Advancing Breast Cancer Care for Hispanic Women

Transcript

00:00 --> 00:01Funding for Yale Cancer Answers
00:01 --> 00:03is provided by Smilow Cancer
00:03 --> 00:04Hospital.
00:06 --> 00:07Welcome to Yale Cancer Answers
00:07 --> 00:08with the director of
00:08 --> 00:10Yale Cancer Center, doctor Eric Winer.
00:12 --> 00:14Yale Cancer Answers features conversations with oncologists
00:14 --> 00:15and specialists who are on
00:15 --> 00:17the forefront of the battle
00:17 --> 00:17to fight cancer.
00:18 --> 00:20This week, doctor Tracy Battaglia
00:20 --> 00:21is filling in for doctor
00:21 --> 00:22Winer for a conversation about
00:22 --> 00:24breast cancer surgery
00:24 --> 00:25and some of the racial
00:25 --> 00:27disparities that exist in breast
00:27 --> 00:29cancer care with doctor Monica
00:29 --> 00:29Valero.
00:30 --> 00:31Doctor Valero is an assistant
00:31 --> 00:33professor of surgical oncology at
00:33 --> 00:34the Yale School of Medicine.
00:35 --> 00:36Here's doctor Battaglia.
00:36 --> 00:37So why don't you tell
00:37 --> 00:38us a little bit about
00:38 --> 00:38yourself,
00:39 --> 00:40your area of expertise in
00:40 --> 00:42surgical oncology, and what brought
00:42 --> 00:43you to this field?
00:45 --> 00:46I am a breast cancer
00:46 --> 00:47surgeon
00:48 --> 00:48specialized
00:49 --> 00:51primarily in breast cancer and
00:52 --> 00:53lesions of the breast.
00:53 --> 00:55I have been working as
00:55 --> 00:58an assistant professor of surgery
00:58 --> 00:59since twenty nineteen.
01:02 --> 01:03I'm passionate about the care of
01:04 --> 01:06breast cancer, specifically because of
01:06 --> 01:07the multidisciplinary
01:07 --> 01:08team and multidisciplinary
01:09 --> 01:10care that is involved.
01:10 --> 01:12Additionally, I feel like it's
01:12 --> 01:13a field where
01:15 --> 01:17research continues
01:17 --> 01:18to evolve, and I feel
01:18 --> 01:20very passionate to join breast
01:20 --> 01:22cancer treatment since I was
01:22 --> 01:24very young during medical school.
01:25 --> 01:26And, so thank you for
01:26 --> 01:27sharing that. I know that
01:28 --> 01:30our paths crossed in Boston,
01:30 --> 01:31but you're here in Connecticut
01:31 --> 01:32now. Can you tell us
01:32 --> 01:32a little bit about your
01:32 --> 01:34training and your path to
01:34 --> 01:35getting to Yale Cancer Center
01:35 --> 01:36and caring for patients here
01:36 --> 01:37in Connecticut?
01:37 --> 01:40Yes. So I did my
01:40 --> 01:41research in breast cancer and
01:41 --> 01:43my training in general surgery
01:43 --> 01:45at Brigham and Women's Hospital
01:45 --> 01:46in Boston, Massachusetts.
01:47 --> 01:48During that time
01:48 --> 01:49I was very lucky to
01:49 --> 01:51cross path with you. And
01:51 --> 01:51and then I
01:52 --> 01:54started my career as an
01:54 --> 01:55assistant professor
01:55 --> 01:57at the Beth Israel Deaconess
01:57 --> 01:58Medical Center, where I spent
01:58 --> 01:59three years as a
02:01 --> 02:02junior faculty.
02:04 --> 02:06Most recently,
02:06 --> 02:07I have had the
02:07 --> 02:09privilege to join
02:09 --> 02:12the Yale Breast Cancer department
02:13 --> 02:14here where I had the
02:14 --> 02:15opportunity to
02:16 --> 02:18circle back and work again
02:18 --> 02:19with my prior mentors
02:20 --> 02:22and it has been an
02:22 --> 02:22amazing
02:24 --> 02:26time. And it's great to
02:26 --> 02:28be working with.
02:33 --> 02:33Well, we're lucky to have
02:33 --> 02:35you here in Connecticut.
02:37 --> 02:38I want to go back to a comment
02:38 --> 02:39that you made about
02:39 --> 02:40the kind of rapidly
02:40 --> 02:42evolving field and excitement
02:42 --> 02:43in the field. NOTE Confidence: 0.9747726
02:43 --> 02:45Cancer care
02:46 --> 02:47is a rapidly evolving field
02:47 --> 02:48in all fields, whether it
02:48 --> 02:51be surgical oncology, medical oncology,
02:51 --> 02:53or radiation oncology.
02:54 --> 02:55Can you tell us a
02:55 --> 02:56little bit about
02:57 --> 02:59the innovations in the surgical
02:59 --> 03:01care of breast cancer patients
03:01 --> 03:02and what you're most excited
03:02 --> 03:03about for the future?
03:04 --> 03:06Tracy, as you
03:06 --> 03:06know,
03:07 --> 03:08in breast cancer, we work
03:09 --> 03:09hand to hand,
03:10 --> 03:12surgery, medical oncology, and radiation
03:12 --> 03:13oncology.
03:13 --> 03:15And as you already mentioned,
03:15 --> 03:16this field continues to
03:16 --> 03:18evolve with a growing focus
03:19 --> 03:21on balancing effective care with
03:21 --> 03:22quality of life. So the
03:22 --> 03:23multidisciplinary
03:23 --> 03:25teams are working towards the
03:25 --> 03:26deescalation
03:27 --> 03:28of surgical procedures that are
03:28 --> 03:30not going to impact
03:30 --> 03:33additional recommendations or additional
03:33 --> 03:33treatment.
