Where Are We Today -- A Look Back on Breast Cancer
1 in 8 women in the United States will develop breast cancer at some point in their lives. It's the second most common type of cancer amongst women after skin cancer. Dr. Patrick Borgen discusses where we are today with breast cancer, what we know, and where we can go from here.
Featured Speaker:
Patrick Borgen, MD
Dr. Patrick I. Borgen is Chair of the Department of Surgery at Maimonides Medical Center. He also heads the Maimonides Breast Center at the Maimonides Cancer Center, which is the only fully-accredited Breast Center in Brooklyn. Dr. Borgen was recruited from Memorial Sloan Kettering, where he served as Chief of Breast Services, Head of the Breast Cancer Research Laboratory, and Director of the Breast Cancer Disease Management Team. Dr. Borgen has received numerous research grants from the National Institutes of Health, the American Cancer Society, the US Army and the National Cancer Institute. Widely published in peer-reviewed publications, Dr. Borgen is on the Editorial Board of Annals of Surgical Oncology, and on the Peer Review Board of The Journal of the American Medical Association (JAMA). He is Guest Editor for: Surgery, Annals of Surgery, The Journal of the American College of Surgeons, Breast Diseases, Breast Diseases Quarterly, The Breast Journal, The Lancet, Archives of Surgery and Journal of Clinical Oncology. He is editor of three major textbooks on breast disease, and has contributed chapters to 15 other texts. To date, he has published over 200 articles in peer-reviewed journals, 139 abstracts and 15 editorials. Dr. Borgen has been Chairman of the American College of Surgeons Breast Cancer Trials Group, as well as a Member of the Executive Board of Directors of the American Society for the Study of Breast Disease. He is currently on the Executive Boards of the Breast Cancer Alliance, Inc. and of Tulane University, and a member of the American Joint Committee on Cancer, Breast Task Force. His special interests include motorcycling, horseback riding, painting and music. His honors and awards include: Best Doctors in America, Castle Connolly Guide, 2002-2008; Best Doctors in New York, New York Magazine, 2003-2008; Who's Who in American Medicine (Harper Row, 1997-2002); Vincent Feliciano Memorial Lecturer; Harvey Lecturer 2002, American Association of Cancer Educators, Toronto; Lawson Memorial Visiting Professor, East Tennessee State University, Johnson City, TN, November, 2002; Foundation Fellow, Royal Australasian College of Surgeons, 1998; Molin Foundation Award, April 1993 Grant Period, 1993-1994; and the Jarrell Memorial Traveling Fellowship Award, American College of Surgeons, 1989. Transcription:
Where Are We Today -- A Look Back on Breast Cancer
Cheryl Martin (Host): One in eight women here in the United States will develop breast cancer at some point in their lives. It's the second most common cancer among women after skin cancer. Coming up next where we are today, a look back on breast cancer.
This is my Maimo Med Talk. I'm Cheryl Martin, and with me is Dr. Patrick Borgen, chair of surgery at my Mandi Medical Center. So glad you're here, Dr. Borgen, to provide some perspective on the impact breast cancer has made on our lives.
Dr Patrick Borgen: Well, thank you so much for inviting me to join you today, and it's a pleasure meeting you, and I look forward to our conversation.
Cheryl Martin (Host): Likewise. First of all, Dr. Borgen, talk briefly about the history of breast cancer awareness.
Dr Patrick Borgen: Sure. So the thing that I like to say is that breast cancer is both the great American tragedy and the Great American victory. And the tragedy is that more than 300,000 American women this year will be told you have breast cancer. That is appalling to think of. It's one in eight or one in nine women who live to be 80 will will fight this disease during their life. The Great American victory is that there have been enormous. Meaningful strides, in the cure rate for breast cancer. And in fact, we've seen cure rates go up from by more than 1% per year for the last 20 years. And so more women than ever are being cured of their breast cancer. And that's an incredible fact.
Cheryl Martin (Host): Yes it is now. Doctor, what difference do you think awareness campaigns have made?
Dr Patrick Borgen: That's really a great question. women. Can congratulate women for their role in the war against breast cancer. In the 1990s, as advocacy groups started getting together and as mammography was popularized, women descended on Washington, they descended on their legislators. They even descended on the military because of the enormous number of women who serve in the US armed forces. So even the US military, the Department of Defense was called into action in the fight against breast cancer. So breast cancer had more funding, had more resources than any other solid or liquid tumor, and it's all due to the advocacy that women did.
Cheryl Martin (Host): Now we all know about the pink ribbon. What's the origin of the pink ribbon?
