Maggie McKay (Host): Meaningful Medicine is a Novant Health Podcast bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. Today we're speaking with Dr. Michelle Fillion, Surgical Oncologist.

Host: Thank you so much for being here today.

Dr. Michelle Fillion: Thank you so much for having me.

Host: We're going to talk about breast cancer screening and treatment. Such an important topic. So to start with, how important is it to discuss family history to have an awareness if relatives have had breast cancer?

Dr. Michelle Fillion: Yeah, it's very important and it's one of those that you can have the conversation with your immediate family members and even like aunts and uncles from both the mom and your father's side to really understand what is your risk. It comes to play when there is one or more family members, immediate family members who's had a diagnosis of breast, ovarian, even pancreatic or melanoma cancers, as those can increase your risk of developing a future breast cancer.

We use several models that are out there to do risk assessment and algorithms that can help us predict whether you are average risk of developing breast cancer over your lifetime, and that's one in eight women, or are you going to be someone that's considered high risk, which is anybody that has a lifetime risk greater than 20%, so it's greater than a one in five out of individuals of developing breast cancer.

That lets a stratify on what screening pathway that we'd allow a patient to be screened on.

Host: And if there are family histories, should individuals consider meeting with a genetic counselor to explore personal risk a little bit further?

Dr. Michelle Fillion: I think those are great options. So meeting with a genetic counselor, they can really deep dive into that family tree, specifically looking at age of diagnosis of the family members and whether it's a full family member as a first degree relative or if there's half siblings to go down those pathways to do the risk assessment, and then they can start to put those in little algorithms to help do the risk assessment would you be somebody that would qualify for genetic testing on the out front, even without any kind of personal history of cancer.

Host: So with those statistics, one in eight, let's talk about breast cancer screenings a little more. Who needs a screening mammogram and how often should they get it?

Dr. Michelle Fillion: From the American Society of Breast Cancer Surgeons, American College of Radiology, and American College of Obstetrics and Gynecology, we're all pushed for age of 40 is where we start with screening mammography. And that's done on an annual basis. But it's also coupled with the fact that you need a breast exam at least once a year.

So whether that's through primary care provider that can do that, or whether it's like, say an OB GYN that can do that breast exam, but it's mammography coupled with a annual breast exam via a trained provider.

Host: So if someone gets breast cancer, what are some of the common treatment options that would be on the table today? And if it's easier, you can start with localized cancer that hasn't spread.

Dr. Michelle Fillion: There's a lot that goes into this, and breast cancer treatment has gotten more and more nuanced. The way I like to talk about it when we break it down to patients, it really comes into subtypes. And I'll just spend a, just a brief moment on subtypes. And so when we look at is a breast cancer hormone positive, that gives us an array of different treatment options, such as hormonal blockade with surgery, potentially radiation, potentially with chemotherapy as well.

Then we look at breast cancers that maybe aren't as hormonally driven. Some people may have heard of a triple negative breast cancer. That's one relies a little bit more on chemotherapy in the addition of surgery and plus radiation therapy. There also, you can add to that immunotherapy. Then the last subtype of breast cancer I talk about is one that has a receptor called HER 2/neu positive that works in addition to chemotherapy, but also targeted agents as well as surgery and chemotherapy and radiation as well. But that's really how we break down because sometimes it changes the sequencing of how we offer the therapies to the patient. What is their subtype of breast cancer?

Host: So it sounds like every patient's different. You really have to tailor it to them, right?

Dr. Michelle Fillion: It truly is, because it really depends are lymph nodes positive upfront, that we may try to do chemotherapy before we do any surgical interventions. If it's a small tumor, lymph nodes negative, we may do a surgical upfront approach.

Host: And locally, the Novant Cancer Institute offers multidisciplinary care and patient navigators for breast cancer. Would you talk a little bit about that?

Dr. Michelle Fillion: Yeah, and that's actually been a really strong suit what Novant Health can offer. We also do have breast navigators, so as soon as a patient is undergoing mammography, and comes across that they need to come back for more imaging, that patient's getting tagged that now they need diagnostic imaging.

This is in addition to just screening, so they'll be called back to do more thorough look. This sometimes is additional mammogram plus ultrasound to better characterize what's going on in the breast. For those then that need to get set up with a biopsy, that navigator is helping them right away at the abnormal imaging to get them scheduled with a biopsy in the next few days.

Those results then are tagged and coordinated with their primary care to help get them seen by a breast specialist surgeon, as well as then getting plugged in with medical oncology, radiation oncology, and the new breast cancers are presented on a weekly fashion at a multidisciplinary conference where we're reviewing the imaging, the pathology, and starting to discuss the sequencing of treatment for that patient.

Host: So, I hate to belabor the point, but you mentioned it. I mentioned it, and it's worth mentioning again I think that one in eight women in the US will develop breast cancer in their lifetime. So that's a pretty significant portion. Are there any healthy habits we should keep in mind that might reduce risk?

Dr. Michelle Fillion: I think the biggest thing is being in tune with oneself. The recommendations for monthly breast exam, not necessarily that they've gone away, it's just there's not literature to support that, but it's been coined the phrase breast awareness. So certainly knowing any changes that are noticed in, in your breast that are different.

Is there a mass, is there a lump? Are you having bloody nipple discharge? Is there changes to your overall skin of your breast? Is something just different that hasn't been there before, that would qualify to meet with your physician, get a breast exam by a trained provider and then that may lead us to diagnostic imaging.

So it's really being aware of those changes that you can get in and get addressed on a timely fashion.

Host: And is there anything we didn't talk about that you'd like to mention?

Dr. Michelle Fillion: Breast cancer is the most common cancer amongst women. I mean, outside of skin cancer, breast cancer is the most common cancer. The overall survival from breast cancer is still really high. The catch is getting it early and our imaging has really helped us pick it up earlier, especially with the 3D mammograms.

 They could really pick up tinier breast cancers. We're finding them earlier and thoughts are that's helping contribute to the overall survival is by picking up them earlier. But even if you do have a little bit later stage breast cancer that's being found, there are so many more targeted agents. Treatment that can help us either shrink down the cancer before chemotherapy or that can be used as adjuncts to help really improve one's overall survival.

Host: And as we prepare to close, I want to ask how surgical oncology became a passion of yours and what drew you to the specialty?

Dr. Michelle Fillion: This is one that's, it's been really interesting. As a surgeon, you've been trained to take care of patients. You can fix a problem surgically, let it move on, but it was really the rapport that I wanted to keep in having some long care patients. And so that I found of being able to take care of patients with cancer is that I end up making long-term

relationships. I'm following my patients for many years and I get to know them. I get them through the cancer diagnosis initially, and then it's so great to see them continually progressing, living their fullest of life. And there's some that have problems that I can help kind of coordinate and streamline them through, through the cancer journey.

But it's just really neat to be able to keep that long-term relationship. And that's one of the things that I, I love most about treating patients with cancer.

Host: I bet that is so rewarding to come out the other side and then see them having a happy, productive life. That's the goal. Right.

Dr. Michelle Fillion: It is.

Host: Thank you so much for sharing your expertise, Dr. Fillion. We really appreciate it.

Dr. Michelle Fillion: No problem. Thank you very much for having me.

Host: Again, that's Dr. Michelle Fillion. To learn more, please visit nh.team/cancer. 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. To find a physician, visit novanthealth.org. And for more health and wellness information from our experts, visit healthyheadlines.org.