03:34 --> 03:35In this way, we reduce
03:35 --> 03:37the physical and emotional burden
03:37 --> 03:38of patients while
03:39 --> 03:39simultaneously,
03:40 --> 03:43we escalate in adjuvant therapies
03:43 --> 03:45such as targeted treatments, immunotherapy
03:45 --> 03:47to achieve optimal outcomes with
03:47 --> 03:48less invasive approaches.
03:49 --> 03:50So this has been,
03:51 --> 03:51you know,
03:52 --> 03:54great, especially for patients to
03:54 --> 03:56have better quality of life
03:56 --> 03:57with better outcomes in terms of decreasing
03:58 --> 04:00chances of breast cancer
04:00 --> 04:01recurrence.
04:02 --> 04:03So you used some terms
04:03 --> 04:05there that I wanna unpack
04:05 --> 04:06a little bit, and maybe
04:06 --> 04:07you can give us some
04:07 --> 04:07examples
04:09 --> 04:10of deescalation
04:11 --> 04:12of surgical approaches because when
04:12 --> 04:14I was training
04:14 --> 04:15many, many years ago,
04:16 --> 04:17you know, surgery was the
04:17 --> 04:18first line of treatment for
04:18 --> 04:20breast cancer and
04:20 --> 04:21some pretty invasive surgical
04:21 --> 04:22approaches
04:24 --> 04:25to treat breast cancer. So
04:25 --> 04:27maybe you can just comment
04:27 --> 04:28and tell our listeners
04:28 --> 04:29a little bit more about
04:29 --> 04:30what you mean by
04:30 --> 04:31deescalation of surgical approaches?
04:32 --> 04:34Yes. So as you mentioned,
04:34 --> 04:34you know, back in the
04:34 --> 04:36days, it was like one
04:36 --> 04:37surgery fits all. There was
04:37 --> 04:39the same surgery for everyone.
04:39 --> 04:40With more research, we have
04:40 --> 04:41learned
04:41 --> 04:43that surgery is going to
04:43 --> 04:45be targeted to tumor subtypes.
04:45 --> 04:46And what I'm
04:46 --> 04:48trying to say, with the
04:48 --> 04:49deescalation
04:49 --> 04:50of surgical procedures
04:51 --> 04:53sometimes there's surgeries
04:53 --> 04:54that are
04:55 --> 04:56not going to provide any
04:56 --> 04:58information that we're going to
04:58 --> 04:58use
04:58 --> 05:00to tailor the treatment.
05:01 --> 05:03And we are avoiding and
05:03 --> 05:05doing less surgeries, avoiding morbidity,
05:06 --> 05:08and side effects.
05:08 --> 05:09For example, right now
05:10 --> 05:12we have recent
05:12 --> 05:13data about
05:13 --> 05:14trials
05:14 --> 05:15where we are omitting
05:16 --> 05:18axillary staging or surgery under
05:18 --> 05:19the arm.
05:20 --> 05:21And this is in specific
05:21 --> 05:22cases where
05:23 --> 05:24the information from the lymph
05:24 --> 05:25nodes is not going to
05:25 --> 05:27impact the treatment
05:27 --> 05:28for those patients.
05:29 --> 05:30And so what does that
05:30 --> 05:31translate to from the patient's
05:31 --> 05:32perspective?
05:33 --> 05:34Translating less time in the
05:34 --> 05:36operating room? Less
05:37 --> 05:38chances for having side effects
05:38 --> 05:40on the arm, less chances
05:40 --> 05:42for having arm swelling, better
05:42 --> 05:42recovery?
05:43 --> 05:44So it's all
05:45 --> 05:46with the goal to improve
05:46 --> 05:48quality of care.
05:49 --> 05:51So that's really helpful. Those
05:51 --> 05:52examples, I think, are really
05:52 --> 05:53helpful for us to sort
05:53 --> 05:54of get our heads around
05:54 --> 05:55what we mean.
05:57 --> 05:59You also mentioned the
05:59 --> 06:01acceleration or escalation
06:01 --> 06:02of adjuvant therapy
06:03 --> 06:04before surgery. Can you talk
06:04 --> 06:05a little bit about that
06:05 --> 06:06and how that's different now
06:06 --> 06:07than it was before?
06:08 --> 06:08Yes.
06:09 --> 06:10So with the evolution
06:10 --> 06:13of medical therapy, systemic therapy,
06:13 --> 06:14and immunotherapy,
06:14 --> 06:15now we can target
06:16 --> 06:18specific cancer with a specific
06:18 --> 06:20therapist, avoiding giving
06:20 --> 06:21the one size fits all.
06:22 --> 06:23So now we know that
06:23 --> 06:24there are specific medications that
06:24 --> 06:25are going to be targeted
06:25 --> 06:27to a specific cancer subtype,
06:27 --> 06:28and this is going to
06:29 --> 06:31allow for some cancers
06:31 --> 06:33to even downgrade or
06:33 --> 06:35shrink before surgery, allowing for
06:35 --> 06:37smaller surgeries, not only on
06:37 --> 06:38the breast, but also under
06:38 --> 06:39the arm.
06:40 --> 06:41So perhaps a message to
06:41 --> 06:42our listeners
06:43 --> 06:45who perhaps are dealing
06:45 --> 06:47themselves or family member with
06:47 --> 06:49a breast cancer diagnosis, understanding
06:49 --> 06:49your tumor
06:50 --> 06:51and it's what you call
06:51 --> 06:53subtype is an important step
06:53 --> 06:54towards understanding
06:54 --> 06:57what options you have surgically
06:57 --> 06:58and otherwise. Is that fair to say?
