Scott Webb (Host): Though breast cancer isn't
entirely preventable, limiting alcohol intake and not smoking can help reduce
the risk for women, but mammograms are essential to early diagnosis and
survival. And joining me today for a conversation about the effects of women
delaying mammograms during COVID and how survivable breast cancer is,
especially if women get their mammograms, is Dr. Julie Fu. She's a medical
oncologist with the Mass General Cancer Center at Emerson Hospital.

Host: This is the Health Works Here Podcast from Emerson
Health. I'm Scott Webb. Dr. Fu, thanks for your time today. We're going to
essentially talk about breast cancer, what's new, what's different, how we can
prevent it. So as we get rolling here, have there been any changes in the rates
of breast cancer since the pandemic?

Dr. Julie Fu: Yes. But the answer is actually a
little less straightforward, so if you could bear with me going back to
pre-pandemic. So for all-comers of patients, the rates have increased slightly
by 0.5% per year. But in the younger patients with breast cancer between 2015
and 2019, so pre-pandemic, the annual incidence of breast cancer has increased
by 2% per year. And then, you know, that brings us to the start of the pandemic
in 2020. And as we all unfortunately know, just around the world, hospital
resources were allocated to those who really needed the most urgent care. So,
surveillance like mammograms was understandably delayed. And therefore, the
absolute diagnosis of breast cancer, all stages actually decreased in 2020. But
not because it didn't exist, it's because women were not getting their regular
screening.

Host: Sure. Okay.

Dr. Julie Fu: So then, as the world opened up, if you
recall, Italy was one of the first European countries to be most affected by
the pandemic, and they actually did a study that there's an increase in the
rate of later stage breast cancers, and a similar study out of California
showed the same thing. So, there have been less stage what we call zero to II
breast cancers and, unfortunately, more stage III to IV breast cancers compared
to pre-pandemic years. And even prior to the pandemic, they were seeing an
increase of cancers in younger patients. And then of course, as things opened
up, there's also this just backlog of patients trying to reschedule their
mammograms and, in general, just catch up on life. So, you know, some patients
have delayed their routine healthcare screenings or doctor visits. And with
that, that might have caught an earlier stage diagnosis and some people are
actually still catching up. So for whoever is listening, if you haven't got
caught up on your annual mammogram or colonoscopy or GYN exam, just go schedule
it.

Host: Yeah. Those surveillance exams, of course. So,
it's not so much that more women have been afflicted, let's say, with breast
cancer since the pandemic. It's that folks are finally getting caught up. And,
unfortunately, now, it's being diagnosed in later stages, right?

Dr. Julie Fu: Correct.

Host: And so, let's refocus then and talk about
prevention. How do we prevent breast cancer? What are maybe two or three of the
most important things that women can do?

Dr. Julie Fu: So first regarding diagnosis, this is
kind of just a current update, but while Massachusetts, most providers
generally continued recommending mammograms at age 40 years old, on May 9th so
very recent, the US Preventative Services Task Force also recommended a first
screening mammogram at 40 years old versus 50 years old. So, you know, now
that's just kind of throughout the US. So if you fall into that category and
you're 40, just go get your first mammogram.

And then regarding prevention, it's really important to
limit alcohol intake. And the general recommendation is no more than one drink
a day as even small amounts can increase your risk. And then, what probably
every doctor tells you is to just try to work really hard at maintaining a
healthy weight. And if you were not where you should be, you know, talk with
your doctor. Reduce amounts of calories per day, increase activity and being
physically active can help prevent breast cancer. And most adults should try
for about 150 minutes or two-and-a-half hours a week of moderate activity and
strength training maybe at least twice a week.

But the most important thing to prevent cancer is stop
smoking. Smoking causes at least 15 different cancers including breast cancer.
So if you smoke, try to quit as soon as you can and it's almost never too late
to get the benefits. And there are a lot of options besides cold Turkey. So, I
always emphasize to patients if there's anything you can do to better your
health is to stop smoking.

Host: Yeah, definitely. Great advice from an expert
of course. And let's just say that a woman had a mammogram, did the right
thing, and cancer was indicated, it shows cancer. So, should fear be the first
reaction to that? Or are there some things that you can tell them today that,
you know, it's not great, but we can help?

