← Tony Mantor: Why Not Me ?
Tony Mantor: Why Not Me ?
Bonus Episode : Dr Steven Quay: Breast Cancer Awareness Month
00:25:29
Special guest Dr. Steven Quay, a globally recognized physician-scientist and founder of Atossa Therapeutics, shares insights on breast cancer prevention, early detection, and treatment options. The conversation highlights the importance of self-breast exams, mammograms, and understanding the different types of breast cancer and their survival rates
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A
Happy Holidays. Want to give your host a gift? Consider subscribing, rating and reviewing the show this holiday season. It really helps the show grow. From all of us at Believe, have a Merry Christmas, everyone and a happy holiday.
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Welcome to why Not Me Embracing Autism and Mental Health Worldwide hosted by Tony Mantour, broadcasting from the heart of Music City, usa, Nashville, Tennessee. Join us as our guests share their raw, powerful stories. Some will spark laughter, others will move you to tears. These real life journeys inspire, connect and remind you that you're never alone. We're igniting a global movement to empower everyone to make a lasting difference by fostering deep awareness, unwavering acceptance and profound understanding of autism and mental health. Tune in, be inspired and join us in transforming the world one story at a time.
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Hi, I'm Tony Mantour. Welcome to why Not Me Embracing Autism and Mental Health Worldwide. Today's episode is a bonus episode for October, which is Breast Cancer Awareness Month. Joining us today is Stephen Kuei who is the founder of Seattle based Atosa Therapeutics. With an MD and PhD from the University of Michigan, training at MIT and Harvard with 91 US patents, Dr. Kuei is a global leader in medical innovation, ranked in the top 1% of all scientists worldwide. In his current passion, prevention of the 2 million yearly breast cancer cases worldwide. He's a visionary physician, scientist, inventor and has so many insights to share with us today. So before we dive into our episode, we'll be back with an uninterrupted show right after a word from our sponsors. Thanks for joining us today, Noah, Pleasure to be here. Yes, very happy to have you. If you would give us a little information on what you do.
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C
So I am a physician scientist and have done a career sort of developing new drugs, new medicines and then getting them approved by the FDA and out to patients.
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B
Can you expand and give us a little insight on what type of drugs you've developed?
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C
So the first drug was a, was a gadolinium that's used in MRI. I've used about 80 million people. Contrast agent for HAART was used in about 36 million people. But I started Atosa Therapeutics to try to prevent breast cancer risk with a drug that I've invented called endoxifen. So that's my mission.
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B
That's a great mission. As you know, October is Breast Cancer awareness Month. Can you tell us what the benefits are for performing a monthly self breast exam and how it can help in the early detection of breast cancer?
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C
Well, let me reflect on that and maybe we can have a little bit of A conversation. So the way that you detect breast cancer primarily is with a self exam we which people recommend different recommendations about doing. But I still like it. Some people say don't bother, but I like it. You pick the same time each month and you get to know your breasts and that's very useful. And then if you find something different, you talk to your healthcare provider. The second is mammography. If a woman has just background, you know, nothing special in her family history, she starts at 40 years old with her first mammogram. Family history is strong, maybe at 35, and then you have them every two years. Some people say to stop at 70, but now people are living so long I think it's probably good to, to continue them even after that.
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B
Many women will perceive a breast cancer diagnosis as a death sentence. Oftentimes it isn't. Can you provide some detailed information on breast cancer survival rates?
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C
This is really, really important. So breast cancer has emotional overtones that can sometimes cloud just the facts. But it actually, for the majority of women who have breast cancer, 95 will be alive in five years, 92 will be alive in 10 years. So the number of women that die from primary breast cancer in a 5 to 10 year period of time is under 10%. So other cancers are sort of much more difficult. There is one kind of breast cancer called triple negative which does have about a 40%, five year, you know, 60% survival rate. But the average bread and butter, 80% of breast cancers, the survival is greater than 90% after five years.
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B
Some women, they always fear the worst. How can we support them in overcoming the mental and emotional fears associated with breast cancer? Empowering them to confidently seek screenings, engage with support systems, doctors and ensure their safety and well being.
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C
So Tony, look, I mean I've been in medicine my whole life and so one of the things, one of the commonalities that happen in these situations is until you know a path forward, whether you're healthy or whether you're gonna, you can actually have some treatment, that sort of thing, that's the highest time of anxiety. And so with that knowledge, getting people to say, hey I, I am worried about breast cancer, but what is the next thing I could do? Remember that little, that little fish in the kids movie, you know, what's the, you know, the next right step sort of thing. So it's getting a mammogram or it's doing your self examinations or it's talking to your healthcare physician. So information is power and the more information you can have, the better. If cancer is caught in the breast, Those numbers are 90 to 95% if it is metastatic in the body. We're now at a very different situation. We're no longer able to cure women. Typically with metastatic cancer, we fight really hard to keep it at bay and we can extend life for two or three or four or five years. But it's a very different, it's almost like a light switch. So getting it while it's still in the breast and hasn't spread is super important.
