Amanda Wilde (Host): Welcome to St. Joseph's Health MedCast, a podcast from St. Joseph's Health. We'll talk about what's new and what's next in breast cancer treatment with leading medical oncologist, Dr. Haider Khadim. I'm Amanda Wilde, your host, and Dr. Khadim, thank you so much for being here.

Haider Khadim, MD: Thank you very much for having me.

Host: First, in your role as medical oncologist, how do you work with someone who is going through breast cancer?

Haider Khadim, MD: So as a medical oncologist, there is multiple roles in terms of treatment for breast cancer. It all depends on what kind of receptors someone's cancer presents with. You can go either with no treatment after surgery or you can ask for giving hormonal therapy, chemotherapy and immunotherapy, whatever have you. So it all depends in what kind of receptors the cancer is showing. And then we make the decisions on those treatment options available.

Host: So breast cancer isn't just one disease. Can you possibly break down the different types in a way that's easy to understand?

Haider Khadim, MD: There is three different kinds of receptors that breast cancers present and no one breast cancer is similar to the other breast cancer. So there could be two women in one room with breast cancer and both would have a totally different kind of breast cancer. Some people have estrogen receptor breast cancer, and for that, after surgery, a lot of times you have to give hormonal therapy to which basically is a pill form that they would have to take at least once a day for five years, five to 10 years.

They could have something called HER2 receptor positive breast cancer. And for HER2 receptor positive cancer, they get immunotherapy, which is an antibody which targets the HER2 receptor present on the cancer cells and kills the cancer cells specifically, or they could have no receptor positive, meaning the estrogen receptor is also negative. The progesterone receptor is negative and the HER2 receptor is negative. And in that case you get chemotherapy plus immunotherapy combination, which is very promising these days.

Host: Well, I was going to ask how the way we treat breast cancer has changed over the last few years, but I think you just described different treatment for different situations for different receptors. There have been some exciting breakthroughs recently. Can you share a few that stand out?

Haider Khadim, MD: So there are a few big breakthroughs really. In terms of immunotherapy, advent of immunotherapy, especially something called pembrolizumab or Keytruda that you may have seen on commercials, that has improved response rates for patients with triple negative breast cancer significantly to a point that before the surgery is done, if it is a sizable cancer, we choose to use chemotherapy plus the immunotherapy combination first to reduce the size of the cancer enough, and about 63 to 67% of the times people would go into complete response even before the surgery is done. So, and that translates into the best possible survival.

Host: With triple negative being one of the most difficult breast cancers.

Haider Khadim, MD: Most difficult and most aggressive. Absolutely.

Host: I want to talk about the St. Joseph's Cancer Care program. Does that stand apart from others in the region? And if so, how?

Haider Khadim, MD: We take pride in getting the patients in very quick. There has been many times a surgeon would call me and ask me that what do you think about a patient who has this big cancer? And if I think that they need chemotherapy right away, my next question is to the surgeon, where the patient is. And if they're right in their office, I tell them to, the patient does not need an appointment, just send them over to St. Joe's and we'll take care of them quick.

Standard of care is available in all places. Absolutely. It's the matter of getting the patients started on the standard of care treatment is the most difficult part, which we take pride in taking care of the patients no matter what insurance they have, very quickly at St. Joe's.

Host: Couple other questions about breast cancer prevention. First of all, there's been talk about changing the recommended age for mammograms. What should people know about mammograms, which is our best screening tool?

Haider Khadim, MD: The best screening tool is mammogram for sure. Sometimes we run into a situation where the breast tissue is dense. The mammogram is always complimented with ultrasound, but in general, we still recommend for the patients to be screened at age 40 once a year.

Host: And beyond the science, what are some of the biggest concerns your patients have?

Haider Khadim, MD: The side effects of treatment is one of the biggest concern. Especially long-term side effects. Sometimes the side effects can be long-term too, like for people who get chemotherapy for triple negative breast cancer, especially the one drug can cause neuropathy symptoms. And if that develops, sometimes it could be lifelong kind of side effect, they would have to be with. But also, bear in mind, do not be afraid because the benefits are more than the risks are, and even if the person develops the long-term effect, like neuropathy, your body is very resilient. It gets used to it and the, the sensation of neuropathy or numbness, sensation goes down as the time goes on, so you get used to it.

Host: Are there ways you help patients manage the physical and emotional side effects of treatment?

Haider Khadim, MD: With cancer medicine, especially a medical oncologist, it's just not giving the treatment with chemotherapy and immunotherapy. I would say that's one part of it, and the majority of the part is counseling the patient. So we consider ourselves as counselors too at the same time, and try to always be there for the patient if they have questions.

And with cancer medicine, if a person is going through the treatment of cancer, if there is a question they need it answered very quickly. Otherwise, if you don't answer or you don't reply their phone calls, the anxiety kicks in pretty badly. And that can affect the treatment too, because if the anxiety is not under control, people don't show up for their appointments. So we are very mindful of that and try to answer the patients whatever questions they have pretty efficiently.

Host: So giving that emotional support and are there physical strategies to cope with the side effects such as physical therapy?

Haider Khadim, MD: Absolutely. After the surgery, we do recommend patients to be evaluated with the physical therapist and our community surgeons are very good about it. I mean, once the, the surgery is done, they refer the patients right away to the physical therapist for adequate range of motion exercises and things actually get better, people recover quicker with physical therapy also.

Host: Doctor, if someone listening now just got diagnosed or has a loved one who did, what's the one thing you'd want them to hear today?

Haider Khadim, MD: Help is available and very close to home. That's my takehome point. I would recommend the two things. The people who are at the appropriate age, please try to get their mammograms done at age 40 to catch the cancer at a very early stage because it's the matter of trying to diagnose the cancer at the earliest stage possible so that the cure rates are higher.

And if you are diagnosed with cancer, it's easy for me to say that don't worry. Yes, you worry. But also know and have comfort in mind that help is available. And majority of the times the treatments are very successful.

Host: Well, there are constant advances in the field, so it's always evolving, so there's that kind of support available for people who are newly diagnosed as well.

Haider Khadim, MD: Correct.

Host: Doctor, thank you so much for sharing the latest information and bringing us up to date in this evolving field of breast cancer treatment. I really appreciate your insights.

Haider Khadim, MD: You're welcome.

Host: Dr. Haider Khadim is medical oncologist at St. Joseph's Health. Visit Sjhsyr.org/services/cancer for more information. If you found this podcast helpful, please share it and check out the entire podcast library for topics of interest to you. Thanks for listening to St. Joseph's Health MedCast, a podcast from St. Joseph's Health.