Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
Anushka Chaudhry - Consultant Oncoplastic Cosmetic Breast Surgeon. Health Educator.
26 Plays11 months ago
Dr. Anushka Chaudhry, an esteemed Consultant Oncoplastic and Cosmetic Breast Surgeon with a passion for education and patient-centered care.
Dr. Chaudhry brings invaluable expertise, and we’re going to discuss the critical decisions faced by breast cancer patients—from surgical options and what they entail, secondary patients, to the latest insights on the right age for screening, and the various drug therapies available today. Whether you’re navigating your own diagnosis, supporting a loved one, or simply wanting to know more, this conversation promises a blend of knowledge, empathy, and practical advice.
Recommended
Transcript
Introduction and Social Connections
00:00:13
Speaker
you doing? It's happened, we're we're talking. I know, it's amazing, finally. Yeah, well actually it's a second time isn't it? Yeah, that's so true, that's so true other than on social media.
00:00:25
Speaker
This is it. This is this is the thing. and Yeah, we met very briefly at the Future Dreams Ladies' Lunch. That's it. A very glam event, wasn't it? And I was in shocking pink. It was so long ago, I can barely...
00:00:41
Speaker
You mean you don't remember what I was wearing at the time? Of course, I remember. would Everyone looked amazing that day. Of course.
Inclusive Events and Charity Work
00:00:47
Speaker
Will you be attending this year's non-branded Ladies Lunch at Future Dreams? Oh my goodness. Hopefully, yes. Yeah, I'd like to go again. i'm hoping I don't don't know why it's not called Ladies Lunch. I don't know whether it was put in Men off. Maybe that was a thing. Exactly. That's the thing. We've got to think of everybody nowadays. Well, this is it. this is I actually was in two minds whether to go or not because it was a lady's lunch. I was like, am I allowed? Well, I'm glad you were there.
00:01:16
Speaker
So, obviously I know who you are. um We interact a little bit. I appreciate all your support, which is unexpected, but amazing.
Role and Impact of Breast Cancer Organizations
00:01:28
Speaker
um But what is it that you actually do is your, what's your involvement with the breast cancer community slash job?
00:01:38
Speaker
So I am a breast cancer oncoplastic surgeon. and So I provide reconstructive services. I work in Wiltshire. I also am co-founder and chair of a young women's breast cancer charity called Aurora Breast Cancer Wellbeing. And we provide ah support, psychological well-being and well-being days and get togethers essentially for women diagnosed under the age of 50 in our region. But women from all over the country are welcome.
00:02:06
Speaker
And this week, excitingly, we also hosted our first secondary and network as well, which is the first time in this area, which was unfortunately much more well attended than I was expecting. And I mean, unfortunately, because it just showed how many ladies were in our area who didn't have that kind of network before.
00:02:23
Speaker
Yeah, there seems to be, I've definitely heard that there's a lack of, well, people give me the indication there's a lack of support for secondary patients. Yeah, very much. And I think it's also quite geographical. You know, if you live in a bigger city, there is more access and some hospitals have secondary support affiliated with them. But certainly in our region, I think women were finding it quite difficult that they had to either go to Bath or London for that interspersed with multiple hospital appointments and treatments. It makes it very different difficult to fine so we're about as the group so this at the moment is in wheelchair wheelchair right okay i'm not not very geographic so it's between redding and bristol how does that sound okay yeah yeah i know where that is well no but i mean again it's good to share that because it may be something that people absolutely absolutely it's literally just just off the m4 you know so along that whole corridor really
00:03:19
Speaker
One of the things which i've I'm working on, which i think I think you did leave a comment, is doing a Northern. England event. But one of the things, obviously it becomes very apparent that people are like, well, I'm in Bristol. There's nothing for me. I'm in Bournemouth. There's nothing. And there's like disease disease pockets of space where people just don't feel supported. So I'm hoping to do my my bit. It should be, obviously I'm going to get the community to kind of rally around. So it should be a good thing. um One of the
00:03:55
Speaker
it's interesting that obviously the charity you're in, did you actually start the
Trends in Breast Cancer Diagnoses
00:03:59
Speaker
charity? I did with one of my Bresna specialist colleagues and now I'm a really really good friend, we set it up in 2015 but we became officially registered only last year. I remember the photos in the pub. There we are. What I was going to say was it's quite interesting because one of the questions I was going to ask you was the occurrence or have you noticed a larger occurrence in women under 50, more recently being diagnosed or having surgery?
00:04:33
Speaker
Yeah, absolutely. I mean, historically data would say from Cancer Research UK and other other figures that about 20% of all breast cancers diagnosed in the yeah UK are under the age of 50, around that number. um And if you think about it, so about 55,000 women are diagnosed a year, so about 20% of that But what um more recent data shows, especially since the pandemic, and I'm not relating it directly to the pandemic, but since the pandemic, global rates of breast cancer and other cancers has risen, but specifically in the younger age group as well. And certainly we're seeing that here, you know, from an Aurora registration point of view, we used to have maybe two ladies a month. Now, sometimes it's four or five a week. it's
00:05:19
Speaker
it's significantly higher for a period of time and it's difficult to explain, you know, I think um there isn't just one reason for that happening and I don't think we can just put it down to more awareness. We are genuinely diagnosing more younger women with breast cancer. I mean do you think, is obviously you say you can't put it down to one thing but do you think there is an element of people being more forthcoming and getting to the doctors earlier i don't I don't know if that's the case really, because I feel like when we say about if someone came earlier, then we'd we'd we'd end up finding more, for sure. But I think we would eventually find those ladies, be whether they present with primary breast cancer or cancer that's already spread. So if this is just literally the number of women being diagnosed. um Yes, absolutely, more women are coming to clinics than ever before. And I think my colleagues around the country who are breast surgeons who run breast clinics will find that they are
00:06:13
Speaker
very very busy at the moment more than ever before. Next question, what about male? Yeah so with male breast cancers, so for example where I work in Swindon we usually have about 400-450 cancers a year overall and generally we tend to have about too many a year. So I think I mean in the UK it would be approximately 370-ish cancers a year are men out of all the cancers. I haven't yet, and I don't think we've had enough time really to study it, but I haven't yet seen a significant increase in men being diagnosed. That seems at the moment to be quite stable. Yeah. Well, it's quite, um obviously from my point of view, I'm kind of, I'm interested. Yeah, absolutely.
00:07:00
Speaker
I mean, I think the key thing isn't it is and the importance of what you do really is to really be a face to it, no matter, ah despite everything you've gone through is raising that awareness is so important. In my practice, you know, generally we know that men who get breast cancer tend to be over 60, but that is not always the case.
