Podcasts about breast cancer program

For Breast Cancer Awareness Month, we're joined by Dr. Patrick Borgen, Chair, Surgery and Director of the Breast Cancer Program at Maimonides Medical Center. After working at Memorial Sloan Kettering, Dr. Borgen came to Maimonides to work with patients from under-resourced communities. Maimonides Health is Brooklyn's largest healthcare system, serving over 320,000 patients each year through the system's three hospitals, with 7,000+ employees, 1,800+ physicians, and more than 80 community-based practices and outpatient centers.  Patients with advanced breast cancer treated at Maimonides lived longer than the national average. For more, visit maimo.org.

Drs. John Sweetenham and Angela DeMichele discuss potentially ground-breaking abstracts in breast and lung cancer as well as notable research on artificial intelligence and its impact on cancer care, all of which were featured at the 2024 ASCO Annual Meeting.  TRANSCRIPT Dr. John Sweetenham: Hello, I'm Dr. John Sweetenham from UT Southwestern's Harold C. Simmons Comprehensive Cancer Center and host of the ASCO Daily News Podcast. My guest today is Dr. Angela DeMichele, the Marianne and Robert McDonald Professor in Breast Cancer Research and co-leader of the Breast Cancer Program at the University of Pennsylvania's Abramson Cancer Center. Dr. DeMichele also served as the chair of the 2024 ASCO Annual Meeting Scientific Program. Today, she'll be sharing her reflections on the Annual Meeting and we'll be highlighting some advances and innovations that are addressing unmet needs and accelerating progress in oncology.  Our full disclosures are available in the transcript of this episode.  Dr. DeMichele, congratulations on a very robust and highly successful program at ASCO24, and thanks for joining us on the podcast today. Dr. Angela DeMichele: Well, thanks so much for having me, Dr. Sweetenham. It's a pleasure to be here.  Dr. John Sweetenham: The presidential theme of the Annual Meeting this year was the "The Art and Science of Cancer Care: From Comfort to Cure." And this was certainly reflected throughout the meeting in Chicago that welcomed more than 40,000 attendees from across the globe. I know our listeners will be interested to hear some of your own reflections from the meeting now that we're on the other side of it, so to spea  Dr. Angela DeMichele: Yes. Well, I will say that playing this role in the annual meeting really was a highlight of my career, and I feel so fortunate to have had the opportunity to do it. We had over 200 sessions, and in many, if not all of these sessions, we really tried to make sure that there was a case that really sort of grounded the session to really help people understand: you're going to hear about science, but how are you going to apply that? Who is the patient for whom this science really is important?  We had over 7,000 abstracts submitted, and our 25 tracks and their chairs really pulled through to find really the best science that we could present this year. I think what you saw really was a representation of that across the board: incredible advances in lung cancer, breast cancer, melanoma, GI cancers; also really cutting-edge technologies: AI, as we'll talk about in a little while circulating markers like ctDNA, new drug development, new classes of drugs. So it was really an exciting meeting. I mean, some highlights for me, I would say, were certainly the Plenary, and we can talk a little bit about that. Also, we had a fantastic ASCO/AACR Joint Session on “Drugging the “Undruggable Target: Successes, Challenges, and the Road Ahead.” And, if any of the listeners have not had a chance to hear this, it's really worth going in and watching this because it really brought together three amazing speakers who talked about the successes in KRAS, and then really, how are we using that success in learning how to target KRAS to now targeting a variety of other previously thought to be undruggable targets. I learned so much. And there's really both the academic and the pharma perspective there. So I'd really encourage watching this session. The other session that I really thought was terrific was one that I was honored to chair, which was a fireside chat (“How and Where Will Public Investment Accelerate Progress in Oncology? A Discussion with the NIH and NCI Directors”) with both Dr. Monica Bertagnolli, who is the director of the NIH, and Dr. Kim Rathmell, who's now the director of the NCI. And boy, I'll tell you, these two incredibly smart, thoughtful, insightful women; it was a great conversation. They were really understanding of the challenges we face conducting research, practicing medicine. And maybe different from leadership at the NIH in the past, they've really taken the approach to say that everything they do is focused on the patient, and they don't limit themselves to just research or just science, that everything that the NIH does, and particularly the NCI does, really has to be focused on making sure we can give patients the best possible care. And I think they're being very thoughtful about building important infrastructure that's going to take us into the future, incorporating AI, incorporating new clinical trial approaches that are going to make it faster and easier to conduct clinical trials and to get the results that we need sooner. So just a few of the highlights, I think, from some really interesting sessions. Dr. John Sweetenham: It certainly was an extremely enriching and impactful ASCO24. And I think that the overall theme of the meeting was extremely well reflected in the content with this amazing mix of really, truly impactful science, along with a great deal of patient-centered healthcare delivery science to accompany it. So, I completely agree with you about that. There was a lot, of course, to take in over the five days of the meeting, but I'm sure that our listeners would be very interested to hear about one or two abstracts that really stood out for you this year.  Dr. Angela DeMichele: Sure. I'm a breast cancer specialist, so I can't help but feel that the late breaking abstract, the DESTINY-Breast06 trial, was really important for the field of breast cancer. So just briefly, this is a study of the antibody drug conjugate T-DxD, trastuzumab deruxtecan. This is a drug that is actually now approved in metastatic breast cancer, really effective in HER2-positive disease. But the question that this trial was trying to answer is, can this drug, which is built with the herceptin antibody against HER2, then linked to a chemotherapeutic molecule, can this work even in the setting of very, very low HER2 expression on a tumor? I think this is an incredibly important question in the field of antibody drug conjugates, of which there are now many across diseases, is how much of the target do you really need to have on the surface of the tumor?  We had seen previously HER2 overexpressing tumors respond really well to this drug. HER2 tumors that have an intermediate level of expression were tested in the DP04 trial, and we saw that even those 2+ intermediate tumors responded well to this drug. The DP06 trial that was presented at ASCO was looking at this group of patients that have even less HER2 on the surface. So we typically measure HER2 by immunohistochemistry as 0, 1+, 2+, or 3+. And this was looking at patients whose tumors were over 0, but were at 1+ or below, so low and ultra-low. And it turned out that compared to treatment of physician's choice, the drug really had quite a lot of activity, even in these patients who have very little HER2 on their tumors, really showing progression-free survival benefits in the HER2-low and HER2-ultra-low groups that were appreciable on the order of about 5 months, additional progression free survival hazard ratios around 0.6, so really demonstrating that utilizing an antibody drug conjugate, where you've got very little target, can still be a way to get that drug to a tumor.   And I think it'll remain to be seen whether other ADCs can have activity at very low levels of IHC expression of whatever target they're designed against. I think one of the tricky things here for implementing this in breast cancer will be how do pathologists actually identify the tumors that are ultra-low because it's not something that we typically do. And so we'll go through a period, I think, of adjustment here of really trying to understand how to measure this. And there are a bunch of new technologies that I think will do a better job of detecting low levels of the protein on the surface of the tumor because the current IHC test really isn't designed to do that. It was only designed to be focused on finding the tumors that had high levels. So we have some newer technologies with immunofluorescence, for example, that can really get down to very low levels. And I think this is going to be a whole new area of ADCs, target detection – how low can you go to still see activity? So I thought that this was an important abstract for many reasons.  I will just say the second area that I was really particularly impressed with and had a big impact on me were the two lung cancer abstracts that were presented in the Plenary, the LAURA trial (LBA4) and the ADRIATIC trial (LBA5). And I think, I've been in the field of oncology for 30 years now, and when I started in the late ‘90s, lung cancer was a disease for which we had very few treatments. If we didn't catch it early and surgery wasn't possible for non-small cell lung cancer, really, it was a horrible prognosis. So we knew this year was the 20th anniversary of the discovery of EGFR as a subtype of lung cancer. That was really, I think, a turning point in the field of non-small cell lung cancer – finding a target. And now seeing the LAURA trial show that osimertinib really had such an enormous impact on progression-free survival amongst these patients who had EGFR-positive non-small cell lung cancer, progression-free survival hazard ratio of 0.16; there was a standing ovation.  And one of the really big privileges of being the Scientific Program Chair is getting to moderate the Plenary Session, and it's a really amazing experience to be standing up there or sitting there while the presenter is getting a standing ovation. But this was well deserved because of the impact this is having on patients with EGFR positive lung cancer. And it was similar with the ADRIATIC trial, which looked at the benefits of adding immunotherapy in limited-stage small-cell lung cancer. Again, a disease that treatment has not changed in 30 years, and so the addition of durvalumab to the standard backbone of chemotherapy for small cell lung cancer had its survival advantage. These patients are living longer and it was really an impressive improvement. And I think it really underscores just the revolution that has happened in lung cancer between targeted therapy and immunotherapy has completely changed the prognosis for patients with this disease. So to me, these were really landmark reports that came out at ASCO that really showed us how far we've come in oncology. Dr. John Sweetenham: Yeah, absolutely. I think that, as you mentioned, those results are truly remarkable, and they reflect extraordinary advances in science. I think we see that both in terms of the therapeutic arena, but also, I think we've started to see it in other areas as well, like symptom control, remote patient monitoring, and so on and so forth, where some of the newer virtual technologies are really having major impacts as well. Dr. Angela DeMichele: Yes, we really wanted to have a focus on artificial intelligence in this meeting, because it's having such an enormous impact on our field in everything from care delivery to diagnostics. I'd love to hear what you thought was the most interesting, because there really was just new data across the board presented. Dr. John Sweetenham: I've actually chosen 3 abstracts which I thought were particularly interesting for a couple of reasons, really. They're all based on virtual health interventions, and I think they're interesting in really reflecting the theme of the meeting, in that they are extremely advanced technology involved in the virtual platforms, a couple of which are artificial intelligence, but very impactful to patients at the same time in terms of remote symptom control, in terms of addressing disparities, and in one case, even influencing survival. So I thought these were three really interesting abstracts that I'll walk the listeners through very quickly.  