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Cancer Conversations: New Frontiers in Breast Cancer Detection · Talking FACS

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  We've all heard the phrase, early detection saves lives, but what does that
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  really mean when it comes to breast cancer?
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  I'm your host, Mindy McCulley, Extension Specialist in Family and Consumer Sciences
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  Extension at the University of Kentucky.
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  My guest today is Dr. Julie Lang, Section Chief of Breast Surgery,
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  and we are going to chat about the critical role of breast cancer screening,
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  how specialized health care teams work together
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  to provide comprehensive care, and the innovative research that is changing
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  how cancer is detected and monitored.
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  Welcome to Talking FACS, and thank you for tuning in to Cancer Conversations on Talking FACS,
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  a podcast collaboration between the University of Kentucky Markey Cancer Center
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  and the UK Martin Gatton College of Agriculture, Food, and Environments Cooperative Extension Service.
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  We will share with you the latest developments in cancer prevention,
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  diagnosis, treatment, and research from the experts at Markey Cancer Center,
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  Kentucky's only National Cancer Institute designated comprehensive cancer center.
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  Talking FACS is hosted by the UK Family and Consumer Sciences Extension Program.
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  Our educators share research knowledge with individuals, families,
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  and communities to improve quality of life.
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  Hello, and welcome to Cancer Conversations on Talking FACS.
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  Dr. Lang, thank you for joining me today.
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  Thanks, Mindy. It's great to be here. I am so glad that you are here so that
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  we can talk about everything from mammograms to liquid biopsies and explore
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  tools helping patients receive more personalized care and better outcomes.
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  First, let me ask you, I know that your career combines surgery,
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  research, education, and leadership. So how have those experiences shaped your
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  approach to patient care?
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  My role is as a breast surgical oncologist, I get to see patients first and
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  help them at a time when they're really in the difficult times in their lives
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  with a new diagnosis of breast cancer.
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  And for other patients who are at high risk for breast cancer based on family
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  history or other factors, we help them to learn how to manage that level of
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  risk, what tests to get, and what their ongoing follow-up should be.
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  So my interest in clinical breast surgery really pairs well with my research
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  interests of trying to always look for better options for patients.
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  Patients need better treatments. Patients that are suffering with advanced stage
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  cancers need hope that there will be better treatments, better cures in the future.
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  So as a laboratory researcher, we are able to study advances in the field and
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  try to make contributions to advance the field and bring clinical trials to
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  the UK Markey Cancer Center in the process of doing so.
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  As you talk about multidisciplinary care, what does that look like in practice
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  and why is it so important?
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  Multidisciplinary care is when all of the specialists that a patient needs come
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  together to talk about their case and to choose the best way forward.
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  For example, we have tumor boards in which we discuss care of our patients with
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  our medical oncologists, our radiation oncologists, our breast surgeons.
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  We look at their films with our radiologists. Our pathologist shows us
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  the patient's slides and special tests that were done so that we're able to
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  combine our expertise and bring this directly to the patient's care,
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  which is really very meaningful because sometimes
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  it's not so straightforward what should be done for a given patient.
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  So we factor in the patient's health history and other factors to make a personalized
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  treatment plan for each patient.
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  I love that the team that is working to eradicate the cancer in that patient
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  really is focused on the individual patient.
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  So how do you balance achieving the best cancer outcome while preserving quality
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  of life and cosmetic results? Because that's really important to many patients.
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  The field of breast surgery is really very interesting because there was once
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  a time when there was no systemic therapy, there was no chemotherapy,
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  and so surgery was truly the only option that patients had.
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  So back in the day long ago, surgeons were doing things like radical mastectomies
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  and very, very radical surgeries.
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  But nowadays, through evidence-based medicine, we know that lumpectomy plus
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  radiation is equal to mastectomy for survival.
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  And so whether the patient chooses the lumpectomy and radiation or they choose
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  the mastectomy, the complete removal of the breast, their chance of living to
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  an old age is just the same.
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  Nowadays, in contemporary medicine, we think about oncoplastic surgery.
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  How can we do that lumpectomy that achieved the very best aesthetic results?
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  And sometimes this involves partnership with our plastic surgery colleagues,
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  but sometimes the breast surgeons themselves, using oncoplastic surgery techniques,
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  can offer those same techniques, very precise removal of the tumor and repair
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  of the tissue to get the best result that we can for our patients.