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B
You've been a doctor and a scientist for a very long time now. What are some of the changes that you've seen from when you first started to what it is now? How has medicine and care evolved?
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C
Yeah, so I'm going to give you a hundred year perspective. So that's maybe more than you asked for. I wasn't around 100 years ago, just in case anyone's asking. World War I was partially fought with chemical weapons, mostly something called mustard gas, which was very lethal. Of course. A man named Dana Farber in the 40s said, could I repurpose this, use much lower doses and actually try to kill tumors. So that was the first idea of doing anything but surgery and then radiation. It was chemotherapy. But it was harsh because you were trying to balance killing a tumor and not killing the patient. It wasn't until 1977 when tamoxifen became available for breast cancer. So first directed drug in any sort of cancer and it was breast cancer. And this was a drug that blocked the effect of estrogen on the cancer. So about 80% of women's tumors are actually driven by the thing that makes them female, the estrogen hormone. And so this drug, tamoxifen was intended to block that interaction and, and stop the cancers from growing. And it was, it was a miracle drug when it came out because while it has some side effects and things, it was not, you know, mustard gas like chemotherapy. So since then we've continued to refine both in getting better and better of efficacy and then now trying to improve the quality of life. One of our Advisors is named Dr. Laura Esserman, wonderful physician at the University of California, San Francisco. She's a surgeon. Full disclosure, she was a medical student of mine when I taught at Stanford Medical School, you know, a long time ago. But her mantra is, look, we've gotten cure rates for breast cancer in the 90 to 95% of five years, but we still, there's still a lot of quality of life issues. When that happens, women know they've had breast cancer, they know they've been treated. So now our focus is finding drugs that have that same efficacy, but then can reduce the side effects. And that's one of the things that motivates us at Atosa Therapeutics to develop the investigational drug endoxifen, because it does seem, at least in our 700 patients so far, to have a lower side effect profile, a better tolerance.
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B
What do you tell people when they are first diagnosed? How do you guide them down that path so that they can know, number one, it is not a death sentence. And number two, there may be some side effects, but they can still have a good quality of life?
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C
Yeah. The key is what is the report you get back from the biopsy that is done to start the process? So what you want to know is, is it breast cancer or not? And of course, you know, check that box, it's breast cancer. And then there's something called the differentiation. So it's a big long word, but what it means is the more normal the cancer looks like to normal breast, the more well differentiated is, the better it is for it being a cancer that's not likely to kill you. So there's well differentiated, medium differentiated and poorly differentiated. And each of those carries an increased risk of cancer. So that's step one. You check that box. What's this differentiation? And then you ask about what is driving the cancer. So as I've said, 80% of cancers, the doctor will tell you your cancer is driven by estrogen. So it's what's called capital E, capital r, positive. So er, positive breast cancer. 80% of all cancers, there's a second hormone that goes along with estrogen called progesterone. So typically, again, in about 60 of the 80%, you are er, positive, PR positive. There's a small number that don't have the PR and that's like sort of the alpha and omega or the A and Z of the Alphabet. So the ER is at the beginning of the Alphabet, the PR is at the end of the Alphabet. So that's the next thing. And then there's a third thing called HER two. Her two. And that. That's typically negative. So there is a breast cancer called triple negative, which is. It doesn't have ER, it doesn't have PR, it doesn't have HER2. That is a different cancer. It's in the breast, but it's much more aggressive, probably takes some pretty harsh chemicals. But if you don't have that kind of breast cancer. I'm sorry, there's one more factor you need to do and that's what's called the Ki67. How many cells are dividing, you know, in your tumor? So it's a percentage. It varies between one and, you know, 80 or 90. The lower the number, the better. If your number is under 10%, that's really, really good. It's 10 to 50 or 60. What you want to do is then see what happens when you take therapy. Because if you can get it below 10%, really large clinical trial called the poetic trial. Every clinical trial has a name, so we all can remember them. But the poetic trial showed that if this particular marker got below 10% in your @ the time of biopsy and therapy, you would not have a recurrence in about three years time. So it's very predictive of the future. All of that information you have, you know, within the first month. And then your doctor or your healthcare provider will begin to develop a care path. And that's where you really, you know, you can settle down and you can say, okay, these are the things I need to do. I need to prepare for surgery. These are the things I need to do if I'm going to have radiation or if I'm going to take other drugs. And I find with patients, the most challenging time is between the diagnosis and when you have a plan. Once you have the plan, it really takes a lot of the anxiety away. And then, you know, you do have to follow the plan. But all of our lives are full of challenges. And this is unfortunately 1 out of 12 women you know are going to have breast.