06:58 --> 06:59Yes, I think
06:59 --> 07:01that's totally fair to say.
07:01 --> 07:02That's great.
07:04 --> 07:05I wanna ask you a
07:05 --> 07:07little bit about
07:07 --> 07:07the current
07:11 --> 07:12incidence of breast cancer.
07:13 --> 07:14And many of us are
07:14 --> 07:16hearing more and more of
07:17 --> 07:18cases and colleagues and friends
07:18 --> 07:19and family members who are
07:19 --> 07:21developing breast cancer early,
07:22 --> 07:23younger than before.
07:24 --> 07:25And I wonder if you
07:25 --> 07:26can comment a little bit
07:26 --> 07:27on sort of the rising
07:27 --> 07:29incidence in younger populations with
07:29 --> 07:30breast cancer.
07:31 --> 07:32Yeah. So I think the
07:32 --> 07:34incidence of breast cancer,
07:35 --> 07:36there is evidence that it is
07:36 --> 07:38arising. It continues to
07:38 --> 07:40rise. And specifically in the
07:40 --> 07:42younger population, although
07:42 --> 07:44for the younger population, they're
07:44 --> 07:45still reminded to be
07:45 --> 07:47less common compared to the
07:47 --> 07:47older groups.
07:48 --> 07:50Breast cancer, the natural history
07:50 --> 07:51of breast cancer is
07:51 --> 07:52this is a disease of
07:52 --> 07:54the older population, not of
07:54 --> 07:55the younger populations.
07:55 --> 07:57But I think right now,
07:58 --> 07:59nowadays, there are several factors
07:59 --> 08:01that may be contributing
08:01 --> 08:03to the trend.
08:03 --> 08:04And I think some of
08:04 --> 08:06them could be just lifestyle
08:06 --> 08:08and environmental factors.
08:08 --> 08:08We know that there is
08:08 --> 08:10a rise in obesity and
08:10 --> 08:11sedentary lifestyles.
08:12 --> 08:13It has been well
08:13 --> 08:15reported that increased rates of
08:15 --> 08:15obesity,
08:16 --> 08:18even at younger ages, is
08:18 --> 08:19linked to higher risk for
08:19 --> 08:20breast cancer.
08:21 --> 08:23Also, as women
08:23 --> 08:24continue to be in
08:24 --> 08:27the professional area, we're
08:27 --> 08:28seeing delay with childbearing.
08:29 --> 08:30And we're also seeing an
08:30 --> 08:32increase of alcohol consumption,
08:33 --> 08:34and a different diet,
08:34 --> 08:36a more processed diet. So
08:36 --> 08:37to start, lifestyle and
08:37 --> 08:38environmental factors that are modifiable,
08:40 --> 08:41and we have seen
08:41 --> 08:42a link
08:42 --> 08:43with an increase in
08:43 --> 08:44breast cancer.
08:44 --> 08:45On the other side, I
08:45 --> 08:46think it's not only
08:47 --> 08:49increasing the disease, it's also
08:49 --> 08:50the fact that we
08:50 --> 08:52have better imaging.
08:52 --> 08:53Right? So we have improved
08:53 --> 08:54detection.
08:54 --> 08:56We're also doing
08:57 --> 08:58good work in awareness of
08:58 --> 09:00breast cancer screening. So I
09:00 --> 09:01think there are more women
09:01 --> 09:02that are
09:03 --> 09:05very efficiently getting mammograms on
09:05 --> 09:08time, and we have better
09:08 --> 09:09quality of imaging. So I
09:09 --> 09:11think the combination of those
09:11 --> 09:12two are allowing us to
09:12 --> 09:12see
09:13 --> 09:14and detect more cancers at
09:14 --> 09:16an earlier stage too.
09:16 --> 09:18That's great. So it's complicated.
09:18 --> 09:20It's not too straightforward. So,
09:21 --> 09:22I wonder, you're
09:22 --> 09:23a cancer
09:24 --> 09:26treatment doctor, right? So you
09:26 --> 09:27see patients after they have
09:27 --> 09:28a cancer diagnosis.
09:28 --> 09:30And so, I also know
09:30 --> 09:31and you mentioned in your
09:31 --> 09:33opening remarks, that you're passionate
09:33 --> 09:33about
09:34 --> 09:35awareness
09:35 --> 09:37and access to care. So
09:37 --> 09:38I wonder if you can
09:38 --> 09:39talk a little bit about
09:40 --> 09:42cancer screening and
09:42 --> 09:44sort of any prevention or
09:44 --> 09:46you mentioned the word modifiable
09:46 --> 09:48sort of risk factors.
09:49 --> 09:50What are some messages you
09:50 --> 09:52can give our audience around
09:53 --> 09:54breast cancer prevention and early
09:54 --> 09:56detection and your experience with
09:56 --> 09:57screening?
09:57 --> 09:58With screening,
09:58 --> 10:00right now there are a
10:00 --> 10:02few guidelines in
10:02 --> 10:04breast cancer. I will say
10:04 --> 10:06my practice, I follow the
10:06 --> 10:07NTCN guideline,
10:08 --> 10:10which recommends that
10:11 --> 10:13for an average risk women,
10:13 --> 10:14and when I say we
10:14 --> 10:15try to say with average
10:15 --> 10:17risk women, are those women
10:17 --> 10:19without personal or strong family
10:19 --> 10:21history of breast cancer and
10:21 --> 10:22without any genetic mutation or
10:22 --> 10:24prior history of breast cancer.
10:24 --> 10:25So that will be the
10:25 --> 10:26overall population.