Dr Patrick Borgen: My friend, and a former patient, Evelyn Lauder, who really ran Estee Lauder Industries, was the ultimate advocate for breast cancer, and she is generally credited with really taking the pink ribbon, not only national, but international as a symbol of our support for women with breast cancer and our support of the war against breast cancer. And so, every year and in October, which is Breast Cancer Awareness Month. There would be new product releases and a portion of those sales went to support women with breast cancer to support breast cancer research. So I really credit Evelyn Lauder with the popularization of the now famous pink ribbon.
Cheryl Martin (Host): So everyone knows about it. In your opinion, has it become, let's say, too commercial?
Dr Patrick Borgen: Again, that's a really great question. There's a term that has been coined called pink washing. And Pink washing describes a situation where a product call it a toaster oven is not selling, and the advertisers paint it pink and then put a note that 1 cent off of every sale or whatever, goes to support breast cancer. And it turns out that the sales increase, but this has really, in my opinion, gotten out of hand. In October, everything on TV is pink. Athletes on the football field are wearing. Pink shoes and the balls are pink and the, towels and the goalposts are all pink. I even saw an ad for a pink floating beer pong table, from something called the Keep a Breast Foundation.
And while each one of these in and of itself might not be completely egregious, I do think that when everything is pink and there's a commercial motive, I think you. The sobering fact that 42,000 women will die this year of breast cancer. I think it detracts from the message, and I just think it's caused a sort of a numbness, if you will, for the color pink.
Cheryl Martin (Host): So you bring up a very good point. Do you ever think we can get away from it being commercialized? Can we go back to the original intent or will we have to come up with another alternative?
Dr Patrick Borgen: I think it's much more likely that we'll come up with a fresh, new alternative. I think that, we are seeing whole new generations of breast cancer patients. I'm learning a lot about Generation Z now, and I think that as. Patients evolve and as patients families evolve, I think it's inevitable that we will have a new touchstone for breast cancer. So I think you're right and I think that's going to be the future.
Cheryl Martin (Host): So what can we do to increase awareness? Because you talk about the new generation and we are seeing, breast cancer increase in the younger generations. What do we need to do?
Dr Patrick Borgen: There is nothing more important than early detection and I say that. Knowing that we have better drugs and better surgery and better radiation than we've ever had before, but nothing comes close to the power of early detection. 1And so what I think is gonna happen is that we will have to capitalize on social media. On these platforms that are so incredibly important to the Gen Z culture, to reinforce the message of the importance of breast cancer awareness, the importance of getting your mammogram. The best data we have suggests that a yearly mammogram, Every year after age 40 reduces breast cancer mortality by 40 or 50%. So I think we're going to have to message the next generation a little bit differently, but the message is equally important.
Cheryl Martin (Host): Are you recommending at all that women should start getting a mammogram, you mentioned Gen Z, even younger than 40?
Dr Patrick Borgen: The only time we would really consider screening before 40 would be if someone's mother was quite young developing breast cancer. So for example, if someone's mom was 45, there's something called genetic anticipation where if, a patient's grandmother was 60 at diagnosis, her mom is likely to be 50 and she's likely to be 40. So if someone's mom was say 45, we might start screening mammograms at 35 or 36 years old.
Cheryl Martin (Host): Are there some prevention strategies to stop breast cancer before it starts?
Dr Patrick Borgen: So, In families where there is a gene for breast cancer or in families where you have multiple relatives who have been diagnosed with breast cancer, there are trial proven, FDA proven medications that will reduce circulating estrogen, and in doing so, Decrease the risk of breast cancer in premenopausal women. The drug is called tamoxifen. Tamoxifen is the most commonly prescribed anti-cancer drug in the world. But the problem with Tamoxifen is that it has side effects and some of them are not trivial.
So this becomes a really important conversation between a patient and their doctor. In postmenopausal women, we have drugs called aromatase inhibitors that also block estrogen, but tend to be better tolerated. At the pinnacle of risk, you have a patient like Angelina Jolie. Almost every woman in Angelina Jolie's family got breast cancer and the evidence is that they got a particularly virulent form of breast cancer. The family had the gene called BRCA, and Angelina had the gene, and she elected to remove both breasts.
Prophylactically as prevention against breast cancer. And this is something that's, out there. It's something that doctors will talk about. but it, applies to a very, very small subset of patients.
Cheryl Martin (Host): So what do you say when I looked at this, Some will say, if you change your diet, if you do more exercise, eating healthy, does this really make a difference to, let's say, prevent breast cancer from starting in the first place?
