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Test Those Breasts ™️
This podcast by Jamie Vaughn is a deep-dive discussion on a myriad of breast cancer topics, such as early detection, the initial shock of diagnosis, testing/scans, treatment, loss of hair, caregiving, surgery, emotional support, and advocacy.
These episodes will include breast cancer survivors, thrivers, caregivers, surgeons, oncologists, therapists, and other specialists who can speak to many different topics.
Disclaimer: I am not a doctor and not all information in this podcast comes from qualified health care providers, therefore does not constitute medical advice. For personalized medical advice, you should reach out to one of the qualified healthcare providers interviewed on this podcast and/or seek medical advice from your own providers.
Test Those Breasts ™️
Episode 85: Empowering Patients & Caregivers w/ Dr. Tiffany Troso: A New Era in Cancer Care
In this episode, we are thrilled to welcome back Tiffany Troso-Sandoval MD, a distinguished medical oncologist with a quarter-century of experience in women's cancers. Dr. Troso shares her insights from a recent breast cancer symposium, illuminating groundbreaking patient care and treatment strategy advancements. As she shares her journey from the clinic to her broader role in cancer advocacy through her company, Winning The Cancer Journey, Dr. Troso unveils some of her plans aimed at educating and empowering both patients and caregivers.
We explore the complex world of metastatic breast cancer treatment, emphasizing estrogen receptor-positive cases. We review the different types of anti-estrogen therapies including how and why they work. We discuss the role of CDK4/6 inhibitors used with aromatase inhibitors, breaking down how these treatments target estrogen pathways to curb cancer growth. We navigate the intricacies of ESR1 mutations and explore how selective estrogen receptor degraders (SERDs) are crucial in overcoming treatment resistance.
From chemotherapy timing to empowering caregivers, we delve into the multifaceted nature of breast cancer treatment decisions. Dr. Troso shares her transition from hands-on patient care to creating impactful online resources, highlighting the ongoing nature of the cancer journey for both patients and caregivers.
drtiffanytroso@winningthecancerjourney.com
Dr. Troso on Facebook
Winning The Cancer Journey on Facebook
Dr. Troso on Instagram
Winning The Cancer Journey on TikTok
San Antonio Breast Cancer Symposium Guide
CNN interview: https://www.youtube.com/watch?v=MU38D89YlQ0
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I am not a doctor and not all information in this podcast comes from qualified healthcare providers, therefore may not constitute medical advice. For personalized medical advice, you should reach out to one of the qualified healthcare providers interviewed on this podcast and/or seek medical advice from your own providers .
Hello friends, welcome back to the Test those Breasts podcast. I am your host, jamie Vaughn. I'm a retired teacher of 20 years and a breast cancer thriver turned staunch, unapologetic, loud supporter and advocate for others, bringing education and awareness through a myriad of medical experts, therapists, caregivers and other survivors. A breast cancer diagnosis is incredibly overwhelming, with the mounds of information out there, and other survivors A breast cancer diagnosis is incredibly overwhelming, with the mounds of information out there, especially on Dr Google. I get it. I'm not a doctor and I know how important it is to uncover accurate information, which is my ongoing mission through my nonprofit. The podcast includes personal stories and opinions from breast cancer survivors and professional physicians, providing the most up-to-date information. At the time of recording Evidence, research and practices are always changing, so please check the date of the recording and always refer to your medical professionals for the most up-to-date information. I hope you find this podcast a source of inspiration and support from my guests. Their contact information is in the show notes, so please feel free to reach out to them. We have an enormous breast cancer community ready to support you in so many ways.
Speaker 1:Now let's listen to the next episode of Test those Breasts. Well, hello, friends, Welcome back to this episode of Test those Breasts. I am your host, jamie Vaughn, and today I am super honored and happy and excited to have my guest, dr Tiffany Troso-Sandoval, on my show. And some of you may know, but I have interviewed her in the past and I have her back. We've been in touch ever since, just because, well, we like to collaborate with each other and I learn a ton from Dr Troso. So I wanted to bring her back on the show to talk about some really important things that are coming up that she learned, and I want her also to talk about what she's doing for the cancer community as a whole. So Dr Troso Sandoval is a highly esteemed medical oncologist with over 25 years of expertise in treating women's cancers. Throughout her career at Memorial Sloan Kettering, she published over 20 research papers in a prestigious medical journals and authored a specialized publication focused on providing care for elderly patients with ovarian cancer. Dr Troso is now expanding her reach outside of the medical clinic to help women across the country through her company winning the cancer journey. She is now utilizing her skills and expertise to help others through public speaking, webinars, virtual medical consultations and workshops. After caring for thousands of patients with breast and gynecological cancer. Dr Truso has a passion to improve the outcome and quality of life for cancer patients by providing education, guidance and development of winning mindset. Let me start this over. Well, hello friends. Welcome back to this episode of Test those Breasts. I am your host, jamie Vaughn, and I am super excited to have my guest, dr Tiffany Troso Sandoval, on my show again. Some of you may remember that I interviewed her quite a few months ago and we've just kept in contact because we like to collaborate with each other and I learn a lot from her, and so I am so excited to introduce Dr Troso-Sandoval and she is a highly esteemed medical oncologist with over 25 years of expertise in treating women's cancers. Throughout her career at Memorial Sloan Kettering, she published over 20 research papers in prestigious medical journals and authored a specialized publication focused on providing care for elderly patients with ovarian cancer.