10:27 --> 10:28And for the overall
10:28 --> 10:29population,
10:29 --> 10:31it is recommended that women
10:31 --> 10:32start with annual screening mammography
10:32 --> 10:34at the age of forty.
10:35 --> 10:36There is another group, which
10:36 --> 10:38is the higher risk women.
10:38 --> 10:39These are the women that
10:41 --> 10:42have genetic predispositions.
10:43 --> 10:44They're well known BRCA one
10:44 --> 10:45and two mutations
10:46 --> 10:47or have a strong family
10:47 --> 10:49history of breast cancer,
10:49 --> 10:52prior history of chest radiation,
10:53 --> 10:54between the ages of ten
10:54 --> 10:55to thirty,
10:56 --> 10:57or those that have
10:57 --> 10:59biopsies in their breast that
10:59 --> 11:01return with high risk lesions.
11:02 --> 11:03Those women's have a higher
11:03 --> 11:05risk of developing breast cancer
11:05 --> 11:06in the future, and they
11:06 --> 11:07should be managed in a
11:07 --> 11:08different way. They need
11:08 --> 11:09increased
11:09 --> 11:10screening and follow-up.
11:10 --> 11:12So it is recommended
11:12 --> 11:13that these women
11:15 --> 11:17obtain annual mammography,
11:18 --> 11:19and the majority,
11:19 --> 11:21specifically for the ones
11:21 --> 11:22with the genetic predispositions
11:23 --> 11:24or those that have
11:24 --> 11:26an increased risk higher than
11:26 --> 11:27twenty percent, and I can
11:27 --> 11:28dive into that in a
11:28 --> 11:30little bit, it is recommended
11:30 --> 11:31that I alternate the MRIs
11:31 --> 11:33with the mammograms every six
11:33 --> 11:34months, meaning
11:34 --> 11:36these women's will obtain a
11:36 --> 11:36mammogram
11:37 --> 11:38and then an MRI six
11:38 --> 11:40months later. So, one imaging
11:40 --> 11:41each year. And of course,
11:41 --> 11:43clinical breast exam follow.
11:44 --> 11:46So what I'm hearing you
11:46 --> 11:46say is sort of a
11:46 --> 11:48really powerful message to our
11:48 --> 11:48listeners.
11:49 --> 11:50You know, even
11:50 --> 11:51if you don't have cancer,
11:52 --> 11:54understanding your personal risk of
11:54 --> 11:54developing
11:55 --> 11:57breast cancer can guide you
11:57 --> 11:58on the appropriate screening regimen
11:58 --> 11:59for yourself.
12:00 --> 12:01And so we can't go
12:01 --> 12:02through every scenario
12:02 --> 12:04this evening in our conversation
12:04 --> 12:06to understand what
12:06 --> 12:07path
12:07 --> 12:09individuals might take depending on
12:09 --> 12:11their risk, but just understanding
12:11 --> 12:11their risk
12:12 --> 12:13is an important step forward.
12:14 --> 12:16You mentioned genetic predisposition, and
12:16 --> 12:17I wonder if you can
12:17 --> 12:18talk a little bit about
12:18 --> 12:19genetic
12:20 --> 12:20predisposition
12:21 --> 12:22to breast cancer.
12:22 --> 12:24Yeah, I will say,
12:24 --> 12:26the majority of the breast
12:26 --> 12:26cancers
12:27 --> 12:29are non genetically driven. So
12:29 --> 12:30it's a small percentage,
12:31 --> 12:32about five to ten percent
12:33 --> 12:35of women's that
12:35 --> 12:36present with breast cancer that
12:37 --> 12:38will have a genetic mutation.
12:39 --> 12:39These cancers
12:40 --> 12:42usually are seen in women
12:42 --> 12:43that have a very significant
12:43 --> 12:45family history of breast cancer
12:45 --> 12:47or breast cancer diagnosis at a
12:47 --> 12:48very young age.
12:48 --> 12:50And the genetic testing would
12:50 --> 12:51allow us to understand if
12:51 --> 12:53there is any genetic mutation
12:53 --> 12:54that is making them more
12:54 --> 12:56prone to develop another cancer
12:56 --> 12:57down the road. So that's
12:57 --> 12:58why these women will have
12:58 --> 13:00a different and separate type
13:00 --> 13:01of screening
13:02 --> 13:02and surveillance
13:03 --> 13:04down the road.
13:04 --> 13:05Well, that's certainly a lot
13:05 --> 13:07of information for us to
13:09 --> 13:10understand and sort of take
13:10 --> 13:12in. Unfortunately, we have
13:12 --> 13:13to take a one minute
13:13 --> 13:14break.
13:14 --> 13:15And when we come back,
13:15 --> 13:17I wanna dive into your
13:17 --> 13:18work from a disparities
13:18 --> 13:20perspective and access to care.
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14:05 --> 14:08fertility issues, and an increased
14:08 --> 14:09risk of second cancers.
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14:42 --> 14:43Okay. Welcome back listeners to
14:43 --> 14:45Yale Cancer Answers.
14:45 --> 14:47This is Doctor Tracy Battaglia
14:47 --> 14:48here, and I am thrilled
14:48 --> 14:49to have been joined tonight
14:49 --> 14:51by my guest, Doctor Monica
14:51 --> 14:51Valero.
14:52 --> 14:54I wanna transition our
14:54 --> 14:55conversation a little bit to
14:55 --> 14:57talk about your expertise in
14:57 --> 14:59cancer inequities or cancer disparities.
