 Welcome back to EveryWay Woman. Now we have some questions and answers for our doctors from the audience. What's your name? I'm Dawn. What's your question? What does breast link offer for patients who cannot afford treatment? That's a tough question. We definitely have a good social services support. So we do try to direct them to help get resources to afford their care. We also have cash pricing options available to patients. And we definitely try to work with everybody we can to try to help afford their care. Thank you. Who else had a question? What's your name? My name is Erin Schaffer. Hi Erin. What's your question? The question is it seems like a really exciting time in medicine. A lot going on technologically with the psychology of healing. People looking inside and outside the borders of our country. What are you excited as medical professionals? What are you most excited about? Yeah, I think it is an exciting time. I think we've seen a lot of progress made in all areas of treating breast cancer. In my own area, medical oncology, this is really an era of targeted therapy. Where we're able to get away from the old kind of typical type of chemotherapy drugs and move more towards targeted immune based therapies that target directly to the cancer cell and can avoid a lot of the healthy cells that's minimizing side effects. And we see greater efficacy too with these drugs. Surgery too is amazing. New innovations in surgery used to be removing the whole breast. Now we remove much less if we can. We even give radiation at the same time in surgeries. It's called intraoperative radiation. There's even a really cool new thing in surgery which is freezing the tumor. It's called cryoablation. Is that like freezing the fog? Cryo means freeze, right? So you freeze and then ablate and remove, get rid of the tumor. So there's a lot of new things going on, even in imaging too. In imaging it's been a really great decade because one of the newest things is 3D mammography. So now where it used to be harder to see through tissue when we did a mammogram with 3D mammography we can see through the tissue much better. And we're finding cancers that we wouldn't have seen before, which in turn means that we find them much smaller and we can do a lot more to help the patient. I think from my perspective I really enjoy our model of practicing care or delivering care for breast link or for breast cancer patients because it's very communal. We talk about every case. We have multiple angles that we see each patient from. We actually have, you know, we're working on survivorship and counseling services and nutrition and kind of the whole person as we treat them from all of our different specialties. Thank you doctors. Let's take our next question. What's your name? Karen. Hi Karen, what's your question? Are there any non-traditional options such as acupuncture or herbs? Yeah, that's a great question. And to answer that, there are emerging new therapies that are outside the scope of typical medicines. You mentioned acupuncture. One thing we try to do as the medical community is really see that there's some substantial evidence-based confirmation that the treatment works. And acupuncture happens to be the one treatment that we've really seen confirmed in recent studies just as of two years ago to show that it's helpful in treating nausea. It fell a little bit short in some of the other areas, but for patients who have chemotherapy-induced nausea that really requires something else. What about the pain? Pain, that's a good- it trended towards statistical significance for the pain. And some patients again have found that acupuncture has helped tremendously with pain. Have you seen more of a correlation between the Eastern and Western medicine in treating cancer? I think there should be. I mean, I think it makes sense to have the whole body treated and the whole- all of the options available. But you have to be careful with these things. You know, I had someone try to use warm compresses to take care of her breast cancer. And that didn't work. So you want to be very cautious with what kinds of things and alternatives you do say are acceptable or not. But we all want to treat the whole patient and use everything available. Nutrition, diet, exercise, as well as alternatives. Yeah, I think I tell my patients as well that these alternative therapies are not proven. And how we're trained is we need data to support recommendations that we make. So it may not be that it's not effective. There's just no data necessarily to support it. So I usually tell my patients we prefer that you continue on with standard data proven measures and trying other things on your own, you know, it's kind of at your risk. But yes, want to take into account all the other options as well. I think it's important to point out there's difference between alternative medicine and complementary medicine also. Alternative medicine tends to apply more towards doing something instead of surgery or radiation or chemotherapy whereas complementary medicine helps to alleviate side effects and symptoms. Why not try a little bit of everything? That's my motto. Why not, right? It can be dangerous, however. Well, that's what the marijuana is for. No comment. Thank you so much. That was so informative. What's your name? Susie. What's your question? Why isn't there more information on the severe side effects of cancer treatment? That's a great question. A lot of work actually has been done at looking at reducing the side effects from cancer treatment. And many of us in the medical oncology community know that in the last 15 years we've seen a big breakthrough in nausea, very potent nausea medicines that enable us to really control nausea almost 100%. We have several lines of nausea therapy we can use, for instance, that can completely control a patient's nausea in almost every case. So we've made tremendous strides and breakthroughs. The one area is fatigue, just kind of feeling crummy, feeling yucky after you've had chemotherapy. What about vitamin B12? I've heard taking vitamin B or vitamin D as a complementary treatment to that can help with fatigue. That's a good question. I think that there's really no solid data showing that giving vitamin B12 and somebody who has normal vitamin B12 levels is going to do anything to augment their energy level. So we certainly test patients for vitamin B12 if we think they're low. To address that as well, Dr. Link, one of our medical oncologists in our group, has written a few books, Breast Cancer Survival Manual, to go into those details and those risks and those side effects. We do try to provide resources. You have to search sometimes for them. They're not always given to you and saying, here you go, this is what you might deal with. Sometimes you have to look and ask. Sometimes you have to ask other patients who've gone through it. We do have a support group of volunteers that have gone through breast cancer treatment. So they've kind of experienced all of these potential side effects and they're a great resource for our patients. Well, and that's the keyword potential because not every patient is going to experience it. We don't want to scare people, right? That, oh, you're going to have this and that and the other because you might not. Sure. These are really good questions. Thank you. We have, what's your name? Sharon. Sharon, what's your question? Are such drastic measures as a complete mastectomy really necessary if you have the gene or family history? That's a good question. Good question. You know, I think the recommendation is made, I think in the majority of cases, for risk reducing surgery when you have the genetic mutation. I think that could be called like the Angelina Jolie effect. Yes, exactly. So the BRCA gene is what the gene you're referring to. There's BRCA 1 and 2. There's several other genes related to breast cancer that increase the risk. A breast cancer up to even 86%, but it's not true for everyone. And actually Stanford has a little tool model that you can predict your overall chances of getting a breast cancer or even ovarian cancer. And there's high risk screening. So we don't have to do the radical double mastectomy that Angelina Jolie went through, but that's a very personal decision. She's got the budget for it, but does insurance cover preventative medicine in that case? Yes, it does. If it's high risk enough? Definitely. Interesting. Any more questions? Thank you, doctors, for answering everything so perfectly and audience for all your questions. For more information, please visit our website, everywaywoman.com.