00:07:19
Speaker
um And because of that age and that lack of talking about it, you know, the majority of men I've seen in the last few years, i tell I tell people this openly when I go to my husband's golf club or something, is they've been playing golf and they've taken a golf swing and they felt something against their, when they've put their arm went against their chest. And then they went, oh, there's a lump there. You know, so um they tend to find it like that. i Yeah, that's quite interesting. I've never really thought, oh, maybe the way in is push it.
00:07:48
Speaker
We need a charity golf day and a male breast cancer awareness day. There you go, there's an
Becoming a Breast Surgeon
00:07:54
Speaker
idea. I how just i mean, out of curiosity, do you you you know when you when you originally like trained,
00:08:03
Speaker
at what point do you decide to become a breast surgeon and not a brain surgeon? what So um the training programs have changed over the years, but just as a snapshot of my life, when when you come out of med school, you become a basic doctor. So you do a bit of everything, six months of different things, a year in medicine and a year in surgical specialties. And then at that time you have to decide, do you want to be a surgeon or do you want to be a medical doctor? For example, dealing with the heart, the lungs, et cetera, but not operating on people.
00:08:33
Speaker
And I definitely wanted to be a surgeon. You know, I was always the one carving up that Christmas turkey, but no, generally I absolutely love anatomy and that that surgical side of things. So I went through surgical training and I actually loved every part of training I did. It was really difficult for me to decide actually, because when I did bowel surgery, I loved it. I loved keyhole, laparoscopic surgery. When I did liver surgery, I loved it. So I just was fascinated by all of it.
00:08:58
Speaker
But through my training, every time I did a breast specialty post, something always drew me back to it. And I think it was that significantly different side of of breast surgery you see is that that communication with your patients, the relationship and rapport that you build with your patients.
00:09:15
Speaker
but actually that element of team working with immersed specialists and that kind of it's really fast paced you know you get to a lot of work within a week but you've got your the patients who are diagnosed it it takes a lot of really tight wheels in that cog to make everything flow for that person and everyone takes responsibility for it and it just drew me back along with the I think the psychology of it all um And I really love art and I loved doing art when I was younger. And I suppose I get to combine all the parts of surgery and medicine that I love with the scientific side, with that kind of creative side, I suppose, with breast reconstruction and cosmetic surgery.
00:09:54
Speaker
i mean well I mean, that's an unusual, unexpected way of kind of looking at that. Breast reconstruction is art. yeah Just from my observation. I mean, my my scar is, ah you know, a lot of people have said it's like really tiny and really clean. and But then i I see a lot of people on on Instagram. And their scars are I would, i I kind of imagine what it must, be it must be quite difficult to live with some, some of the scars that I've, I've seen that whether they're older, less advanced techniques we use I don't know but
00:10:36
Speaker
um I think you're right to talk about that kind of scarring side of things because I think part of being an oncoplastic breast surgeon is is not just about reconstruction, it's actually about considering every the approach to every patient as how can I optimize the aesthetics whilst prioritizing that cancer removal.
00:10:56
Speaker
And so even if somebody is having a mastectomy and doesn't want to reconstruction, I want to think about putting my scar in the best possible place that in case they want to reconstruction later, is that scar going to facilitate it? And sometimes you just can't. Sometimes you have to remove skin in a higher part of the chest or an angle that you don't want to. and to ideally put a scar. um But if a tumour, for example, is close to the skin or in a, you know as I say, an anatomically difficult place, you have to just get on with it and do that. And then you're right, there are other factors. So for example, people who work with black skin or Asian populations may have a higher chance of getting keloid scarring or thickened scarring. um So we have to counsel them for that. And how can we minimise that?
00:11:43
Speaker
and And other considerations, really, you know, are they smokers? Do they have other medical conditions? So it's all part of the consent process, of what that scar means for them. But you're right, they have to live with that as a reminder. So how can we make it as as good as possible?
00:11:57
Speaker
I was speaking to somebody, and obviously this and this isn't one of your patients, but I was speaking to somebody and they had actually told me that they, no, actually I was talking to their daughter and and I was curious, I said, have you seen your mum's scar? And she said, no, she said she won't eat now you even get undressed in front of her partner. yeah And i yeah, again, obviously, because that's not something I'm,
00:12:27
Speaker
I'm quite, um you know, obviously I'll go into the swimming baths and and show my scar. It's not an issue. And I know it's different for men and women, but that kind of shocked me a little bit.
Psychological and Aesthetic Aspects of Surgery
00:12:36
Speaker
That was a surprise. Yeah. Well, you know, when you say it's different for men and women, can I ask, were you offered a breast reconstruction? Was that something that was discussed with you? ah The only thing I was offered was a yeah the 3D tattoo.
00:12:54
Speaker
okay okay and And since then a few people have actually Yeah, I've been offered a 3D tattoo. and then so And then I wanted to interview someone that actually does the tattoos. And she said, well, why don't we do the why don't we do a podcast while you're getting a tattoo done? Oh, I love that. Did you do? Well, i've I haven't even got any any tattoos. yeah Normal tattoos. Because I don't think I could actually decide. So to actually decide on a what I would put there,
00:13:29
Speaker
and live with forever. I don't know whether I could actually make a decision. However, I did see, I think you've seen the video where I use AI to generate ideas. There's one with like, it's kind of like leaves and a rose. And I was like, actually, quite it looks quite good. And whether you can actually recreate that in real real life, I don't know.
00:13:50
Speaker
but um Obviously, I'm quite, I'm not, I'm quite a slender guy, so. Yeah, yeah. Roop instruction was never a thing. I think I've spoke to one guy in America who had, who had a, like an implant. Yeah, absolutely. I think there's different options for men. And as you say, it depends on how slim you are, because actually, of course, compared to women, the breast tissue generally takes up a lot less space on a man's chest. And most of their contour is from their pec muscles, really.
00:14:20
Speaker
But um you know a lot of men are therefore, we think, happy with just that area being removed. But sometimes, of course, if the nipple is removed, you can offer tattooing of the nipple to be put back. And the amazing thing about tattooing is the inks are safe for people who've had breast cancer. They can match the dyes to exactly what your other nipple looks like if you've got one. Some people can have silicon molds made of their other nipple and that they can just pop it on and have a silicon mold there if they wanted to do that.
00:14:50
Speaker
Some people can have ah a special contour made breast implant or fat transfer. I don't know if you've heard of that where it's a liposuction technique, but whereas liposuction for fat cosmetics really is a vigorous thing and destroys the fat and you you don't keep the fat, with fat grafting or lipo filling, we actually treat the fat a bit better, clean it, and it's put back in to try and build up a bit more of a contour on the chest wall again. Yeah. I mean, I'm not, I'm not afraid of a man getting the little nipple.