Dr Patrick Borgen: There certainly is compelling evidence that, regular cardiovascular exercise is capable of reducing the incidence of about 15 different cancers. We know that diet plays a role, however, we have to be careful. That we don't lay too much responsibility at the foot of our patients because there are some patients with a perfect diet who are long distance runners who get breast cancer. And so lifestyle factors definitely play a role. Some things that are hard to control the age at first full term pregnancy birth matters.
And we've seen an increase in the average age at first birth from the early twenties to the early thirties, and there's some theory that series of unbroken cycles that occur may actually increase the risk of breast cancer. So the age of first pregnancy and first baby matters, but in general, we are left with a pretty weak shopping list of what women can do to really, to protect themselves.
Cheryl Martin (Host): What about sugar intake? Is that a factor?
Dr Patrick Borgen: So sugar is not a driver of breast cancer, and this is one of the many, many internet myths that's out there. We have a scan called a PET scan that tracks where sugar goes in the body, and of course, cancers use more sugar than non-cancerous, but the fact is, is that there's not evidence that in and of itself, sugar drives breast cancer, however, There are other things that sugar leads to that are generally unhealthy. We know that being overweight, having a high body mass index, which sugar can drive leads to a deposition of estrogen in these fatty tissues, and that can play a role in who gets breast cancer. So sugar should be avoided, but for indirect reasons, not direct reasons.
Cheryl Martin (Host): In this conversation, do you wanna discuss at all some of the latest options for treating breast cancer?
Dr Patrick Borgen: I'm excited as a breast surgeon to report that we have continued to deescalate breast surgery over the last 30 years. When I started my training, we were doing radical mastectomies, removing not only the breast and the lymph glands under the arm, but actually the muscle below the breast today. Most patients have a small operation, which is a lumpectomy. We check a single lymph node called a sentinel lymph node. So the surgery has become far less disfiguring, far less painful, and equally successful. So in my field, that has been the big revolution in terms of medically treating breast cancer, there are really countless advances.
The one I'm the most excited about is a class of drugs that activate a woman's immune system against her own breast cancer. So these are called T-Cell. T as in Thomas, T-cell modulators, and they literally activate these T-cells so that the immune system attacks a woman's breast cancer and in certain types of breast cancer. These are incredibly effective and these are the drugs that I'm currently the most excited about.
Cheryl Martin (Host): Thank you so much for telling us about that particular drug and doctor, before we close, anything else you'd like to add just on where we are today as we look back on breast cancer?
Dr Patrick Borgen: The thing that I would say about today in breast cancer is that great strides are being made every day, every week, every month, and it continues to go back to the advocacy that we talked about at the beginning of the podcast where women continue to advocate for women. I have found in my own career over 25 years that I'm incredibly optimistic about each and every patient that I meet and get a chance to participate in their care. We see great things. We see miracles every day, and I've lost a lot of the pessimism that I had back in the 1990s where we didn't have the weapons that we have today. So mine is a message of hope and it's a message of.
Cheryl Martin (Host): Dr. Patrick Borgan. This has been very informative and I appreciate the sensitivity in which you address this topic.
Dr Patrick Borgen: Thank you so much. I really enjoyed talking to you. Great questions. Thank you so much.
Cheryl Martin (Host): Thank you. Now to make an appointment, call 718-765-2550. That's 718-765-2550. And for more information, visit my maimo.org. That's m a i m o.org. If you found this information helpful, please share it on your social media and thanks for listening to this episode of Maimo Med Talk.
Where Are We Today -- A Look Back on Breast Cancer
Cheryl Martin (Host): One in eight women here in the United States will develop breast cancer at some point in their lives. It's the second most common cancer among women after skin cancer. Coming up next where we are today, a look back on breast cancer.
This is my Maimo Med Talk. I'm Cheryl Martin, and with me is Dr. Patrick Borgen, chair of surgery at my Mandi Medical Center. So glad you're here, Dr. Borgen, to provide some perspective on the impact breast cancer has made on our lives.
Dr Patrick Borgen: Well, thank you so much for inviting me to join you today, and it's a pleasure meeting you, and I look forward to our conversation.
Cheryl Martin (Host): Likewise. First of all, Dr. Borgen, talk briefly about the history of breast cancer awareness.
