Summary of "Nothing But The Breast - feat. Vandana Abramson"

Released on October 30, 2024, "Nothing But The Breast" is a pivotal episode of The Interview with Leslie Heaney. In this episode, host Leslie Heaney engages in a comprehensive discussion with Dr. Vandana Abramson, a renowned medical oncologist specializing in breast cancer at Vanderbilt Ingram Cancer Center. The conversation delves into breast cancer statistics, risk factors, screening methods, treatment options, genetic considerations, lifestyle modifications, and the latest advancements in breast cancer research.

1. Introduction and Breast Cancer Prevalence

Leslie Heaney sets the stage by highlighting the significance of October as Breast Cancer Awareness Month. She introduces Dr. Vandana Abramson, praising her extensive expertise and contributions to breast cancer research and treatment.

Leslie Heaney [00:05]:
"One in eight women will develop breast cancer in their lifetime. So for all of my women listeners, this really is a very important episode for you to listen to."

Dr. Abramson underscores the global and national prevalence of breast cancer, emphasizing its commonality and the critical nature of the discussion.

Dr. Vandana Abramson [02:22]:
"There are about two and a half million cases of breast cancer worldwide each year. And in the United States alone, there are about 300,000 new cases each year."

2. Age and Incidence Rates

The conversation transitions to the relationship between age and breast cancer incidence.

Leslie Heaney [03:08]:
"Most men will end up developing prostate cancer if they live that long. Is it similar with breast in that regard that you know your higher rates the older that you get?"

Dr. Abramson [03:17]:
"Certainly higher rates the older you get."

Dr. Abramson explains that while age is a significant risk factor, unlike prostate cancer in men, most women do not develop breast cancer. The majority of cases occur in women over 50, but screening recommendations begin at 40 to ensure early detection.

3. High-Risk Factors for Breast Cancer

Dr. Abramson outlines the primary risk factors associated with breast cancer, providing a foundation for understanding individual risk profiles.

Dr. Abramson [05:28]:
"Age, family history, genetic mutations like BRCA1 and 2 can play a role for sure. There are other things like reproductive factors, age of menarche or your first period, how much estrogen you have over a lifetime, childbirth, breastfeeding, other factors like dietary factors, alcohol, breast density."

She delves into how factors such as early menarche (first menstrual period), late childbirth, lack of breastfeeding, obesity, and alcohol consumption contribute to increased breast cancer risk by prolonging estrogen exposure or through other biological mechanisms.

4. Lifestyle Choices and Risk Reduction

Empowering listeners with actionable steps, Dr. Abramson discusses lifestyle modifications that can mitigate breast cancer risk.

Dr. Abramson [41:01]:
"Exercise, that's linked. And obesity, we know that's linked to breast cancer. So just getting out and exercising, 30 minutes a day of walking. That's huge."

She advocates for regular physical activity, maintaining a healthy weight, limiting alcohol intake to moderate levels (defined as three to five drinks per week), and adhering to a healthy diet that minimizes red meat and avoids charred meats to reduce carcinogen exposure.

5. Screening and Detection

Regular screening is critical for early detection, which significantly improves treatment outcomes. Dr. Abramson emphasizes the importance of starting mammograms at age 40 and discusses the challenges posed by dense breast tissue.

Dr. Abramson [43:55]:
"The reason that you might have increased rates of breast cancer if you have more dense breasts is because there's more of that [glandular tissue]. And some of the more connective tissue."

Advanced screening methods like 3D mammograms and ultrasounds are recommended for individuals with dense breasts to enhance detection accuracy, despite potential increases in false positives and associated costs.

6. Stages of Breast Cancer and Treatment Options

Understanding breast cancer staging is essential for grasping prognosis and treatment strategies. Dr. Abramson breaks down the staging system and its implications.

Dr. Abramson [26:06]:
"Stage one is really no lymph nodes involved, under 2cm in size. So a smaller tumor without lymph nodes under the arm on the same side as the breast, involved with cancer."

She explains:

• Stage I: Small tumor (<2cm), no lymph node involvement.
• Stage II: Larger tumor or limited lymph node involvement.
• Stage III: Extensive lymph node involvement or tumor spread to breast skin.
• Stage IV: Metastatic cancer spread to other body parts.

Dr. Abramson highlights that over 90% of breast cancers are diagnosed in stages I-III, with approximately 80% being curable. Treatment options vary based on stage and may include surgery (lumpectomy or mastectomy), chemotherapy, hormone therapy, and radiation.