Speaker 1:Dr Troso is now expanding her reach outside of the medical clinic to help women across the country through her company winning the cancer journey. She is now utilizing her skills and expertise to help others through public speaking, webinars, virtual medical consultations and workshops. After caring for thousands of patients with breast and gynecological cancer, dr Troso has a passion to improve the outcome and quality of life for cancer patients by providing education, guidance and development of a winning mindset. Her upcoming book, winning the Cancer Journey, will be published in early 2025. And she is also working on the development of an online interactive educational platform for cancer patients and their caregivers. Hello, dr Truso, how are you? How are you doing? Wow, that was a mouthful. Huh. I know you have so much to offer. I love it.
Speaker 2:I love it. Thank you so much for having me. I'm so excited to be able to speak to your audience. This is really exciting, thank you.
Speaker 1:Me too, and I just, you know, I just always love to follow you and I've had other people follow you on our especially Facebook group and stuff like that and you've. You have just provided such needed information and education for our cancer community. So we're lucky to have you and I'm excited because you just went to the breast cancer symposium and gosh darn it, I didn't go and I should have gone.
Speaker 2:I was here, I was planning on it.
Speaker 1:Yes, we are and I was planning on it and just things got in the way and stuff. So next year for sure. But you learned some things there that are just a you know mind blow and of how people are going to be cared for coming into the near future, and I just want you to share what it is that you learned. I know there's a ton.
Speaker 2:So much.
Speaker 1:I know you can pick some of your top, your top things that you learned that you can share with our audience.
Speaker 2:I may have to come back another time because I've got so many things.
Speaker 1:Totally fine with that, Anytime really.
Speaker 2:Sure, sure. Well, thank you again. I'm thrilled to talk about all these things, so let me just I'm going to try to give some broad strokes. So you know, if you follow me on Instagram or even Facebook, linkedin, we'll give you all those addresses at the end, because I do post a lot of detailed information about some of these studies that I'm going to be going over. But just for the purpose of an overview, I don't want to sort of get too much into the weeds, so I'll probably be talking a little more topically on some of these things. So, some of the biggest things that I found at San Antonio well, my number one favorite thing you're going to like this, jamie is I was blown away by how much interaction and support and utility that all of the patient advocates brought to San Antonio Breast Cancer Symposium.
Speaker 2:It was unprecedented, in my opinion, and so needed. So what do I mean? So they had patient advocates and these would be women that had cancer or have cancer, and there would be some major educational platform. One of them I'll talk about is about CT DNA, and they would have the patients up there on the stadium on the platform with the physicians and the researchers, and they would discuss this topic intellectually, they would discuss some of the research and then they would turn to the patient advocate and the patient advocate would give her opinion of that drug. And you know things that were discussed in the platform.
Speaker 2:And it was amazing because a lot of times when doctors discuss different things, what we consider to be well-tolerated is not exactly so well-tolerated for the patient. So, for example, there was one woman that was up on the platform during one of the review sessions about some of the bigger topics and they were talking about patients that take CDK4-6 inhibitors like palbocyclob, and the patient you know they were discussing. Well, this is a very important study because we know that palbocyclob is so well tolerated by the patients and it shows such an advantage for them to be taking it. And the patient advocate was like, yeah, define well-tolerated, because four to six loose bowel movements a day is not exactly well-tolerated. So doctors speak well-tolerated. That means well, okay, they are still living their lives. They're not in the hospital, they're not. You know what I'm saying Versus what in reality is really well-tolerated. It's just a good reality check for physicians to sort of take it back down to the real level of the patients and how they're experiencing the things that we're discussing. It was phenomenal. So patient advocacy was huge.
Speaker 1:Yeah, because I mean, like, quality of life is so important and it's it is important for them to understand where the patient is coming from. For them to understand where the patient is coming from. So that's I love it, I love that that was presented in that way.
Speaker 2:So there was actually another study, not specifically about advocacy, but bringing on the fact that having what the patients have to say makes a difference in terms of quality of life. There was a study that they produced it's called the PROB study in which they looked at women that had metastatic breast cancer and they had an online sort of AI driven check-in. They found that the patients that had regular, every three month follow-ups with their physicians versus this online reporting platform where they would be reporting their different symptoms on an almost daily basis these patients that had that reporting system not only had a better quality of life, they lived longer. I mean, that's unbelievable, if you ask me. It sounds very you know. Obviously you know they had better quality of life because somebody was actually paying attention to them on a day-to-day basis, but the fact that it also translated into the women living longer I think that's you know it's really groundbreaking and it makes you wonder like, well, why don't we have these systems all around the country? Everybody should have this ability. So hopefully there'll be some movement in computerized AI interactions with patients in the near future. Let's see. What else should we talk about? The other big theme I saw was what we call de-escalation, and what I mean by that is that instead of giving everybody the whole kitchen sink, we try to bring it back and see, well, what's really necessary here.
Speaker 2:So one of the very exciting studies that they discussed was about patients that had low risk DCIS ductal carcinoma in situ and that's like the pre-malignancy you know. Right now the standard of care pretty much across the board is to remove the tumor or the area of the pre-malignancy. That's called a lumpectomy. Some patients have a mastectomy for other reasons. You don't need to have a mastectomy for DCIS. That might be a personal choice or because of genetics, but with the lumpectomy then they would get radiation therapy to that area. With the lumpectomy then they would get radiation therapy to that area and then they'd often be offered tamoxifen for five years.
