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The Future of Breast Care in Kentucky · UK HealthCast

• 0:02
  Gina Kaye (Host): Welcome to UK HealthCast, a podcast
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  presented by UK HealthCare.
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  I'm Gina Kaye.
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  And joining me today is Dr.
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  Julie Lang, breast cancer surgeon and Medical Director of the
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  Comprehensive Breast Care Center at the UK Markey Cancer Center.
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  Our topic today is the future of breast care in Kentucky.
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  Dr.
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  Lang, thank you so much for joining us today.
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  Dr. Julie Lang:
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  Thanks, Gina.
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  Great to be here.
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  Host: All right.
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  Well, let's just dive into our questions.
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  I know we have a lot of information to cover.
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  So to start us off, you've just arrived at UK as the Section Chief of Breast Surgery.
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  What excites you the most about this next chapter?
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  Dr. Julie Lang:
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  We are a growing dynamic program within the UK Markey Comprehensive Cancer Center.
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  We provide state-of-the-art advanced breast cancer care to
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  the Commonwealth of Kentucky.
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  We have a dedicated team of specialists, including breast imagers, breast
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  medical-oncologists, radiation oncologists, and are the only center in
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  Kentucky with four fellowship-trained breast surgical oncologists.
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  Host: That's exciting.
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  What are your top priorities then during your first year?
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  Dr. Julie Lang:
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  My top priority is meeting the needs of our population by reducing the
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  interval between screening mammography and further diagnostic workup for
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  women with abnormal mammograms.
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  This will allow us to reduce our time to treatment and greater serve our local
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  patient population here in Lexington and beyond in the entire Commonwealth.
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  We will ensure that our breast center is prioritizing the needs of
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  patients and primary care doctors to get patients access into our breast
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  care center in a timely manner.
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  Expanding our clinical trial offerings to better serve our patient
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  population is also top of mind.
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  This will establish the University of Kentucky as the premier location
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  in Kentucky for the treatment of locally advanced and metastatic breast
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  cancer patients seeking therapies only available on clinical trials and will
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  help improve upon the current standard of care by continuously optimizing
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  therapies for cancer patients.
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  One of our breast surgeons, Dr.
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  Ibrahim, and I are preparing to bring robotic nipple-sparing mastectomy as an
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  option at the University of Kentucky.
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  This new procedure was recently approved by the US FDA.
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  We are planning to offer this advanced technique that requires
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  specialized training, credentialing, and equipment that is currently
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  only available at a small number of centers around the country.
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  This procedure offers improved surgical precision, reduced visible
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  scarring, and enhanced preservation of nipple sensation and blood flow.
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  It allows surgeons to operate through small inconspicuous incisions that are
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  often placed away from the breast toward the armpit, leading to better cosmetic
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  options and potentially faster recovery
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  Host: That's fantastic.
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  This next question is one of my favorites.
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  What inspired you to become a breast cancer surgeon?
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  Dr. Julie Lang:
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  I really enjoy how multidisciplinary the care of breast cancer patients is.
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  As a breast surgeon, we get to see the patient first and help them at
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  a point in their lives that they consider to be a major crisis.
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  For many patients, this is the first time that they are confronted
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  with their own mortality.
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  They were well, they had an abnormal mammogram.
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  And here they are in my office seeing a surgeon for the first time.
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  It's very scary for them.
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  So, patients develop a close relationship with their breast surgeons
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  since we are there for them to guide them through this difficult time.
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  And in many cases, surgery is their first course of cancer treatment.
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  I did my residency at the University of California San Francisco and got to see
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  the difference that it makes when a highly expert team of breast cancer specialists
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  come together to provide multidisciplinary treatment where team members really
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  work together to take care of patients, provide the highest level of expertise,
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  and contribute to life-saving research.
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  I also saw this pattern of care at the MD Anderson Cancer Center where
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  I did my fellowship, one of the top cancer centers in the country.
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  At academic medical centers, this kind of expertise really comes
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  together to provide the highest level of quality care for patients.
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  Host: Your career combines surgery, research, education, and leadership,
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  which by the way is a lot.
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  How have all of those experiences shaped your approach to patient care?
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  Dr. Julie Lang:
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  I think that these experiences are really very complementary and help
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  to strive for continuous improvement across the care of cancer patients.
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  By striving for excellence in surgery and using research to try to save
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  patients' lives, in every aspect of my job, we're fighting cancer
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  and advocating for the patient.
