Cheryl Martin (Host): Breast cancer has come a long way and the progress is inspiring. WakeMed breast oncologist, Dr. Pallavi Kopparthy, is here to share how treatments are now more precise, recovery more gentle, and how early detection continues to save lives.

This is WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. I'm Cheryl Martin. Dr. Kopparthy, thanks for being on to discuss breast cancer breakthroughs.

Pallavi Kopparthy, MD: Glad to be here. Thank you for the opportunity.

Host: First, what inspired you to specialize in breast oncology?

Pallavi Kopparthy, MD: So, I think I'm fortunate to be able to say that this is truly my passion, breast oncology. And there were a few factors that inspired me to become a breast oncologist. So firstly, I would say it's my patients. I mean, truly their strength and resilience is a daily reminder of why this work matters to me. It's also a very humbling experience to walk alongside them through one of their most difficult journeys. So, I would say it it was my patients.

Second, I really like the intellectual challenge breast oncology presents. So, each patient is very unique. And when I have a patient sitting in front of me, I'm obviously trying to pick the most effective treatment for their breast cancer. But depending on where my patients are in their stage of life, the most effective is not always the best treatment for them. So, I'm very commonly having to kind of pick a treatment that's best suited. And I really like the challenge where I'm bringing in cutting edge treatments with compassion.

I would say the earliest factor that inspired me to become a breast oncologist is my passion for women's health. So, I was fortunate to have very strong female role models growing up, and it showed me what a profound impact a woman can have on their families and the community by extension. So, I think with breast oncology, it's a perfect space to bring all of my passions together.

Host: That's wonderful. I love it. And I can just sense the passion in your voice. So, what's one thing about breast cancer today that makes you feel hopeful every day?

Pallavi Kopparthy, MD: I feel incredibly hopeful when I see where our field is shifting in the current day and age. So, the care has become much more personalized than ever before. I think we are no longer treating breast cancer as one disease. We are focusing on the whole patient with, you know, advancements in targeted therapies and genomics. And this is allowing us to make our treatments more effective and less toxic. There's obviously been more progress in early detection and screening. And as we are detecting these cancers earlier and earlier, most of them are actually being cured, which is amazing for our patients. There's also, I would say, a push to identify patients at high risk for developing breast cancer. We are using risk models, genetic screening, taking family histories, and identifying a group of patients that are at high risk for breast cancer and even helping them prevent developing breast cancer throughout their lifetime. So, that's very exciting as well.

Host: Talk also about how breast cancer, you touched a little bit on this, but how breast cancer survival changed over the last few decades?

Pallavi Kopparthy, MD: Yeah. So, our patients are living longer than ever before because the survival has improved dramatically. I would say compared to five or six decades ago, right now the survival for early stage breast cancer is upwards of 90%. The death rates keep falling. And I think this is mostly because of earlier detection. There's more personalized treatments. Treatments are not only just effective, but also I think kinder, which is helping patients live longer with breast cancer.

Host: So, why is early detection still the best tool we have?

Pallavi Kopparthy, MD: So despite all of the advancements we have these days, I would say early detection is still the best tool we have to beat this cancer. When we detect patients early, we can aim for cure and what that does is it improves the survival rates. So, I would encourage everyone to go get their mammograms. That'll increase detection and cure and survival rates

Host: And what is now the targeted year for your first one?

Pallavi Kopparthy, MD: Forty years.

Host: Still 40 years. Okay. Now, how has the move, would you say, toward personalized or targeted therapy changed patient care?

Pallavi Kopparthy, MD: Yeah. So, I think what I'm seeing more these days is we are moving away from a one-size-fits-all approach. We are, you know, focusing more on the unique biology of the tumor. So, that means, you know, we are no longer doing extensive surgeries, more radiation, chemotherapy, hormone therapy for all our patients regardless of the biology. We are focusing more on the patient and tailoring it towards their genomics and biology.

So for example, we have HER2-targeted therapies like trastuzumab, pertuzumab, T-DXd, and we have immunotherapy for triple negative breast cancer. So, these are cancer biologies that were historically thought to be aggressive. But now, with these targeted therapies, their survival rates have improved. And this is not just for early stage cancers, it's true for metastatic disease as well.

Similarly, for our hormone receptor-positive subtypes, we have CDK4/6 inhibitors, PI3K inhibitors. so a lot of targeted therapy, which is exciting because it's not only extending survival but are making treatments more tolerable.

Host: Can you give us an example of how today's treatments-- you have shared in your last response, but can you think of one patient in particular, let's say, who came in and maybe they were at stage II or III and how a treatment was more tailored or precise for that particular person, and the difference it made.