Speaker 2:All of that for this in situ preventative type of thing that nobody dies from DCIS. It's really a matter of trying to prevent it from progressing into an invasive cancer that somebody could develop. So they looked at this study and certain criteria were met. Where the tumor was estrogen receptor positive, it was low grade, it wasn't that aggressive, and they actually looked at observation versus standard surgery with radiation, and patients were offered in both groups actually to take tamoxifen if they chose to. There was about 8% of the patients that were randomized or sent over to the group. That was supposed to be just observation, that they didn't feel comfortable with that and that they wanted to be in the other group, and so you were able to switch the group, but at any rate they actually showed that after two years they're still following these, but after two years there wasn't any substantial difference in terms of recurrence or new breast cancers being formed, even if they didn't take it out.
Speaker 2:That's pretty groundbreaking in terms of de-escalation right I mean think about all these patients that had DCIS that have the lumpectomy and the radiation and the tamoxifen. We're treating it almost like it's a stage one breast cancer, right?
Speaker 1:So are you saying that it was kind of this idea of over-treating things that were not necessary, of this idea of over-treating things that were not necessary.
Speaker 2:That's what I mean by de-escalation. Yeah, so we're sort of peeling back. How much do we really have to do? There was another study on women with breast cancer and this was sort of like an upfront surgery. So Dr Monica Morrow, who is the head of breast cancer surgery at Ford Kettering, presented this data looking at women who had, again, what appeared to be a low-stage estrogen receptor positive breast cancer and they were looking at whether or not it made any difference in the long run. They had the axillary dissection done and so this is groundbreaking, right.
Speaker 2:So how many women have had axillary lymph node dissections or even central lymph nodes done where they've had problems or complications from having somebody in that axilla? So in the study they showed that again, no significant increased risk of metastatic disease if you don't take those lymph nodes out. But it's a little provocative to do that because as a medical oncologist I need to know what's in those lymph nodes because that helps me decide what I'm going to do. So it's not considered, you know, practice changing yet we're still just discussing it. But it was very interesting information that in terms of how well the patient does in the long run, as long as it's a low risk seemingly early stage cancer they don't even have to take the lymph nodes out, yeah because I remember they took three out on the breast cancer side and one out on the other side, specifically just to make sure that nothing was there.
Speaker 2:Yeah, yeah, so I thought that was pretty interesting.
Speaker 1:Very.
Speaker 2:So let's see what other kind of stuff. Do you have any specific things you want me to talk about? You want me to talk more about metastatic cancer, early cancer let's talk about metastatic cancer.
Speaker 1:I've been talking to a lot of people who are dealing with metastatic cancer now. So, yeah, let's talk about that.
Speaker 2:Okay, let me pull up a couple of studies Now, as I mentioned to you before we got online, I'm referring to a document where I sort of made an outline of some of the different talks that I want to discuss with you, and I'm going to clean it up and make it patient, user-friendly and I'm going to give that to you after the production and so that you could put that down in the notes so that people can access that document so you can refer back to it. So, at any rate, one of the very exciting studies was called the PADMA study. So, first of all, to back up, because I don't know what your audience knows, so do you talk about CDK4-6 inhibitors? Never.
Speaker 1:Gotcha Never. I've never even heard of that.
Speaker 2:Really Okay, all right, so that's really important. So an estrogen positive metastatic breast cancer, the standard of care it kind of goes back and forth is to use upfront an aromatase inhibitor, right. Or if a patient's not in menopause they have to get a Lupron or something to make them chemically in menopause, and then an aromatase inhibitor like Arimidex or Letrozole and Astrozole, right. And then we add another drug to that called CDK slash six inhibitors and that second drug which I was referring to before that can cause the diarrhea, right, actually substantially improves response. So it substantially improves the cancer responding.
Speaker 2:And basically it's because with an estrogen receptor positive cancer you're giving two different drugs and it's kind of killing it in two different ways, right, so it's hitting the pathway. So the way a cancer would grow is, say that the receptor, which is like a little antenna on the outside of the cancer cell, right, and it pulls some estrogen from the body and that estrogen, once it binds to the receptor, causes the cell to get a signal that it can grow and spread and survive. And so by the different ways of getting rid of estrogen, one of which is the aromatase inhibitors. Aromatase inhibitors prevent estrogen being made in your body outside of the ovaries when you're in menopause.
Speaker 1:Interesting.
Speaker 2:Yeah, so premenopausal women. Like 98% of the estrogen in your body comes from the ovaries right. And when you're in menopause and the ovaries are either not there because they were removed they were shut down chemically by a shot of Lupron, or they went into menopause and they stopped working because of chemotherapy, or you just reached the age where it just stopped working right. So there's a couple of different ways. You hit menopause. At that point that 98% of estrogen isn't coming from the ovaries anymore, but there's still this little bit of estrogen that's being made in other parts of your body.
Speaker 1:Okay.
Speaker 2:And the estrogen in that situation is converted from other hormones, like testosterone, that our bodies make, and it's chemically converted into estrogen. And that conversion is created by an enzyme called aromatase. So a chemical reaction taking one hormone, switching it into estrogen. Now, all of a sudden, there's some estrogen floating around in your body when you're in menopause, and it's caused by this enzyme called aromatase. So an aromatase inhibitor blocks that enzyme and prevents that conversion. Does that?
