
It's an exciting time to live for surely.
Speaker 3 (44:05):
I have to agree with you one hundred percent.
Speaker 2 (44:08):
So Amy, can you tell us about is your book available.
I didn't know that there was an actual book same.
I'm like, we got to get the book.
Speaker 3 (44:18):
So this is a wonderful workbook that I was fortunate
to collaborate with with doctor Beth Frady's and doctor Michelle Tollison.
It's called Paving the Path to Wellness Workbook. It is
on Amazon or on the publisher's site healthy learning dot com.
And by the way, the proceeds do not go to
meet They go to our nonprofit called Paving Wellness, and
(44:39):
that's Paving Wellness dot org. But bottom line is, this
is a great workbook that goes with our program. And
I am working on one focused on breast cancer, and
we also have one already written by my amazing colleague,
doctor Tollison. She was the first author focused on menopause.
And by the way, you would love it. It's all
about it's somewhere over there, but it's focused on lifestyle
(45:05):
strategies to optimize our health during menopause, which is something
that you're already an expert on. So but I think
you would love it because a lot that she does
focus a lot, We focus a lot about everything, but
certainly exercise is key in that too.
Speaker 1 (45:17):
All right, I'm getting it. I feel like I order
more books from podcasts.
Speaker 3 (45:23):
Let I know. It's going to be a gift for me.
I'm sending it to you, so oh, I helping all
I am sending it to you, so I will do
that because you will absolutely love it.
Speaker 2 (45:33):
Oh, I'm so excited. Well, thank you so much for
your time, doctor Commander. We is always just a special
treat to have you, especially during the month of breast
cancer awareness and menopause month as well, so we kind
of tackle two big women's health yes, women's health. So
thank you so much for your time and we will
(45:54):
catch up with you soon.
Speaker 3 (45:56):
Thank you so much for the opportunity, and thanks for
all the amazing work you do.
Speaker 1 (46:00):
Thanks for listening everyone.
Speaker 4 (46:01):
If you enjoyed this episode, please consider giving us a
five star rating and sharing the body Pod with your friends.
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