The first of these was a study, Abstract 1500 (“National implementation of an AI-based virtual dietician for patients with cancer”) which looked at an artificial intelligence-based virtual dietitian for patients with cancer. This is based on the fact that we know nutritional status to be a key driver of patient experience and of cancer outcomes. And as the authors of the presentation noted, 80% of patients look for nutritional support, but many of them don't get it. And that's primarily a workforce issue. And I think that's an important thematic point as well, that these new technologies can help us to address some of the workforce issues we have in oncology. So this was an AI-based platform developed by experts in nutrition and cancer patients, based on peer reviewed literature, and a major effort in terms of getting all of these data up together. And they developed an artificial intelligence platform, which was predominantly text message based. And this platform was called INA. And as this is developing as a platform, there's a machine learning component to it as well. So in theory, it's going to get better and better and better over time.  And what they did in their study was they looked at little over 3,000 patients across the entire country who were suffering from various types of cancer, GU, breast, gynecological malignancy, GI and lung. And most of them had advanced-stage disease, and many of them had nutritional challenges. For example, almost 60% of them were either overweight or obese by BMI. And the patients were entered into a text exchange with the AI platform, which would give them advice on what they should eat, what they shouldn't eat. It would push various guidance and tips to them, it would develop personalized recipes for them, and it would even develop menu plans for the patients. And what's really interesting about this is that the level of engagement from the patients was very high, with almost 70% of patients actually texting questions to this platform. About 80% of the patients completed all of the surveys, and the average time that patients interacted with the platform was almost nine months, so this was remarkable levels of engagement, high levels of patient satisfaction. And although at this point, I think it's very early and somewhat subjective, there was certainly a very positive kind of vibe from patients. Nearly 50% have used the recommended recipes. More than 80% of them thought that their symptoms improved while they were using this platform. So I think as a kind of an assistant for remote management of patients, it's really remarkable. And the fact that the level of engagement was so high also means that for those patients, it's been very impactful.   The second one, this was Abstract 100 (“AI virtual patient navigation to promote re-engagement of U.S. inner city patients nonadherent with colonoscopy appointments: A quality improvement initiative”) looked again at an AI-based platform, which in this case was used in an underserved population to address healthcare disparities. This is a study from New York which was looking at colorectal cancer screening disparities amongst an underserved population, where historically they've used skilled patient navigators to address compliance with screening programs, in this case specifically for colorectal cancer. And they noticed in the background to this study that in their previous experience in 2022, almost 60% of patients either canceled or no-showed for colonoscopy appointments. And because of this and because of the high burden of patients that this group has, they decided to take an AI-based virtual patient navigator called MyEleanor and introduce this into their colorectal cancer screening quality improvement.  And so they introduced this platform in April of 2023 through to the end of the year, and their plan was to target reengagements of around 2,500 patients who had been non adherent with colonoscopy appointments in a previous year. And so the platform MyEleanor would call the patients to discuss rescheduling, it would assess their barriers to uptake, it would offer live transfer to somebody to schedule for them, and then it would go on closer to the point of the colonoscopy to call the patients and give them advice about their prep. And it was very nuanced. The platform would speak in both English and Spanish versions. It could detect nuances in the patient's voice, which might then trigger it to refer the patient to a live agent rather than the AI platform. So, very sophisticated technology. And what was most interesting about this, I think, was that over the eight months of the study, around 60% of patients actually engaged with this platform, with almost 60% of that group, or 33% overall, accepting a live transfer and then going on to scheduling, so that the completion rate for the no show patients went from 10% prior to the introduction of this platform to 19% after it was introduced. So [this is] another example, I think, of something which addresses a workforce problem and also addresses a major disparity within cancer care at the moment by harnessing these new technologies. And I think, again, a great interaction of very, very high-level science with things that make a real difference to our patients.  So, Dr. DeMichele, those are a couple of examples, I think, of early data which really are beginning to show us the potential and signal the impact that artificial intelligence is going to have for our patients in oncology. I wonder, do you have any thoughts right now of where you see the biggest impact of artificial intelligence; let's say not in 20 years from now, but maybe in the next year or two?  Dr. Angela DeMichele: Well, I think that those were two excellent examples. A really important feature of AI is really easing the workload on physicians. And what I hope will happen is that we'll be able to use AI in the very near future as a partner to really offload some of the quite time-consuming tasks, like charting, documentation, that really take us away from face-to-face interaction with patients. I think this has been a very difficult period where we move to electronic medical records, which are great for many reasons, but have really added to the burden to physicians in all of the extra documentation. So that's one way, I think, that we will hope to really be able to harness this. I think the other thing these abstracts indicate is that patients are very willing to interact with these AI chatbots in a way that I think, as you pointed out, the engagement was so high. I think that's because they trust us to make sure that what we're doing is still going to be overseen by physicians, that the information is going to get to us, and that they're going to be guided. And so I think that in areas where we can do outreach to patients, reminders, this is already happening with mammograms and other sorts of screening, where it's automated to make sure you're giving reminders to patients about things that they need to do for some of their basic health maintenance. But here, really providing important information – counseling that can be done by one of these chatbots in a way that is compassionate, informative and does not feel robotic to patients.   And then I was really impressed with, in the abstract on the screening colonoscopy, the ability of the AI instrument to really hear nuances in the patient's responses that could direct them directly to a care provider, to a clinician, if they thought that there might be some problem the patient was experiencing. So again, this could be something that could be useful in triaging phone calls that are coming in from patients or our portals that just feel like they are full of messages, no matter how hard you try to clear them all out, to get to them all. Could we begin to use AI to triage some of the more mundane questions that don't require a clinician to answer so that we can really focus on the things that are important, the things that are life threatening or severe, and make sure that we're getting to patients sooner? So there's just a few ways I really hope it'll help us. Dr. John Sweetenham: Yeah, absolutely. I think we're just scratching the surface. And interestingly enough, in my newsfeed this morning through email, I have an email that reads, “Should AI pick immunotherapy combinations?” So we'll see where that goes, and maybe one day it will. Who knows? Dr. Angela DeMichele There was a great study presented at ASCO about that very thing, and I think that is still early, but I could envision a situation where I could ask an AI instrument to tell me all of the data around something that I want to know about for a patient that could deliver all of the data to me in real time in the clinic to be able to help me make decisions, help me quote data to patients. I think in that way it could be very, very helpful. But it'll still need the physicians to be putting the data into context and thinking about how to apply it to the individual person. Dr. John Sweetenham: Absolutely, yes. And so just to round off, the final abstract that caught my eye, which I think kind of expands on a theme that we saw at an ASCO meeting two or three years ago around the impact of [oncology] care at home, and this was Abstract 1503 (“Acute care and overall survival results of a randomized trial of a virtual health intervention during routine cancer treatment”). So, a virtual platform but not AI in this case. And this was a study that looked at the use of an Integrative Medicine at Home virtual mind-body fitness program. And this was a platform that was used to look at hospital admission and acute care of patients who used it, and also looked at survival, interestingly enough. So what was done in this study was a small, randomized study which looked at the use of virtual live mind, body and fitness classes, and compared this in a randomized fashion to what they called enhanced usual care, which essentially consisted of giving the patients, making available to the patients, some pre-recorded online meditation resources that they could use. And this was applied to a number of patients with various malignancies, including melanoma, lung, gynecologic, head and neck cancers, all of whom were on systemic therapy and all of whom were reporting significant fatigue.  This was a small study; 128 patients were randomized in this study. And what was very interesting, to cut to the chase here, is that the patients who had the virtual mind-body program, compared with the control group, actually were less likely to be hospitalized, the difference there being 6.3% versus 19.1%, respectively. They spent fewer days in the hospital. And remarkably, the overall survival was 24.3 months median for patients in the usual care arm and wasn't reached in those patients who were on the virtual mind-body fitness class platform. So very preliminary data, certainly are going to need more confirmation, but another example of how it appears that many of these non-pharmacological interventions have the potential to improve meaningful endpoints, including hospital stays and, remarkably, even survival. So again, I think that that is very consistent with the theme of this year's meeting, and I found that particularly interesting, too.  I think our time is up, so I want to thank you, Dr. DeMichele, for sharing your insights with us today on the ASCO Daily News Podcast. We really appreciate it. And once again, I want to congratulate you on what was really a truly remarkable ASCO this year.  Dr. Angela DeMichele: Well, thanks so much for having me. It's been a tremendous pleasure to be with you today. Dr. John Sweetenham: And thank you to our listeners for joining us today. You'll find links to the abstracts discussed today in a transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts.   Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Follow ASCO on social media:    @ASCO on Twitter    ASCO on Facebook    ASCO on LinkedIn      Disclosures:   Dr. John Sweetenham:   Consulting or Advisory Role: EMA Wellness  Dr. Angela DeMichele: Consulting or Advisory Role (an immediate family member): Pfizer Research Funding (Inst.): Pfizer, Genentech, Novartis, Inviata/NeoGenomics  

