Pharmacy Focus
S2 Ep36: Pharmacy Focus- Oncology Edition: Delayed Breast Cancer Screenings
(upbeat music) - Hi, I'm Kennedy Farigia with Pharmacy Times and you're listening to pharmacy focus oncology edition, where we break down the latest news in the oncology pharmacy space. (upbeat music) On this episode of Pharmacy Focus, we sat down with Dr. Bonnie Lee Gurman, a hematologist and oncologist director of the Breast Cancer Treatment and Prevention Program at Overlook Medical Center of Atlantic Health System. Dr. Gurman discussed reasons why many women are behind on their annual breast cancer screenings, along with the latest cutting-edge treatment in the breast cancer space. - Well, thank you for having me. My name is Dr. Bonnie Garran. I'm the director of breast services at the Carole G. Simon Cancer Center at Overlook Medical Center. I work with the Stacey Goldstein Breast Center here, all part of Atlantic Medical Group and Atlantic Health Systems. - So recent data displayed that 41% of women skipped or delayed their breast cancer screenings. So why do you believe this has contributed and how does it impact early prevention? - Oh, that's a great question. I think the reasons why a woman might be late to get her mammogram or skip or probably is varied as women themselves. I think we can all agree that life has become pretty complex and we're all so darn busy and there's lots of competing responsibilities and I think sometimes screening seems something that's so easy to put it off. It's not something that it really, maybe somebody feels, well, it doesn't really matter if I do it this month or next month, just as long as I get it done. It doesn't have the sense of urgency. Women are now taking on the primary role of taking care of not only their households, but their children, aging parents, most households that have two parents are double income, they're both parents are working and it's hard to find time. So that can be a big problem just carving out the time. And really, there's so many single parent households, they're becoming more and more commonplace and the primary parent is usually the woman. Many of those women, in fact, more than half of single moms in this country are working maybe shift work or blue collar jobs where they don't have as much discretion with time. Many rely on assistance like assisted income or public transportation and that can be a real problem. For many of my patients, just getting childcare, time off from work and getting the bus, just to get a screening mammogram that potentially could add another bill. So it's a tall order. Still for other people, you know, that pain is interesting. I never would have thought this but studies time and time again say that women are afraid to get mammograms because they hurt. And I mean, let's face it, mammograms are not comfortable. But I don't believe for the vast majority of patients, they are, I guess, truly painful. Some of my patients that find them really uncomfortable, if they take an Advil or a Tylenol beforehand, that can take the edge off it. But it's a small, I guess it's a small trade off for our chances of finding a breast cancer very early. I think in my practice, what's important is looking at that woman as an individual. Like I said, there's as many reasons as there are women and find out what her reason is and kind of meet them where they are and figure out what we need to do to get them their mammograms. - Yes, definitely. So there's a lot of things that are going on in people's lives that kind of goes on the back burner and especially the large misconception that they could be more painful than women think. So moving forward, what are some innovative, diagnostic technologies and their clinical efficacy? - Diagnostic technologies. So basically you're asking me, what new ways do we have to find breast cancer? You know, I think, you know, of course mammograms, ultrasounds and even MRIs, they probably formed the backbone of how we image breasts looking for cancer. I think one exciting technology is something called contrast-enhanced mammograms. It's sort of kind of an amalgam between an MRI and a mammogram. It is the mammogram, but we use contrast or dye to help enhance the image. And it is purported to be able to find more cancers, of course, than mammography, but almost rivals an MRI. That's gonna be a lot shorter test and a lot less expensive than an MRI. So that's probably practically speaking, the hottest emerging technology in terms of diagnosis. - Yeah, definitely. So kind of going with that, can you describe some of the emerging treatment protocols and their integration into current practice? - Huh, emerging treatments. Well, I can tell you that although I sound young, I'm older than I sound. And years ago, when I met a patient who had breast cancer, they would simply be put in one of three or four buckets. We would know what stage they were. Perhaps we knew if they were estrogen-driven or even her too positive, and they would be treated accordingly. Now we really are learning not to look at a breast cancer as one of those three or four buckets. And even more so, not just that it's a breast cancer, but looking at the signature of that tumor. Looking at a tumor that perhaps Lauren's tumor would be different than Carol's tumor. Looking at the genetic material inside that breast cancer to learn what makes it tick. And now we have a very large repertoire of targeted therapies. Therapies that work on a particular gene, and it matters little whether the gene is in a breast cancer or