Speaker 1:make sense. Yes, it does. Well, I'm picturing it in my head because I wondered where the estrogen comes from after you don't have ovaries, Like I don't. Mine was ERP or negative anyway, but I had my ovaries removed during my first or second. It was my second surgery, so I always wondered where is that estrogen?
Speaker 2:coming from Right, right, sure. So another concept I think that your patient, everybody, should understand is what an ESR1 mutation is. So again, going back to that whole, I wish I had a diagram to draw. Going back to a cell, and there's that receptor antenna that's looking for the estrogen in the blood, floating by. Sometimes this after you've deprived it from the estrogen by taking that aromatase inhibitor. So now there's no estrogen and the cell's like looking for it right. So, by survival of the fittest, one of these cells, when they're duplicating themselves, might make a mistake and one of them might have a mistake where that estrogen receptor is broken. I didn't mean to give you the finger Broken Love it, it's broken right.
Speaker 2:And it's broken in that it's turned on, so it doesn't care anymore if there's estrogen in the body. It thinks that there is and it's still turned on. It's sort of like the gas pedal gets broken and stuck on right.
Speaker 1:Okay.
Speaker 2:So now the cell doesn't care if it has estrogen and it's just growing and spreading, and what have you? So patients are taking aromatase inhibitors can become resistant to them by this mechanism.
Speaker 1:Okay.
Speaker 2:And that thing that happens is called ESR1, estrogen receptor 1, anyway. And so there are drugs that we use in that situation that go after the estrogen receptor that's broken, goes after it here and makes the cancer cell just kill off, get rid of the estrogen receptor. So now it gets rid of that broken receptor, and those are called SIRDs selective estrogen receptor degraders. Okay, so, as opposed. So there's three different ways that we kill estrogen receptor positive cancers. The other one is called a CIRM Selective Estrogen Receptor Modulator, and that's tamoxifen or Evista, so tamoxifen again. Going back to our receptor, right, looking for estrogen in the blood premenopausal or postmenopausal, doesn't matter, there can be estrogen in the blood but tamoxifen looks just like estrogen and it binds into that receptor, okay, and it blocks the receptor. So the estrogen is still floating around and it can't get to it because the tamoxifen is blocking it.
Speaker 2:Okay, so that's a CIRM. A CIRD is where it just degrades or gets rid of the receptors altogether, and then the aromatase inhibitors are the ones that prevent the creation of estrogen from other hormones. So if you understand all that, you can understand a lot of the treatments that go into estrogen positive breast cancers. Okay.
Speaker 1:So I'm trying to remember what the chemo. I had two chemos and mine, was ERP or negative, so what?
Speaker 2:Wait, did you have HER2? I did so you were ER negative, pr negative, her2 positive. Yes, correct, okay, so Herceptin is an antibody against HER2.
Speaker 1:Okay. That was the first one.
Speaker 2:So here are the receptors again, right? So in the receptor situation with HER2, HER2 is normally present on all the cells but there's only supposed to be two copies of it. So there are only supposed to be two genes in each cell that make HER2. In a HER2 positive cancer, those genes get duplicated and so that's why you get a HER2 positive score and that means that, say, there's six genes that are making the HER2 receptor. Now, all of a sudden, instead of two receptors, there's like six of them on the outside, and so those cells are like revved up because they're getting growth factors in the blood binding to those receptors and signaling the cell to grow and spread and live. So Herceptin and Pertuzumab are the antibodies.
Speaker 2:Perjeta is the other name for Pertuzumab, perjeta. Yeah, perjeta, herceptin and Perjeta are antibodies that bind to those HER2 receptors and help block them from signaling.
Speaker 1:Okay, so question yeah, I had four things that were infused in me every time I went in. One was the Herceptin and Progetta and the other one's Progetta, the two chemos though there were two chemos as well, and I don't remember.
Speaker 2:Probably Taxotere and Cytoxan, maybe.
Speaker 1:Taxotere sounds familiar, I didn't know what it was. I know that it was supposed to help shrink the tumor, which it did. But those two. I'm just curious why those ones are chosen over other ones. I mean, I know that there's just different kinds.
Speaker 2:There are other regimens that where I came from, at Soncada, and we didn't use that regimen quite as much. If a patient was going to get full chemotherapy because you had positive lymph nodes, for example, we were using adriamycin and cytoxin, which is AC. Patients would get four cycles of that and then we would usually use weekly Taxol or every two-week. Taxol depends, and Taxol which is a cousin of Taxotere would be given once a week and then Herceptin and Progetto would be given every three weeks.
Speaker 1:Okay, so I got the two chemos and the two meds every three weeks together. Correct, correct.
Speaker 2:It's just a different regimen and, to be honest with you, you're on the West Coast or closer to the West Coast, and I'm on the East Coast and a lot of these regimens have been compared and what have you. And there's usually more of like an institutional bias from where you're being treated and it might depend on which clinical trials your institution was actually working on before these drugs were approved. But what's actually interesting from San Antonio is that they looked at a clinical trial in which patients with HER2, let me just pull this one up for you where patients with HER2 positive breast cancers actually didn't necessarily have to get chemo at all. So isn't that cool. So there was a trial where they looked at using an anti-HER2 medication in combination with something else and they were actually even able to not need chemotherapy in some certain circumstances. There was also Lucky them. Well, they still were. So here's another study. Okay, so there's something called an ADC. You know what I think? I think, Jamie, I think we're probably better off doing like just general topics and maybe I'll come back and go over some of the trials or I'll just post them, because I think I feel like we need to kind of make sure that everybody's on the same playing field of understanding.