Pallavi Kopparthy, MD: Sure. Yeah. I can think of a young patient that was in her 30s, you know, had kids in elementary school present with stage II, HER2-positive tumor. So historically, for something like this, we would have done surgery first and then maybe chemotherapy later. The survival rates were very bad. But now, we look at the size of the tumor, the lymph node status, the biology, and then a lot of times give them systemic treatments, which is, you know, chemotherapy and targeted HER2 therapies upfront. We try to shrink the tumor, then take them to surgery. So, this has definitely improved the survival rates, specifically with the HER2 targeted treatments. And then, based on their responses during surgery, we can add on more treatments.

The other thing I want to mention, you know, with our younger patients, is I really focus on fertility treatments as well. So, this is a patient that wanted to still. think about having pregnancy in the future, have more kids. So, I would send someone like this to an REI, infertility specialist, talk to them about how they can preserve their fertility. So, you know, there's a lot of focus on survivorship as well. I think that has definitely improved personalized treatment for our patients.

And I think with this treatment plan where their focus is on their tumor biology, their genes, their life goals, patients improve their trust in the system. They have more satisfaction. You know, they have more quality of life.

Host: So, are you seeing then that a mastectomy is not as quickly considered as the first option?

Pallavi Kopparthy, MD: Yes, I would definitely say that. So as a medical oncologist, obviously, everything that we discussed so far was in terms of advancements in medical oncology. But with breast, there's a lot more other departments involved. So, we have our surgical oncology colleagues, radiation oncologists, plastic surgeons, pathologists. So, everyone's focus these days in this field is to deescalate treatment, but also keep it effective. So, you're right in that we don't really have to do mastectomies in everyone. We can do a lumpectomy and not do extensive axillary surgery. Maybe just do a sentinel lymph node biopsy. You know, with radiation, they're more shorter regimens. The treatment side effects are much better tolerated. The outcomes are equally effective as well.

Host: I'm glad you mentioned treatment side effects. Talk more about how they have improved or become more manageable.

Pallavi Kopparthy, MD: There are certain acute side effects that we see during treatment. For example, nausea, but we have excellent strategies to control nausea, and it is pretty much non-existent with the regimens we have these days. Similarly, we have growth factors to help with your blood counts. We are being more proactive in managing these side effects. We have a whole team with, you know, clinical staff, nurses, navigators, who are in touch with these patients throughout their treatment so that we can proactively manage these acute side effects.

For my female patients worry about hair loss, we have scalp cooling techniques that we educate them about. Like I mentioned, we refer them to fertility preservation if they're, you know, our younger population. We look into bone health. We have bone strengthening agents. So, the supportive care has increased tremendously, which is making these treatments more gentler on patients. And even long-term effects, so with our survivors, we focus on things like their mental health, their sexual health. And I think overall patients have more satisfaction and a better quality of life, and they're able to do the things that matter to them, spend time with their families better with all of these strategies.

Host: Anything else you wanted to add just about the surgery options and how there have been changes just over time?

Pallavi Kopparthy, MD: Yeah. So, there's been deescalation. So, we are seeing more lumpectomies as opposed to mastectomies. And this has been possible using upfront chemotherapy in a certain situation. Radiation, we no longer have to use like the prolonged course for every patient. We are using a more abridged version. Sometimes we even do intraoperative radiotherapy treatments. So that way, they're better tolerated. And we also collaborate with our plastic surgeons very frequently. We offer our patients options for reconstruction. And when you have improved cosmesis, I think that automatically improves their confidence, that leads to more satisfaction, quality of life.

Host: Doctor, what would be the one message that you would want every woman to hear about breast cancer today?

Pallavi Kopparthy, MD: What I would definitely want them to know is, while breast cancer diagnosis can feel overwhelming, you are not alone in this. The treatments are much more effective, personalized than ever before. There is an entire team of people that's with you in this journey, you have your doctors, your navigators, nurses, you know, huge survivor community, who are amazing supporters. And I'm just amazed about how much they do for the community. So, everyone's with you, walking with you through this journey. So, the focus is not on getting you through treatment, but also on living well during and after. I think I just want them to know that they're not alone in this.

Host: Dr. Pallavi Kopparthy, thank you so much for bringing us up to date on the breakthroughs that are making breast cancer treatment effective, and helping women thrive after a diagnosis. Your passion is obvious. Thank you so much.

Pallavi Kopparthy, MD: Thank you. Thank you for having me.

Cheryl Martin (Host): To learn more about our breast cancer services, visit wakemed.org. Now, if you found this podcast helpful, please share it on your social channels, and you can check out our entire podcast library for other topics of interest to you. Thanks for listening to WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina.