Maggie McKay (Host): In the United States, after skin cancer, breast cancer is the most common cancer diagnosed in women. And years ago, when a woman got the diagnosis of breast cancer, the odds of survival seemed overwhelming. But today, thankfully, there has been so much research and so many advancements in breast cancer care, giving new hope to patients suffering from this disease.

We're going to talk about these advancements today with our guest, Dr. Kim Brennan, medical oncologist with Mass General at Emerson, and Dr. Liza Ragulin Coyne, general and breast surgeon and Medical Director of Emerson's Comprehensive Breast Health Center.

This is the Health Works Here podcast from Emerson Health. I'm Maggie McKay. I think it's safe to say that most people listening have been touched in some way by breast cancer, either firsthand or maybe a family member or friend has gone through it. So thank you both so much for being here today and making the time. I'm so interested to hear more about these advancements in breast cancer care.

Dr. Brennan, to get started, what have been some of the biggest changes in breast cancer treatment in the last decade?

Dr Kim Brennan: I think it's been amazing, mind-blowing, the types of changes that we've seen. There's been so many advances in not only detection of breast cancers. We have now 3D mammograms that can find smaller lesions easier. We are utilizing ultrasounds and MRIs. We're more effective at deciding who to use them on. And even when someone gets a diagnosis, we have testing to help determine what treatments they're going to have with their cancer. There's a test called an Oncatype DX, and subsequent studies that have been related to that oncatype testing have really helped us to cut down on the amount of people that we treat with chemotherapy, finding that there's a lot of breast cancer patients that don't even need chemotherapy that we were probably giving it to before we had this testing. And we also have new drugs as well, targeted agents, we are using immunotherapy and all sorts of new types of medications that are extending people's lives far beyond what they were before.

Maggie McKay (Host): So just all that within a decade.

Dr Kim Brennan: Right.

Maggie McKay (Host): That's so great. I wonder what we'll see 10 years from now, Dr. Ragulin Coyne, would you like to add anything?

Dr Elizaveta Ragulin Coyne: As Dr. Brennan mentioned, I think the amount of stride that happened within the field of breast cancer is really significant over the last decade. And big themes are really customization of care and target-focused, patient-specific plan that's determined by cancer biology and imaging and genetics as well as the oncotype and the other tests that determine how much treatment we need, how little we can get away with without causing unnecessary toxicity.

And I think there's also, in addition to oncology side with new medications, there was a big movement within the surgical field, one looking really more on oncoplastic options. Whereas, in the past, we focused on removing the cancer and the cosmetic component really took second seat and wasn't the priority. Whereas, over the last 10 years, there was significant movement showing that we can really do a good cancer surgery and rearrange the tissue even after lumpectomies and have good cosmetic result with good breast contour and good symmetry without compromising the actual long-term outcomes. And I think additional training that nationally is being offered for breast surgeons and implementation of that is really amazing as well as new options for reconstruction where the implants now can be put in prepectoral position and sometimes can be done on the same day as a single-stage procedure for some patients. I think all those things make something that certainly is never fun to go through for the patient, give us more options.

I think other things that from imaging standpoint and intraoperatively, there's ways to assess margins to determine can we take a little extra tissue to minimize needs to go back to the operating room more frequently. There's also new technology in terms of resolution for imaging and all that helps for us take care of patients and mostly have good results.

Dr Kim Brennan: There's also been significant research that we can actually have patients help in their breast cancer treatment recovery and recurrence risk by assuming lifestyle changes. What we've noticed is that, for patients who exercise, are able to keep a low body weight, minimize alcohol and not take hormone replacement therapy, that it has definitely decreased the breast cancer risk in those patients. And at Emerson Bethke, we're able to incorporate all of those treatments and surgical techniques that Dr. Ragulin Coyne was talking about and all of the preventative strategies. We even have some classes here for lifestyle management for our patients.

With our chemotherapy patients, we have a cool cap that's a new advance where it can lessen the amount of hair loss that they have with chemotherapy. So now, not everybody needs to lose their hair with our breast cancer chemotherapy if they need it.

Maggie McKay (Host): Dr. Ragulin Coyne, has the patient population changed for breast cancer? And if so, how?

Dr Elizaveta Ragulin Coyne: I think overall the population that we are seeing has been mostly stable. One thing that we notice over time, especially with the COVID pandemic, is that patients are waiting a little longer to come in, delaying their screening mammograms because they haven't seen the PCP and that is what worries me because the cancers are presenting a little later. Whereas, for some cancers, they would have had smaller surgery and radiation and a pill and would have been done, now we have to consider chemotherapy or larger surgery and much more invasive treatment And I think slightly later stage diagnosis tend to be the trend in a lot of locations across the US.

And interestingly though, I think another thing that we are seeing over the last year or two is that, if we look at overall trends, the percentage of patients diagnosed is actually about 10% lower than that's been for many years. And I suspect that those patients haven't gone away. It's just they haven't come in to see their PCPs. They haven't come in for their screening imaging, so we'll probably see them at some point. But I think that, it's an important message to tell everyone that they really need to get in and get their screening mammograms. Because a lot of times, the best way to diagnose it is by imaging. By the time we can feel something, that means that the area is larger, so we have to worry about it more.

Maggie McKay (Host): And Dr. Brennan, what do you hear from patients about the treatments? Are they easier than they were years ago? Do they have better outcomes? What are they saying?

