Evo Terra (Host): This is Checkup Chat with EvergreenHealth. I'm Evo Terra. Today, your next steps after a breast cancer diagnosis. I'm joined by two general surgeons, Dr. Analisa Armstrong, who has expertise in breast surgery and fellowship training in minimally invasive or robot surgery; and by Dr. Marian Johnson, who brings more than 20 years of experience to her patients specializing in mastectomy and lumpectomy.

Doctors, thank you very much for being with me here today.

Dr. Analisa Armstrong: Thank you.

Dr. Marion Johnson: Thank you.

Host: Dr. Armstrong, I'll start with you. Can you walk us through what the typical diagnostic process looks like for someone who suspects they might have breast cancer?

Dr. Analisa Armstrong: Yeah. So fortunately, the vast majority of breast cancers are actually diagnosed early stage these days, and that's thanks to screening mammograms. So with screening mammograms, which are recommended after the age of 40 on an annual basis, the vast majority are actually found not suspected. They're found on screening mammograms early stage, completely treatable.

For individuals who feel an abnormality, then the next step is to present to your primary doctor immediately if you feel anything that's off, that's not consistent with your normal exams or is just new to you. And from there, a diagnostic mammogram imaging can be ordered as appropriate, making sure your primary doc is aware right away, that's the next step. And from there, imaging, biopsies as appropriate. And that's where we start to get involved once there has been a diagnosis.

Host: Great. And Dr. Johnson, what happens after someone is diagnosed with breast cancer? I mean, does treatment start immediately? Should patients expect additional testing?

Dr. Marion Johnson: So, we're very fortunate here at Evergreen that we have a good system in place. Once a patient's diagnosed, the team gets involved, and the decision's made who needs to see that patient next time, whether that's a surgeon, as Dr. Armstrong or I would be involved, or the medical oncologist.

And at that point, deciding what other testing needs to be done. Sometimes that's an MRI, if that's not been done already. There are situations where a more systemic workup gets done. But it's very tailored to the patient. That being said, the team in general is the radiologists. The pathologists are in the background. But the general surgeons, medical oncologists, and radiation oncologists are all up front and in the forefront, seeing those patients pretty quickly.

Dr. Analisa Armstrong: Also, because we have such a good cohesive group, an individual once they have diagnosis will have a nurse navigator on their side, which is a lovely thing where there's someone kind of their quarterback who's helping to coordinate all of us specialists. All of us specialists are in close communication, but that additional person can kind of be the quarterback early on when you're not sure who to talk to and what are the next steps and where do I go from here.

Host: Building off of that, let's talk about some of these common treatment options that are available. And how do you decide which one to use?

Dr. Analisa Armstrong: Yeah. So fortunately, so thanks to modern medicine and breast cancer research in the last couple of decades have really shifted things, it's incredibly tailored. So, the three main categories of breast cancer treatment—so go with the three specialists. So, surgery, and that's generally lumpectomy or mastectomy; radiation oncology, which not everybody necessarily needs radiation, but that can be a part of the overall treatment plan. And then, systemic or medication-based, so that can be when it's indicated, chemotherapy; that can be a once-a-day pill that's an endocrine medication to block receptors from creating a future cancer.

So, these are incredibly tailored to the type of cancer. So, breast cancer has a number of different types and a number of different hormone receptors and ways to categorize breast cancer. And so, treatment is incredibly tailored these days, which makes it actually a huge improvement from where we used to be a few decades ago.

Dr. Marion Johnson: And on that, breast cancer is a disease that we talk about as if it's one disease, but in fact, it's multiple diseases, and as such is treated as multiple diseases, and has multiple prognoses. And as Dr. Armstrong pointed out earlier, the vast majority of women do quite well, even with the more advanced breast cancer.

Host: Yeah. Hooray for the advancements in technology that we have seen over the last decade.

Dr. Marion Johnson: Yeah. Huge.

Dr. Analisa Armstrong: Absolutely. Absolutely. We go to breast cancer conferences every year. And every year is more hope and more encouragement and more progress, which is really heartening. Yeah, we've made huge strides

Host: I think you've both touched on this, but I want to be very specific. And let's talk about the healthcare team there at Evergreen. When someone is undergoing treatment for breast cancer, who are the people on their side?

Dr. Marion Johnson: We're quite fortunate. We have the group of radiologists, the breast imagers that are dedicated to doing breast imaging. They do mammograms, ultrasounds, MRIs, biopsies. We call them non-invasive breast biopsies. But of course, they're very invasive when you're having it done. So, that oftentimes is where women start.