Speaker 2:Adc is an antibody drug conjugate and what that is. That's super cool. So we already talked about the receptors, right, the receptor on the outside of the cell. There's all different kinds of receptors, and so an ADC is a drug where they find a receptor that's frequently found on all breast cancer cells, or most breast cancer cells, and it can be the HER2. There are HER2 ADCs and they take that. So it's something that binds to a receptor. Like in this manner it's called an antibody. So they take the antibody to HER2, and then they link it to a chemotherapy agent that is not activated until it's gotten into the cell. So again, it's like a smart bomb some people will call it, and basically you have the antibody and it finds a cancer cell and linked to it here is a chemotherapy. So once it binds to the cell by the receptor, it gets taken into the cell and then the chemotherapy gets released and it kills the cell from the inside out. Smart bomb, Very interesting.
Speaker 2:Isn't that cool. So there are. These are tons of these are being are in development right now, and I'm sure some of your patients that may have more advanced breast cancer may have heard of some of these.
Speaker 2:So for example, inher2, I don't know if anybody's heard of that one, t is what it's called, and that's a Herceptin-based drug. And there are others that they found that are supposed to bind one of the not HER2, but a different HER receptor. And they are finding that cancer cells that even aren't considered HER2 positive, so you say that your cancer cell is HER2 positive. That's why you got Herceptin and Progetta. They're finding that patients' cancers that are HER2 low, meaning they didn't have, you know, instead of having eight receptors on the outside, maybe they only had two, maybe they had three, something. So it's still considered like pretty low that some of these ADCs that bind to HER2 still work. So now we've got these smart bombs that are binding to cancer cells, even you know sort of very specifically, and they're showing that some of these ADCs work even better than chemo. Wow, yep.
Speaker 1:And much better tolerated, much, much better tolerated when you were practicing. Were you very upfront and able, or did you find that you explained what patients were getting and why? Because I was never told any of this. I was like we're doing this, this and this and I had no idea why. Like, here's what. Here's one of the things, and I think I've asked you this before At the beginning of mine, I was told that I was going to go through the chemo first and then have surgery. And all I ever heard was from all these other people where they got breast cancer, had surgery and then chemo. Why is there a difference between when you have surgery and chemo? You know, like and and some are just completely opposite. Those were never actually. That's not true. She did explain to me that part of it was for efficacy. She wanted to see if that chemo would work on me, wanted to see whether the tumor would shrink first. So she actually did explain that part to me whether the tumor would shrink first. So she actually did explain that part to me.
Speaker 2:Why doesn't everyone do that?
Speaker 2:Well, first let me answer that second part.
Speaker 2:So the reason all this stuff flows right off my tongue is because this is how I spoke to my patients all the time and I pride myself in my ability to explain these things, and I usually unfortunately I didn't set up like for this today, but I often will make drawings and my patients will go home with like pages of my drawings and my illustrations of why things work, and it's a little easier to draw things out and explain at the same time, and that's exactly what the basis of my entire company is.
Speaker 2:Winning the cancer journey means that you are going to get the best outcome you possibly can with your breast cancer treatment. In other words, I want you to get through this with confidence, clarity about what's going on and why you're doing all these things, and also with a sense of community. In other words, I want you to be able to be confident enough to speak to your physician and ask the right questions because you understand. And also I want you to be able to partner with your physician and your whole care team so that you are part of the decision process, and I think all of that boils down to knowledge is power education, and so what we've been talking about tonight is standard fare for how I help patients these days, and always actually. So, going back specifically to your question about it's really what you're asking me is why do some patients get adjuvant chemotherapy Neo meaning before?
Speaker 1:the surgery.
Speaker 2:Yep, so you know you've already mentioned one of the reasons.
Speaker 2:So if you can give somebody chemotherapy and actually can still feel the tumor you can check it every week or two and make sure that it's shrinking right, and so you have sort of a litmus test is how sensitive the cancer is to the chemotherapy. So that's one benefit, but that's not usually why we do it, that's sort of like an added benefit. We usually do it for two main reasons. One most usual common reason is because the tumor is too big and the patient wants a lumpectomy, for example, and so we need to shrink the tumor down so it's more contained, so that they can do a clean, easy lumpectomy, remove the tumor.
Speaker 2:We also have to, potentially sometimes we have to downstage the axilla. So if we see on the MRI, for example, that there are four positive lymph nodes, we'll give chemotherapy first to try to kill off most of the cancer cells in those lymph nodes, so that we don't have to take 20 lymph nodes out afterwards because that would cause more problems later on. So downsizing the tumor is probably the main reason and the two types of cancers that we usually do that in I mean we could do it in all three types, but the main two that we do it in are either triple negatives or HER2 positive breast cancer, exactly, and those are usually the cancers that are dividing more rapidly than an ER positive breast cancer.
Speaker 1:But one more thing.
Speaker 2:Let me just tell you the third one. So the third reason is because of these ones that are dividing more rapidly like a triple negative or like a HER2 cancer, we want to make sure that we get the chemo in there to control the cancer, to make sure it doesn't spread anywhere else before you get to surgery. So we're killing off micrometastatic disease before it gets a chance. So I'm sure you had a CT scan or a PET scan before you started chemotherapy to make sure that it hadn't already spread at least to what was visible to our eyes on radiology. And then, because you had an aggressive types of cancer with the HER2 and your tumor you started to say was five centimeters, they wanted to shrink it down and get rid of any microscopic cancer cells that might've escaped out into the body before you went to surgery.