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B
Cancer. What is the typical time frame from diagnosis to completing all the necessary steps for treatment or.
- [11:17]
C
Resolution? Yeah, again, I'm going to talk in typical terms and very important. I'm not practicing medicine when I'm talking to you, even though I'm a licensed doctor, because every patient is different and every woman will have a different care path. But typically with, er, positive breast cancers, there's going to be surgery. And the choice then is, do you take it out as a lump, do you do a mastectomy and take the whole breast out? And there'll be some other diagnostic tests, maybe some imaging tests to see has it spread into the, under the armpit in what's called the axilla. There are lymph nodes there that are designed to protect, to form a filtration system and an immune surveillance system. So as a tumor spread from the breast to the axilla, which is a little, you know, a little bit later in the process, all those kinds of things will determine what kind of surgery you have. And Again, it can vary from a lumpectomy to a mastectomy to a surgery in the armpit. There's often radiation accompanied that's designed to, after the surgery to prevent a local recurrence in that spot. And then typically at the time of surgery's done, radiation, if you're going to have it is done. You do what's called adjuvant treatment, which is a five year process with either tamoxifen or neuromatase inhibitors, or hopefully our drug in the future, where you're trying to do two things. You're trying to prevent breast cancer in the breast that just had the surgery that had the cancer. And once a woman has cancer in one breast, she's at a much higher risk in the other breast. And so you're preventing a new cancer in the other breast. Five years of treatment is the standard of care. Now, some people will go to 10 if the tumor was a little more aggressive, but that's the mantra. And so typically between diagnosis and that surgery is maybe as little as a month and, you know, maybe even, you know, four to six months if they want to do some therapy between the diagnosis and the time of surgery. It's not common in the regular bread and butter kind of breast cancer, but there's a process called neoadjuvant treatment where like, from the day after the diagnosis until you have your surgery, you're taking something to make the tumor smaller, to begin to kill the tumors. This is called neoadjuvant. And so sometimes that is dumb, and sometimes, sometimes you actually wait four to six months to be sure that's run its course. Because the surgery can get a lot easier if the tumor gets smaller, the surgery can get easier if you, you know, if some of the tumor is dead by six months, you are pretty much done with everything except for that daily pill for the next five.
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B
Years. Okay, so afterwards it's just a daily.
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C
Pill? It is, it is. At that point in time.
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B
Yes. Okay, so what does that daily pill consist of? Is it like a vitamin pill you take once a day, then all of a sudden it goes in and attacks the cancer cells? Is that how it.
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C
Works? There are two kinds of pills currently, and my investigational endoxan will, will be sort of a third kind of pill. So one kind is that traditional tamoxifen, which goes into the body and blocks the estrogen from binding, you know, from. Blocks estrogen activity basically in any cancer cells, in any cancer cells that have escape either the radiation or the surgery. So it goes through the entire body, obviously It's a pill you take. And so anywhere there's. There might be a single cell or a couple cells, it'll stop them from growing. The other drug that's given in women who are postmenopausal after menopause is called an aromatase inhibitors or.
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And it turns out that when women are postmenopausal, of course, the ovaries have stopped making estrogen, so they no longer have any estrogen from the ovaries, but they still have estrogen in their bloodstream. Where does it come from? Well, it turns out there's an enzyme that takes the testosterone women make. Remember, we're both, you and I have a little estrogen, we have a little testosterone. We have more testosterone than estrogen for men. It's the other way around for women. So but women will take the testosterone they have as postmenopausal and this enzyme will convert it to estrogen. So they make a little bit of estrogen even when the ovaries are shut down. So the aromatase inhibitor is to stop that activity. And so those are the.
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B
Two. Are there any side effects to.
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C
These? They do have some side effects, which is one of the reasons I'm developing my drug. Of course, women taking tamoxifen will have hot flashes, night sweats, kind of the menopause like symptoms. And sometimes the aromatase inhibitors cause arthritis, joint pain when you get up in the morning, and that sort of thing we don't know because my drug is investigational. But we're really focusing on can endoxifen that we're developing improve on those two kinds of side effects? Because at least in our preliminary trials, it seems to be having an effect in that direction. But of course, I can't claim it because it's all.
