Gina Kaye (Host): Welcome to UK HealthCast, a podcast presented by UK HealthCare. I'm Gina Kaye. And joining me today is Dr. Julie Lang, breast cancer surgeon and Medical Director of the Comprehensive Breast Care Center at the UK Markey Cancer Center. Our topic today is the future of breast care in Kentucky. Dr. Lang, thank you so much for joining us today.

Dr. Julie Lang: Thanks, Gina. Great to be here.

Host: All right. Well, let's just dive into our questions. I know we have a lot of information to cover. So to start us off, you've just arrived at UK as the Section Chief of Breast Surgery. What excites you the most about this next chapter?

Dr. Julie Lang: We are a growing dynamic program within the UK Markey Comprehensive Cancer Center. We provide state-of-the-art advanced breast cancer care to the Commonwealth of Kentucky. We have a dedicated team of specialists, including breast imagers, breast medical-oncologists, radiation oncologists, and are the only center in Kentucky with four fellowship-trained breast surgical oncologists.

Host: That's exciting. What are your top priorities then during your first year?

Dr. Julie Lang: My top priority is meeting the needs of our population by reducing the interval between screening mammography and further diagnostic workup for women with abnormal mammograms. This will allow us to reduce our time to treatment and greater serve our local patient population here in Lexington and beyond in the entire Commonwealth.

We will ensure that our breast center is prioritizing the needs of patients and primary care doctors to get patients access into our breast care center in a timely manner. Expanding our clinical trial offerings to better serve our patient population is also top of mind. This will establish the University of Kentucky as the premier location in Kentucky for the treatment of locally advanced and metastatic breast cancer patients seeking therapies only available on clinical trials and will help improve upon the current standard of care by continuously optimizing therapies for cancer patients.

One of our breast surgeons, Dr. Ibrahim, and I are preparing to bring robotic nipple-sparing mastectomy as an option at the University of Kentucky. This new procedure was recently approved by the US FDA. We are planning to offer this advanced technique that requires specialized training, credentialing, and equipment that is currently only available at a small number of centers around the country. This procedure offers improved surgical precision, reduced visible scarring, and enhanced preservation of nipple sensation and blood flow. It allows surgeons to operate through small inconspicuous incisions that are often placed away from the breast toward the armpit, leading to better cosmetic options and potentially faster recovery

Host: That's fantastic. This next question is one of my favorites. What inspired you to become a breast cancer surgeon?

Dr. Julie Lang: I really enjoy how multidisciplinary the care of breast cancer patients is. As a breast surgeon, we get to see the patient first and help them at a point in their lives that they consider to be a major crisis. For many patients, this is the first time that they are confronted with their own mortality. They were well, they had an abnormal mammogram. And here they are in my office seeing a surgeon for the first time. It's very scary for them.

So, patients develop a close relationship with their breast surgeons since we are there for them to guide them through this difficult time. And in many cases, surgery is their first course of cancer treatment.

I did my residency at the University of California San Francisco and got to see the difference that it makes when a highly expert team of breast cancer specialists come together to provide multidisciplinary treatment where team members really work together to take care of patients, provide the highest level of expertise, and contribute to life-saving research.

I also saw this pattern of care at the MD Anderson Cancer Center where I did my fellowship, one of the top cancer centers in the country. At academic medical centers, this kind of expertise really comes together to provide the highest level of quality care for patients.

Host: Your career combines surgery, research, education, and leadership, which by the way is a lot. How have all of those experiences shaped your approach to patient care?

Dr. Julie Lang: I think that these experiences are really very complementary and help to strive for continuous improvement across the care of cancer patients. By striving for excellence in surgery and using research to try to save patients' lives, in every aspect of my job, we're fighting cancer and advocating for the patient.

Education is a natural part of a surgeon's career. We're privileged to have outstanding surgical trainees and medical students rotating with us and contributing to our patients' care, and we learn from our trainees as well.

Host: Dr. Lang, in addition to clinical care, you also have an interest in breast cancer research. Tell us more about that.

Dr. Julie Lang: I am a clinical trialist and a clinical translational researcher as well as a surgeon. I have enrolled patients on therapeutic clinical trials evaluating surgical interventions as well as drug interventions such as chemotherapy. I have also designed and carried out some clinical trials in collaboration with my teams, which we have published.

My work on circulating tumor cells, rare cancer cells shed into the bloodstream of breast cancer patients, involved developing methods for sequencing the RNA of these rare cells to better understand the molecular biology of cancer. Some of my lab's research was used to support a successful U.S. Food and Drug Administration application for a company.

My laboratory has been studying inflammatory breast cancer, one of the most aggressive forms of breast cancer, and we successfully made a new mouse model in which we can study experimental therapeutics to see which medicines might work better than what we currently use in the hopes of trying to eradicate this cancer.

Patients expect that most doctors are working on better treatments for cancer, but in reality, most physicians in practice do not have very much time for research. We at the Markey Cancer Center are committed to improving outcomes for breast cancer patients by constantly seeking to improve all aspects of breast cancer care via clinical outcomes research, therapeutic clinical trials, and basic scientific studies to make important new observations that can lead to future therapies.

Gina Kaye (Host): Earlier when I asked you what excites you the most about this next chapter, you spoke about multidisciplinary care. So what does that look like in your practice and why do you feel it is so important?

Dr. Julie Lang: Multidisciplinary care is when we bring expertise to the table that is relevant to the patient. And this includes a variety of different specialties: breast surgery, medical oncology, radiation oncology, expert breast imagers, nuclear medicine, pathology, expertise in psychology, genetics, integrative medicine, and social services.