Dr. Julie Fu: I mean, I think how someone responds to
bad news, that's how they respond. But it's more just not letting that fear
overwhelm you. I think it's very normal to be scared after anyone throws the
word cancer at you. But we also have to remember that, you know, they're not
alone. Overall, one in eight women in the US will be diagnosed with breast
cancer in their lifetime. That is a lot of women. And so, I would say don't be
scared. The earlier we catch this, the better. And sometimes the cells have
changed but not become invasive. You may only need surgery. And even the other
treatment options that might be recommended, they're very time limited.
,They're very well tolerated, even in our older patients. And 65% or more of
breast cancer cases are actually diagnosed in the local stage, meaning that no
signs of cancer has spread outside the breast, and that would mean that the
five-year survival rate is 99%.

Host: Yeah. So, you can see just how important
mammograms are as you stressed earlier and will continue to stress today of
course. So, let's talk about the latest treatment options for breast cancer.
And when we think about, as you say, five years out or more, I'm assuming that
the goal is obviously to prevent the cancer from spreading, to save lives and
so on. But maybe you can just talk about some of the latest options.

Dr. Julie Fu: Yeah. So in general, the overall
treatment pattern, assuming you're in the local stage, is surgery. Basically,
get it out, radiation therapy, sterilize that field, endocrine or hormonal
therapy, for example. If there's anything that cancer feeds on, then try to
target that. And then, chemotherapy, if there are no set specific targets, for
example, you're hormone negative, that's an option as well. And in the past, we
used to treat all healthy women with chemotherapy to try to be as aggressive as
possible. But now, we have something called a recurrence score, which is sent
on the person's individual pathology or tissue, determines if chemotherapy in
addition to hormone therapy would be helpful or not. And it's been very
instructive to guide whether or not someone would benefit from chemo and really
has allowed us to be more selective in those who would benefit. And, you know,
cancer tries to outsmart us, so we, you know, put patients on medications and
then there are now even more ways to target mutations. For example, if your
hormone-positive, HER2-negative breast cancer recurs, sometimes other mutations
can develop. And there was a recent approval just in February of this year, if
you have a something called an ESR1 mutation, this can be treated with a pill.
And these are patients with metastatic stage IV disease. So, we have pills for
even patients with advanced breast cancers. And we're able to diagnose this and
other mutations with a blood test and look for circulating tumor DNA cells. And
as we're able to find more things, we're developing drugs to target the
mutations we find, and sometimes I feel like it's something new every month.
It's pretty exciting. All these advances definitely increase a person's life.
There are over 3.8 million breast cancer survivors in the US. And death has
been decreasing since 1989 and an overall decline of about 43% through 2020.
And in general, these decreases are thought to be the results of some of the
treatment options I just reviewed, earlier detection through screening and just
greater breast cancer awareness, exactly like what you're doing with this
podcast, so thank you so much.

Host: Yeah. Awareness is so key. Awareness,
education. And I just want to give you an opportunity. I know you sound pretty
excited and I get excited too when we think about just science and medicine and
technology and how fast things are changing and who really benefits, obviously
patients, but also doctors, nurses, everybody really in the end. I'll give you
a chance here. What do you love most about being an oncologist?

Dr. Julie Fu: Definitely working with the patients.
It is not an easy job by any means, as you can imagine. You know, this is a
profession where you're trying to help the patient navigate probably one of the
scariest and most challenging times of their lives. From diagnosis to treatment
to managing toxicities and expectations, it is literally a life-changing
diagnosis for many, and it affects their entire lives, their close
relationships, their careers, their children or their desire to have children.
And you see patients reprioritizing things, you see them grow through
challenges. And, you know, for a hem-onc doctor like myself, we see them
through those good and sometimes really bad times, and it's a very humbling
experience and just an honor to care for these patients when they really need
someone to help. And, you know, not only to give them quantity of life, but
quality as well. Patients are just amazingly resilient and they inspire a lot
of hope. And just working with the patients that I get to work with and just
being really with the patient and listening to them is just such a privilege
and just what I love most about being an oncologist.

Host: Yeah. That's awesome. That brought a smile to
my face. Cancer of course is a heavy topic, but more and more women, thanks to
things like this podcast and mammograms and all the great advice that they get
from doctors like you and everyone else, there's just so many reasons to be
optimistic. And as you say, you know, you feed off the patients, they feed off
of you. Just really good stuff. Thank you so much, and you stay well.

Dr. Julie Fu: Thank you so much. You too.

Host: And visit emersonhealth.org/mammo to request an
appointment for a mammogram or call 978-287-3436. To learn more about Dr. Fu
and oncology care at Emerson.

And thanks for listening to Emerson's Health Works Here
podcast. I'm Scott Webb. And make sure to catch the next episode by subscribing
to the Health Works Here Podcast on Apple, Google, Spotify or wherever podcasts
can be heard.