New data from the Phase III KEYNOTE-756 clinical trial show that adding pembrolizumab immunotherapy to chemotherapy before and after surgery for high-risk breast cancer (which was estrogen receptor (ER)-positive and human epidermal growth factor receptor 2 (HER2)-negative) resulted in better outcomes for patients regardless of their age or menopausal status. The findings were presented at the 14th European Breast Cancer Conference by KEYNOTE-756 study co-author Heather McArthur, MD, MPH, Clinical Director of the Breast Cancer Program and Komen Distinguished Chair in Clinical Breast Research at the UT Southwestern Medical Center. She reported the findings at the Milan conference on behalf of her co-author Javier Cortés MD, Head of the International Breast Cancer Centre in Barcelona, Spain. After her talk in Milan, McArthur called into the OncTimesTalk Studio to talk about the findings with Peter Goodwin.

No two breast cancers are the same, and researchers have come a long way in understanding what makes each breast tumor unique. This is the entire premise behind personalized medicine. By looking at a tumor's biomarkers, doctors can tailor their patient's treatment to best fight their unique tumor. On today's show, we'll be discussing biomarkers that doctors look for in breast tumors and how they use them to design a treatment plan. We'll also hear about a new twist on an old biomarker, the estrogen receptor, and how it's being put into clinical practice. Joining us today to share her expertise is Dr. Virginia Kaklamani, M.D. Dr. Kaklamani is a professor of medicine and leader of the Breast Cancer Program at UT Health San Antonio MD Anderson Cancer Center.

In this episode, Dr. Wassim McHayleh, Clinical Program Director for the Breast Cancer Program, AdventHealth Cancer Institute shares insights into his background, AdventHealth's Breast Multidisciplinary (MCD) Model, how the model benefits both patients and providers, advice for other systems adopting this model, and more.

I wanted to replay this important episode with Dr. Alejandra Perez that we released in January 2022. Dr. Perez has been working in the field for more than 20 years and is now director of the Breast Cancer Program at Sylvester-Plantation for the University of Miami Health System. Covering topics such as early detection and prevention, Dr. Perez offers her advice and suggestions regarding breast cancer risk and diagnosis. Learn what Dr. Perez feels is the number one factor for breast cancer risk and what we can do to take control over our health, and the health of our families We delve into the topics of genetics and genomics and what that means for cancer risk and treatment, and what the future holds for cancer treatment. If you want to know what you can do to help offset your risk of cancer, take a listen to this podcast. You will surely walk away with some valuable tips and lessons from this incredible doctor. You can find more information about Dr. Perez at her university website page.

It's Breast Cancer Awareness month, and so I wanted to replay this important episode with Dr. Alejandra Perez that we released in January 2022. Dr. Perez has been working in the field for more than 20 years and is now director of the Breast Cancer Program at Sylvester-Plantation for the University of Miami Health System. Covering topics such as early detection and prevention, Dr. Perez offers her advice and suggestions regarding breast cancer risk and diagnosis. Learn what Dr. Perez feels is the number one factor for breast cancer risk and what we can do to take control over our health, and the health of our families We delve into the topics of genetics and genomics and what that means for cancer risk and treatment, and what the future holds for cancer treatment. If you want to know what you can do to help offset your risk of cancer, take a listen to this podcast. You will surely walk away with some valuable tips and lessons from this incredible doctor. We discussed: The importance of prevention in managing your breast cancer risk Why making lifestyle changes is not a one-off practice How age affects your breast cancer risk Why we need to focus more on prevention of breast cancer The importance of genetic and genomic testing in breast cancer prevention Why personalized treatment is key to better outcomes Taking a holistic approach to lifestyle and breast cancer prevention You can find more information about Dr. Perez at her university website page. If you would prefer, you can read a transcript of this episode

“Inflammatory breast cancer is very aggressive and rare and a lot of times the diagnosis can be missed,” said Margaret Gatti-Mays, MD, MPH, a medical oncologist who specializes in breast cancer and is one of the leaders of the Stefanie Spielman Comprehensive Breast Center's Inflammatory Breast Cancer Program. In this episode, she explains that this rare form of breast cancer “accounts for less than 2 percent of all breast cancers, adding that “one-third of all inflammatory breast cancers will be metastatic [when first diagnosed] while only 5 percent of the more typical types of breast cancer we see are metastatic [when first diagnosed].” One of the reasons inflammatory breast cancer is initially misdiagnosed is that the symptoms “are non-specific,” Gatti-Mays said. “The onset is rapid and includes redness in the breast, or it can be pink, red or purple, and appear over one-third of the breast, as well as a rapid swelling of the breast; it feels full and swollen and the skin of the breast looks like an orange peel, with dimpling.” These symptoms can be misdiagnosed as mastitis or duct ectasia, which are more common and non-cancerous. Mastitis and duct ectasia are initially treated with anti-biotics. “If the symptoms don't improve, I encourage women to come to the Stefanie Spielman Comprehensive Breast Center,” Gatti-Mays said. “We have a diagnostic clinic and patients can self-refer and get imaging. Because of how aggressive inflammatory breast cancer is, there's a sense of urgency to get a biopsy, make a diagnosis and evaluate if it has spread.” The team that comprises the Spielman's Inflammatory Breast Cancer Program are experts in diagnosing and treating this type of cancer. “Breast cancer care has become more complicated and having a team at a comprehensive cancer center is important to identify patients who need to start treatment immediately.” Treatment options include surgery, radiation, chemotherapy, and immunotherapy. Soon after she arrived at the Spielman, Gatti-Mays treated a pregnant woman with inflammatory breast cancer. “That drove me to want to learn more and figure out how to better treat these patients,” she said. “I realized a lot of my Spielman colleagues shared this interest” and this led to the formation of the Inflammatory Breast Cancer Program. “As a physician-scientist, I can say with absolute certainty that the patients I see in my clinic gives me the fuel we need to push forward and do better and better.”

Editor-in-Chief Sue Yom co-hosts with Dr. Jean Wright, Breast Section Editor and Associate Professor of Radiation Oncology and Director of the radiation oncology Breast Cancer Program at Johns Hopkins University. Joining is Dr. Juliane Hörner-Rieber, Managing Senior Physician and Associate Professor at the Department of Radiation Oncology of Heidelberg University Hospital, who was supervising author of an article published this month, "Non-inferiority of Local Control and Comparable Toxicity of Intensity-modulated Radiotherapy With Simultaneous Integrated Boost in Breast Cancer: 5-year Results of the IMRT-MC2 Phase III Trial." Also joining is is Dr. Danielle Rodin, Associate Section Editor, radiation oncologist at Princess Margaret Cancer Centre, and Assistant Professor at the University of Toronto, who first-authored our Oncology Scan this month, "The Internal Mammary Node Irradiation Debate in Node-Positive Breast Cancer: Case Closed."

Continuously increasing treatment costs for patients with metastatic breast cancer can create financial hardship, which is known as financial toxicity. According to The Kaiser Family Foundation, more than 50% of women delay or avoid breast cancer care because of the associated costs. Financial toxicity can lead to difficulty accessing nutritious food and paying bills, as well as keeping up with the cost of basic living expenses. There can be many other hidden costs that add up quickly, including the cost of childcare during medical appointments and gasoline for trips to the doctor. All these stressors negatively impact cancer care by affecting a patient's health, medication adherence, quality of life and mental health. Here today to talk to us about these unexpected costs associated with an MBC Diagnosis are Komen Scholar and Professor of Medicine and Epidemiology and Director of the Breast Cancer Program of the Herbert Irving Comprehensive Cancer Center, Dr. Dawn Hershman, and an incredible woman who has been living with MBC for 18 years, Deborah Croskrey.

When Dr Emilia Dauway decided to relocate to regional Queensland from Texas, she didn't intend for it to be permanent. The 40-bed Queensland hospital she relocated to was a far cry from the 700-bed academic hospital in the US where she was Chief of Breast Surgery and Director of the Breast Cancer Program. Now, based permanently in Harvey Bay, Dr Dauway's committed to raising funds and educating women in regional Queensland on breast cancer treatments, through ‘Restore More' a non-profit she founded in 2018. Dr Emilia Dauway: http://dremiliadauway.com/ RACS Post Op Podcast is proudly brought to you by leading financial services organisation the Bongiorno National Network: https://bongiorno.com.au/about-us/our-bongiorno-national-network/See omnystudio.com/listener for privacy information.