00:15:19
Speaker
external nipple things, maybe women, I don't, I don't know. you know It's all like all options, isn't it? If it's you feel you need help,
00:15:32
Speaker
kind of like, I don't know. I just, for me, I'm like, it's gone. I joke about it. I'll show it. I've had photos. I'll go to women. I'm not, no one's ever asked me about it. I kind of think, oh, I wonder if there's any female
00:15:50
Speaker
survivors are in the swimming baths looking at me and going, oh Matt, you know, that guy must have had breast cancer and I do wonder, but no one's ever mentioned anything to me. No, no, I can understand that. I think it's and it's, you know, it's a whole can of worms and it's um it's a talk I would love to have with someone who has kind of studies people's psychology over the generations because even women's decisions on their body is because of society to a lot of extent. You know, we talk about body image and we talk about what's important to the person. um And, you know, some people make decisions to have a reconstruction, not necessarily for themselves, but because of their relationship or because how they think people need to see them look.
00:16:28
Speaker
and We hear it all the time with women, some of my ladies who come back when they've had chemotherapy and if they're wearing a wig, for example, they say, oh, I can't wait to get that wig off. And in fact, I'm only wearing it because my kids expect me to wear it or, you know, so we're doing it for other people a lot of the time. Maybe men to some extent, or I can't prove it, are more comfortable and don't have that society pressure to have a specific kind of contour or shape or look in your clothing. I don't know.
00:16:54
Speaker
Yeah, yeah it's it's a weird one. i think I think it's whatever people are used to. I think people expect you to kind of return to how you were, I imagine. yeah so So at the beginning, you were saying ah about the different options for reconstruction.
00:17:14
Speaker
So what what would they be if someone's kind of like newly diagnosed and they're being overwhelmed a little bit by the amount of information that they're to be given. I mean I don't don't know what at what point do they have to make a decision as regards the reconstruction technique. This is for men and women basically? for Well I mean it's going to be mainly for men and ah women I would imagine. you Yeah obviously I've heard a few I've seen a few people recently have had the I want to say DF. Yeah that's right absolutely die that that's the the kind of abdominal fat flap basically.
00:17:49
Speaker
You're right. I think the the the main thing at the moment is for anyone being diagnosed with breast cancer is um there is a huge shift and it has been for a long time. We do everything to not have to do a breast reconstruction. And in that, what I mean by that is we try everything to try and not to do a mastectomy in the first place. There are so many different techniques now that are not volume replacement, so making a new breast, but actually just changing the shape of that breast.
00:18:17
Speaker
And it there are so many really good techniques for tumours that are, you know, quite big in a breast, whereas in the past we would have said, oh, with that size lump in that size breast, we really should remove the breast. Now we've got um different ways of kind of making making it possible to preserve a breast. That might mean though altering the shape that it used to have, so maybe uplifting it or making it smaller than it used to be, um in which case the person would then expect that they need surgery on the other side to match them up.
00:18:49
Speaker
But actually sometimes um we can replace some of the tissue on the breast by using the fat, for example, on the side of the chest wall here, and you don't need an operation on the other side. So we look at it as volume displacement, so shifting the volume to to somewhere else in the breast. and say justice Let me say che chest wall. I'll show you on my camera. So the fat here at the side of the chest, basically.
Genetics and Preventative Measures
00:19:12
Speaker
So, yeah, absolutely. So, you know, the bit that women don't like is that bunched up bit there. But actually, for tumors in the outer part of the breast, if you've got a good bunch of that, we can lift up a flap, which is just keep being kept alive on very tiny blood vessels that come out between your rib spaces, we call them perforator vessels, and we can replace the volume at the out on the outside of the breast.
00:19:37
Speaker
And then there are other versions of that you can do for different parts of the breast, depending where the tumour is. So more and more the shift is to train surgeons in these newer techniques. So women are offered a huge range but that is appropriate for them. We don't want to have too many choices, do we? Because there are so many decisions to make.
00:19:55
Speaker
um But it's nice to have various tools available to be able to offer somebody. And the importance of trying to not do a mastectomy, if possible, is we know that quality of life is directly related to the kind of aesthetic outcomes of a breast. And women who keep a breast live longer than women who don't. Now, that's not to say there's a huge significant difference.
00:20:18
Speaker
but provider say that again so if a woman is able to keep her breast yeah she has a better survival than a woman who doesn't keep her breast that's that's i mean that's good but that's surprising it's surprising isn't it You're right. And the study shows that that is independent. It doesn't matter what tumor type you had, whether you had a triple negative or not, it is solely based on other factors like quality of life, depression, schools, sexual wellbeing. All of these things are so important once hospital treatment finishes and that can have an impact on how your survival is down the line.
00:20:56
Speaker
Oh, sure. Of course, it's not always possible, is it? Sometimes we have to do a mistake to me because the tumor might be too big. It might be there might be more than one in different parts of the breast. It might be involving the skin, for example, or there may be a gene mutation, you know, like a BRCA1 or a BRCA2 gene mutation, just as to name two of them that might suggest that you're better off having a mistake to me. Yeah. Sometimes we don't have a choice. And then we've got to just think about the options there.
00:21:24
Speaker
What kind of percentages um of surgery that you do is is a preventative? is that is i mean it is I know this may sound like a deaf question, board is preventative but double mastectomy is on the NHS. That is a thing.
00:21:38
Speaker
Yes, it is. So essentially, um in the NHS, we have a screening program. And there are women who can be identified as having a what we call high risk, or very high risk in those different categories. And that can be based on genetics, for example, if they've been confirmed to have a gene mutation, or confirmed on whether they have a very strong family history of breast cancer. So some women are screened much earlier using um MRI, for example, before they end up going into having mammograms.
00:22:07
Speaker
And out of that, a significant number of women um in the highest 70s percentages tend not to go for bilateral prophylactic mastectomy. They choose to just have the screening. And there's various reasons for that. Because we know that with a regular screening program, the aim is to diagnose a cancer. okay So not to die from a cancer. And so if you put that versus the impact of having both your breasts removed,
00:22:37
Speaker
maybe not having a reconstruction or having a reconstruction and the implications of that on your body image, your function, your relationships, all of that. So a lot of women would say, i I'd rather keep my breasts and just have screening. And then there are those who feel there's a ticking time bomb because they have a gene mutation and they're so worried about developing a cancer that if they're in the high risk category, we can then go and offer them a bilateral mastectomy with or without reconstruction.
00:23:05
Speaker
Because obviously they the weird thing is, I then i don't I'm not sure, because I follow some BRCA groups and then there are, i actually I do follow a few people that are ah they so you know in their profile that says BRCA to positive or whatever, but I kind of,
00:23:27
Speaker
What is the name of, because obviously you've got, are they pre-vivars? Are they still, are they clusters? Oh, I see. Yeah, there's obviously going to be different terminology in those in those communities, you know. um It's a whole different psychology, I suppose, having, um you know, a prophylactic mastectomy or the knowledge that you have a gene mutation which puts you at a significantly high risk.
