Harold Bernstein

Your Healthy Life with Kim Carrigan
Wednesday, October 18th

Kim interviews Dr. Harold Bernstein for Breast Cancer Awareness month


Transcript - Not for consumer use. Robot overlords only. Will not be accurate.

This can Kerrigan everybody and you are listening Jeanne you're healthy life and this is of course October which means if Breast Cancer Awareness Month and I am so thrilled. To have with me this morning one of the forest researchers in this field is doctor Harold burns did. And it's nice to have you served from Dana Farber Cancer Institute. Thank you sir for joining us up to be. I'm a doctor could just get started with a very simplistic question but one that I think is so important to every single person who has interest in this topic. And that's this are women who have breast cancer living longer now than they were ten years ago. Absolutely yes so there actually are really good numbers on this in four women diagnosed with breast cancer. Almost a year by year for the past 25 years the mortality rate has gone steadily down. We are seeing more and more women surviving breast cancer we're seeing women doing better and better. Obviously there's still work to do it we all know women who are are battling breast cancers stills but. The outcomes are getting better better. You know for the longest time winner woman was told your breast cancer she felt like it was a death sentence. How we hear that. And it's understandable. But 80% plus so women who were diagnosed with breast cancer are cured of their disease. They often require rather intensive therapy and that's not easy. But the good news is that most women will do very well. Someone from your point of view. Do you believe that some day there will be a total cure and we won't lose women to this disease or do you think this is a disease that will always have those times we can't now. Well I think that there isn't going to be like one hill that you take and shows AM everybody's cure to breast cancer. But I do think we're going to get to the point where most women you know even more than 80% something closer to ninety or even 95% of women will rationally expect to be. Treated cured of their disease and go want to have a very normal life. I think it's. In our dream was possible to imagine that that reach a 100% but there's still going to be work to do to mop up. Those last. Tough cases at the extremes. So we talk about those numbers and percentages to keep me some real hard facts how many women are losing their lives a year. To breast cancer. There are in the United States about thirty or 40000 women every year who die of breast cancer. But there are 250000. Women who were diagnosed with breast cancer each year. And so that's where we sort of look at those numbers and say obviously lots of work to be done. But it the same time we're probably curing you know upwards of eighty plus percent of those. Well we're talking to doctor Harold bursting from Dana Farber let's talk a little bit about what UC. As having been the best in the greatest breakthrough in the last ten years what's making this difference are. So they're really are. Multiple. Claims to ownership for the biggest innovation in the past ten years. What field expression you know success as a thousands fathers and failure as an orphan. But there's been a lot of success and a lot of people who are clean means. Justifiably that there interventions are most important. A few things that are for worth remembering the first is this is truly be any multi disciplinary. Set of progress of and so it's. That or surgery which often means actually less surgery for women on its better radiation. Therapy which means that worked Elaine our radiation treatment to help higher risk patients get more thought into better for that reason. And there a couple of drug therapy interventions that have been really powerful. On what has been the use of anti estrogen medicine's hormone therapies for breast cancer the majority of breast cancers are so called estrogen receptor positive. We use anti estrogen medications for these women wanted to do listings there has been that in younger women pre menopausal women we have found that actually. You know pushing those women into menopause with drug manipulation can help prevent the cancer from coming back and that's been a real boon for our younger patients. We've also learned longer durations of the anti estrogen it doesn't help. And then there's some subset of breast cancer in particular this subset of breast cancer is called her two positive for HER two positive breast cancers. Those are about fifteen or 20% of all breast cancers. And for them this drug called perceptive portraits to some have has been a real game changer dramatically lowering the risk of recurrence. So all those pieces coming together have helped and again we don't want to miss the other piece which goes on in the background which is. Breast awareness and early detection through mammography there is academic controversy as to how important memoir he is the there's no doubt. That Mel Martinez contributed to ongoing improvements and mortality. I am so happy to hear you saying that that was actually going to be my next question about mammography because I am a woman. Who are very young age with my very first high heeled there was something detected in my brush so I started to get mammograms much earlier. Then maybe the average woman would. I have felt so much more comfortable and so much safer in my life as a result of that. And yet just two years ago I was told it was necessary for me to have them on a regular basis anymore. I was very bothered by that. Yeah it's. You know they're they're so. The world has changed is the first mammogram studies were done in the 1960s and 1970s. There's much more awareness of breast health these days. We have extra tools including ultrasound or an MRI for women Wear the mammogram