Today's episode is nostalgic I sit down with an old friend and fellow fundraiser, Maddie Hansen. We share a few memories from our time singing together in our College a cappella group and analyze what skills we learned there that we can apply to fundraising. We then learn from Maddie about her grateful patient fundraising and how she has built an authentic voice and path finding meaning in her work. Madeleine Hansen is a Senior Associate Director of Development for Penn Medicine's Abramson Cancer Center. In this role, Maddie works closely with physicians, scientists, and grateful patients to support diverse research and patient care programs for women's cancers. This includes Penn's Breast Cancer Program, 2-PREVENT Translation Center of Excellence (TCE), Ovarian Cancer Research Center (OCRC), and Gynecologic Oncology Clinical Research Unit. Maddie also serves as a point person for fundraising for diversity, health equity, and inclusion (DEI) within the Division of Hematology Oncology. Maddie is a graduate of Trinity College in Hartford Connecticut where she received her BA in American Studies. --- Support this podcast: https://anchor.fm/devdebrief/support

Lynn Henry, M.D., Ph.D., disease lead of the Rogel Cancer Center's Breast Cancer Program, discusses metastatic breast cancer. This is the process of breast cancer that has spread to another part of the body, including bones, liver, lung, and brain. Additional resources: Breast Cancer Metastases: https://www.rogelcancercenter.org/breast-cancer/about-breast-cancer/breast-cancer-metastases IMPACT the Brain: https://www.rogelcancercenter.org/breast-cancer/about-breast-cancer/breast-cancer-metastases/metastatic-breast-cancer-coordinated-treatment Clinical Trials: https://www.rogelcancercenter.org/breast-cancer/about-breast-cancer/breast-cancer-metastases/metastatic-breast-cancer-researchBreast Cancer Awareness Video: https://youtu.be/T2_L9dqW8eEThe transcript for this episode can be found here. Cancer Wise is a part of the Michigan Medicine Podcast Network. You can subscribe to the Cancer Wise podcast on Apple Podcasts, Google Podcasts, Stitcher or wherever you listen to podcasts. See acast.com/privacy for privacy and opt-out information.

Today I had a candid conversation with breast oncologist Dr. Alejandra Perez. Dr. Perez has been working in the field for more than 20 years and is now director of the Breast Cancer Program at Sylvester-Plantation for the University of Miami Health System Covering topics such as early detection and prevention, Dr. Perez offers her advice and suggestions regarding breast cancer risk and diagnosis. Learn what Dr. Perez feels is the number one factor for breast cancer risk and what we can do to take control over our health, and the health of our families We delve into the topics of genetics and genomics and what that means for cancer risk and treatment, and what the future holds for cancer treatment. If you want to know what you can do to help offset your risk of cancer, take a listen to this podcast. You will surely walk away with some valuable tips and lessons from this incredible doctor. We discussed: The importance of prevention in managing your breast cancer risk (2:17) Why making lifestyle changes is not a one-off practice (6:06) How age affects your breast cancer risk (11:55) Why we need to focus more on prevention of breast cancer (15:48) The importance of genetic and genomic testing in breast cancer prevention (17:00) Why personalized treatment is key to better outcomes (22:12) Taking a holistic approach to lifestyle and breast cancer prevention (28:58) You can find more information about Dr. Perez at her university website page. If you would prefer, you can read a transcript of this episode

This podcast interview features Erin Prendergast, RN, CBCN®, an oncology nurse navigator and Senior Breast Clinical Coordinator in the Breast Cancer Program at UT Southwestern Simmons Comprehensive Cancer Center. Ms. Prendergast explains what she does in her role as an oncology nurse navigator and shares strategies that her team has implemented to ensure that patients with breast cancer receive optimal access to treatment and supportive care during the COVID-19 pandemic.