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  Education is a natural part of a surgeon's career.
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  We're privileged to have outstanding surgical trainees and medical students
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  rotating with us and contributing to our patients' care, and we
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  learn from our trainees as well.
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  Host: Dr.
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  Lang, in addition to clinical care, you also have an interest
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  in breast cancer research.
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  Tell us more about that.
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  Dr. Julie Lang:
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  I am a clinical trialist and a clinical translational
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  researcher as well as a surgeon.
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  I have enrolled patients on therapeutic clinical trials evaluating surgical
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  interventions as well as drug interventions such as chemotherapy.
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  I have also designed and carried out some clinical trials in collaboration
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  with my teams, which we have published.
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  My work on circulating tumor cells, rare cancer cells shed into the bloodstream
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  of breast cancer patients, involved developing methods for sequencing the RNA
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  of these rare cells to better understand the molecular biology of cancer.
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  Some of my lab's research was used to support a successful U.S.
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  Food and Drug Administration application for a company.
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  My laboratory has been studying inflammatory breast cancer, one of
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  the most aggressive forms of breast cancer, and we successfully made a
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  new mouse model in which we can study experimental therapeutics to see
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  which medicines might work better than what we currently use in the hopes
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  of trying to eradicate this cancer.
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  Patients expect that most doctors are working on better treatments
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  for cancer, but in reality, most physicians in practice do not
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  have very much time for research.
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  We at the Markey Cancer Center are committed to improving outcomes for
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  breast cancer patients by constantly seeking to improve all aspects of
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  breast cancer care via clinical outcomes research, therapeutic clinical
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  trials, and basic scientific studies to make important new observations
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  that can lead to future therapies.
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  Gina Kaye (Host): Earlier when I asked you what excites you the
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  most about this next chapter, you spoke about multidisciplinary care.
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  So what does that look like in your practice and why do
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  you feel it is so important?
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  Dr. Julie Lang:
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  Multidisciplinary care is when we bring expertise to the table
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  that is relevant to the patient.
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  And this includes a variety of different specialties: breast surgery,
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  medical oncology, radiation oncology, expert breast imagers, nuclear
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  medicine, pathology, expertise in psychology, genetics, integrative
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  medicine, and social services.
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  All these team members come together and play a critical role
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  for our breast cancer patients.
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  Not all patients may require each of these specialties, but only at a comprehensive
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  cancer center like the Markey Cancer Center do we have all these elements
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  working together where we can make them available for patients and provide them
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  with all the care that they will need.
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  Host: Perfect.
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  How do you balance then achieving the best cancer outcomes while also preserving
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  quality of life and cosmetic results?
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  Dr. Julie Lang:
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  Achieving the best cancer outcomes, including prolonging life, avoiding
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  recurrence of the breast cancer.
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  But increasingly, it's been noted that we should not do this at
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  the expense of quality of life.
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  Quality of life is very important.
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  And so where there are opportunities to avoid over-treatment of breast
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  cancer patients, the whole field of breast cancer treatment has
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  been very interested in this.
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  And in recent years, we've seen de-escalation.
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  For example, in surgery, there are some patients that we can omit checking
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  lymph nodes, whereas in the past, much more radical surgeries were done.
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  So, guided by clinical trials, we've seen a progressive improvement in
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  outcomes for breast cancer patients, while at the same time, we've been able
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  to de-escalate or remove certain parts of treatment where we can, where it did
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  not actually produce better results.
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  We work hand in hand with other specialties, and a great example of
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  this is the collaborative nature of breast surgeons and plastic surgeons.
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  When a patient desires breast reconstruction for mastectomy,
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  we plan the incisions together.
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  We make a flight plan so we know what the other specialist is
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  thinking, and we work together.
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  How can we get a widely negative margin but also preserve the most
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  aesthetic form or contour to the breast?
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  And this is a really exciting part of being a breast surgeon.
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  The collaborative nature of the specialty, it really benefits the patients
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  Host: Wonderful.
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  Talk to us a little bit then about how clinical trials expand treatment
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  options for patients at UK Markey
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  Dr. Julie Lang:
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  Clinical trials are very important when there are patients that have
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  advanced disease, breast cancers that have spread to other organs, they're
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  known as metastatic breast cancer, and those patients are not usually
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  considered curable at that point.
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  However, medicine is always striving to do better.
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  And nowadays, we actually have highly effective therapies that
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  were not available previously.
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  So, we're seeing durable or prolonged survival in many
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  more patients than in the past.