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  And this is something that's very important in modern breast surgery.
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  And I love that you're talking about this because as you and I talked about
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  before I came on to record.
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  We have been recording this podcast for about nine years, and the changes that
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  I have heard about since the very first time I talked to anyone about breast
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  cancer treatment, they've come light years, it seems like.
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  So your work focuses on circulating tumor cells and circulating tumor DNA and liquid biopsies.
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  So can you explain these concepts in terms that our listeners are going to resonate with?
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  Absolutely, yes. The idea of liquid biopsy is a blood-based test to determine
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  something about a cancer.
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  And so in this case, it's a breast cancer.
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  And so circulating tumor cells are rare cells shed by a primary tumor or a distant
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  metastatic site into the bloodstream.
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  And we can actually pull out those cancer cells and profile them.
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  So scientifically, in the laboratory, we could look at the RNA level,
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  the DNA level, the protein level to make determinations about the tumor's biology.
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  There are FDA-approved tests that look at circulating tumor cells,
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  but nowadays, more popularly, circulating tumor DNA is being used more and more in the clinic.
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  And this is because this looks at circulating DNA that is tumor-specific DNA
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  that's present in a cancer patient's blood, but is absent from a healthy individual's blood.
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  And it can be detected in many cancer patients, but not all cancer patients.
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  So there's certainly an evolution happening.
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  And so this is a very exciting field. Some of these tests are screening tests
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  where they're looking for a variety of different cancers by a blood test.
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  And some of that is developing and evolving, but not so much for breast cancer.
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  So what I'm referring to is specifically for a patient who already has a breast cancer.
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  There's testing that we can do to either look at if a cancer has come back and
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  detect that early before an x-ray could find it, or in a patient who has a breast cancer.
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  If we want to know what type of treatment to give, if the clinical care pathway
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  is not so clear what the next line of treatment should be for a patient,
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  or if they're struggling with a course of treatment and we want to look for
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  something more specific, a precision medicine-based approach,
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  there are treatments that relate to personalized medicine based on DNA mutations
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  that can be detected either in tumor or in blood.
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  And so that's what we mean by liquid bias. It sounds, as I hear you talking,
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  it sounds like the forensic detectives, you know, that were popular on television
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  many, many years ago, but the work that you're doing sounds just as exciting.
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  And so impactful for breast cancer treatment and recovery.
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  So when it comes to breast cancer, we always hear that early detection saves
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  lives. So why is regular screening so critical from a medical standpoint?
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  And how does catching something early change a patient's treatment options and
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  their recovery outlook?
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  There have been many advances in the field of breast cancer that have resulted
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  in improved outcomes for breast cancer patients over the years.
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  But screening mammography accounts for about 40% of the benefit in saving patients'
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  lives from breast cancer.
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  It turns out that most breast cancer deaths are from patients who did not participate
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  in screening mammography.
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  Studies showed more than 60% of patients who passed away due to breast cancer
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  did not have a mammogram at the time that their breast cancer was found initially.
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  So it turns out in the United States, only about 50% of patients who have insurance
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  that would qualify them for screening mammogram actually go ahead and get that mammogram.
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  So every October, we breast cancer specialists are here to tell everybody,
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  if you're over age 40, please go ahead and get your screening mammogram.
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  I think that that is so important. And I have been maybe part of that cohort
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  that doesn't always remember to go get their mammogram, but, you know, it is easy.
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  It's something that maybe a few minutes of discomfort really can save a life, right?
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  It makes such a big difference.
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  Dr. Lang, thank you so much for taking the time to share with our listeners
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  today why this is so important. And of course, it is October,
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  which is Breast Cancer Awareness Month.
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  And we always encourage our listeners to get their cancer screenings.
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  And this month specifically, get that mammogram.
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  That's fantastic. Thanks, Mindy.
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  If you are just tuning in, you're listening to Cancer Conversations on Talking
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  Thank you for listening to Cancer Conversations on Talking FACS.
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  Our goal is to connect you with the latest advances in cancer research in the Commonwealth.
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  If you enjoyed today's podcast and have a suggestion for a future show topic,
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  please message us on the UK Markey Cancer Center Facebook page at facebook.com forward slash UK Markey,
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  or visit our website at markey.uky.edu for more information.
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  You can find University of Kentucky Family and Consumer Sciences Extension programs
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  at your local Extension office or online at fcs.uky.edu.
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