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B
Investigational. When someone first gets this diagnosis, I'm sure it has to be panic. It's the big unknown. How do you help them get through that? This way they can understand that, yes, it may be invasive, even though it's going to be six months or a year of trauma and then five years of taking a pill. How do you get them so that they understand the other side of that they can live a very fulfilling.
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C
Life? Well, you know, it's really important. And I have to say, again, the women now may not remember back someone like a Nancy, Nancy Reagan. And it was a big deal because cancer wasn't spoken of. There was a time actually before I was practicing medicine when you, when you often didn't tell the patient they had cancer, you told their family, which is so bizarre out for me to even imagine. But we've come a long way because a lot of, you know, well known people that women look up to or aspire to or know about, Cheryl Crow, she was very vocal about her breast cancer and the, and the journey of it. So there's a lot of shared history. I mean, again, I think one of the things we all want to do is we, we don't want to feel like we're alone. Right. Both existentially and, you know, in our communities and things. So being able to tell a woman, look at, yes, this is unique to you, but, you know, one woman a minute during this, this podcast with you. Tony is being diagnosed with breast cancer. So it's a very common thing and most women get through it. It's not pleasant, it's not, you know, it's not the year, the six months that you thought you wanted to have, but a lot of women come out the other end and then for the most part, they go right back to the lives they had. You can really not promise that, but you can say, I've seen a lot of this and you know, nine out of 10 times, it's, it's a blip in their life.
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B
Story. You brought up mastectomies. What? Women that have it in their history, then they decide they have a double.
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C
Mastectomy. Yeah, Angelina Jolie, the famous.
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B
Actress. Yes, she was the one I was thinking.
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C
Of. So there's a couple, there's. I haven't gotten to it, but now you've introduced it. Well, for me, there is a special kind of cancer that primarily in the people of Ashkenazi Jewish descent, which is sort of eastern European, about 5000 BC, there was a mutation in one of these DNA repair enzymes that led to an increased risk of breast cancer at a very early age. Ovarian cancer, and in men, prostate cancer, it's called the BRCA gene. For these people, it's a real challenge because they're likely to have breast cancer in both breasts. It's likely to be aggressive. They're likely to have ovarian cancers. And so brave women like Angelina and other women have said, you know, I'm gonna, I'm gonna stop this now. And so that's, that's a very special case. That's about 5% of all breast cancers. You almost can predict based on family history. So, you know, you know, do you, did you come from Eastern Europe? Do you think you have some of that heritage in your family tree or in your genealogy? Because if you don't it's much, much rarer in people outside of that.
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B
Population. There might be some of the listeners wondering, does this really actually work prior to the cancer prognosis? Does a double mastectomy actually really stop.
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C
It? Well, yes, when you have a bilateral mastectomy, I think the number is 1 to 2%. There's 1 to 2% of breast tissue left, but then the chance of getting breast cancer in that is very little. So it is entirely possible to be very, you know, sort of unlucky and to have a double mastectomy, then also get breast cancer. But it's so, so rare. It is not the kind of thing you worry.
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B
About. Okay, all right, so what can they do that is very preventative? Something other than a double mastectomy? Is there something they can be proactive about that will lessen their chances of getting.
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C
This? Absolutely. Let's go there, because this is really, really important. If estrogen drives breast cancer, in 80% of the cases, things that can lower estrogen can help prevent it. And things that increase estrogen will actually increase your risk. So what is one of the things that will reduce estrogen in women not drinking alcohol? So, you know, it's well known that if you drink even one drink a day, you will slightly raise your estrogen level. The change in the risk for you may be very minimal, but probably 1 out of 75, 1 out of 100 breast cancers are in women in which their nearly one glass of wine induced the breast cancer. I mean, that's what the statistics would say. So keeping your alcohol consumption to a minimum, or, you know, if you prefer, not at.
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B
All. What about their diet? Can they customize their diet in any way that might help it as.
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C
Well? Things that cause inflammation. So if you have, you know, chronic infections or other sorts of inflammatory eating, foods that are not high inflammation, so fatty foods, fried foods at very high temperature, all of these will increase your.
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B
Inflammation. Okay, that makes sense. What about exercise? Is there any type of exercise that will help them as.