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  Clinical trials are what have brought that to us, so we seek
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  to have a diverse portfolio of clinical trials for our patients.
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  This gives advanced cancer patients the chance at living longer, and
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  it gives us a better opportunity to improve therapies for patients.
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  This will also apply to patients with earlier stage diseases.
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  For example, situations in which we would have a patient that might
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  need to have a mastectomy because the cancer is of a sufficient size
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  where lumpectomy is not possible.
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  But with chemotherapy before surgery, also known as neoadjuvant chemotherapy,
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  we can shrink the tumor down and convert that patient to a situation
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  where a lumpectomy could be offered.
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  So, it's only by having these types of clinical trials available can
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  we progress the field and have better options for our patients.
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  And so, clinical trials are really very important.
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  And we hope to make, the UK Markey Cancer Center the premier clinical
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  trial center in the state of Kentucky.
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  Gina Kaye (Host): So then tell us, how do you hope to expand access to
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  breast cancer care across Kentucky?
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  Dr. Julie Lang:
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  Interestingly, around 60% of our patients come to us from outside of Lexington.
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  The majority of our patients are traveling one, two, three, four hours to come
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  see us at the Markey Cancer Center.
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  We are collaborating with the Markey Cancer Network in terms
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  of collaborating with sites that UK is affiliated with, as well as
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  community-based sites, to refer patients to us needing advanced cancer care.
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  And in some cases, patients receive all of their care at the UK Markey
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  Cancer Center, and we're pleased to take care of these patients and
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  provide them with these services.
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  In other circumstances, patients wish to have their breast surgery with us
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  but might return closer to home for some portions of their care, such
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  as for medical radiation oncology.
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  Host: You know, optimally eradicating breast cancer would be job one.
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  But if you could change one thing about how breast cancer is diagnosed
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  or treated today, what would it be?
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  Dr. Julie Lang:
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  We need to make this process be more patient-centered.
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  When a woman goes for a routine screening mammogram, this
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  should be very straightforward.
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  This should be at a place that's close to her home, have a mammogram.
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  She shouldn't wait more than 10 or 15 minutes for that test, and we
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  should be able to provide timely notification to patients about results
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  so that people are not waiting.
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  The waiting often is the hardest part for our patients, and we are striving
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  to do better to tackle that problem.
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  Host: That's great.
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  What continues to inspire you after so many years caring
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  for breast cancer patients?
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  Dr. Julie Lang:
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  What's incredible is that one in eight women gets breast cancer in their lives,
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  and more than 95% of these women do not have a strong family history or genetic
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  components to their breast cancer.
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  So, this is such an important public health problem.
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  And so, I am inspired by the patients themselves, seeing so
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  many patients struggling with their breast cancer diagnosis.
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  And we at the Markey Cancer Center need to take on this responsibility and ensure
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  that they get the very best of care.
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  Host: As we wrap up our discussion today, Dr.
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  Lang, what message would you like to leave with patients and
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  families who may be listening today?
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  Dr. Julie Lang:
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  The treatment of breast cancer is getting better.
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  I've seen remarkable changes in the span of my career.
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  I've been in practice for 19 years now, and treatments have gotten less invasive,
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  and outcomes with care by the medical and radiation oncologists have gotten
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  better with fewer side effects as well.
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  An example with radiation oncology is that, for many patients, it used
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  to be six weeks of radiation therapy.
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  Then, clinical trials show that it could be three weeks for many patients.
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  And in recent years, clinical trials show that many patients could be
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  treated with five treatment days.
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  So, clinical trials have really made major advances in the field, and we're
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  able to deescalate or do less and provide better outcomes for patients.
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  The field of breast cancer is ever-changing.
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  So if a patient had a family member who was treated in decades past, they should
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  know that what treatment looks like today might be a little bit different.
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  And so, the future of breast cancer care is really very bright.
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  Host: That is wonderful news.
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  Dr.
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  Lang, thank you so much, not only for the very important work that you are
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  doing on a daily basis, but thank you very much for your time today on such
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  an important and informative topic.
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  Dr. Julie Lang:
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  Thank you, Gina.
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  Host: Thank you for listening to UK HealthCast.
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  For more information about today's episode, please visit markey.uky.edu.
• 14:42
  If you enjoyed this podcast, please share it on your own social media channels.
• 14:46
  I'm Gina Kaye, and this has been UK HealthCast, a podcast from UK Healthcare.
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  Thanks for listening.