00:23:49
Speaker
And I suppose the support for women who undergo that kind of surgery, um who still have life-changing surgery and life-changing decisions to make, they may not have that same kind of community support in person as the women who've gone through cancer treatment.
00:24:04
Speaker
Yeah, because I mean, obviously, I've spoke to a few people this week about the genetics. Obviously, the risk is ah is highly increased, especially with brackets here, isn't it? yeah and um But obviously, they've they've not had surgery. They're kind of just under observation, aren't they? Well, that must be and quite worrying.
00:24:30
Speaker
um I suppose up until the point where they go, look I want a preventative mastectomy. Yeah, absolutely. I think when I meet with, um, ladies, you have either are in the high risk category, um, or have a gene mutation and want to talk about their options. The key thing is, I think the good thing about the genetic services that we have is that there is a counselor, a genetics counselor who goes through all the options of if you stay with screening, this is how we're going to keep an eye on you. But you can also discuss your options with a surgeon and sometimes it's not just a breast surgeon. They have to see, they have to see a gynae surgeon as well to think about what do we do with my ovaries? Are those part of this risk process?
00:25:06
Speaker
And then there are also other genetic conditions that don't increase the risk of ovarian cancer that might have something to do with your bowel, for example, or your thyroid. So there are so many different gene mutations that we have to consider and what each of those risks is.
00:25:20
Speaker
And I think the thing is once you balance up the conversation of, we you know, what the person's options are. And I also think it's really important for ladies to understand that if you are thinking about having prophylectomy, have you optimized yourself from every other possible way? For example, is your weight as good as it can be?
00:25:41
Speaker
you know, because obesity contributes to breast but to cancer risk as well as operative complications. You know, you want to be as good as you can be. Do you smoke? Because if you smoke, you're increasing your cancer risk and not just lung cancer, all cancers, um but also smoking increases the risk of complications. So you just see what I mean. There's other factors to take into account before you think, oh, I've got a gene mutation. I've got to reduce my risk. is Are we doing all the other lifestyle factors that we can take into our control to help reduce risk?
00:26:11
Speaker
um and then people have to think about that alongside the fact that for some women they may have lost multiple family members to cancer and that's going to spew your decision as to whether you go for surgery or not you know some people just want to be able to focus on themselves, their work, their family and not think about their breasts. Yeah it's it's a real complicated im Well, you know, I think one of the things that everyone will say and and and the thing that becomes apparent, the more people you speak to is that, and it's a bit it's a bit of a cliche, but it's so true that everyone's journey is just completely different. I know. And and i I can't say it enough, which is why I think there is such power in social media and such power on the internet, but also so difficult it must be so difficult to navigate all of that and when you are do you well you Well, you know, you only you only get the bit that is relevant to you, hopefully. don dont Go and Google it. um You get the bits that are relevant to you and then you can find someone in the community that can maybe give you, you know, but a bit of guidance or you can follow them and and get guidance from that. But it's so, especially I got, um so I went to, I met ah Wendy Watson. Wendy Watson.
00:27:32
Speaker
I don't know Wendy Watson. Apparently, I didn't realise she's the first woman in the UK to get a double masta preventative mastectomy. Oh wow, okay. In 1992. So she's making so she's making a um she's making a musical of her life. Oh wow, okay. She's a bit of a character and then I met Gareth Edwards. Yes.
00:27:55
Speaker
And he's a bit of a character as well. and he got up and He got up and sang and dance danced at this thing that was I got invited to. But he was he was telling me all the stats. So obviously Gareth Edwards, how I took it was he was working on the He was looking at identifying what is now bracket two gene. It's in the research, yes. Yeah, so he was working on that. And then he, so we were talking about the stats and he just hit me with like so many stats and I was like, wow, this is like a lot of information.
00:28:34
Speaker
yeah Especially you when you're, because I mean, I was kind of curious from a male point of view, what the increased rate of maybe prostrate cancer is if you, if you're carrying the BRCA2 gene, um which again, weirdly, you know, people say, oh, you've got the good cancer. Well, weirdly, like BRCA1 and BRCA2 will now, now I understand and correct me if I'm wrong, but BRCA2 is a worse, is a higher risk, is what I kind of took from So for for men, you mean, well, most men... Well, men and women, isn't it? I think i think it's a bit of it's a bit of both because one of them will increase your risk of breast cancer more than the other, and the other will increase your risk of ovarian more than the other, but they're both generally a significantly higher risk. yeah So both of them, yeah, absolutely. With men, they tend to more likely have BRCA2. That was what you said, yeah. Yeah, absolutely.
00:29:30
Speaker
um Yeah, he told me a lot. But then, well, then the thing that kind of affected me because I'd I'd been to the doctor recently to get a ah pain I was having in my chest looked at. And then I spoke to um Wendy and Becky, her daughter, because they'd mentioned about and i if you if you've tested positive for if you've had breast cancer and you've tested negative, you need to go and get tested again. I think quite fully understand why. Do you mean for do you mean for gene in genetics? Yeah, so but then when I spoke to Gareth Edwards, he then, well, I kind of got my head around a little bit. He said the they've only tested four, five extra
00:30:21
Speaker
genes that can cause breast cancer in the last two years. So theoretically, if you've had genetic testing before, then you will have only been tested for BRCA1 and BRCA2. So now you probably need to go back and get further testing done. So now I kind of understand that. I didn't understand it. So I'm going to, I've got a genetics form to fill in, which I've already done seven years, well, six years ago. I see. Okay.
00:30:50
Speaker
So, because obviously i was i'm I'm negative for bracket one and bracket two. Well, I'm kind of curious what caused my... Yeah. And sometimes we don't know because, you know, you can see how long it takes for new genes to be determined as to the causes of different cancers. And that's where a lot of research is going in this field. I mean, we know about different gene gene mutations. um So we all have these genes. It's whether they're working properly or not. um So the point of a gene mutation is it allows a bad cell to get through that would normally have been destroyed by the body. So our body is like little checkpoints. And when all of our cells are being produced,
00:31:29
Speaker
The point is that any cell that looks bad or defective is destroyed and isn't allowed to carry on. But when you have a gene mutation, that checkpoint doesn't work and a bad cell can get through and carry on growing. And it doesn't detect those bad cells. So you know you have a higher risk of bad cells being able to grow. This is just very very generalized. Well, again, no it's like that's a that's that's completely opposite to what I imagined having the gene actually meant. so does that mean Does that mean that if you if everyone has these genes in them
00:32:07
Speaker
and at the moment they get destroyed. Does that mean someone can generate BRCA 1 or 2 from next generation from not having it to have it? and night No, not necessarily. So as I said, we all have the genes that we talk about. I have BRCA 1 and 2, but mine work. So we call it a gene mutation. So if someone has a gene mutation, it means that that gene is not doing its job properly.