is not a definitive for. Raises questions that need to be resolved. But it's still very important for most women particularly between the ages of 1572. Routinely get a mammogram every year or two. Four women in their forties it's a little more controversial. The incidence of breast cancer is lower in these younger women. And because these younger women tend to have more dense breast tissue the mammogram as they tool is a little bit less likely to see subtle things that are like looking through. And opaque collapse a little more when you're trying to look at the mammogram image. So there are. Technical reasons why there are controversies over the mammography debate. And many women know that if they go for mammograms. They're also more likely to have to have biopsies which her physically uncomfortable and often make people nervous or anxious. Having settled that. You know there's no doubt that. For the majority of women between ages 45 and fifty of them for the next twenty years that regular mammography is very important instantly major part of their basic help me. It's not as a young person growing up I was constantly talked to about self exam talk to us about that is that's still important in our women still. You know early detection through self exam is it is it's still working. So early detection by self exams actually never been shown to really change long term outcomes. They did some huge studies in China actually would probably order a 100000 women trained to do breast self exam or not. And unfortunately. It's really hard thing to depletion. And the press is a difficult thing to evaluate. And so what do I encourage patients to focus on is not so much of a regular press so for example sort of general breast awareness he should know. The general contours and feel of the breast. So that is something seemed different or. Unusual for given woman she reaches after her health care team for a proper valuation. You're listening to your healthy life and we're talking this morning with doctor Harold bursting at he is from Dana Farber Cancer Institute talking about. Breast cancer where we've been where we are where we're headed we're talking about early detection here let's talk about heredity sir. And there's you know through the last 1015 years I have spoken to more and more women. Who lost a grandmother lost a mother a loss to not. To breast cancer and they've gone in and even done some some preventative. Types of surgeries. Absolutely so. About 5% of the cases of breast cancer have a true read it Terry nature that is. There's a gene abnormality we can test for that gene abnormality. If you harper that abnormality you're at much greater risk for developing breast cancer. Having said that the vast majority of cancers 95%. Are not hereditary and so even if on that breast cancer or cousin had breast cancer things like that. Chances are that any given woman is not at her credit Terry risk. So in the past decade we've seen real transformation of the tools for this kind of genetic testing. It's gone from being a relatively academic and. Expensive and complicated thing to it relatively widely available less expensive. Broad. Genetic testing approach. And lots of our patients get now and it really does help clarify whether they cancer a rose because of a genetic predisposition or for some other reason. The other thing which is change this dialogue has been the Angelina Jolie story you know he came out a couple years ago. Announced that she had a hereditary cracked a one mutation. And that she was choosing to have prophylactic mastectomy as a consequence of that and she subsequently had her. Prophylactic removal of the ovaries because there's a risk of ovarian cancer as well. And I think that experience you read. Caught the the public imagination in the sense that it showed people that. When they could be. Empowered to make these choices that even. Famous Hollywood celebrity's. Might choose to have prophylactic surgery given the quality of the reconstruction in the other things that make the experience last. All opening used to be and that I think has released stimulated the more genetic testing. And more action by women who have these mutations. So who is that woman who is that profile though because it does seem like it's a very dramatic step. You know so these are typically women who have any dramatic family history so wander more. First degree relatives. Often there is any links to other cancers including ovarian cancer. Perhaps they're so much usual things like onset of breast cancer very young family members less in the age forty or band in the and we who have breast cancer. Those kinds of things that flag. People for attention. And we often refer all those patients to the genetic counselors so that they can have this genetic testing. I think the real thing that's changed in the past decade is we've gone from a situation where there was a family history and thus you might be a greater risk. Too there's a family history. We do the genetic testing and we know if you're greater than average risk score appear just at normal risk for breast cancer and that has really transformed. A woman's ability to stay informed and make good decisions. Let's talk about the future because you've told us so many positive things about where we've been and how we're moving forward nine you said it would be terrific if we just had a pill but I do also recognized. That would be naive they're all different kinds of breast cancers were not just dealing with one. One issue here but what do you anticipate and are you hoping gets to 90% or even last. Or am I read it more I'm sorry of women who are cured of this. But what do you anticipate over the next ten years what do you hope to see. Yeah I think we'll see a couple of things one is we're gonna have much more molecular details about it given cancer. That's gonna tell a woman and her medical team a lot