Maggie McKay (Host): When you find out you have breast cancer, it's scary. No way around it. But the more you know, the better. So today, breast surgeon, Dr. Cheryl Olson will discuss breast cancer stages from diagnosis to treatment.

Welcome to Mountain Medicine, a podcast from Northern Inyo Healthcare District. I'm your host, Maggie McKay. Thank you so much for being here today, Dr. Olson.

Dr. Cheryl Olson: Thank you for having me.

Host: Absolutely. Can you walk us through the different stages of breast cancer and how they're typically defined?

Dr. Cheryl Olson: Sure. It can be a little bit complicated, but when we simplify it and when we talk about stages, it's I, II, III, and IV. And each stage is made up of a couple of things. We use the TNM staging. So, T is generally for the size of the cancer. The N stands for whether lymph nodes are involved. And then, the M is for whether or not the cancer has spread to other parts of the body from the breast. And so, that's sort of the building blocks that we go with to make up then the stage I, II, III, and IV.

Host: And what are some of the key differences between an early stage breast cancer diagnosis and a more advanced stage?

Dr. Cheryl Olson: Well, kind of common sense, it's the size of the tumor. So, the early stages are the T1s and T2s. T1 is anything up to 2 centimeters. T2 can be 2 centimeters to 5 centimeters. And those are typically very, very favorable stages. When you start having lymph node involvement, so when you get an N1, then it becomes more complex, usually more treatment is required, all the way to sometimes patients present with a very advanced stage, which can be locally advanced, meaning breast, the very big tumor, versus something that's already spread at the time of their presentation.

Host: So, when you get a diagnosis and let's say you hear stage IV, I imagine you need to take immediate action?

Dr. Cheryl Olson: Well, yes, it's something that's very serious. However, stage IV, because it means that it's spread to a distant site, or a distant organ, like your liver or brain, we don't typically think of that stage as curable. It is treatable, very treatable. And instead of what it used to be many, many years ago where stage IV was like death within weeks or months, stage IV now for breast cancer is treatable and patients can survive a long, long time depending on the location of the metastasis. So, it's not absolute immediate death sentence, but we always make it clear that stage IV is typically not curable.

Host: So, do treatment options change a lot depending on the stage of breast cancer?

Dr. Cheryl Olson: Absolutely. So when you're diagnosed very early, usually we can choose both treatment options from a surgical arm, so lumpectomy plus radiation, or if the patient prefers, they can have a mastectomy and hopefully avoid radiation. But most of the time patients in an early stage won't then require chemotherapy, depending on the tumor types. It gets a little complicated with breast cancer now, because depending on the patient's age and depending on the hormone status of the tumor, meaning estrogen-sensitive tumors are a little bit easier to treat or not quite as aggressive. Whereas even if somebody is presenting with an early stage but triple-negative breast cancer, they will need chemotherapy just by the nature of the more aggressive cancer.

Host: Dr. Olson, how important is early detection, like through mammograms, when it comes to planning treatment?

Dr. Cheryl Olson: I think early detection is really critical. It really changes what we're able to achieve and what the patient has to go through. When you think of an early stage I cancer, it's very treatable, 90%. Even if it's a triple-negative, it's still 90% curable. The hormone-positive tumors are 99% curable at a stage I. But when you go to a stage II or III, the cure rate is lower, but even to get the patient that long disease-free interval considered cure, they will have to go through a lot more, potentially radiation even after a mastectomy, potentially chemotherapy or hormone suppression for five years. So, the early detection, the early diagnosis really makes a difference.

Host: And how might a patient's experience and symptoms change as breast cancer progresses through the different stages?

Dr. Cheryl Olson: Well, I think most patients present very anxious, afraid, they don't know a lot, so I think that part of it is pretty universal regardless of stage. But as you encounter a different scenario than what you imagined when you do surgery and you find a positive node or two, or the tumor's bigger, then the patient has to go through not only the surgical part of it, the potential chemotherapy, then they have to get radiation.

For those women who are diagnosed with a larger tumor, sometimes preserving the breast is not an option. So then, they have to go through more, which is a mastectomy, if they're young or desire a reconstruction, then they have to go through that and the recovery from that is much longer. So, the differences between an early stage and a late stage can be significant.

Host: Is there anything else in closing that you'd like to add that we didn't cover?

Dr. Cheryl Olson: Well, I think breast cancer is very complicated and a lot of patients read on the internet. They talk to their friends and there's lots of subtle nuances that make the treatment different. Many, many different, avenues we can take. And so, I would just strongly recommend that people take their friend's advice, but then go talk to their doctor. Ask the doctor the questions. If they're uncomfortable, get a second opinion. But don't rely on your friends or the internet or your perceived understanding of what you read on the internet to really guide you. Look to those of us who do this every day for many, many years to help guide you through the process.

Host: Right. That's so important. Thank you so much. This has been so informative, and we really appreciate you sharing your expertise with us today.

Dr. Cheryl Olson: All right. Well, thank you. It's been a pleasure to be here.

Host: Again, that's Dr. Cheryl Olson. If you or a loved one has been diagnosed with breast cancer, understanding your stage is vital for informed decisions. Early detection is key. So, schedule regular screenings and talk to your health care provider. Northern Inyo Health Care District is here to support you through every step of your breast cancer journey.

To schedule a mammogram, call 760-873-2155, that's 760-873-2155, or visit nih.org. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Mountain Medicine from Northern Inyo Healthcare District.