00:32:36
Speaker
and And there's various ones that might relate to different cancers. And there's been a a big study of over a thousand men with breast cancer. And they also looked at men without breast cancer to see if they could associate the gene mutations that happen in men to ones that happen in women. And although that data is still ongoing, they are finding that there is some likeness between gene mutations in men and women.
00:33:04
Speaker
And I think it's important to know that because we want to know that the treatments that we look at and the ways that we think of screening people and supporting them is as good as it can be. But, you know, as you say, having spoken to Gareth, it's just about just, you know, it is a fast moving field. When someone has a gene or a genetic test, you know, on the NHS, it can take some time. It can take, you know, longer than two months, sometimes even longer than that for a result to come back.
00:33:33
Speaker
um And we can push for it to come back much quicker if we think it's going to change the treatment that that person is going to have. So we can we can expedite it, we can make it more rapid and get it quicker.
00:33:46
Speaker
And more often than not, we find that someone does not have a gene mutation. So it's only about 10%, 15% of breast cancers. yeah And then you either get a, we have not found a gene mutation, or we have found a gene mutation, or you might get something called VUS. So it's kind of variation of uncertain significance. And this is the kind of gray bit that people go, what does it mean? Do I or do I not?
00:34:16
Speaker
And what it means scientifically is it's something that they will keep on a database, on a radar. We can't confirm you have a gene mutation, but as future research and data comes out, we will know if this is related to it. yeah But it doesn't mean that that person has an increased risk. Yeah, because I think that they they kind of told me, the the women's in Liverpool, they they said, if you hear of any new discoveries kind of maybe go back to your EG point and ask for another test. So I think this is this is the time I'm i'm kind of going to do that. I mean, mainly mainly for, I mean, obviously I want to know if I'm i'm at higher risk um anyway, but um from my daughter's point of view, that would be something that obviously could affect her. So
00:35:03
Speaker
Yeah, I think the important thing to say, for example, with BRCA 1 and 2, is the way that they go down through generations is if someone is diagnosed with BRCA 1 or 2, it doesn't definitely mean that your children are going to have that gene mutation as a 50% chance. Yeah. um So that's, again, part of that, as you say, that consent process. Yeah. all this Well, this is it. I mean, they've already said that my daughter will be screened at 14 and not 50.
00:35:31
Speaker
OK, so so that's good that they are going to screen her early. If only that was the case for everybody. and Yeah, well, so this brings me on to my next. question, which obviously bit of an issue, bit of a, bit of a thing. A lot of, a lot of younger people that are diagnosed start petitions about this, reducing the, the breast screening age to 40. Now, obviously I know there's a complication with overlapping with, um,
00:36:06
Speaker
the younger the person that dents the breast tissue and potential false negatives or So I don't know whether you're allowed to have an opinion on breast cancer. I can absolutely have an opinion, but obviously, because it's my personal opinion, and I'm not speaking on behalf of my hospital or anything. But I i do feel that women should be screened from 40, as has now started in the States, which was a more recent change. Historically, we know in the UK that screening starts from 50. And um with the increasing rates of cancer diagnosis in younger women, I think there's every reason to be s screened from 40 onwards.
00:36:41
Speaker
I think we've got to look at pros and cons when it comes to this. So what are the pros of screening early?
Advancements in Detection Technology
00:36:47
Speaker
Well, the point is, of course, if you're younger, we want to know that you've got a cancer sooner. And the reason for that is because we know that younger women are more likely, not definitely, but more likely to have a more and faster type of growing cancer.
00:37:01
Speaker
The biology or the type of tumor that young women can get is different to women who are older. So a grade two cancer in a 30 year old is not the same as a grade two cancer in a 60 year old. and And that's what our research is looking at is you know we can't treat them both as the same just because they look the same on paper, they behave very differently.
00:37:22
Speaker
So we want to find those cancers as soon as possible so that we can treat them sooner because technically or theoretically women who are younger are supposed to live up to a longer time right up to the national life expectancy compared to a woman who's 78 who has already lived past that national life expectancy. I'm not saying anyone's life is more important than the other I'm just giving facts.
00:37:45
Speaker
Then you've got to think about, okay, so there's benefits to diagnosing someone early. We want to do that as soon as possible so we can start treatment and get them through it. And then what's the cons of that? Well, you mentioned dense breasts and I know 90 or all women who've got very dense breasts, but yes, you're right. Younger women do tend to have dense breasts.
00:38:03
Speaker
And when we talk about mammograms um looking for cancers, cancers are tend to be white on a mammogram and dense breasts look white on a mammogram. But imaging techniques have advanced so hugely over the years. We have contrast enhanced mammography. We've got 3D mammography called tomosynthesis. We now have contrast enhanced and MRI. We've got so many new tools.
00:38:27
Speaker
Plus, with the benefits of years of reflection and analysis of the screening program to date, we can analyze younger breasts or dense breasts better. And um so even though there is that caveat when you put it in with younger women, it's still worth looking at.
00:38:44
Speaker
Just out of curiosity, what are the risks or are there any risks with so the the technology the screen and technology that you mentioned then, like there's risks associated with having a mammogram?
00:38:58
Speaker
So yeah, I mean, a mammogram is an x-ray. X-ray is a radiation. We don't want to give somebody unnecessary radiation. So the screening program for women over 50 is every three years, once every three years. And the reason for that is because you want to know and if you screen someone at 50 and it looks OK, and then I screen them again at 53, technically you hope to find a cancer within the three-year time.
00:39:22
Speaker
In an ideal world, I think most of my colleagues would agree that actually two years with it would be better than three, because the quicker you find one, the better. In younger women, however, I would suggest that women have them every year from 40 to 50. Because as we talked about, their cancers are a different biology. And so it might occur within a year, not within two years, not within three years.
00:39:46
Speaker
And then you want to look at the radiation of having a mammogram every year for 10 years. And the studies do not suggest that there is a significant increased risk of developing cancer because of a mammogram. So I think, oh gosh, I read somewhere that a radiation induced death from of from breast cancer because of mammograms is you know one in every 72,000 years. I mean, it's it's it's negligible compared to the benefit of being able to find a cancer earlier in a young one. Garth said it was 20 in a million.
00:40:18
Speaker
Yeah, that's there we are. So quite similar, I would say. The amazing thing that's coming out more than ever before, and there's lots of studies and work being done on it, is the power of AI when it comes to mammogram reading. And the American Society of Breast Cancer Surgeons and recently in Orlando, there was a presentation about AI being significantly better than human beings at detecting triple negative breast cancers um in women, which is just absolutely phenomenal.