15:00 --> 15:02You came to Connecticut and
15:02 --> 15:03to Yale Cancer Center to
15:03 --> 15:04lead the
15:05 --> 15:07Hispanic Breast Cancer Program,
15:08 --> 15:09because of your passion for
15:09 --> 15:11caring for this particular population.
15:11 --> 15:12So can you tell our
15:12 --> 15:13listeners a little bit about
15:14 --> 15:16your program and specifically
15:16 --> 15:18anything that's important for our
15:18 --> 15:20listeners to understand about cancer
15:20 --> 15:20inequity?
15:21 --> 15:23Yes, Doctor Battaglia, just
15:23 --> 15:24a little bit of background.
15:24 --> 15:26We know that the Hispanic
15:26 --> 15:28population of Hispanic women are
15:28 --> 15:29less likely to develop breast
15:29 --> 15:30cancer
15:30 --> 15:32than when they're compared to
15:32 --> 15:34non Hispanic white women. However,
15:34 --> 15:36despite this lower incidence of
15:36 --> 15:36disease,
15:37 --> 15:39when the incidence is compared,
15:40 --> 15:41we have seen that the
15:41 --> 15:42Hispanic population
15:43 --> 15:45is usually diagnosed at a
15:45 --> 15:46advanced stage
15:47 --> 15:49and sometimes with a worse
15:49 --> 15:49prognosis.
15:50 --> 15:51We know that social determinants
15:51 --> 15:53of health and socioeconomic factors
15:53 --> 15:55can interfere. So my
15:55 --> 15:57goal with this program was
15:57 --> 15:59to meet the needs of
15:59 --> 16:00a growing and underserved Hispanic
16:01 --> 16:03population diagnosed with
16:03 --> 16:03breast cancer
16:04 --> 16:05and to inform these women
16:05 --> 16:07about the most important facts
16:07 --> 16:09about the disease. So this
16:09 --> 16:10is like an inclusive
16:10 --> 16:12health care environment that
16:12 --> 16:13provides service to the Hispanic
16:13 --> 16:15population, and we we try to
16:17 --> 16:18allow them to have the
16:18 --> 16:19entire
16:19 --> 16:21visit in their native language.
16:21 --> 16:22Can you talk a little
16:22 --> 16:23bit more about some of
16:23 --> 16:26the examples of other access
16:26 --> 16:28related initiatives to target the
16:28 --> 16:30population besides offering
16:30 --> 16:32programs in their native language?
16:32 --> 16:34Yeah. We're doing community
16:34 --> 16:35outreach. We also have a
16:35 --> 16:38mobile mammo van that allows
16:38 --> 16:40patients to obtain mammograms and
16:40 --> 16:42ultrasound in their community.
16:43 --> 16:44We do educational,
16:45 --> 16:46group support,
16:46 --> 16:48and we provide a lot
16:48 --> 16:49of education,
16:49 --> 16:51making sure patients
16:51 --> 16:53know of the programs that
16:53 --> 16:55the state also provides.
16:56 --> 16:57There are programs that allow patients
16:57 --> 16:58that are uninsured or
17:01 --> 17:03live in an underserved area.
17:03 --> 17:04They allow them for them to
17:05 --> 17:07obtain mammograms and ultrasound.
17:08 --> 17:08And this is a well
17:08 --> 17:10known program that is not
17:11 --> 17:13specifically in Connecticut,
17:13 --> 17:14but is available in many other
17:14 --> 17:16states. So increasing the awareness
17:16 --> 17:18and making sure patients
17:18 --> 17:20understand there is a possibility
17:20 --> 17:22for them to come and
17:22 --> 17:22have access,
17:23 --> 17:24is one of our
17:25 --> 17:27main goals. Can you talk
17:27 --> 17:28about what's involved in creating
17:28 --> 17:29a pathway for access
17:30 --> 17:31for these populations?
17:31 --> 17:33Yes. So, currently,
17:34 --> 17:36their health care
17:36 --> 17:36pathways
17:36 --> 17:37that allow
17:38 --> 17:40for physicians and patients
17:40 --> 17:42to have a more tailored
17:42 --> 17:43treatment. As as you know,
17:44 --> 17:45we are working together in
17:46 --> 17:48streamlining time sensitive referrals,
17:49 --> 17:51for these patients which the
17:51 --> 17:52goal is to optimize the
17:52 --> 17:54time to breast cancer diagnosis
17:55 --> 17:56in a vulnerable population.
17:57 --> 17:57What I'm trying to say
17:57 --> 17:59is when patients obtain
17:59 --> 18:00an imaging or a mammogram,
18:01 --> 18:01sometimes
18:02 --> 18:03something abnormal can be seen,
18:03 --> 18:05and additional imaging or biopsies
18:05 --> 18:06are required afterwards.
18:07 --> 18:08This is not usually a
18:08 --> 18:09smooth
18:09 --> 18:11process because it requires multiple
18:11 --> 18:12visits. As we know, it's
18:12 --> 18:14hard with our busy life.
18:14 --> 18:15It's very hard to take
18:15 --> 18:16time off work. And, you
18:16 --> 18:17know, if you have kids,
18:18 --> 18:19so there are many factors
18:19 --> 18:19that
18:20 --> 18:22may make
18:22 --> 18:23a woman take longer
18:23 --> 18:25and obtain subsequent images and
18:25 --> 18:27biopsies. And this time
18:27 --> 18:28or this lag
18:29 --> 18:30allows for
18:30 --> 18:31late diagnosis. And when we have
18:31 --> 18:33late diagnosis
18:33 --> 18:34usually the disease is
18:34 --> 18:36technically more advanced and
18:37 --> 18:38the outcomes are better the
18:38 --> 18:40earlier the stage
18:40 --> 18:41and the sooner we
18:41 --> 18:42can treat the cancer.