The Gary Null Show Notes – 06.16.21 VIDEOS 1. RIGHT NOW – Robert Malone, Steve Kirsch, and Bret Weinstein! 2:17:34-2:42:00 Dr. Robert Malone is the inventor of mRNA Vaccine technology. Mr. Steve Kirsch is a serial entrepreneur who has been researching adverse reactions to COVID vaccines. Dr. Bret Weinstein is an evolutionary biologist. 2. Former Pfizer VP and Virologist, Dr. Michael Yeadon – Del Bigtree.  Sorry, Liberals. But You Really Shouldn't Love NATO.  Fauci Is Under Fire On All Sides Now Wuhan Lab Controversy Illustrates How Government Funding Throttles Scientific Integrity Why Democracies in G7 & NATO Should Reject U.S. Leadership  Britain is a Parasite on Other Countries EU Parliament Overwhelmingly Votes to End Caged Animal Farming Biden's Climate Irresponsibility Thousands of women and children flee Haiti gang violence, Unicef says Climate change leads to unprecedented Rocky Mountain wildfires U.S. College COVID Vaccine Mandates Don't Consider Immunity or Pregnancy, and May Run Foul of the Law   Brown Seaweed as an Intervention for Diet-Induced Obesity  University of New South Wales (Australia), May 21, 2021 Abstract: The therapeutic potential of grown in Australian tropical waters was tested in a rat model of metabolic syndrome. Forty-eight male Wistar rats were divided into four groups of 12 rats and each group was fed a different diet for 16 weeks: corn starch diet (C); high-carbohydrate, high-fat diet (H) containing fructose, sucrose, saturated andfats; and C or H diets with 5%mixed into the food from weeks 9 to 16 (CS and HS). Obesity, hypertension, dyslipidaemia, impaired glucose tolerance, fatty liver and left ventricular fibrosis developed in H rats. In HS rats,decreased body weight (H, 547± 14; HS, 490 ± 16 g), fat mass (H, 248 ± 27; HS, 193 ± 19 g), abdominal fat deposition and liver fat vacuole size but did not reverse cardiovascular and liver effects. H rats showed marked changes in gut microbiota compared to C rats, whilesupplementation increased gut microbiota belonging to the family. This selective increase in gut microbiota likely complements the prebiotic actions of the alginates. Thus,may be a useful dietary additive to decrease abdominal and liver fat deposition. New health benefits of red seaweeds unveiled Institute for Genomic Biology at University of Illinois, June 15, 2021 Red seaweeds have been prevalent in the diets of Asian communities for thousands of years. In a new study, published in Marine Drugs, researchers have shown how these algae confer health benefits. “In the past, people have wondered why the number of colon cancer patients in Japan is the lowest in the world,” said Yong-Su Jin (CABBI/BSD/MME), a professor of food microbiology. “Many assumed that it was due to some aspect of the Japanese diet or lifestyle. We wanted to ask whether their seaweed diet was connected to the lower frequency of colon cancer.” Although several studies have shown that Asians who eat seaweed regularly have lower risk of colon, colorectal, and breast cancer, it was unclear which component was responsible for the anti-cancer effects. In the study, the researchers broke down the structure of different types of red seaweed using enzymes and tested the sugars that were produced to see which one of them caused health benefits. Among the six different sugars produced, agarotriose and 3,6-anhydro-L-galactose, or AHG, showed the most promise. “After we produced these sugars, we tested their prebiotic activity using the bacteria Bifidobacterium longum ssp. infantis,” said Eun Ju Yun, a former postdoctoral researcher at the Carl R. Woese Institute for Genomic Biology. B. infantis is a probiotic bacterium; it colonizes the gut of infants and provides health benefits. Among the seaweed-derived sugars, the bacteria could only consume agarotriose, indicating that it works as a prebiotic i.e., it improves the growth of probiotic bacteria. “We also tested another strain, B. kashiwanohense, and found that it also consumed agarotriose,” Jin said. “These results show us that when we eat red seaweed, it gets broken down in the gut and releases these sugars which serve as food for the probiotic bacteria. It could help explain why Japanese populations are healthier compared to others.” The researchers also tested the sugars to see if they had any anti-cancer activity. “We found that AHG specifically inhibits the growth of human colon cancer cells and does not affect the growth of normal cells,” Yun said. The anti-cancer activity of AHG is due to its ability to trigger apoptosis or cell death. “There is a lot of information on how red seaweeds are degraded by microorganisms in the ocean and in the human body,” said Kyoung Heon Kim, a professor of biotechnology and the co-advisor on the paper. “Our work explains why red seaweeds are beneficial by providing the molecular mechanism. We will continue studying their function in animal models and hopefully we will be able to use them as a therapeutic agent in the future.”       Hiking Workouts Aren't Just Good For Your Body – They're Good For Your Mind Too University of Hertfordshire (UK), June 11, 2021 Before COVID-19, the popularity of hiking was on a downward slope in both adultsand children. But its popularity has spiked during the pandemic, seeing many more people taking to trails than usual. Hiking is not only a great way to get outside in nature, it also has plenty of physical and mental health benefits for those who take part. Hiking differs in many way from taking a regular stroll around your neighbourhood. Not only is the terrain on many hiking routes uneven or rocky, there's also typically some change in elevation, such as going up or down hills. People also tend to wear different footwear – such as hiking boots – which can be heavier than what they're used to wearing. These differences in terrain and footwear mean hiking has a higher energy expenditure (more calories burned) than walking on flat ground does. This is due to the fact that we need to use more muscles to stabilise ourselves when walking on uneven terrain. While brisk walking at a speed of around 5km/h uses up to four times as much energy as sitting down and resting, hiking through fields and hills uses over five times. This means you can achieve the recommended 150 minutes of moderate to vigorous physical activity without even needing to go for a run or head to the gym. The benefits of getting enough exercise are clear. Not only will it improve your physical health, sleep and stress management, exercise also reduces your chances of developing certain chronic diseases, such as dementia, type 2 diabetes, cardiovascular disease, depression and certain cancers. In older adults, some research suggests hiking may be able to improve hypertension. Hiking is also beneficial even for those with pre-existing health conditions. Research shows hiking leads to weight loss and improves cardiovascular health in pre-diabetic adults, likely reducing their risk of getting type 2 diabetes. It's also been shown to improve other aspects of health, including muscle strength, balance and flexibility in older adults with obesity. Even those who suffer with balance issues or joint problems can hike – as trekking poles may be able to reduce the load on the legs. The popular form of hiking called Nordic walking – where participants use trekking poles to help them along – is also shown to engage the upper body and increase the intensity of the walking. Research shows this form of hiking increases cardiovascular health, weight loss, and muscle strength in people without any pre-existing health conditions, as well as those with chronic conditions, such as Parkinson's disease. A further health benefit of hiking is that it's classed as “green exercise”. This refers to the added health benefit that doing physical activity in nature has on us. Research shows that not only can green exercise decrease blood pressure, it also benefits mental wellbeing by improving mood and reducing depression to a greater extent than exercising indoors c   This is why some research suggests healthcare professionals should recommend hiking to patients as a low-cost way of improving health where possible. In England, there's even an initiative being piloted by the National Health Service to assess the health impacts of green prescribing – where patients are being prescribed outdoor activities – such as hiking or gardening – to improve their mental and physical health. Get outdoors Even if you've never hiked before, it's easy to get started. There are plenty of apps you can download on your phone to help you navigate and find routes. These usually work with your GPS and are even easy to follow for those who have a poor sense of direction. You can also try the 1,000 mile challenge if you want to start hiking. This encourages people to walk 1,000 miles in a year. This has helped many people – including my own parents – to be more active, especially during COVID-19.   If you have a young family (or simply want to make hiking more interesting), a more interactive way of getting out into nature is geocaching. This is where you following a GPS route to a location where someone has hidden a box or trinket of some kind. You can also record what you've found using an app. Geocaching is a worldwide phenomenon, so can be done almost anywhere in the world. Hiking is a great way to get active and improve mental and physical wellbeing. And with many of us still likely to be vacationing locally this year, it can be a great way to get away from home and explore new sights. Trial finds improvement in metabolic syndrome components, fatty liver, insulin resistance in garlic-intake participants   Baqiyatallah University of Medical Sciences (Iran) June 10, 2921 A randomized trial reported  in Phytotherapy Research found an association between intake of garlic and improvement in several components of metabolic syndrome—a cluster of factors that increase the risk of developing diabetes and/or cardiovascular disease. The trial also revealed a reduction in insulin resistance and fatty liver—conditions that are common among metabolic syndrome patients. Metabolic syndrome is defined as the presence of three of the following five disorders: abdominal obesity, high blood pressure, high triglycerides, elevated blood sugar and low levels of high-density lipoprotein (HDL) cholesterol.  The trial included 90 men and women with metabolic syndrome who received tablets containing 1,600 milligrams garlic powder (which provided 6 milligrams per day of the garlic compound allicin) or a placebo daily for three months. Blood pressure, fasting glucose, triglycerides, HDL cholesterol, gamma-glutamyltransferase (GGT, an enzyme that is elevated in liver disease and also is associated with cardiovascular disease and diabetes risk), appetite (including hunger, fullness, desire to eat and ability to eat), height, weight, waist circumference, food intake and physical activity were evaluated upon enrollment and at six and twelve weeks.[1, 2] Serum insulin levels were measured at the beginning and end of the study.  At the trial's conclusion, participants who received garlic had levels of beneficial HDL cholesterol that were significantly higher than the beginning of the study as well as higher in comparison with the placebo group, whose levels declined. Systolic and diastolic blood pressure, triglyceride levels, waist circumference, insulin and insulin resistance, GGT and fatty liver index (calculated by a standard formula using other measured parameters) were all reduced in the garlic-intake group compared to the placebo. All parameters related to appetite were also improved compared to placebo. “To the best of our knowledge, there is no clinical trial evaluating the effects of garlic consumption on insulin resistance, appetite, and fatty liver index (FLI) as an accurate predictor of hepatic steatosis among subjects with metabolic syndrome,” authors Abbas Ali Sangouni and colleagues announced.  “Our study demonstrated a significant decrease in the mean intake of calories after 3-month garlic powder [intake],” they also noted. “There is no clinical trial evaluating the effect of garlic on appetite.” The current findings reveal a benefit for garlic intake against metabolic syndrome components and related factors. Considering garlic's low cost and wide availability, as well as its prebiotic action and cardiovascular benefits, adding garlic to a healthy diet and exercise regimen could be an easy and effective measure to help protect against metabolic syndrome and its associated disease risks. Evaluation of the effect of curcumin on pneumonia: A systematic review of preclinical studies Isfahan University of Medical Sciences (Iran), May 3, 2021 Pneumonia is a major cause of morbidity and mortality worldwide and causes a significant burden on the healthcare systems. Curcumin is a natural phytochemical with anti-inflammatory and anti-neoplastic characteristics. The aim of this study was to conduct a systematic review of published studies on the effect of curcumin on preclinical models of pneumonia. A comprehensive search was conducted in PubMed/Medline, Scopus, Web of Science and Google Scholar from inception up to March 1, 2020 to recognize experimental or clinical trials assessing the effects of curcumin on pneumonia. We identified 17 primary citations that evaluated the effects of curcumin on pneumonia. Ten (58.8%) studies evaluated the effect of curcumin on mouse models of pneumonia, generated by intranasal inoculation of viruses or bacteria. Seven (41.2%) studies evaluated the inhibitory effects of curcumin on the pneumonia-inducing bacteria. Our results demonstrated that curcumin ameliorated the pneumonia-induced lung injury, mainly through a reduction of the activity and infiltration of neutrophils and the inhibition of inflammatory response in mouse models. Curcumin ameliorates the severity of pneumonia through a reduction in neutrophil infiltration and by amelioration of the exaggerated immune response in preclinical pneumonia models. Healthy levels of vitamin D may boost breast cancer outcomes   Roswell Park Comprehensive Cancer Center, June 10, 2021 Breast cancer patients who have adequate levels of vitamin D—the “sunshine vitamin”—at the time of their diagnosis have better long-term outcomes, a new study finds. Combined with the results of prior research, the new findings suggest “an ongoing benefit for patients who maintain sufficient levels [of vitamin D] through and beyond breast cancer treatment,” said study lead author Song Yao. He's a professor of oncology in the department of cancer prevention and control at Roswell Park Comprehensive Cancer Center in Buffalo, N.Y. The study also found that Black women had the lowest vitamin D levels, which might help explain their generally poorer outcomes after a breast cancer diagnosis, Yao's group said.  The findings were presented at the recent virtual annual meeting of the American Society of Clinical Oncology. One oncologist unconnected to the research said the findings could offer women a simple new way to fight breast cancer. Vitamin D “can be found in some foods and is made when sunlight strikes human skin,” explained Dr. Alice Police, a breast cancer researcher at Northwell Health's Katz Institute for Women's Health, in Westchester, N.Y.  “This may be an opportunity for an important intervention in breast cancer outcomes for all women, but particularly in the Black population,” she said. The study involved nearly 4,000 patients who had their vitamin D levels checked and were followed for a median of almost 10 years. The patients were divided into three levels: vitamin D deficient (less than 20 nanograms per milliliter in blood tests); insufficient (20 to 29 ng/ml); or sufficient (30 or more ng/ml). The study wasn't designed to prove cause and effect. However, it found that—compared to women deficient in the nutrient—women with sufficient levels of vitamin D had 27% lower odds of dying of any cause during the 10 years of follow-up, and 22% lower odds for death from breast cancer specifically. The team also found that the association between vitamin D levels and breast cancer outcomes was similar regardless of the tumor's estrogen receptor (ER) status. The association appeared somewhat stronger among lower-weight patients and those diagnosed with more advanced breast cancers. “Our findings from this large, observational cohort of breast cancer survivors with long follow-up provide the strongest evidence to date for maintaining sufficient vitamin D levels in breast cancer patients, particularly among Black women and patients with more advanced-stage disease,” Yao said in a Roswell Park news release. Dr. Paul Baron is chief of breast surgery and director of the Breast Cancer Program at Lenox Hill Hospital in New York City. He wasn't involved in the new research, but called it “an important study, as it shows the significance of sufficient vitamin D levels towards improving long-term survival for breast cancer patients.” For her part, Police said the findings highlight the importance for women of adequate vitamin D. The difference in outcomes between Black and white breast cancer patients“narrowed with higher vitamin D levels at the time of diagnosis,” she noted. “This could be an important step in efforts to level the playing field for this disease: Let the sunshine in!” Because these findings were presented at a medical meeting, they should be considered preliminary until published in a peer-reviewed journal   Researchers Say This One Tiny Life Adjustment Can Reduce Depression Risk Harvard, MIT, and the University of Colorado, June 11, 2021 Research continues to pour in showing an increase in mental health problems from the COVID-19 pandemic (and government policies resulting from it). One medical study found that depression symptoms were three times higher than before the pandemic. A separate survey published by the Washington Post found one third of Americans now show symptoms of anxiety, depression, or both. Fortunately, new research shows there's an easy step we can all take to help prevent depression. Wake up an hour earlier. That's right, just one hour of sleep reduces a person's risk of major depression by a whopping 23 percent. The study, conducted by researchers from Harvard, MIT, and the University of Colorado Boulder, studied 840,000 individuals, and its findings are some of the strongest evidence that a person's sleep schedule influences depression risk. “We have known for some time that there is a relationship between sleep timing and mood, but a question we often hear from clinicians is: How much earlier do we need to shift people to see a benefit?” said Celine Vetter, assistant professor of integrative physiology at CU Boulder. “We found that even one-hour earlier sleep timing is associated with significantly lower risk of depression.” The discovery is especially important as the increase in remote-working schedules has led many to sleep in later, which could have important implications on their mental health. It's also important because it's a cheap and readily accessible option for treatment.   Americans face many barriers to mental healthcare. First and foremost, it is expensive. An hour-long therapy session costs between $65 – $250 per session without insurance. And thanks to bad government policies meddling in the insurance market, many therapists do not accept insurance at all. Furthermore, a more severe mental health diagnosis can be even more costly. Patients with severe depression who receive medical care spend nearly $11,000 a year on average, according to a report by CNBC. The expense, coupled with a shortage in providers and medical deserts throughout large parts of the US, lead many to forgo treatment altogether. According to the National Council on Behavioral Health, 56 percent of patients want to access a mental health provider but face barriers. Those barriers were of course increased during COVID as facilities were shut down and non-COVID patients were denied care. The numbers have already begun trickling in showing lockdowns led to greater drug use, youth suicides, and increases in depression and anxiety. When one is struggling with depression, it is especially hard to overcome external barriers to care. Making a phone call can feel like climbing a mountain, and if you are rejected it can be all but impossible to summon the energy to keep looking and asking for help. But this new research shows individuals have the ability to take charge of their own circumstances by making small, daily changes that can help them fight their disease. Alice Walker, the author of the Pulitzer Prize-winning novel The Color Purple,famously said, “People give up their power by thinking they don't have any.” People often forget that they have power within themselves to confront their problems and in turn, seek protection from other external, earthly things—namely the government or their leaders. But this cycle produces dependency, not empowerment, which is not the life we as individuals were intended for.   In The Law by Frederic Bastiat he says, “Life, faculties, production—in other words, individuality, liberty, property—this is man. And in spite of the cunning of artful political leaders, these three gifts from God precede all human legislation, and are superior to it.” When dealing with mental health issues—as full disclosure, I do—an important guiding principle is self-responsibility. Yes, you may face additional burdens that others do not in your daily life. But it is still your responsibility to confront them, work through them, and move forward. Ultimately, your mental health is your responsibility and no one can do that work for you. This same principle can be applied more broadly to those without mental health issues too. Yes, there may be circumstances that are unjust or unpleasant, yes we may have barriers placed on our paths that are outside of our control (especially by the government). But we can control how we face (and hopefully overcome) those circumstances. We can't turn back the clocks on all that has happened over the past year and a half, but if we turn the alarm clock one hour back we just might be a step closer to regaining control of our health.