00:40:47
Speaker
so um Is that one is ah on um mobile on and on a mammogram? Absolutely. So the work that's being done right now is can AI do the job of a human or better? As a standard right now, all mammograms are read by two trained people and a report is given. And I suppose the miss rate for that is tiny. It's supposed to be like less than 1% or around 1%. And we know so far that AI has got the same miss rate as a human being. So it's not worse then.
00:41:13
Speaker
It can deliver, um you know, the same work with half the workforce, which we know is an issue in the and NHS as well. And now the study is showing that if it can detect aggressive cancers or triple negative cancers, should I say better than we can on a mammogram, it can find them, you know. How is triple negative identified ah through a mammogram? How visually is it is it different? how So um that's a difficult thing. So I have to say, just from, again, personal experience and and my opinion with with my colleagues and what I see when I look at mammograms, we know triple negative cancers can grow very quickly in a short space of time. So when a cancer develops, if you imagine it's growing like this, and it's kind of like a star. So it's spreading. And you tend to see what we call a stellate lesion, or one that looks like a blob with strands coming off the sides of it.
00:42:06
Speaker
But when something develops very quickly in a short space of time, it doesn't have time to give those strands, and you might get more of a round circle. So you might see more of a different shaped lesion. Sometimes one that could actually look, oh, that just looks like a benign, non-cancerous lump. But because colleagues are so experienced, they go, I'm suspicious of that. Let's call that back. Let's biopsy it. Right, OK. No, I was just kind of curious, because obviously I From my layman's point of view, i I understood triple negative was more to do with the kind of like, how the ah the tumor is fed, is that? No, you're absolutely right. So most tumors, about 85% of cancers are fueled by oestrogen, so they're oestrogen positive. um And then you've got the ones that are growing independent of our oestrogen, so they're oestrogen negative.
00:42:59
Speaker
um but yes believe it or not yes you're right triple negative does refer to the receptors or the growth features of a tumor but they also behave differently and that's I think where the training of people of you know specialists like myself and my colleagues comes in is that you can recognize that by imaging as well and you can see the features and characteristics of that so when we have a multi-disciplinary team meeting um a typical scenario would be So and so this age, here's a nanogram. We saw a lesion that is like five millimeters or 10 millimeters, whatever. And I think it looks a bit like this. Um, so I did a biopsy and they might say, I think it's probably a triple negative. Then the pathologist in the room puts her slides up, um, on the screen and says, well, here's what the cells show. And yes, indeed it is. And so, you know, we know we've got something to benchmark ourselves against as well.
00:43:51
Speaker
Yeah, so so just to go back, the non-mammogram screenings, are there any risks with those? So the screening, other than the mammogram, the only other tool we that we know of at this moment that is good for screening, but only in a certain age group, is m MRI.
00:44:14
Speaker
and that is what about what What about the other ones that you you gave me a list of? oh so those Sorry, those are not um standard screening tools. 2D mammogram in two views is the standard screening. Those other tools are actually the way ma mammography has evolved over time. So we used to look at mammograms on a film, you know, like you see in the movies, they pick up a piece of thing and they stick it on a light board and that's how we used to look at mammograms. Now it's on digital screens, so the resolution of those is is much, much better. And when I mentioned about 3D mammogram, not everybody gets that as standard, but if a woman is recalled, she may have a 3D mammogram, or if we know that someone's got a cancer, we will do one. And what you can do with that mammogram is number one, you see the three the first the first picture, which is the 2D image, and then you can scroll, and it takes you through the breast in slices. So you see slices of X-ray through the whole breast.
00:45:09
Speaker
So it gives you a good spatial awareness of where that lump is in the breast and how much space it's taking up. And is that is that still involve x-rays? It does involve x-rays, yes. I just, I obviously have seen a few technologies and I just assume there'll be a mammogram replacement that would, is not as, you know, there's less risks.
00:45:32
Speaker
So when you talk about risk, you mean radiation. So ultrasound is is definitely being evaluated as a tool for screening. There are some really promising machines out there which are not rolled out as standard at the moment. So I wouldn't want people to go and pay for a private screening ultrasound unless you knew how sensitive and accurate those results are. But that's definitely something that is on its way and would really be helpful in the NHS.
00:45:58
Speaker
An ultrasound generally is you know where you have a probe with a bit of jelly on it, and it's run across the breast. And it's really good for looking at a specific area. So let's say we've seen a mammogram, and there's a lesion on the mammogram, and we want to look at it further. Then an ultrasound is good. Because you know on the mammogram where specifically you want to look, and then you can use the ultrasound to focus on it. You understand the shape, the depth,
00:46:25
Speaker
and And is there anything around it? And that's how, of course, the biopsy is done with a bit of focus, ideally. Yeah. um Whereas if you're doing a screening ultrasound, it is something that is like a cup shape that fits over the whole breast and can take like a 45 minute scan. So there is things that are in progress. Yeah. Cause I've seen these like non, it's like a, it's like a hole in a in a table and you and obviously the breasts go like, so you can sit and it's not, there's no, um
00:47:01
Speaker
You don't need to compress. so and and ah An m MRI is done like that. So when a lady has an MRI, I'll actually say, oh, it's really dignified. You get to lie on your tummy with the boobs hanging down between two holes. And that's how an um MRI is done. You're right. There's no compression. So we see what then the breast images are taken upside down and then we have it converted to look at it the right way. So our um MRI is ah a substitute for mammamagras i say there is like to microgram Am I asking daft questions here? You can get in breast scans and I wonder if that the future?
00:47:38
Speaker
These are all questions that our community ask all the time. And in fact, in America, you would find, I think, a lot more women have MRI than anywhere else in the world, and there's different and reasons for that. One is about accessibility. you know An MRI, a standard breast m MRI, will take about a minimum of 45 minutes. A mammogram takes a couple of minutes. um How do we, as a health care system, and MRI everybody?
00:48:04
Speaker
The other thing with MRI is it's got a much higher chance of picking up a load of things that don't need to be looked at that are benign that might lead to a higher rate of biopsy, more anxiety for somebody with no extra benefit. um And then with an MRI, you also have to give a contrast and called gadolinium, which helps enhance the pictures within the breast.
00:48:26
Speaker
And there are studies to show that gadolinium can also go around the body. And do we need to give you that? So it's a combination of putting up the risks versus the benefits. the What are we doing it for? And what are we looking for?
00:48:38
Speaker
right So it can be used, it's very useful, as you say, for dense breasts, for certain types of cancers, for example, lobular cancers. So we know that most breast cancers are ductile, they form in the milk ducts, but then about 10% of them form in the milk lobules, which are the milk producing part.