Speaker 1:So I'm sorry I'm going to ask you. No, that's okay, you just totally. I what I wanted to know was I don't even know what is considered to be big. You know, is five centimeters considered to be big? Yeah, because I mean, I felt it. I yeah, that's a sizable tumor. Yeah, I had a mammogram and an ultrasound less a little less than a year prior to my diagnosis. They saw nothing, so that must have started growing from that point forward, and pretty fast. Yep, just very fascinating.
Speaker 2:One of the things that people can look for in terms of the growth rate of the cancer cell if you looked at your pathology report is the KI-67. And that is a measure of the growth rate of a cancer cell. So something like an acute leukemia that grows really, really fast has a KI-67 of like 90% 95% so that's really fast Whereas something that's like a low grade tumor, meaning like less aggressive looking, might have a KI-67 of 15 or 20.
Speaker 1:If I go back to my pathology. From my diagnosis I can see what that level is and then I can kind of think about how fast that was growing that whole year. Interesting.
Speaker 2:Yep, so often the patients usually get chemo before surgery neoadjuvant is the word again and then they have surgery and then usually we'll get more chemo afterwards as well, and then you probably got maintenance, perceptive and progenitor for a year.
Speaker 1:Right, the rest of the year, yeah exactly a year, right, the rest of the year, yeah, exactly, yep, yeah. And then, of course, I. I always tell people it's like oh, you know, when you get breast cancer, or any kind of cancer for that matter, there's always something else that's going to happen, like for me. For me, I developed a rare anemia and, because of the thymoma tumor that they found right, and it was putting off antibodies and it was attacking my red blood cells that was already producing too slow, and I had to be on this cyclosporine for quite some time, and they weaned me off of it, though, and so far, so good.
Speaker 1:But, there's just always something else. But I asked my doctors how would I have ever have known that that thymoma tumor was in there, had I not gotten breast cancer? Who would know?
Speaker 2:Yeah, and or maybe that thymoma wouldn't have necessarily developed or gotten aggressive or active without the chemotherapy.
Speaker 1:Oh, maybe Right, and that's what I was thinking too. That's why, when I was first getting anemic, my oncologist thought it was an iron deficiency, because she had seen that happen with yeah, and she had seen that happen with chemo and stuff like that, and it turned out to be a completely different type of anemia Like I could do a whole Ted talk on it. I was going to say that people that learn from you, I feel like you give them enough information where they actually could go do a TED Talk. You know, I hope it's not overwhelming. No, I think it's important for people to know this, and so I want to go in next to talking about winning the cancer journey. How is that structured? How has that kind of changed over time since you and I first met?
Speaker 2:So you know, as you know your audience probably doesn't I actually retired from Memorial Sloan Kettering in August and that was a rough month or two, to be honest with you, because I left this job that I had been part of. My life was my life for 25 years, right. So now I'm not going and seeing my patients every day and we're not going to get into this today, but I had a medical issue, a chronic medical problem, that contributed to my retiring. But I am still functional enough that I have and I have still have so much to give and to teach that I needed to pivot and find another way to do this, and so I developed let me just step back. So that same month my last kid moved out from college to go to college. So I became an empty nest and changed my whole career path. So that was a tough couple months.
Speaker 2:But winning the cancer journey, as I mentioned. I named it that because I want people to get the best that they can out of their cancer care and their treatment, to go through their journey. And the reason I use the word journey is because I don't feel like it really ends when the chemotherapy ends. You still are. The journey changes a little bit and the road will wind, but you're still always thinking about cancer and dealing with the fact that you had cancer, et cetera, et cetera, and unfortunately, some patients recur, and so the journey is never really over, because I know some of my patients are not sure they like that word or not, so I'm thinking about rebranding, but at any rate.
Speaker 2:So what I love to do is to speak. I am very passionate about trying to get into some of the breast cancer organizations and be able to give some of my talks talks both about mindset as well as about educating, and you know if I'm speaking to caregivers about how to educate patients better, and I am actually in the process of writing two online courses, as you had mentioned. So wonderful, yeah, so one is specifically for caregivers and one is specifically for patients, and the reason I decided to do both is that I think they're both critically important.
Speaker 2:I often find that patients, when they're in the exam room with me, will not necessarily absorb everything that I've said, which is why I write things down and send them home with drawings and such. But I feel like if you had in your own time, in your own space, at your own pace, the ability to sort of understand and learn a lot of the concepts, for example, that I discussed tonight, I feel like that would be very, very helpful to patients.
Speaker 1:Very helpful.
Speaker 2:Yeah, and then the caregiver course has a lot of that same education in it but also talks about how to be a good caregiver, because a lot of times patients, people that are the caregivers don't really know what to do. They don't know how to best help their loved one or their friend. And you know, I've been in the space for so long, I know how important it is to have the caregiver on board, sort of not just as like the support system, but also to be the advocate for the patient, when the patient isn't, you know, feeling well or isn't able to sort of ask the questions that they need to ask, and so I feel like it's really important to educate both sides.
Speaker 1:For sure. Yeah, yeah, no, I totally agree. My husband came with me to all of my appointments. It was very rare if he wasn't there. I don't even know if there was any time.
Speaker 1:You know, he came with me to my infusions and all of that, but he took very, very detailed notes because I was just in a world of you know, um, and so when we would come home, I would take his notes and I would reformulate the verbiage and how I wanted to put it out there, cause I had a caring bridge and I also had um, had a Facebook private group, and that's how I would update. All of my friends and family is taking his notes, and then I, and then that helped me absorb what was going on in my own body. So, yeah, sure.