18:44 --> 18:45So with this
18:45 --> 18:45pathway,
18:46 --> 18:47where we are trying
18:47 --> 18:48to navigate patients
18:49 --> 18:50and make sure if
18:50 --> 18:52there's any barriers or challenges
18:52 --> 18:52that they're facing
18:53 --> 18:54to get to the diagnosis
18:54 --> 18:55point, and then from there
18:55 --> 18:56to see a surgeon
18:57 --> 18:57or a provider,
18:58 --> 19:00we try to
19:00 --> 19:01overcome those barriers.
19:02 --> 19:03So I wanna
19:03 --> 19:04talk a little bit more
19:04 --> 19:05about the navigation piece in
19:05 --> 19:06a minute, but, I just
19:06 --> 19:08wanna reiterate
19:09 --> 19:09some of the points that
19:09 --> 19:10you made, that
19:10 --> 19:11mammography
19:11 --> 19:13is the best test that
19:13 --> 19:14we have to identify cancer
19:14 --> 19:15before we have symptoms.
19:16 --> 19:17And that's why we promote
19:17 --> 19:19mammography, right, in average risk
19:19 --> 19:21populations at forty and for,
19:21 --> 19:22you know, high risk populations,
19:23 --> 19:24maybe sometimes earlier.
19:24 --> 19:26But mammography, like any screening
19:26 --> 19:27test, is not a perfect
19:27 --> 19:28test. So as you point
19:28 --> 19:29out,
19:29 --> 19:30I think it's important for
19:30 --> 19:32our listeners to understand that,
19:33 --> 19:35you know, once an abnormality
19:35 --> 19:36is detected on a mammogram,
19:36 --> 19:38your screening test is not
19:38 --> 19:39over. You need to really
19:39 --> 19:41be diligent about following up
19:41 --> 19:42in a timely way to
19:42 --> 19:44make sure that initial problem
19:44 --> 19:45that was identified in the
19:45 --> 19:47mammogram is either cleared or
19:47 --> 19:49further testing is done to
19:49 --> 19:49make sure
19:50 --> 19:51that there is or is
19:51 --> 19:52not a cancer. So critical
19:54 --> 19:55point for our listeners to
19:55 --> 19:55understand
19:56 --> 19:57and as you
19:57 --> 19:58point out, it's not easy
19:58 --> 19:59for any of us to
19:59 --> 20:00follow-up on sort of that
20:00 --> 20:02cascade of care that's needed
20:02 --> 20:03to get to a cancer
20:03 --> 20:04diagnosis or to rule out
20:04 --> 20:05cancer
20:05 --> 20:07and navigation or patient navigation
20:07 --> 20:08is a
20:09 --> 20:10care delivery model that I'm
20:10 --> 20:11very passionate about as you
20:11 --> 20:12know in our prior work
20:12 --> 20:13together.
20:14 --> 20:15Can you talk about what
20:15 --> 20:17navigation means after an abnormal
20:17 --> 20:18mammogram and how it can
20:18 --> 20:19help a patient?
20:19 --> 20:20Yeah, so navigation,
20:21 --> 20:24has been well defined as
20:24 --> 20:26an amazing tool to guide
20:26 --> 20:28patients and to make sure
20:28 --> 20:29that if there is any
20:29 --> 20:31challenge, we can help them
20:31 --> 20:32to overcome those and to
20:32 --> 20:34obtain a timely diagnosis.
20:35 --> 20:36As we all
20:36 --> 20:39know, we have navigation
20:39 --> 20:41support at some of our
20:41 --> 20:42sites
20:42 --> 20:43where we practice.
20:44 --> 20:46However, this navigation support
20:46 --> 20:48starts after the patients are
20:48 --> 20:49diagnosed. And what I mean
20:49 --> 20:50with navigation support is,
20:50 --> 20:51every time we meet a
20:51 --> 20:52patient with breast cancer,
20:53 --> 20:54they have the opportunity to
20:54 --> 20:55meet one of our nurse
20:55 --> 20:56navigators.
20:56 --> 20:58We'll walk with
20:58 --> 20:59them through the process of
20:59 --> 21:01the breast cancer diagnosis, not
21:01 --> 21:02only through the surgical portion,
21:02 --> 21:03but also through the medical
21:03 --> 21:06oncology and radiation oncology because
21:06 --> 21:07this is a process
21:07 --> 21:09that takes many months. So
21:09 --> 21:11the navigators are able
21:11 --> 21:13to identify if there is
21:13 --> 21:14any specific
21:14 --> 21:15factor that will,
21:16 --> 21:17you know, impact the patient's
21:18 --> 21:19care and treatment.
21:20 --> 21:21And what we're trying to
21:21 --> 21:22do right now, as you
21:22 --> 21:23mentioned before,
21:24 --> 21:25screening mammography
21:25 --> 21:27is not the only portion
21:27 --> 21:29of the studies, right, for
21:29 --> 21:31detecting breast cancers. So when
21:31 --> 21:33additional procedures are
21:33 --> 21:34required afterwards,
21:35 --> 21:37it is important that patients
21:37 --> 21:38understand that the sooner we
21:38 --> 21:40obtain the additional recommended
21:40 --> 21:42imaging or biopsies is going
21:42 --> 21:43to be beneficial for them.
21:43 --> 21:44So this is where
21:44 --> 21:46navigation, upstreaming navigation
21:47 --> 21:48to the time of
21:48 --> 21:50the abnormal imaging
21:50 --> 21:51will allow, so that's our
21:51 --> 21:53thought, will benefit patients in
21:53 --> 21:55decreasing the time from
21:55 --> 21:57the abnormal imaging to the
21:57 --> 21:58definitive diagnosis.