00:48:58
Speaker
And the difficulty with lobular cancer is it doesn't tend to form as an obvious lump like we see a ductal cancer. It has what we call single filing and so it forms in sheets. So you might feel a lump, but you go and have a mammogram and the mammogram is completely normal. You have an ultrasound and it doesn't really show anything. That cancer could be, and I'm not saying always is, but could be a lobular cancer.
00:49:23
Speaker
or you have a cancer that's found on a mammogram and an ultrasound and it measures about eight millimeters, but because it's lobular, we would get an m MRI. And the reason for that is sometimes you find there's a bit more than meets the eye. So for certain cancers, we do an MRI just to let us know, are we happy with the size of what we've seen? Are we happy that that's all that we're seeing? But it's not a standard for every cancer.
00:49:49
Speaker
Right, I'm with you. And so is loblia cancer, breast cancer, is that discovered, normally discovered later because of those reasons? and It can be. So not significantly, but yes. But again, the screening program, the point of it is to try and detect as many cancers within that timeframe as possible. Yeah. So really the solution is we we reduce the screening age to 40 and then we... Let's do that. so i i I would think that you know it would be it would be
Addressing Disparities and Personalized Care
00:50:21
Speaker
great. And you know the other key thing is we know now, but not from UK data, but black women tend to develop breast cancer a decade earlier than white women. um And you know they also tend to have a higher risk of developing a triple negative breast cancer. So we need to be finding cancers in all women earlier, and especially if we've got data to show that a certain group of women are at a higher risk at a younger age,
00:50:46
Speaker
you know, that's all we need to be moving to. Yeah, I do wonder, because obviously there's um there's a breast screening panel, I think, who determine the age I wonder, who the hell are they? I might cut this bit out, but who the hell, where, what information are they actually looking at? I mean, obviously they've got a factor in cost as well. I am- I think that's the huge thing. You know, we're dealing with a really emotive thing, aren't we? Like healthcare, cancer, and money. And, you know, we can work as hard as we can on awareness programs, but we've got to think, I think eventually we'll get there. I think we'll eventually start screening women earlier. I would just like to see things move quicker.
00:51:29
Speaker
like would you Would you agree that the cost of, or rather, what is your what is your view on the cost of screening women 10 years earlier versus the cost of more aggressive treatment because cancer is caught later?
00:51:46
Speaker
Well, absolutely. you know So there's two costs here, isn't there? If we don't find a cancer as early as we can, it's not only the cost financially to the treatment, the need for hospital stay, chemotherapy, radiotherapy operations, people not being able to go to work for a period of time, the financial impact on their families and their lives, but actually the cost of that person's quality of life, their life span. you know We want to keep people and living well and to the best of their ability. so the sooner we find a cancer the better? I mean again no medical view but i I just assume because I've seen the the obviously the figure that is thrown around regarding like chemo per year in this country and it's gigantic huge and so I wonder
00:52:37
Speaker
I mean, my I just assume at some point it needs to shift from chemo to or ah you know aggressive treatments to early detection and then that has got to save That's got to save money in my non-medical- No, it absolutely will. I mean, we've certainly moved in postmenopausal women to being able to prevent a significant number of women having chemotherapy who would normally have been offered it. So the decision for chemotherapy is based on various things. And in the past, we are not in the past, we, you know, we use different algorithms based on the tumor size, the tumor grade, lymph nodes, the receptors, et cetera.
00:53:17
Speaker
And now we have something called genomic testing. And genomic testing is actually a test that's done on the cancer that's already been removed or on the biopsy that's been taken. And it gives us a score. And that score tells us if somebody is at high risk of developing a cancer somewhere else in their body later on in the next five to 10 years. And in those women, those are the people we should be giving chemotherapy to.
00:53:43
Speaker
Whereas if your school comes back as low, then yes, you had a breast cancer. But biologically, it doesn't mean it's got a high risk of coming back. We can never say never. So why would you give chemotherapy to somebody and give them toxic treatment for six months that changes every organ in your body to some extent, if there was no significant benefit?
00:54:02
Speaker
And so genomics has been a huge advance in our field and not everyone is eligible for it on the NHS. And you've got to take results in younger women with a pinch of salt. So it's not recommended for women under 40 because generally under 40, remember we said the biology is different. So, yeah you know, use those decisions wisely. So but dave withouts in I've been tested for genomics.
00:54:29
Speaker
I don't know because I'm not sure of your exact you know tumor characteristics and i i it's very difficult to say. so I've never received any information. I mean I had genetic screening but that was as far as far as it went. I just assumed the tumor went in the bin or Well, no, mostly tumors don't tend to get binned, they you know, the slices and things are stored for a period of time. But in men, there is limited data for genomic testing. So I wonder if that's why, you know, even if they did it for you or on your on your tumor, um they would have not been able to really use those results wisely. And remember, these tests are really costly. But
00:55:09
Speaker
And on the NHS, unfortunately, there are criteria for you to meet with your tumor characteristics to have one on the NHS. Whereas if somebody might be, and you know, borderline eligible, or really be interested in it, it's important to ask your doctor because, you know, it is available for self pay, but it can range between 1600 and just under 3000 pounds. Okay.
00:55:34
Speaker
I mean obviously as as a primary survivor occasionally I don't worry about it all the time but I do wonder more so because I speak to people that have had recurrence that obviously I do wonder you know when I get a twinge I'm like oh god what's that? Yeah I can understand that absolutely. So I am you know I am kind of curious and um ah weirdly I did have a but I was getting pains and metastacles, which i did again, I didn't know that that was a potential and sign of breast cancer in men. I never knew that was a potentially a thing. oh I guess it's the it's the lymph nodes and you're growing or something, I guess. that yeah So why was I was like, I'll need to go to the that the GP and get it checked out. And so they they gave me an ultrasound.
00:56:27
Speaker
And then the guy who was, who did the ultrasound said he wanted to scan my back and then he went quiet and disappeared but to your doctor. Well, no, but I mean, actually I think he was being quite professional. He said, you'll get your results from your doctor. And I was like, right. Okay.
00:56:43
Speaker
And then they rang me on the Tuesday and said, so basically they found a mass in my back. this It was like the week of my discharge, my official five year discharge. And um that was actually when the when the doctor rang me and said, we found a 45 mil by 40 mil mass in your back. I was like, that was actually probably,
00:57:08
Speaker
as upsetting as getting the initial diagnosis. Cause I was like, what, that's big. like That's a big thing. and It actually turned out, I mean, it took me a while to actually get the information back, but it turned out it was kind of like, it it said it was um a growth, I know it was a system near my spleen. okay I had an, obviously I'm getting pains at the moment, which I've got checked out. and i
00:57:38
Speaker
it looks like they, it's slightly different. the u the I had another ultrasound about two weeks ago and they said it's a, I've got cysts on my kidneys, which are fine, which are nothing to worry about. And then the mass is native. It just seemed like it was described a little bit differently and it wasn't as big as the original scan. But yeah, I mean, obviously every time I go in,
00:58:08
Speaker
I mean, i you know, obviously I feel incredibly lucky because i'm um I'm healthy and I'm not, you know, because I caught it early. That was a good thing. And everyone that knows me knows I'm like early detection. That's what you need to do. Like just get yourself to the doctor. And thankfully, I think the message does kind of get out.