Dr Patrick Borgen: Sure. So the thing that I like to say is that breast cancer is both the great American tragedy and the Great American victory. And the tragedy is that more than 300,000 American women this year will be told you have breast cancer. That is appalling to think of. It's one in eight or one in nine women who live to be 80 will will fight this disease during their life. The Great American victory is that there have been enormous. Meaningful strides, in the cure rate for breast cancer. And in fact, we've seen cure rates go up from by more than 1% per year for the last 20 years. And so more women than ever are being cured of their breast cancer. And that's an incredible fact.
Cheryl Martin (Host): Yes it is now. Doctor, what difference do you think awareness campaigns have made?
Dr Patrick Borgen: That's really a great question. women. Can congratulate women for their role in the war against breast cancer. In the 1990s, as advocacy groups started getting together and as mammography was popularized, women descended on Washington, they descended on their legislators. They even descended on the military because of the enormous number of women who serve in the US armed forces. So even the US military, the Department of Defense was called into action in the fight against breast cancer. So breast cancer had more funding, had more resources than any other solid or liquid tumor, and it's all due to the advocacy that women did.
Cheryl Martin (Host): Now we all know about the pink ribbon. What's the origin of the pink ribbon?
Dr Patrick Borgen: My friend, and a former patient, Evelyn Lauder, who really ran Estee Lauder Industries, was the ultimate advocate for breast cancer, and she is generally credited with really taking the pink ribbon, not only national, but international as a symbol of our support for women with breast cancer and our support of the war against breast cancer. And so, every year and in October, which is Breast Cancer Awareness Month. There would be new product releases and a portion of those sales went to support women with breast cancer to support breast cancer research. So I really credit Evelyn Lauder with the popularization of the now famous pink ribbon.
Cheryl Martin (Host): So everyone knows about it. In your opinion, has it become, let's say, too commercial?
Dr Patrick Borgen: Again, that's a really great question. There's a term that has been coined called pink washing. And Pink washing describes a situation where a product call it a toaster oven is not selling, and the advertisers paint it pink and then put a note that 1 cent off of every sale or whatever, goes to support breast cancer. And it turns out that the sales increase, but this has really, in my opinion, gotten out of hand. In October, everything on TV is pink. Athletes on the football field are wearing. Pink shoes and the balls are pink and the, towels and the goalposts are all pink. I even saw an ad for a pink floating beer pong table, from something called the Keep a Breast Foundation.
And while each one of these in and of itself might not be completely egregious, I do think that when everything is pink and there's a commercial motive, I think you. The sobering fact that 42,000 women will die this year of breast cancer. I think it detracts from the message, and I just think it's caused a sort of a numbness, if you will, for the color pink.
Cheryl Martin (Host): So you bring up a very good point. Do you ever think we can get away from it being commercialized? Can we go back to the original intent or will we have to come up with another alternative?
Dr Patrick Borgen: I think it's much more likely that we'll come up with a fresh, new alternative. I think that, we are seeing whole new generations of breast cancer patients. I'm learning a lot about Generation Z now, and I think that as. Patients evolve and as patients families evolve, I think it's inevitable that we will have a new touchstone for breast cancer. So I think you're right and I think that's going to be the future.
Cheryl Martin (Host): So what can we do to increase awareness? Because you talk about the new generation and we are seeing, breast cancer increase in the younger generations. What do we need to do?
Dr Patrick Borgen: There is nothing more important than early detection and I say that. Knowing that we have better drugs and better surgery and better radiation than we've ever had before, but nothing comes close to the power of early detection. 1And so what I think is gonna happen is that we will have to capitalize on social media. On these platforms that are so incredibly important to the Gen Z culture, to reinforce the message of the importance of breast cancer awareness, the importance of getting your mammogram. The best data we have suggests that a yearly mammogram, Every year after age 40 reduces breast cancer mortality by 40 or 50%. So I think we're going to have to message the next generation a little bit differently, but the message is equally important.
Cheryl Martin (Host): Are you recommending at all that women should start getting a mammogram, you mentioned Gen Z, even younger than 40?
Dr Patrick Borgen: The only time we would really consider screening before 40 would be if someone's mother was quite young developing breast cancer. So for example, if someone's mom was 45, there's something called genetic anticipation where if, a patient's grandmother was 60 at diagnosis, her mom is likely to be 50 and she's likely to be 40. So if someone's mom was say 45, we might start screening mammograms at 35 or 36 years old.
Cheryl Martin (Host): Are there some prevention strategies to stop breast cancer before it starts?