All these team members come together and play a critical role for our breast cancer patients. Not all patients may require each of these specialties, but only at a comprehensive cancer center like the Markey Cancer Center do we have all these elements working together where we can make them available for patients and provide them with all the care that they will need.

Host: Perfect. How do you balance then achieving the best cancer outcomes while also preserving quality of life and cosmetic results?

Dr. Julie Lang: Achieving the best cancer outcomes, including prolonging life, avoiding recurrence of the breast cancer. But increasingly, it's been noted that we should not do this at the expense of quality of life. Quality of life is very important. And so where there are opportunities to avoid over-treatment of breast cancer patients, the whole field of breast cancer treatment has been very interested in this. And in recent years, we've seen de-escalation. For example, in surgery, there are some patients that we can omit checking lymph nodes, whereas in the past, much more radical surgeries were done.

So, guided by clinical trials, we've seen a progressive improvement in outcomes for breast cancer patients, while at the same time, we've been able to de-escalate or remove certain parts of treatment where we can, where it did not actually produce better results.

We work hand in hand with other specialties, and a great example of this is the collaborative nature of breast surgeons and plastic surgeons. When a patient desires breast reconstruction for mastectomy, we plan the incisions together. We make a flight plan so we know what the other specialist is thinking, and we work together. How can we get a widely negative margin but also preserve the most aesthetic form or contour to the breast? And this is a really exciting part of being a breast surgeon. The collaborative nature of the specialty, it really benefits the patients

Host: Wonderful. Talk to us a little bit then about how clinical trials expand treatment options for patients at UK Markey

Dr. Julie Lang: Clinical trials are very important when there are patients that have advanced disease, breast cancers that have spread to other organs, they're known as metastatic breast cancer, and those patients are not usually considered curable at that point. However, medicine is always striving to do better. And nowadays, we actually have highly effective therapies that were not available previously. So, we're seeing durable or prolonged survival in many more patients than in the past.

Clinical trials are what have brought that to us, so we seek to have a diverse portfolio of clinical trials for our patients. This gives advanced cancer patients the chance at living longer, and it gives us a better opportunity to improve therapies for patients.

This will also apply to patients with earlier stage diseases. For example, situations in which we would have a patient that might need to have a mastectomy because the cancer is of a sufficient size where lumpectomy is not possible. But with chemotherapy before surgery, also known as neoadjuvant chemotherapy, we can shrink the tumor down and convert that patient to a situation where a lumpectomy could be offered.

So, it's only by having these types of clinical trials available can we progress the field and have better options for our patients. And so, clinical trials are really very important. And we hope to make, the UK Markey Cancer Center the premier clinical trial center in the state of Kentucky.

Gina Kaye (Host): So then tell us, how do you hope to expand access to breast cancer care across Kentucky?

Dr. Julie Lang: Interestingly, around 60% of our patients come to us from outside of Lexington. The majority of our patients are traveling one, two, three, four hours to come see us at the Markey Cancer Center. We are collaborating with the Markey Cancer Network in terms of collaborating with sites that UK is affiliated with, as well as community-based sites, to refer patients to us needing advanced cancer care.

And in some cases, patients receive all of their care at the UK Markey Cancer Center, and we're pleased to take care of these patients and provide them with these services. In other circumstances, patients wish to have their breast surgery with us but might return closer to home for some portions of their care, such as for medical radiation oncology.

Host: You know, optimally eradicating breast cancer would be job one. But if you could change one thing about how breast cancer is diagnosed or treated today, what would it be?

Dr. Julie Lang: We need to make this process be more patient-centered. When a woman goes for a routine screening mammogram, this should be very straightforward. This should be at a place that's close to her home, have a mammogram. She shouldn't wait more than 10 or 15 minutes for that test, and we should be able to provide timely notification to patients about results so that people are not waiting. The waiting often is the hardest part for our patients, and we are striving to do better to tackle that problem.

Host: That's great. What continues to inspire you after so many years caring for breast cancer patients?

Dr. Julie Lang: What's incredible is that one in eight women gets breast cancer in their lives, and more than 95% of these women do not have a strong family history or genetic components to their breast cancer. So, this is such an important public health problem. And so, I am inspired by the patients themselves, seeing so many patients struggling with their breast cancer diagnosis. And we at the Markey Cancer Center need to take on this responsibility and ensure that they get the very best of care.

Host: As we wrap up our discussion today, Dr. Lang, what message would you like to leave with patients and families who may be listening today?

Dr. Julie Lang: The treatment of breast cancer is getting better. I've seen remarkable changes in the span of my career. I've been in practice for 19 years now, and treatments have gotten less invasive, and outcomes with care by the medical and radiation oncologists have gotten better with fewer side effects as well.

An example with radiation oncology is that, for many patients, it used to be six weeks of radiation therapy. Then, clinical trials show that it could be three weeks for many patients. And in recent years, clinical trials show that many patients could be treated with five treatment days.

So, clinical trials have really made major advances in the field, and we're able to deescalate or do less and provide better outcomes for patients. The field of breast cancer is ever-changing. So if a patient had a family member who was treated in decades past, they should know that what treatment looks like today might be a little bit different. And so, the future of breast cancer care is really very bright.

Host: That is wonderful news. Dr. Lang, thank you so much, not only for the very important work that you are doing on a daily basis, but thank you very much for your time today on such an important and informative topic.

Dr. Julie Lang: Thank you, Gina.

Host: Thank you for listening to UK HealthCast. For more information about today's episode, please visit markey.uky.edu. If you enjoyed this podcast, please share it on your own social media channels. I'm Gina Kaye, and this has been UK HealthCast, a podcast from UK Healthcare. Thanks for listening.