7. Genetic Factors and Testing

Genetic predisposition plays a crucial role in breast cancer risk. Dr. Abramson discusses the significance of BRCA1 and BRCA2 mutations and the current landscape of genetic testing.

Dr. Abramson [34:45]:
"The most common genes associated with breast cancer are BRCA 1 and 2... about one in 400 women carry a BRCA mutation... among Ashkenazi Jews, that goes up to 2.5%."

Genetic testing is recommended for individuals with a family history of breast or ovarian cancer or those of Ashkenazi Jewish descent. Advances post the 2013 AMP vs. Myriad Supreme Court case have made genetic testing more accessible and affordable, removing previous barriers related to gene patenting.

Dr. Abramson [39:14]:
"Now it's $200 or less, and everyone, all health care insurance companies cover it."

8. Advances in Breast Cancer Treatment and Research

Dr. Abramson is enthusiastic about recent advancements in breast cancer treatment and ongoing research efforts aimed at improving patient outcomes.

Dr. Abramson [55:39]:
"Over the last decade, there have been at least 15 new drugs approved for breast cancer and over 30 new indications."

She highlights the development of targeted therapies for specific genetic mutations like PIK3CA and the exploration of androgen receptor-positive breast cancer treatments. Additionally, innovative approaches like using circulating tumor DNA (ctDNA) to monitor treatment efficacy in real-time are showing promise in personalizing therapy and reducing treatment-related toxicity.

Dr. Abramson [60:32]:
"If you could start a treatment and two weeks later, get a blood drawn to see if you're circulating tumor markers... change treatment based on that."

9. Conclusion and Empowerment Through Knowledge

The episode concludes with a strong emphasis on proactive health management, regular screenings, and staying informed about the latest in breast cancer research and treatment options. Leslie and Dr. Abramson encourage listeners to engage with healthcare providers, consider genetic testing when appropriate, and participate in clinical trials to contribute to ongoing advancements in breast cancer care.

Leslie Heaney [63:09]:
"It's important for women to remember, get your scans, do your self-exams, and be mindful about your health and what you're putting into your body."

Dr. Abramson [62:47]:
"We're really fortunate to be in this place right now."

Key Takeaways

• Prevalence and Risk: Breast cancer remains a significant health concern with a lifetime risk of approximately 13-14% for women. Age, genetics, reproductive factors, and lifestyle choices are key risk factors.

• Screening Importance: Regular mammograms starting at age 40 are crucial for early detection. Individuals with dense breasts may benefit from additional screening methods.

• Genetic Testing: BRCA1 and BRCA2 mutations significantly increase breast cancer risk. Genetic testing is recommended for those with a relevant family history or specific ethnic backgrounds.

• Lifestyle Modifications: Maintaining a healthy weight, regular exercise, limiting alcohol intake, and a balanced diet can help reduce breast cancer risk.

• Advancements in Treatment: Recent decades have seen substantial progress in breast cancer treatment, including the approval of new drugs and targeted therapies. Ongoing research continues to enhance treatment efficacy and patient outcomes.

• Empowerment Through Knowledge: Proactive health management, informed decision-making, and participation in clinical trials empower individuals to take control of their breast health and contribute to broader medical advancements.

Notable Quotes

• Dr. Abramson [02:22]:
  "One in eight women will develop breast cancer in their lifetime."

• Dr. Abramson [05:28]:
  "Age, family history, genetic mutations like BRCA1 and 2 can play a role for sure."

• Dr. Abramson [41:01]:
  "Exercise, that's linked. And obesity, we know that's linked to breast cancer. So just getting out and exercising, 30 minutes a day of walking. That's huge."

• Dr. Abramson [26:06]:
  "Stage one is really no lymph nodes involved, under 2cm in size."

• Dr. Abramson [34:45]:
  "The most common genes associated with breast cancer are BRCA 1 and 2... about one in 400 women carry a BRCA mutation."

• Dr. Abramson [55:39]:
  "Over the last decade, there have been at least 15 new drugs approved for breast cancer and over 30 new indications."

• Dr. Abramson [60:32]:
  "If you could start a treatment and two weeks later, get a blood drawn to see if you're circulating tumor markers... change treatment based on that."

This episode serves as a comprehensive resource for individuals seeking to understand breast cancer's complexities, emphasizing the importance of early detection, informed choices, and staying abreast of medical advancements. Dr. Vandana Abramson's expertise provides listeners with valuable insights into managing and mitigating breast cancer risks, underscoring the ongoing fight against this prevalent disease.