Dr Patrick Borgen: So, In families where there is a gene for breast cancer or in families where you have multiple relatives who have been diagnosed with breast cancer, there are trial proven, FDA proven medications that will reduce circulating estrogen, and in doing so, Decrease the risk of breast cancer in premenopausal women. The drug is called tamoxifen. Tamoxifen is the most commonly prescribed anti-cancer drug in the world. But the problem with Tamoxifen is that it has side effects and some of them are not trivial.
So this becomes a really important conversation between a patient and their doctor. In postmenopausal women, we have drugs called aromatase inhibitors that also block estrogen, but tend to be better tolerated. At the pinnacle of risk, you have a patient like Angelina Jolie. Almost every woman in Angelina Jolie's family got breast cancer and the evidence is that they got a particularly virulent form of breast cancer. The family had the gene called BRCA, and Angelina had the gene, and she elected to remove both breasts.
Prophylactically as prevention against breast cancer. And this is something that's, out there. It's something that doctors will talk about. but it, applies to a very, very small subset of patients.
Cheryl Martin (Host): So what do you say when I looked at this, Some will say, if you change your diet, if you do more exercise, eating healthy, does this really make a difference to, let's say, prevent breast cancer from starting in the first place?
Dr Patrick Borgen: There certainly is compelling evidence that, regular cardiovascular exercise is capable of reducing the incidence of about 15 different cancers. We know that diet plays a role, however, we have to be careful. That we don't lay too much responsibility at the foot of our patients because there are some patients with a perfect diet who are long distance runners who get breast cancer. And so lifestyle factors definitely play a role. Some things that are hard to control the age at first full term pregnancy birth matters.
And we've seen an increase in the average age at first birth from the early twenties to the early thirties, and there's some theory that series of unbroken cycles that occur may actually increase the risk of breast cancer. So the age of first pregnancy and first baby matters, but in general, we are left with a pretty weak shopping list of what women can do to really, to protect themselves.
Cheryl Martin (Host): What about sugar intake? Is that a factor?
Dr Patrick Borgen: So sugar is not a driver of breast cancer, and this is one of the many, many internet myths that's out there. We have a scan called a PET scan that tracks where sugar goes in the body, and of course, cancers use more sugar than non-cancerous, but the fact is, is that there's not evidence that in and of itself, sugar drives breast cancer, however, There are other things that sugar leads to that are generally unhealthy. We know that being overweight, having a high body mass index, which sugar can drive leads to a deposition of estrogen in these fatty tissues, and that can play a role in who gets breast cancer. So sugar should be avoided, but for indirect reasons, not direct reasons.
Cheryl Martin (Host): In this conversation, do you wanna discuss at all some of the latest options for treating breast cancer?
Dr Patrick Borgen: I'm excited as a breast surgeon to report that we have continued to deescalate breast surgery over the last 30 years. When I started my training, we were doing radical mastectomies, removing not only the breast and the lymph glands under the arm, but actually the muscle below the breast today. Most patients have a small operation, which is a lumpectomy. We check a single lymph node called a sentinel lymph node. So the surgery has become far less disfiguring, far less painful, and equally successful. So in my field, that has been the big revolution in terms of medically treating breast cancer, there are really countless advances.
The one I'm the most excited about is a class of drugs that activate a woman's immune system against her own breast cancer. So these are called T-Cell. T as in Thomas, T-cell modulators, and they literally activate these T-cells so that the immune system attacks a woman's breast cancer and in certain types of breast cancer. These are incredibly effective and these are the drugs that I'm currently the most excited about.
Cheryl Martin (Host): Thank you so much for telling us about that particular drug and doctor, before we close, anything else you'd like to add just on where we are today as we look back on breast cancer?
Dr Patrick Borgen: The thing that I would say about today in breast cancer is that great strides are being made every day, every week, every month, and it continues to go back to the advocacy that we talked about at the beginning of the podcast where women continue to advocate for women. I have found in my own career over 25 years that I'm incredibly optimistic about each and every patient that I meet and get a chance to participate in their care. We see great things. We see miracles every day, and I've lost a lot of the pessimism that I had back in the 1990s where we didn't have the weapons that we have today. So mine is a message of hope and it's a message of.
Cheryl Martin (Host): Dr. Patrick Borgan. This has been very informative and I appreciate the sensitivity in which you address this topic.
Dr Patrick Borgen: Thank you so much. I really enjoyed talking to you. Great questions. Thank you so much.
Cheryl Martin (Host): Thank you. Now to make an appointment, call 718-765-2550. That's 718-765-2550. And for more information, visit my maimo.org. That's m a i m o.org. If you found this information helpful, please share it on your social media and thanks for listening to this episode of Maimo Med Talk.