Dr Kim Brennan: I'd say both. Definitely, patients sometimes come in with a particular mindset about how things are going to be because a family member years ago had treatment and they're like, "Oh God, it's going to be the same," but they're pleasantly surprised that the treatments are easier to take than they imagined. We have better ways to control side effects like nausea, and anything else that you might think of that goes along with treatment. We have better supportive medications and techniques that we can help patients with, so that they're able to get through their treatments in a much easier fashion than years ago. And we're seeing statistically significant better outcomes in our breast cancer patients from these treatments.

Maggie McKay (Host): So that's good news. That's some more hope. And Dr. Ragulin Coyne, what are you excited about on the horizon of breast cancer treatment? Things that are not yet available, but likely will be soon. I'd actually like to ask you both this, we'll start with you, Dr. Ragulin Coyne.

Dr Elizaveta Ragulin Coyne: I'm really excited about a lot of new medications a lot of new immunotherapies that used to be only opened for metastatic breast cancer, more studies showing that it can be available and beneficial for earlier stage cancer patients. I think for the subgroup of patients with aggressive cancers, that will make a difference.

what I'm most excited about is focusing further on doing excellent surgery, doing it in a least invasive way. We really focus in the OR using nerve blocks to minimize need of narcotics, using newest techniques and technology like Mozart for intraoperative assessment that we have at Emerson, as well as Faxitron LOCalizer, which avoids using wires which we also use at Emerson. And I think the real focus on survivorship and not just getting through the treatment and hanging on for those few months, but truly thriving afterwards, I think the big push on survivorship care is going to be very important and I anticipate that's going to become even more common and will be a great benefit to our patient population.

Maggie McKay (Host): Right. Has that not been a thing in years past?

Dr Elizaveta Ragulin Coyne: I think that's also something that became more common and more talked about over the last five years, probably even less, to really focus on treating cancer more from all aspects, including psychosocial impact. And for some patients it's really more like a PTSD trigger where they come back for a screening imaging or certain things coming back to the hospital. They're having a lot of long-term psychological impact, not just the physical recovery. I think there's a long psychological recovery that goes with that. And I think helping them determine and create a toolbox to help deal with that and move on to survive and thrive, I think it will be a big component that I think we do have a survivorship program and offer some classes here, but I'm excited to grow that long-term for our program and our patients.

Maggie McKay (Host): And Dr. Brennan, what are you excited about when it comes to the future and cancer care treatment?

Dr Kim Brennan: I agree with everything that Lisa said because there's just so many things. I think there's so many more medications coming out. We're trying to harness the body's immune system to help fight against the tumors. There's all sorts of new trials going on with new medications, using antibodies and the traditional chemotherapy together and alone. We have studies going on to look at circulating tumor cells to see if that can help us with detection of early metastatic disease. And I look forward to actually being able to use that in practice. We're not there yet, but I look forward to that in the future that can help guide us with our patients as well.

Maggie McKay (Host): Dr. Brennan, what motivates you to work with people who have breast cancer? What do you love about what you do? What's the best thing about it?

Dr Kim Brennan: Being with the patients is literally the best part of the job. there's such a strength in our patients and such a resilience, and they're so ready to come in and listen and do whatever they can to get back to a healthy state. And you can develop these longitudinal relationships because we have such great treatments that I get to know these people for a very long time. And it really is a joy to be able to get people back to health and to help people feel better on a daily basis.

Maggie McKay (Host): And Dr. Ragulin Coyne?

Dr Elizaveta Ragulin Coyne: I think people really make the biggest difference. While it certainly some days is not an easy job by all means as Dr. Brennan I'm sure will agree, I think I'm always humbled and amazed by the inner strengths of our patients and just perseverance and how they go through it with grace and how strong they are and how much I love seeing them do well and see them come back six months later, two years later and doing well. And even sometimes there are bumps in the road along the way, trying to ease the really hard journey that they go through is the reason I got to come to work every.

Maggie McKay (Host): It is a journey. it sounds like it's quite a long process from beginning to end. So thank goodness for people like you and Emerson who take care of all facets of what people have to go through in this. What is the number one thing you'd like women to know about breast cancer, Dr. Brennan?

Dr Kim Brennan: That early detection saves lives. It really does. Getting your mammograms on a regular basis every year does help to find these tumors when they're smaller and the treatment can be more minimal. and people live a really long time, so mammo is it, and just to know that you can make a difference in your own health and we're here to help.

Maggie McKay (Host): Dr. Ragulin Coyne?

Dr Elizaveta Ragulin Coyne: I second that. Come in, get your mammogram. People are worried about getting radiation. A mammogram's radiation is less than what you get flying from Boston to LA one way. So, it's really important to get it and I see patients so frequently where even I cannot feel the mass yet and it's already showing up in imaging and we can do something about it and do a lot less than we would have if we waited until we could if we didn't get a screening mammogram. So that's really important.

Maggie McKay (Host): Sounds like Emerson offers a lot of wonderful treatment for people going through breast cancer treatment.

Dr Kim Brennan: Absolutely. We have the latest in Detection and treatment,

Maggie McKay (Host): Right. Thank you both so much for sharing your knowledge and news about advances in breast cancer care and giving patients and their families hope. We appreciate what you do and for you being here today.

Dr Kim Brennan: Thank you very much.

Dr Elizaveta Ragulin Coyne: Thank you. It's good to be here.

Maggie McKay (Host): Thank you. For more information, visit Emerson health.org/breast health.

Thanks for listening to Emerson's Health Works here podcast. I'm Maggie McKay. Make sure to catch the next episode by subscribing to the Health Works here podcast on Apple Podcast, Google Podcast, Spotify, or wherever podcast can be heard.