There are many challenges in managing breast cancer. Top among them is the fact that initial breast conserving surgeries often miss vestiges of a patient's tumor. In fact, up to 40 percent of women require another procedure following lumpectomy. Not only can additional surgery, of course, increase a patient's anxiety and be physically taxing, but it can cause delays in critical subsequent treatments like chemotherapy and radiation. So, why is that rate so high? Why is properly identifying the tumor so difficult? Most importantly: What can be done to reduce repeat surgeries? Dr. Mehra Golshan is working to uncover answers to these questions. A BCRF investigator since 2014, Dr. Golshan is the deputy chief medical officer for surgical services and director of the Breast Cancer Program for the Yale Cancer Center, Smilow Cancer Hospital, and Smilow Cancer Hospital Care Centers.

Episode 7 features Dr. Thais Fortes, Medical Director of Sparrow's Breast Cancer Program, talking about the diagnosis and treatments for breast cancer.

On Episode 50 - New Beginning, New Accomplishments we speak to the Chamber's newest team member, Ana Saavedra, Membership and Sponsorship Development Manager. We also speak to Dr. Paul Williams, breast surgical oncologist with AdventHealth Heart of Florida and his colleague Dr. Swati Pathak, medical oncologist with Florida Cancer Specialists to discuss the Breast Cancer Program's recent accreditation with the National Accreditation Program for Breast Centers (NAPBC) and what that means for our community. This podcast is recorded at Dolphin Image Studios and made possible through sponsorships from Citizens Bank & Trust, Mahalak Auto Group/Winter Haven Dodge Chrysler Jeep Ram and AdventHealth.

Drs. Aggarwal and West host Dr. Julie Gralow, Director of the Breast Cancer Program and incoming CMO of ASCO to discuss balancing efforts in advocacy, global oncology, and addressing disparities in access with academic pursuits and clinical research.