more about the specific treatment needs and the prognosis. So right now we have sort of three broad classes of breast cancer we talked about estrogen receptor positive breast cancers. We talked about so called her two positive breast cancers and that we talk about a group called triple negative breast cancers. Which are defined by what they're not that you do not express estrogen or sector or protester or soccer or hurt too. But I think in the future we're gonna have you know a dozen or more different subset of breast cancers in knowing that you have breast cancer types seven. Is going to be a really important thing for understanding how best to treat the patient. The second thing is we're going to see I believe these immunotherapy breakthroughs which we've witnessed in other cancer types. Lung cancer and melanoma in particular. Make their way into specific small groups of breast cancer patients. And these look like very powerful opportunities. For helping people do better and better from a cancer point of view we hope that. That we organization will eventually reach breast cancer. I'm in the third thing is that there's a whole new class of other targeted drugs. Well which seem to be quite active. There's a class of drugs called CD GeForce six inhibitors there have been three FT approvals for them in metastatic breast cancer over the past two years. We're now looking at studies. A moving those drugs into the management of earlier stages of breast cancer to prevent the recurrence I think that kind of forward momentum worthy innovations in metastatic disease are proven and then move forward into the management of earlier stage disease. Will continue over the next decade and it's gonna help women with new diagnoses to better. Doctor version I realize that you're not in this. Habit of fund raising for this issue go were always happy to do. Tell me about fund raising it is there enough money out there to do all these fabulous things that you just said. Well I mean I think everybody would say that they need more money to do the kind of work they wanted to. So a couple big trends one is that the historic funding from the National Institutes of Health has been essentially flat. In dollar terms Aniston's will be declining if you adjust for inflation. Over the past ten or fifteen years and this is you know it threat not just to the breast cancer community but to all of the. Cancer from the populations but also all the other diseases as well. Of the federal funding was such a unique and distinctive feature of the American health care system it's what drove the fifty years of preeminence of Americans. Science and medicine and I think that there's still a tremendous need for people to be aware that this is under threat. It's something that at least historically congress has really agreed upon there's been tremendous bipartisan support for and we need to remind. Congress and the president of just how important this is. This is critical thing for the health and wellbeing of Americans. Everybody benefits from the investments the NIH was making in medical search. In breast cancer particular. You know we've been very fortunate historically. To have tremendous support from pharmaceutical researcher there's a lot of interest in. Developing new drugs for breast cancer it's a common problem drug manufacturers of Biotech companies build that they can find a market for their products. And so they are very interested in sponsoring all sorts of clinical trials. And I would encourage people to reach out to their doctors and talk about the opportunities to participate in those studies. Those are ongoing. The attitude tremendous amount of innovation in those trials and our center and all the other centers around the country participate in many of those studies and then finally you know breast cancer has this tremendous grassroots support through major organizations like the komen foundation in the BC RF. And that kind of money. Really helps whip up on some of the things like green screening mammograms to. Historically underserved communities with making sure people have access to research innovations or newer drugs. Making sure people get second opinions or have high quality care at their community. And then of course there individual hospitals and by Dana Farber friends would. And point out that you know. They try to work that we do here with specific programs for young women who have breast cancer or her breast cancer survivorship program. Or in our has taken center for integrative therapies or in the kind of in house research projects we do we've been doing it. Big catalog of the genetic abnormalities that arise in metastatic breast cancer and. How that affects outcomes for patients. Those kinds of projects are not supported by the NIH or BioPharma. And we really need you know our oil community of people in new England and around the country to continue to help us support those programs. Well and it's wonderful institutions like Dana Farber that are making all the difference for so many women I have to tell you personally. I've been fortunate and to might direct Finley have been fortunate we haven't been treated for this but I had to your friend that you guys treated there Dana Farber. She did very well and so for that I am always thankful. I know that there are many people who are listening who have the same story. Well I'm glad to hear that and. You know Dana Farber really feels like a big part of the New England community where. So lucky to have unbelievable support from golf tournaments and pan mass challenge and passing the hat at Red Sox games and all the things that. You know allow us to really provide world class care to the patients in doing. Doctor Carol Bernstein thank you sir so much for the insight you made me smile today because there's so much positive and I think everybody should know that. Happy to thank you sir have a good day.