Speaker 2:So you had a really good support system you both not everybody does, not everybody does. And the other thing is that you know, sometimes, depending on education levels, sometimes patient doesn't have somebody to go with them. What have you? So that's why I'm still offering second opinions and concierge work, and so you know what that means is basically and I'm not taking a lot of patients to do that, just handfuls of them, because I want to be able to take care of each of these patients on my own, just as opposed to in a clinic where I'm seeing 25 patients every day and I'm writing notes all night long.
Speaker 2:And what have you? If I have a handful of patients that I can take exquisite care with, that I'm their doctor in the pocket, that they can call me on my cell phone and ask me hey, my doctor just said X, y, z. What does that mean? I can set up a Zoom call with them and go over the whole thing. And so I am still practicing in that manner. I'm just not prescribing anymore, I'm just doing virtual second opinions and what I call concierge work, meaning that I'm sort of helping guide patients through what they're going through and helping to interpret and explain to them everything that's going on because not everybody's doctor is adept at doing that or takes the time to do it, and that kind of thing.
Speaker 1:Yeah, I love it. You're, you're clear, you clearly you know, really love what you do and you've helped so many people, and even online. Now tell us about your book. What's, what is the book, what is the structure of that?
Speaker 2:Sure, so thank you for asking that.
Speaker 2:My book is my baby and I am kicking it out the door by January 1st to get its round of its next round of editing, because I've been dreaming about writing this book for so long. This book is currently. The working title is Winning the Cancer Journey, although that is still. I think I might send out a survey to my Facebook group my private Facebook group and see what people think about that name. At any rate, I have a couple of ideas.
Speaker 2:So I take this book, and the chronicity of it is that when a person is first diagnosed meaning that the first time you hear like, oh, I feel a lump, oh, there's an x-ray, that's abnormal. Now what's going on? Maybe it's cancer and I walk you through the entire process, written from a physician's standpoint, speaking on a patient's level. So you know, there are chapters on radiology and the workup, the type of biopsies that you can have, how to look at your pathology report, what is a receptor, as you can imagine. So, and right now it's 13 chapters I am currently finishing up a chapter on mindset and another chapter on integrative medicine.
Speaker 2:So I am not an integrative medicine specialist, but it was one of the things that my patients most frequently asked me about most frequently asked me about what supplements can I take. Can I get a vitamin C infusion? Do I have to take chemo? Can I get a coffee enema instead? And I'm not making light of it, I'm just saying that I have heard it all and I just want to try and address some of the more common questions that I've heard in the past.
Speaker 2:Again, I personally feel like there is a marriage that needs to be made between allopathic and functional slash, integrative medicine. In terms of oncology, I come from an academic institution and functional medicine is very much like not looked at as real stuff. I think it's somewhere in between and I do think that sometime in the you know, hopefully in the not so distant future, that the two will be more married, that sometime in the you know, hopefully in the not so distant future, that the two will be more married because I am kind of off topic here, but I love the fact that functional medicine goes after the root cause of the disease and I think, until now at least, a lot of our medicine is really just treating it after it happens, as opposed to like figuring out how to prevent it.
Speaker 1:I mean, you know, trying to prevent, like inflammation in the body. You know that all goes together. So I've grown up in a family who has been very big into functional medicine. What is it that we can, you know, eat or not eat that can help our body be at an alkaline level or whatever you know, low inflammation, checking your CRP and stuff. We actually have an integrative oncologist here in Reno and one of my friends is seeing him. We're not just working with him, though. He is very much into working with a general oncologist, you know oncologist. So they're working as a team and that to me, that spoke to me because you know he's not just saying, oh no, you should just do this and everything should be fine and your cancer will go away. He's like, no, there is a place for me and there's a place for a general oncologist. Yeah, yeah, I like that place for a general oncologist.
Speaker 2:Yeah, yeah, I like that. I feel like I feel that you know most of the medicine that I'm coming from. You know mainstream Cornell Medical School. You know major hospital systems. We're the closest that we get to going after the root cause of a cancer sort of trying to prevent it can be with. You know some of the immunotherapy approaches, some of the vaccine approaches and then some of the specific drugs like a PARP inhibitor. I don't know if you've heard about those before, but PARP inhibitors are used in patients that have a BRCA mutation, and so those drugs are being used in patients after their treatment, as a maintenance, for example, and helps prevent new cancers as well as recurrence of the same cancer for patients that are at high risk because of BRCA. But they're now looking at using those medicines as preventative as well. So if you know you have a BRCA gene, maybe you have to take this medicine for a couple of years to help prevent you from getting a breast cancer.
Speaker 2:But those types of things are still being looked at, so it's not standard.
Speaker 1:Yet you mentioned, when we talked last week or whenever it was, that when you went to the breast cancer symposium you went in a very different capacity than you used to go. So you used to go as a medical oncologist and you still are, but in a different capacity. Right, how was that for you? What was that like?
Speaker 2:but in a different capacity. How was that for you? What was that like? It was very interesting and in fact, I think in some ways it was much more fulfilling because I spent because I'm doing different types of things I'm doing a lot more advocacy type of work and public education and that sort of thing. I spent more time going and, you know, meeting the advocates and the volunteer groups that were there that are supporting these meetings. I was looking at different spoke to different drug companies that I knew had different developments of things that were coming up, because I wanted to be able to speak for them to my patients as well.