In today’s episode, we discuss the science presented during the 2020 ASCO Quality Care Symposium with the chair of the meeting, Dr. Dawn Hershman, leader of the Breast Cancer Program at the Herbert Irving Comprehensive Cancer Center at Columbia University. Dr. Hershman shares insights on key abstracts that addressed COVID-19, technology innovations, health care disparities, financial toxicity, and more. Transcript: ASCO Daily News: Welcome to the ASCO Daily News Podcast. I'm Geraldine Carroll, a reporter for the ASCO Daily News. Joining me today is Dr. Dawn Hershman, Director of the Breast Cancer Program at Columbia University's Herbert Irving Comprehensive Cancer Center. Dr. Hershman we'll share highlights from the 2020 ASCO Quality Care Symposium. Serving as Chair of the Symposium, Dr. Hershman helped shape the vision of the meeting, which explored technology innovations, health care disparities, financial toxicity, COVID-19, and more. Dr. Hershman is a co-author of a variety of the abstracts featured at the symposium, including several studies that we'll discuss today on clinical trial accrual and the impact of the pandemic on cancer care delivery. Full disclosures relating to all ASCO Daily News Podcasts are available on our episode pages. Dr. Hershman, it's great to have you on the podcast today. Dr. Dawn Hershman: Thank you, it's great to be here. ASCO Daily News: Dr. Hershman, the symposium featured a range of studies on COVID-19 and its impact on cancer care delivery. Some of these addressed telehealth. Many practices and institutions quickly adopted telehealth when the pandemic struck. But despite its benefits, telehealth has also exposed potential disparities in care. Dr. Dawn Hershman: Absolutely. It's hard not to have a conference these days that doesn't have at least some components focused on COVID-19 because it's had such a major impact on all of our lives on every level. We had already decided to have several sessions focused on how we deliver care, including sessions focused on telehealth. The first one was an abstract that was presented by Dr. Cardinale Smith looking at disparities in the use of telehealth during the COVID-19 pandemic (Abstract 87). And while we have learned so much about telehealth, in general, and how institutions had rapidly transformed the care that they give to providing telehealth services, we saw many abstracts focusing on that rapid adoption. What she did, and her colleagues at Mount Sinai, was look at the differences in the adoption of telehealth overall and by ethnic and racial minority groups. And her data really pointed to the fact that the proportion of minorities that were participating in telehealth activities was much less than the non-minority counterparts proportionally. I think that this brings up that with every silver lining, like telehealth was for so many people, it has the potential to introduce new health care disparities. And I think we recognize that not all patients have access to the internet, not all patients have access to smartphones. Some electronic medical record systems require complex interaction with the electronic medical record for these video consults. And issues related to language and health care literacy can all impact a patient's likelihood of having consultations like this, or having access to consultations like this. One of the things they were able to do was to get a grant from the government to provide smartphones to patients, which did help, but it doesn't solve all of the problems. And I think when we think about this in retrospect, we need--and think about how to provide telehealth services, we need to account for all of these things and learn from the lessons that this has been pushed upon us, so that we can figure out what things work and what things don't work remotely. ASCO Daily News: Well, COVID-19 caused huge delays in care. At the height of the pandemic, surgeries were postponed, chemotherapy and radiation therapy were delayed. Dr. Tejus Satish's study, entitled "The COVID-19 Pandemic's Impact on Breast Cancer Care Delivery at an Academic Center in New York City," addresses this issue (Abstract 88). And I believe you are a co-author on this study. Can you tell us more about this? Dr. Dawn Hershman: Absolutely. The second abstract that I think brought up a lot of important issues and data that was really lacking was looking at the impact of the COVID-19 on health care delivery amongst non-infected patients, as similar to the abstract on telehealth, was looking at routine care. This abstract looked at issues related to delays in care as a result of services being shut down or transformed during the height of the pandemic, looking at breast cancer specifically, where there was a large number of patients that had surgeries postponed, had treatments delayed, weren't coming in for infusions. Patients had radiation therapy delayed, changes in the order of their care, and that they had treatment prior to surgery. So there were a substantial number of delays. I think it was reported, over 35% of patients had some type of delay or change in their care during this time. It really wasn't that different for patients that had newly diagnosed cancer versus ongoing treatment. One of the things they found, however, was that delays were longer in patients with Medicaid insurance as opposed to commercial insurance (Abstract 88). And there appeared to be longer delays in some minority populations, although it's not clear that persisted after accounting for confounding with insurance. And there were delays related to age and some other tumor-related factors. It's not clear that any of these delays actually altered patients' outcomes, but much of the research to date has focused on patients with infections. So this was very interesting, in that it focused on just the routine care of patients that we give. ASCO Daily News: Let's focus on financial toxicity. The costs of cancer care continue to rise. And we know that financial toxicity can potentially compromise patients' overall health and well-being. So what are the abstracts that stood out for you on cancer-related financial hardship? Dr. Dawn Hershman: Yes. It's an area of huge importance to the cancer community because, as we've seen over time, increased recognition of the cost of cancer care has a huge impact on patients. And this has been increasingly recognized over time. The financial toxicity was highlighted in both research sections, where two really important research findings were presented. One was looking at the cumulative incidence of financial hardship in metastatic colorectal cancer patients (Abstract 137). And this was a study that was presented by Veena Shankaran. It was a prospective study done through the NCI NCTN and Core System SWOG in particular. And they evaluated patients with colorectal cancer and linked their records to their credit reports. So they were able to show, over the first 12 months of a patient's treatment, that over 70% of patients experienced some form of financial hardship, which I think is eye-opening. A lot of the studies that have been done to date have been cross-sectional studies, observational studies. This is really the first prospective study to look at what happens to patients over time, looking at not only patients' self-report of financial hardship, but also issues related to their credit. I think that was really eye-opening, I think, for a lot of people that saw this as being sort of a rare event. And it also was eye-opening because, I think, a lot of people thought that it couldn't be done. It's hard to do prospective studies and ask people about their finances. It's not something that everybody always feels comfortable about, but patients were eager to participate. And she showed that once patients were approached regularly about this trial, the accrual to this trial really picked up rapidly. And so this answers a really important question. And along with it, Dr. Robin Yabroff from the American Cancer Society then presented her study looking at the association of cancer history and medical financial hardship with mortality, showing that patients that have a history of cancer or cancer survivors that experience financial hardship have a much, much higher mortality rate than those that don't, more than a two-fold increase (Abstract 86). And so this has major implications in terms of thinking about the importance of this issue as it affects the care that patients get that could compromise their overall health and well-being. So these two abstracts really fell in nicely with a session that was designed ahead of time looking at approaches to reducing cancer-related financial hardship. And in this session, several investigators presented work that they're doing prospectively now to understand ways to mitigate financial hardship or understand interventions that might bring it to patients' and providers' attention earlier in their course. So Lauren Hamel looked at an app she called the Disco App as a pilot study of an electronic patient intervention that really focuses on trying to reduce the financial burden of cancer by improving cost communications (Abstract 1). Anne Kirchhoff presented interventions that are focused on mitigating financial hardship in the adolescent and young adult patient population, looking at various apps and other web-based programs to try to mitigate that in that patient population. And then that session also, Dr. Shankaran presented her ongoing study looking at financial navigation, which is being investigated. So it's one thing to know that it exists. It exists really in a profound way. It has huge impact in terms of worsening mortality. But encouragingly, there's a lot of research that's being done looking at interventions to mitigate it. ASCO Daily News: That's great. Let's focus on clinical trials for a moment. The symposium addressed barriers to patient accrual in clinical trials in a few different ways. Can you tell us about these studies? Dr. Dawn Hershman: Yes. So one was a presentation by Dr. Joseph Unger that did a meta-analysis looking at issues related to clinical trial enrollment (Abstract 92). And basically, the title of his abstract was, "When Offered to Participate, a Systematic Review and Meta-Analysis of Patient Agreement to Participate in Clinical Trials." And what they found through looking at the entire literature was that when offered a trial and eligible for a trial, over 50% of patients agreed to participate in that study. A major barrier to participation is not being offered a trial. And despite the well-known disparity in enrollment to clinical trials, when you look at patients that have been offered, there's actually no disparity in enrollment, suggesting that there are either not enough trials being offered to patients or open in the centers where patients are treated, or there are limitations to enrollment, such as not having all patients meet inclusion criteria. And that we may be able to improve the diversity of patients on clinical trials by reducing some of those upfront systematic barriers and institutional barriers to participation. And it falls, maybe, less on the patient level factors as was commonly believed. So I think that analysis got a lot of attention. There was also a study that was presented looking at AYA patient populations and clinical trial enrollment, and in that particular patient population, finding larger disparities in the AYA population, which is a patient population that is often underrepresented in clinical trials, where we should really focus a lot of our energy and effort (Abstract 91). Interestingly, there were two studies focused on the financial impact of clinical trial accrual. And one of them was presented by Dr. Kerin Adelson from Yale Medical Center, where she looked at the association between clinical trial participation, pharmaceutical costs, and saving performance in the oncology care model (Abstract 2). And basically, what they found was that in looking at the overall cost of care, a huge amount of the cost is correlated to the drug costs. And that when patients are enrolled in clinical trials and their drugs are provided, the overall cost of their care goes down. So the thought was that you could enhance institutional finances by putting more patients on clinical trials and reduce, potentially, the out-of-pocket costs to patients that don't have to pay the extra cost associated with those drugs. ASCO Daily News: Dr. Hershman, is there anything you'd like to add before we wrap up the podcast today? Dr. Dawn Hershman: I think that there were some really interesting talks looking at novel ways to enhance communication. There was a session that focused on telehealth. And while we talk about telehealth a lot in terms of providing follow-up appointments to patients, some of the talks really focused on using this technology to help disseminate information to providers and to providers that may be in rural locations. Jens Rueter from the Jacks Lab talked about a very innovative program that they've set up throughout Maine, and there are a lot of rural practices in Maine that looked at disseminating personalized medicine through virtual molecular tumor boards. And they showed that they could engage all of these smaller practices in centralized molecular tumor boards, where there may not be a critical mass at any one location. But using web access or Zoom technology to have experts weigh in on cases, that this improved genomic confidence amongst providers. And it also improved decision making that was based on genomic alterations that may prove to improve outcomes down the line. So very, very interesting presentation, as well as presentations focusing on using telehealth to expand the reach of palliative care because, as we know, there are few and far between palliative care providers. And so sometimes we can use this advanced technology to get specialists out to communities that may not have such expertise, following on that same theme. So I think those were two areas that were highlighted in terms of innovative new ways to practice medicine. ASCO Daily News: Well, thank you, Dr. Hershman for sharing these great highlights from the ASCO Quality Care Symposium. Dr. Dawn Hershman: You're very welcome. Hopefully, we'll all be able to be in person next year for another spectacular conference. ASCO Daily News: Absolutely. I hope so. And thank you to our listeners for joining us on the ASCO Daily News Podcast. If you're enjoying what you're hearing on the podcast, please take a moment to rate, review, and subscribe. Disclosures:  Dr. Hershman has served in an advisory role for AIM Specialty Health within the past two years.  Disclaimer:  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

In this episode, we’re bringing you my conversation Dr. Anant Madabhusi, Professor of biomedical engineering at Case Western Reserve University and Director for the center for computational imaging and personalized diagnosticsIn this episode we cover:Anant’s distinguished background - patents, peer-reviewed articles and the multidisciplinary lab he has created The unique medical research ecosystem in Cleveland, OHThe collaboration across departments, working together towards a common goal and making a real impact on the futureResources & People MentionedDr. Alberto Montero, Director of Breast Cancer Program at UHDr. Joseph Willis, Vice Chairman of Pathology at UHDr. Lee Ponsky, Chair of Urology and Director of Urologic Oncology Center at UHDr. Vikas Gulani, Chair of Radiology at Michigan institute of Imaging Technology and Translation Tata Memorial Cancer Center in MumbaiBaiju Shah, Senior Fellow for Innovation at the Cleveland FoundationCleveland Clinic Cole Eye InstituteCleveland Clinic Glickman Urological & Kidney Institute Connect with Anant Connect with Anant on LinkedInFollow Anant on Twitter: @anantm Center for Computational Imaging and Personalized Diagnostics WebsiteConnect with Tim Follow Refinery Ventures on Twitter: @RefineryVCConnect with Tim on LinkedInFollow Refinery Ventures on LinkedInSubscribe to Fast Frontiers