21:59 --> 22:00So, you know, nurse navigation
22:01 --> 22:02is a pathway to ensure
22:03 --> 22:05equal access to services.
22:06 --> 22:07When we talk about equity
22:07 --> 22:09and ensuring we meet the
22:09 --> 22:10specific needs of patients,
22:11 --> 22:12specifically
22:12 --> 22:14the Hispanic population that you're
22:14 --> 22:15working with,
22:15 --> 22:17how do we tailor navigation
22:17 --> 22:18to these populations to really
22:18 --> 22:19meet their needs? Can you
22:19 --> 22:20give some examples?
22:21 --> 22:23Yeah. I think, there are
22:23 --> 22:23many,
22:25 --> 22:27challenges that we can see
22:27 --> 22:28not only in the Hispanic
22:28 --> 22:30populations that are applicable to
22:30 --> 22:31many,
22:31 --> 22:32you know, ethnic groups.
22:33 --> 22:35However, I will say that,
22:35 --> 22:37you know, the fear of,
22:38 --> 22:39the mistrust in
22:40 --> 22:41the health care
22:41 --> 22:42system,
22:43 --> 22:44the lack of insurance or
22:46 --> 22:48or sometimes the immigrational status,
22:51 --> 22:53and the fear to miss
22:53 --> 22:55work or childcare.
22:56 --> 22:57Those are the main
22:57 --> 22:59factors where we could see
22:59 --> 23:00not only the Hispanic population,
23:00 --> 23:02but many women
23:02 --> 23:03face,
23:03 --> 23:05challenges to come for their
23:05 --> 23:07follow-up imaging and also
23:07 --> 23:09the copays. We know like
23:09 --> 23:10right now, that's
23:10 --> 23:12a very, very important part
23:12 --> 23:13of the
23:13 --> 23:14healthcare system.
23:14 --> 23:16And so your navigation program
23:16 --> 23:18tries to understand those needs
23:18 --> 23:20from the patient's perspective
23:20 --> 23:21and connect them with resources
23:21 --> 23:23to help address them.
23:23 --> 23:25We have multiple programs that
23:25 --> 23:26help those patients to connect
23:26 --> 23:27with
23:27 --> 23:29tools that will allow them
23:31 --> 23:32a better follow-up.
23:33 --> 23:34I imagine coming to see
23:34 --> 23:35a provider like you who's
23:35 --> 23:36linguistically
23:37 --> 23:39con congruent with a population
23:39 --> 23:41where English
23:41 --> 23:42is not necessarily their first
23:42 --> 23:44language is also a way
23:44 --> 23:45of sort of overcoming some
23:45 --> 23:46of those challenges.
23:46 --> 23:47Yeah, I agree. I feel
23:47 --> 23:48like in the
23:48 --> 23:49ideal world,
23:49 --> 23:51every patient should be able,
23:51 --> 23:52specifically due to the breast
23:52 --> 23:54cancer process, which is a
23:54 --> 23:55very complex and
23:55 --> 23:57difficult time for our patients.
23:57 --> 23:59It must be really hard
23:59 --> 24:00to try to express yourself
24:00 --> 24:02and understand and absorb all
24:02 --> 24:03the information that you are
24:03 --> 24:05given.
24:05 --> 24:08It is very in-depth information and
24:09 --> 24:10I think that will be
24:10 --> 24:11ideal. NOTE Confidence: 0.9760034
24:16 --> 24:16I wanna
24:17 --> 24:18ask you about
24:18 --> 24:20you mentioned earlier in your
24:20 --> 24:22comments about research and clinical
24:22 --> 24:23trials. And I wonder if
24:23 --> 24:24you can speak a little
24:24 --> 24:26bit about the role of
24:26 --> 24:28research and clinical trials
24:28 --> 24:30in breast cancer care, either
24:30 --> 24:31through your own program or
24:31 --> 24:32otherwise.
24:33 --> 24:33Yes.
24:33 --> 24:36So research and clinical trials,
24:36 --> 24:38you know, are key
24:39 --> 24:40on finding
24:41 --> 24:43and learning more about better
24:43 --> 24:44options for our patients.
24:45 --> 24:47So here we have the
24:47 --> 24:49option of offering
24:49 --> 24:51patients a lot of clinical
24:51 --> 24:52trials that are available
24:52 --> 24:53across the country.
24:55 --> 24:56And I will say,
24:57 --> 24:58we really encourage our patients,
24:58 --> 25:00the ones that qualify for
25:00 --> 25:01them, to participate.
25:02 --> 25:03And specifically,
25:03 --> 25:04given that
25:04 --> 25:06the Hispanic population is not
25:06 --> 25:06well
25:07 --> 25:08represented in clinical trials, that's
25:08 --> 25:10also one of my areas
25:10 --> 25:12or goals
25:12 --> 25:13is to allow for these
25:13 --> 25:14women to understand
25:15 --> 25:16their options to participate
25:16 --> 25:18and to understand better the
25:18 --> 25:19trial so they feel
25:19 --> 25:21more comfortable about joining.
25:22 --> 25:23And when I say
25:23 --> 25:25that they're not well represented,
25:25 --> 25:26it's like the majority of
25:26 --> 25:27these trials
25:27 --> 25:28have a small percentage of
25:28 --> 25:30Hispanic population. So when you
25:30 --> 25:32obtain data and results,
25:32 --> 25:33sometimes
25:33 --> 25:35they are not totally applicable
25:35 --> 25:37to every ethnic group.
25:37 --> 25:39So the more diverse
25:40 --> 25:41population that we have for
25:41 --> 25:42these trials is, the better.