Speaker 2:So I wasn't necessarily just learning exactly what the new, latest and greatest is of treating ER negative breast cancer. I did learn that, but I also was looking at it from more of an advocacy, patient education side of it as well. It was very fulfilling. It really was. I was exhausted by the time I got home.
Speaker 1:I knew you would, because I I slept for like a day and a half.
Speaker 1:Yeah, I've heard that it was just really awesome. So, absolutely, when we can sign up for that, I will definitely go with you. We'll room together, we'll eat together, we'll have a good time together, learn from each other online. You, um, I have your Facebook page, your Instagram and your LinkedIn that people can follow, and I just really think that what you're doing is so you know, it's just much needed, because I really do believe that, well, not all oncologists actually educate their patients the way you do, and because you are out there and you've retired from you know. You've retired and you're still out there, though, advocating for others willing to help them and actually help tell them what's going on in their body, why they're getting certain you know medications, and then, on top of that, you have a book, and I'm really looking forward to seeing, though, the courses for new patients, but also the caregivers and I just
Speaker 1:just caregivers are just as big of a part of it all. Yeah, Yep, Exactly. Well, I think this has been great. I just I'm glad that you were able to share your highlights from the symposium and what you're doing and and your book that's coming out in January. I am curious what you're thinking about me. You know renaming. You know what words you might be looking at for journey in place of journey, Because I know that people like I don't mind it, I don't care, I know what it is. You know, you know I don't know why that word triggers people so much, but I am curious what kind of name you would come up with.
Speaker 2:So I was speaking to an advocate yesterday or two days ago, who you might know from the Fashionista yes, yes, yes, yes, amazing, amazing woman.
Speaker 1:I just started listening to her podcast. I'm actually going to be on her podcast next week.
Speaker 2:So awesome, yeah, but at any rate. So we, she and I, were chatting about this and she mentioned we talked about it because I had heard from somebody else and it was like the second time I heard somebody say one person said they didn't like the word winning because once you have cancer you never feel like you're winning, but you know okay, and then some people don't like the word journey. So you know again, I I think once I explain it to you and why I called it that I think people would understand better. But I don't want to turn people off obviously from the you know from the get go if they don't know what I mean. So somebody Melissa had actually suggested to me because I want to give her credit calming the cancer chaos.
Speaker 1:Calming the cancer chaos, I love it. What do you think I love it? Slaying the cancer beast. I love it. Slaying the cancer beast, killing the slaying, you know. No, I like that too, you know, because it is chaos and I mean, obviously, you know, you want to calm it.
Speaker 2:And so I think that's really good, yeah, interesting, right, yeah? So I'm working with it. I'm using a little chat GPT, just throwing words in there and let it spit it back to me, see what's there, and then, like I said, maybe I'll throw a survey into my private Facebook group. Absolutely, I think you should Hopefully all your listeners join my group, because that's a nice group.
Speaker 1:Well, I will tag you on when I post about this as well. And yeah, I just. I mean, I just always enjoy getting together with you and chatting about the important things and I just want to know do you have anything to leave us with before we disconnect?
Speaker 2:Thank you for having me. I feel like it's like not only like a duty for me to share all the information that I have, but I also feel very honored to be able to explain to everyone and hopefully make people's journey or pathway, or walk through their cancer chaos to make it easier for them. Like I feel like it's almost a cause, a calling for me to do that, and so I'm really that. Make sure that you're advocating for yourself and make sure that you are always comfortable with the information that you're getting, the recommendations that you're getting, and if you're not, you need to ask more questions, get another opinion, make them explain it again.
Speaker 1:Advocate for yourself, don't be afraid to do that. You know, what's really interesting is that when I first found out that I was getting chemo, someone in my family from the East Coast sent me a message and said don't do chemo, it'll ruin your body. You need to call Sloan Kettering or Mayo Clinic. And so, had I called Sloan Kettering, I might've gotten you. We would have met on a totally different circumstances, right?
Speaker 2:Well, listen, it's very possible, but you couldn't fly from Reno to New York.
Speaker 1:Yeah, how would I do that? But anyway, everything worked out so far, so all right. Well, thank you very much again, and I've learned so much from you, and I continue to learn from you, even into my survival journey, and so we will reconnect again and talk about some other things, and until then, thank you. I hope you have a great holiday. We are recording this, it is the 22nd of December, and so it's almost Christmas and New Year's and Hanukkah and all the things, and Kwanzaa. So happy holidays to you, dr Truso, and to my audience. Thank you again for joining us, and I just really hope that you can go to YouTube. This video will be on YouTube. Dr Truso was showing us a couple of things with her hands that you might want to see, and so if you go to YouTube, you'll see the video, and if you can go to all of your platforms, wherever you're listening and rate and review, it really does help spread this podcast around the world.
Speaker 1:And until next time, we will see you on the next episode of Test those Breasts. Bye for now, friends. Thank you so much for listening to this episode of Test those Breasts. I hope you got some great, much needed information that will help you with your journey. As always, I am open to guests to add value to my show and I'm also open to being a guest on other podcasts where I can add value. So please reach out if you'd like to collaborate. My contact information is in the show notes and, as a reminder, rating, reviewing and sharing this podcast will truly help build a bigger audience all over the world. I thank you for your efforts. I look forward to sharing my next episode of Test those Breasts. Thank you,