Dr. Armstrong and I are the surgeons who've been heading up this program for years. We have a group of really dedicated medical oncologists with the Fred Hutch. And so, that's wonderful, because they partner with the Fred Hutch downtown and have the access to those research trials, but they are dedicated to Evergreen's patients here. And then, we have our radiation oncologists who have been committed to the program for decades, Dr. Young and Dr. Hunter. They're so knowledgeable and so well-read about all of this.

In the background, we have the pathologists who are committed to breast pathology and see a lot of it here, and so are very, very good. We have social services and people behind the scenes, nutritionists, people helping out with things that aren't quite as front and center, but very important in women's journey and recovery.

Host: Great. Thank you. Dr. Armstrong, earlier you and I were talking about, you know, you going to these conferences and all these new things coming out. So, what are the recent advancements in breast cancer treatment that you're most excited about?

Dr. Analisa Armstrong: Well, I would say this is a little bad news. Good news is less and less surgery, honestly, for a lot of breast cancer that's being diagnosed earlier and earlier. Folks do amazing from breast cancer surgery overall. We get to see our patients with longevity and follow them. And it's a pleasure to get to see them years down the road. But also, we're finding with more and more tailored treatment, we can do less and less invasive procedures. And so, that's really heartening.

Dr. Marion Johnson: But even with the more extensive surgeries, mastectomies and reconstruction, the options for reconstruction are extensive, and they're quite cosmetically acceptable. So, I think even for those women who need or opt for mastectomies, there's some very good options for them to move forward in a situation where they feel confident cosmetically.

Host: I know that when someone's diagnosed with cancer, breast cancer included, it's not just them, right? It's going to impact their family, and all of that. But how should families and people who are with these people find some support and community when one of their family members has a breast cancer diagnosis?

Dr. Marion Johnson: I'll let you answer that one, Analisa.

Dr. Analisa Armstrong: Yeah. So through our nurse navigator, we have an amazing community of support networks. And so, we have classes, we have support groups, we really have a strong community of network support. That's really where you can kind of find individuals who had similar journeys and find the folks that can help kind of you along on your journey.

 There are external resources too, which our group here can help connect you with. There are amazing groups out there, amazing nonprofits. But even just here at Evergreen, we really have a really beautiful support network system.

Dr. Marion Johnson: And it's important because the ages of women are so varied that are being diagnosed. At Evergreen, we seem to have a very young population. And that's probably reflective of the population in general on the east side, you know, north and south. There are very young women, there are also very old women, and they have different needs, and their families have different needs too.

Host: I'm realizing that something that I think we're all aware of, and we live in a world of disinformation and misinformation. So, how can someone find trustworthy, fact-based, evidence-backed/based resources on the web after being diagnosed?

Dr. Analisa Armstrong: So, I would say the best go-to resource for individuals that's completely fact-based would be nccn.org for patients. So, NCCN is our National Cancer Network that provides a lot of the guidelines that your specialists will be engaged with. There's a number of our consensus kind of guidelines through our professional organizations, and this is one where you can actually access that information and refers you to the data.

Michael Hunter, one of our breast radiologists, has written actually several books for patients that are widely available. And so, we do have actually a very robust group here at Evergreen that still is involved with publishing and helping to spread information so patients may have the best access to information.

Once you're here, we also have textbooks of information. So internally, there's a lot of information. But while you're kind of in that whirlwind initially of getting a diagnosis, starting with something like nccn.org can be very helpful.

Dr. Marion Johnson: And relying on your team. I think, for whatever you look up online, we are here. We are here to answer the questions, to respond, whether that's through the portal or by phone call or by person. Relying on your team is so important.

Host: I want to switch to prevention, right? So, let's talk about lifestyle changes that someone might be able to make to reduce their risk of developing breast cancer.

Dr. Analisa Armstrong: So, the best data out there, so there's good data overall for just kind of healthy lifestyle choices, as you might imagine. So, Mediterranean, plant-based diet, thirty minutes of vigorous walking at least three times a day, not drinking excessively in terms of alcohol. So, lots of things people are already doing.

And most importantly, really annual screening mammogram, because most breast cancers are diagnosed these days well before you would feel a palpable mass, and that makes all of the difference in terms of treatment. And moving on with really cancer being a blip on your screen behind you, that's the number one for sure.

Dr. Marion Johnson: That's the broad generality.

Host: That's great. That's great. Well, listen, Doctors Armstrong and Johnson, thank you very much for being with me and sharing all this information today.

Dr. Marion Johnson: Thank you.

Dr. Analisa Armstrong: Yeah. Thank you so much.

Host: And for more information and to get connected with one of our providers, please visit evergreenhealth.com. And if you enjoyed this podcast, please share it on your social channels and explore the entire podcast library for topics that interest you. I'm Evo Terra, reminding you that early detection saves lives, so be sure to get regular screenings. This has been Checkup Chat with EvergreenHealth. Thanks for watching.