00:58:26
Speaker
But when you're told you've got something in your body growing, it's a little bit, it can be a little bit frightening. I mean, obviously I'm hoping that it'll it will never come back. i wouldn't what What kind of, do you, without scaring people, do do you feel a lot of recurrence? Do you get people who are flat-chested saying, I found a lump on my breastbone or, orwe Yeah, I mean, I would be lying if I said there wasn't that risk of it happening, you know, and I think um what I'm always surprised by is how many and people who had been patients are surprised that a cancer can come back. And, you know, it's a whirlwind, isn't it? If people go through so much treatment or sometimes not that much treatment, but either way, you're discharged.
00:59:13
Speaker
And you're given loads of leaflets and information along the way. And some of that paperwork will say a breast cancer can come back in the future and you need to look out for things. But I wonder how much that's taken in because it's still a horrendous shock to the system, the possibility of coming back.
00:59:31
Speaker
There are certain types of cancer that have a higher risk of coming back. Um, and you know, you can be recommended to have the treatments for those. And then the important thing is just knowing your body as best as possible because you're right. Every headache, every bone ache can feel like, uh, you know, is it something to do with the cancer and it can be all consuming. So I think the important thing is to, um, really try and get as in tune as possible to your body once treatment has kind of stabilized and you know what your new baseline is.
Post-Treatment Awareness and Support
01:00:01
Speaker
to never feel silly, to contact your breast nurse or your GP if you think something's not right for you because you know yourself better than anyone else. And when it comes to things like pain, um you want to know is there pain that is new, but is there all the time or more often than not? Is it going away with basic painkillers or am I lying awake at night with pain and I can't get to sleep?
01:00:27
Speaker
and and you know And there's nothing to explain it. you know I didn't knock my leg, or you know I didn't fall downstairs, or something like that. That's when it comes to thinking about your bones, for example. But there are some other very generalized difficult symptoms that we often get all the time for various reasons, like nausea, a bit of a loss of appetite, a grumbling in your tummy, headaches that are difficult to explain. So again, it's if there's something that out of that is out of the norm for you and it's persistent,
01:00:56
Speaker
It's important to get checked. I think that um we also understand now more than ever before that there are many people living for many years with the excellent quality of life with secondary breast cancer. So, you know, although it's a completely different ballpark. and One of our mutual good friends, Gemma Duff, who says to me, when you have treatment for primary breast cancer, people tell you there's that light at the end of the tunnel, you keep working towards it. And she said that having secondary breast cancer is always thinking about how to bring light in, rather than that light at the end of the tunnel, which I think always gives me goosebumps.
01:01:39
Speaker
um So if you get, there's different types of recurrence, you could have a local recurrence, so where the cancer used to be and, you know, either in the same breast or in the scar, as you say, on the chest wall, which is possible.
01:01:52
Speaker
So that's why it's important to check your chest even after having a mastectomy. um And for that, if that happens, um you will tend to number one, have another biopsy to confirm it. Is it the same as what you had before? And you're likely to have scans of the rest of your body to say, let's just check the rest of you. And all being well, you're going to be offered ideally, if possible, an operation to remove that recurrence. Yeah.
01:02:17
Speaker
Then you've got what we call loco-regional recurrence. So it's not just where it came from in the first place, but it might be in the lymph nodes in your neck or the or the armpit in that area. And again, now we know that data suggests that that does not affect survival. That's really great news. That just because it's come back and gone to the lymph nodes in the region of where the cancer is, we will aim to treat it and keep it under control, but that does not affect survival.
01:02:46
Speaker
But then when cancer does go further than that, for example, the main organs of the body can be liver, lung, brain and bone, then there is a so survival impact and that will depend on where in the body it is, how much is there. And even then when people say to me, what now? What's my prognosis? My answer is,
01:03:08
Speaker
The important thing is to find out again, the receptors, the biology of this, of this recurrence or what we're dealing with and see what treatments are right for it. And there are many more targeted therapies than ever before and get going with treatment because only once we see the treatment response can we then make plans. We can't say anything upfront. Yeah, I mean, I think I see I see, obviously, i because I follow so many people online and they they start...
01:03:40
Speaker
like and I mean, In Hair 2 is a good example. like They start taking In Hair 2 and they're like, the tumor has vanished. sorry And I'm like, well, that must be an amazing, obviously they they'll be living with a secondary breast cancer diagnosis, but it must be amazing to be able to receive that but that news. Yeah, and that's something I see a lot and that's just absolutely, absolutely great.
01:04:05
Speaker
Yeah. Well, I mean, I mean, it's, it's almost like mind-blowing. I'm like, where's it gone? Like where, where does the chip, where does the chip, when that happens, where does the tumor go? Does it just disintegrate? The tumor cells are killed off essentially. Yeah.
01:04:21
Speaker
i mean Or sometimes they are rendered completely inactive. So for example, if you have um cancer spread to your bone, like a bone metastases, you might still see evidence that there had been something in the bone if you do certain types of scan, so because the bone has changed, but it's not active cancer. So sometimes it will disappear completely, or sometimes it will change characteristics, so you can say it's not active.
01:04:44
Speaker
So is that the NED, what you hear people say? NED, no evidence of disease. They might say NED, absolutely. Yeah. I mean, that's amazing when when when someone's able to share that. so So obviously, the community itself, it can be ah ah a roller coaster of different kind of news on a daily basis. so very much so This is why I'm trying to do my my bit and obviously you' you're supporting people as well and giving information, which is which is good. i just I just think it's um the online community is and an amazing thing. It is. It's connected us in lots of ways. Be part of, yeah. i I'm going to...
01:05:27
Speaker
We've hit an hour now. So obviously you've got to go back to your clinic. Yeah. OK. All right. to worry now Thanks for thanks for talking. and Obviously, there's been ah there's a lot of information there. So I think that is my gosh. Absolutely. i I'll cut out all my rambling bits. Oh, no. Thanks for chatting to me. And maybe. I want to.
01:05:55
Speaker
I want to do my bit to try and, you know, to actually make this 40 year old kind of screening age become a thing. i So I might kind of like harass you a little bit for some help.
01:06:10
Speaker
And I just, I just think it needs to happen. And obviously in a way that is safe for the people that are having it done. It's quite important. And I will see you at the um future dreams. Hope so. Hope so. Good to see you. The non-ladies looked. Yeah. You take care. Thanks for the news care. Take care. Bye.