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C
Well? Building skeletal muscle in the gym? Now, you're not going to look like, you know, like a bodybuilder woman. They may be manipulating their hormones to get that. Look, if a normal woman goes into the gym and lifts weights a little bit, they won't get buff. They don't have to worry about that, but they will build, build muscle, and that that muscle will help build their testosterone and the ratio of the two will shift. And so another thing that women wrestle with during menopause is whether they should use hormone replacement therapy. It does Reduce the menopause symptoms, but it does increase the risk of breast cancer because you're. You're spending the time of taking estrogen in these women. One more thing, Tony, if we have.
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B
Time. Sure. This is a conversation that many people need to hear, and hopefully they learn from.
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C
It. There is a period that's quite important. This is good science, but it's not established science. But I still want to bring it up for your listeners because I think it's important. So a lot of people believe that the cancers that we have, the four major cancers, which are lung, colon, prostate, and breast, arise from mutations in the DNA. And it's actually a relatively small, discrete number, maybe eight or ten mutations to go from normal to growing too fast, to growing too fast in a funny pattern, and then finally into cancer. And that those accumulate one at a time over maybe a lifetime. And so when a woman gets breast cancer at 45 or 50, it's not because she just got breast cancer. It's because the 8th or the 9th of the 10th mutation has just happened, and she's been getting them over her entire lifetime. So a very vulnerable period for girls, for women with breast cancer, is puberty. So you go from having the buds in the prepubescent, you know, nipple, little tiny clumps of cells that are going to become the entire breast. And so from that period of whatever it is, begins at age 6 to 8, and maybe a 15, 16 develop. So there's a lot of cell division going on there. Things are changing. They're growing breasts and the ducts and all of that. And so that's a very vulnerable time. So, for example, if a young girl is recommended to have an X ray, you know, chest X ray during that time, I would want to ask the doctor, is this really necessary? Is there any other way to do this? Could you find it another way? My own daughter went into a children's hospital in Seattle with asthma. I'm a physician. My wife is a cancer biologist. And they were absolutely. They wanted to be absolutely sure she hadn't swallowed a spoon or something like that. So they wanted to take a chest X ray. And I said, you know, you can listen to the two sides. If she swallowed something, one side of the lungs should sound one way and the other side should sound another. We were with her. She, you know, she has asthma. Would you just. And so they were. But they were hell bent on giving her a chest X ray, and we didn't let them. But I really wonder if we hadn't been so adamant about it. Unless you really have to don't X ray. And the other thing is fast foods during that period of time causes atypical cells in the breast. It's a really good study. Fast foods are three things. Sugar, fat and very high temperature. And they form some chemicals that are called initial age. And they're quite bad for your arteries and your general health. And they also are bad for cells that are developing in the area of the.
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B
Breast. In closing, can you give us some information that you think is very important that the listeners hear on what you're doing so they can better understand and help them navigate their journey with hope and confidence that if they do get a breast cancer diagnosis, that it is not the end of the world and they still can live a very fulfilling.
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C
Life? Yeah, I mean, I have a website, you know, drkue.com where I give general health information. I'm not practicing medicine, so I will have blogs once a week every, you know, every couple of weeks here. And so I do like, like people to follow there. You know, getting information off the Internet is a two edged sword. I mean, you can get good information and you can get misinformation. You should all have a healthcare provider. So it's either a doctor or a nurse or some sort of practitioner who you turn your health care over to. It's very important not to be your own doctor. You do your own healthcare and doctors are the worst. So I, believe me, I know that and I have friends who are doctors that know that. So someone else should be primarily responsible for the, the path there. But general health, take care of yourself, get exercise, don't drink too much, don't eat high temperature foods. The lower the temperature, the fewer the bad chemicals that are made. And you know, in general health, and not to worry too much because breast cancer, you know, we can treat it, it's not pleasant. But really, you know, enjoying life, enjoying your family and friends is absolutely.
- [24:48]
B
Critical. Absolutely. Well, this has been great, great information, great conversation. I really appreciate you taking the time to join us.
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C
Today. Well, thank you, Tony. It's wonderful to have here and I appreciate your interest in bringing this message to women.
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B
Everywhere. Oh, it's my pleasure. Thanks again.
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Thanks for taking time out of your busy schedule to listen to our show today. We hope you enjoyed it as much as we enjoyed bringing it to you. If you know someone who has a story to share, tell them to contact us at WhyNotMe World. One last thing, spread the word about why not me. Our conversations are inspiring guests that show you are not alone in this.
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A
World.
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Happy Holidays. Want to give your host a gift? Consider subscribing, rating and reviewing the show this holiday season. It really helps the show grow. From all of us at Believe. Have a Merry Christmas everyone and a Happy Holiday.
- [26:08]
If you like the show, please take a moment to rate, review and subscribe. It really does help the show to grow. Thank you for listening.