Dr. Shaheenah Dawood is the Head of Medical Oncology and the Head of the Breast Cancer Program at Dubai Hospital in the United Arab Emirates. Dr. Dawood completed her M.B.B.Ch at Dubai Medical College in 1998 and a Master of Public Health degree at the Harvard School of Public Health, Boston, USA in 2008. Her postgraduate medical training programs include a Fellowship at McGill University in Canada in 2006, and the Susan Komen Breast Cancer Fellowship at the University of Texas M.D. Anderson Cancer Center in 2007. Dr. Dawood is a member of various professional organizations, including the American Society of Clinical Oncology (ASCO), the American Association of Cancer Research (AACR), the Canadian Association of Medical Oncologists, the Emirates Medical Association, and the Inflammatory Breast Cancer Research Group. She is also the co-director of the Middle East Research Network. If you enjoyed this podcast, make sure to subscribe for more weekly education content from ASCO University. We truly value your feedback and suggestions, so please take a minute to leave a review. If you are an oncology professional and interested in contributing to the ASCO University Weekly Podcast, email ascou@asco.org for more information. TRANSCRIPT [MUSIC PLAYING] Welcome to the self-evaluation episode of the ASCO University Weekly Podcast. My name is Shaheena Dawood, and I am a consulting medical oncologist and lead of the Oncology Research program at the Comprehensive Cancer Center at the Mediclinic City Hospital in Dubai, United Arab Emirates. Today, we feature a self-evaluation question looking at the predictive and prognostic role of pathological complete response attained in the treatment of breast cancer. Let us begin by reading the question stem. Here, we have a 55-year-old woman who presents with a 4 centimeter right breast mass and palpable right axillary lymph nodes. A needle biopsy of the breast mass and a lymph node are both positive for infiltrating ductal carcinoma negative for hormone receptors and negative for HER2/neu expression. The patient is interested in breast-conserving therapy, and she is referred to you for consideration of neoadjuvant chemotherapy. Which of the following do you tell her? Your choices are, A-- patients having a complete response to neoadjuvant chemotherapy have lower local and regional recurrence rates, B-- mastectomy will be required regardless of clinical response to chemotherapy, C-- chemotherapy will be administered before and after surgery, or D-- randomized trials have shown that radiotherapy is not necessary following surgery and chemotherapy if she has a complete response. At this point, please feel free to pause the recording before we discuss the correct answer. [MUSIC PLAYING] The correct answer to this question is A. Pathological complete response in the breast and lymph nodes is associated with lower local and regional recurrence rates. A combined analysis of the NSABP B18 and B27, two large trials that evaluated the role of neoadjuvant chemotherapy, revealed that the rate of local regional recurrence decreased amongst patients who initially presented with positive lymph nodes prior to neoadjuvant chemotherapy, and who become pathologically node negative after neoadjuvant chemotherapy, especially if they also achieved a pathological complete response in the breast. Briefly, the other choices presented in this question do not represent the most appropriate answer for the following reasons. The decision regarding type of surgery in the form of mastectomy versus breast-conserving surgery is dependent on multiple factors. One of the early established benefits of neoadjuvant therapy is that it increases the probability of breast-conserving surgery, making more women candidates for lumpectomy and breast radiotherapy, who otherwise would have been treated with mastectomy. Studies have shown that chemotherapy before surgery in the neoadjuvant setting versus chemotherapy after surgery in the adjuvant setting is associated with similar outcomes. And finally, attaining a pathological complete response currently does not preclude the need for adjuvant radiation therapy, the decision of which would be made on clinical stage of disease at presentation. The NSABP51 RTOG phase III trial is ongoing to evaluate the role of regional radiotherapy in women presenting with clinical N1 axillary node disease before neoadjuvant chemotherapy, and who become pathologically node negative at the time of surgery. Thank you for listening to this week's episode of the ASCO University Weekly Podcast. For more information on the treatment of breast cancer, including opportunities for self-evaluation and board review, please visit the comprehensive e-learning center at university.asco.org. [MUSIC PLAYING] The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care, and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Emily was diagnosed with stage 3 inflammatory breast cancer in April 2016. She had a swollen right breast and inverted nipple, off and on redness, and soreness varying in intensity.Unlike traditional breast cancers, inflammatory breast cancer does not present with a lump but rather with the symptoms Emily was experiencing.She was living in Miami at the time of her diagnosis but came to Dana-Farber for treatment with Dr. Beth Overmoyer. Emily grew up in Massachusetts and her dad was a pharmacist at Dana-Farber.Emily underwent chemotherapy for 5 months, a mastectomy, and radiation culminating just before Christmas 2016.Her family was essential during treatment. She lived with her brother in Central Mass throughout her treatment and her family was by her side every step of the way.Emily's friends from around the country and the world flew in to spend time with her, sent "insanely special" care packages along with daily messages and calls.Traveling has always been an important part of Emily's life, she lived abroad for the first time when she was 16 and constantly flew for work and to visit friends.Dr. Overmoyer approved a quick, 3-day trip in between her two chemotherapy regimens to the Bahamas with her close friends. The trip filled her with more energy to carry her through the end of her treatment, which was rough.Emily works as a literacy consultant. She travels around the world to support schools implementing reading and writing instruction (K-8).

Jennifer Millar is a preschool teacher from northern New Jersey. Last fall, she was experiencing swelling and irritation in her breast. She was treated for an infection. When it became clear that the antibiotics were not resolving her discomfort, Jenny was sent for a mammogram and ultrasound. She was diagnosed with a rare form of breast cancer called inflammatory breast cancer (IBC) in November 2016. Unlike traditional breast cancer, inflammatory breast cancer is not characterized by a lump but by inflammation and tenderness in the breast. Inflammatory breast cancer is often more aggressive than other breast cancers and can be more difficult to treat. Jennifer moved her treatment to Dana-Farber with Dr. Beth Overmoyer who heads Dana-Farber's Inflammatory Breast Cancer program. Jennifer has undergone surgery, chemotherapy and is enrolled in a clinical trial. Jennifer has two small children, ages 3 and 6 – between work, breast cancer and being a mom, she doesn't have much free time. When she does get a chance to get away she likes to travel with her kids.Dr. Overmoyer launched the Inflammatory Breast Cancer (IBC) Program at Dana-Farber in 2009, where she continues to serve as the principal investigator of many IBC research programs and clinical trials.

FOR OVER 30 YEARS, THE ADELPHI NY STATE BREAST CANCER HOTLINE AND SUPPORT PROGRAM HAS OFFERED EMOTIONAL SUPPORT AND INFORMATION TO PEOPLE CONCERNED ABOUT BREAST CANCER. ALSO PROMOTING "CREATIVE CUPS" AUCTION ON MARCH 16TH TO BENEFIT THE BREAST CANCER HOTLINE AND SUPPORT PROGRAM.

Dr. Jennifer McAlister discusses common breast disorders in primary care and decision points about appropriate workup for those disorders. We also discuss the Mission Health Breast Cancer program and its whole-person/multidisciplinary approach to breast cancer care.

Oct. 15, 2015. Robert Clarke provides an update on current research and treatment for breast cancer, as part of Breast Cancer Awareness Month. Speaker Biography: Robert Clarke is professor of oncology and dean for research at the Georgetown University Medical Center and co-director of the Breast Cancer Program at Georgetown. For transcript, captions, and more information, visit http://www.loc.gov/today/cyberlc/feature_wdesc.php?rec=7156

Moderator: SABCS Co-director and AACR Past-president Carlos L. Arteaga, MD, director of the Breast Cancer Program at Vanderbilt-Ingram Cancer Center Analysis of Blood Samples Finds ESR1 Gene Mutations Are Prevalent and Associated With Worse Overall Survival; Breast-conserving Therapy Yielded Better Outcomes Than Mastectomy For Early-stage Patients; Mastectomy Plus Reconstruction has Higher Complication Rates and Costs Than Lumpectomy Plus Radiation; and Resistance of ER-positive Breast Cancer to Tamoxifen Therapy May be Driven by APOBEC3B.

Moderator: SABCS Co-director Virginia Kaklamani, MD, leader of the Breast Cancer Program at the Cancer Therapy & Research Center and professor of medicine at the UT Health Science Center San Antonio Capecitabine Improved Outcomes for Breast Cancer Patients With Residual Disease After Presurgery Chemotherapy; Women With Luminal A Subtype of Breast Cancer Did Not Benefit From Adjuvant Chemotherapy; Denosumab Improves Disease-free Survival for Postmenopausal Patients With HR-positive Breast Cancer; and Pathologic Complete Response to Presurgery Chemotherapy Improves Survival For Patients With Triple-negative Breast Cancer.

Masjidul Quds, Cape Town