25:42 --> 25:44And you are very
25:44 --> 25:45lucky to work with the
25:45 --> 25:47medical oncology group
25:47 --> 25:48where we have
25:48 --> 25:49many,
25:51 --> 25:52clinical trials,
25:52 --> 25:54that will allow for
25:54 --> 25:55new and advanced
25:56 --> 25:57therapies.
25:58 --> 26:00That's really helpful to sort
26:00 --> 26:01of help framing the message
26:01 --> 26:03to our listeners that
26:05 --> 26:06cancer clinical trials
26:08 --> 26:08are
26:09 --> 26:10a form of quality care
26:10 --> 26:11treatment.
26:11 --> 26:12Sometimes,
26:13 --> 26:14especially in
26:15 --> 26:16specific areas that we don't
26:16 --> 26:17know what the best treatment
26:17 --> 26:19might be for a particular
26:19 --> 26:20subtype of a tumor,
26:20 --> 26:22having access to a clinical
26:22 --> 26:24trial sometimes gives you access
26:24 --> 26:25to the most
26:25 --> 26:26cutting edge
26:26 --> 26:28treatment options.
26:28 --> 26:29Can you talk a little
26:29 --> 26:30bit about that?
26:31 --> 26:32Yes. I think
26:32 --> 26:34you said it right.
26:34 --> 26:35I think sometimes,
26:36 --> 26:37we know that there
26:37 --> 26:38are therapies that
26:39 --> 26:41will provide better outcomes,
26:41 --> 26:42but it needs to be
26:42 --> 26:43proven. So in order to
26:43 --> 26:45be proven, right, we,
26:46 --> 26:48organize and lead
26:48 --> 26:50and develop these
26:50 --> 26:51clinical trials.
26:51 --> 26:52And, you know, we're very
26:52 --> 26:54passionate about that because nowadays,
26:55 --> 26:55with all the
26:56 --> 26:58evolution in the therapy
26:58 --> 26:58of breast cancer,
26:59 --> 27:00we
27:00 --> 27:01have a lot of options
27:01 --> 27:03for our patients.
27:04 --> 27:04Amazing.
27:06 --> 27:06Well,
27:07 --> 27:08I wonder if, as we're
27:08 --> 27:10sort of closing out on
27:10 --> 27:11our time together,
27:11 --> 27:13if there are any other
27:13 --> 27:13sort of
27:15 --> 27:16pearls of wisdom that you
27:16 --> 27:18might have for our listeners
27:18 --> 27:19around
27:20 --> 27:22breast cancer care and specifically
27:22 --> 27:24the population of patients that
27:24 --> 27:25you're caring for, or anything
27:25 --> 27:26we didn't touch on that
27:26 --> 27:27you think is important?
27:28 --> 27:30I think what is really
27:30 --> 27:31important is for patients to
27:31 --> 27:33understand or understand that in
27:33 --> 27:34this new era,
27:35 --> 27:36we're open about
27:37 --> 27:39breast cancer diagnosis. I feel
27:39 --> 27:40like back in the days,
27:40 --> 27:41this was like a very,
27:42 --> 27:43kind of, like, taboo,
27:44 --> 27:45thing that
27:45 --> 27:47patients did not feel comfortable
27:47 --> 27:49sharing with family members. So
27:49 --> 27:50I feel like now the
27:50 --> 27:51more we know and the
27:51 --> 27:52more
27:52 --> 27:55we empower ourselves,
27:55 --> 27:56understand and learn about breast
27:56 --> 27:57cancer
27:57 --> 28:00diagnosis, awareness, and we're
28:00 --> 28:02very efficient about obtaining mammograms
28:02 --> 28:04and understanding understanding our risk.
28:04 --> 28:05You know, it's going to
28:05 --> 28:06allow for women
28:07 --> 28:08to be healthier and feel
28:08 --> 28:10better with their care.
28:10 --> 28:12So I really would
28:12 --> 28:13like to empower
28:13 --> 28:14women.
28:15 --> 28:17And it's not easy, go
28:17 --> 28:19for mammograms. Even I think
28:19 --> 28:20it's even more difficult if
28:20 --> 28:22you already went through diagnosis
28:22 --> 28:23or have a lot of
28:23 --> 28:24family history.
28:24 --> 28:26But I will empower women
28:26 --> 28:27to go and continue with
28:27 --> 28:28their screening mammograms and
28:28 --> 28:29not be afraid of
28:29 --> 28:31sharing or asking
28:31 --> 28:33when they have questions to
28:33 --> 28:35any providers or the health
28:35 --> 28:35care system.
28:37 --> 28:38Dr. Valero is an assistant professor
28:38 --> 28:40of surgical oncology at the
28:40 --> 28:41Yale School of Medicine.
28:41 --> 28:43If you have questions, the
28:43 --> 28:44address is cancer answers at
28:44 --> 28:45yale dot e d u,
28:45 --> 28:47and past editions of the
28:47 --> 28:48program are available in audio
28:48 --> 28:50and written form at yale
28:50 --> 28:51cancer center dot org. We
28:51 --> 28:52hope you'll join us next
28:52 --> 28:53time to learn more about
28:53 --> 28:55the fight against cancer.
28:55 --> 28:57Funding for Yale Cancer Answers
28:57 --> 28:58is provided by Smilow Cancer
28:58 --> 28:59Hospital.

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Advancing Breast Cancer Care for Hispanic Women with guest Dr. Monica Valero, January 19, 2025

Yale Cancer Center

visit: http://www.yalecancercenter.org

email: canceranswers@yale.edu

call: 203-785-4095

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Dr. Monica Valero

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