in a colon cancer. It matters whether or not you have that gene. So the idea that I could tailor therapy to match Lauren's particular tumor and her particular fingerprint is been great. We can actually do that by looking at a piece of your tumor. And now more, we're able to look for DNA, even in your bloodstream, to learn a little bit more about the tumor itself. Yeah, so I would have to say those small molecules, those targeted focus therapies are really going to be the backbone of therapy. I'm using a lot more, a lot less chemotherapy now than I did 15, 20 years ago for sure. - That's excellent. So you definitely can see the emerging technologies that are being put into place for all the new treatments ahead. So what are some of the latest research findings regarding early detection and treatment approaches? And now you sort of touched on that a bit, but if you want to expand. - Sure, I mean, we can certainly talk about the science and I personally love the science, but I think one of the most vital pieces of research in 2023, 24 are coming from studies looking at the disparities in breast cancer among different groups of women. You know, it's old news now that white women in this country are more likely to be diagnosed with breast cancer. And yet women of African descent are more likely to die of their disease with over a 40% higher death rate. But I think that in the last couple of years, we've seen some really interesting data, not only better understanding the disparities, but also trying to understand how much of those disparities are based on access. But interestingly, some of the disparities are based on the disease itself. So even the same stage disease, whether it's an Afro-American woman or an Asian woman or a Latina, for instance, Latina women have a lower incidence of breast cancer, right? Now, so I'd love to know what was in my Latino sister's blood that offered them that protection. And I think when I think about emerging therapies, although yes, I'm always drawn to the scientific, you know, what new drug and what new snazzy chemical has come out, I think understanding that it's not just access when we think about disparities, it's actually the cancer itself. But another example would be in the Afro-American population who have a higher incidence of a particular kind of breast cancer called triple negative breast cancer. It's diagnosed three times more often in a black woman than a white woman. Another group that we don't often think about when you initially think about disparities is obesity. The obese woman has at least a 30, perhaps 40% increase chance of developing breast cancer. And why is that? Is it purely because they carry, they have a higher BMI or is there more to it than that? And unfortunately, obesity is the number one cause of cancer in this country. So it's a huge fraction of people that need to be studied. So I know that isn't very raw, sexy and everything, but if you ask me what the new research is that is gonna impact from a public health standpoint, it's gonna be these disparities. - Yes, definitely no, thank you for sharing that. I think it's really important to shed some light on that, especially in regarding access to. That sort of goes into my next question, but how can doctors and pharmacists encourage patients to get these regular breast cancer screenings and provide access to patients who may not necessarily know where to go for that? - Right, right. So I have a million ideas. So at first you asked about how can healthcare providers do it? Well, I think, once again, circling back to my opening comments about understanding that the reasons for not getting them or is varied. So I think each institution has to look at the communities that they serve and ask the question, what's going on here? Do I live in a community where it's all access? And then meeting those people where they are. If I had a community where access was a problem, would a mobile mammography unit be something worthwhile? Could I plant a mammography van somewhere and have easier access where women could just take one bus or one train or one walk and get there? We also talked about childcare. What if your mammography suite had a place where you would be able to have childcare while you went in for your mammogram? That would be kind of clever, right? I think insurance providers could help. They could potentially reward patients or incentivize them to get their mammograms. We hear, I know in some of the incorporate structures, they have, you know, rewards and benefits for those people that participate in healthcare prevention. Well, I think insurance companies might be able to do that and it would potentially be a win for them by where an insurance company, I'd love to know all my ladies were getting mammograms. What about drugstores or pharmacists? Maybe they could hand out coupons for an Uber or a coupon for a mammogram if they could align themselves with the hospital. And then of course they're the families themselves, you know, the mothers and sisters and brothers and fathers of women, could they step up and say, hey, you know, mom, did you get your mammogram? I was lecturing about six months ago to a group of high school seniors about healthcare as a profession. And we talked a bit about breast cancer and I asked them all to go home and ask their moms, hey, mom, did you get your mammogram? Well, about two weeks later, I got a phone call from a mom who said, my son has been harassing me and I know I'm not your patient, but can you hook me up? And I was like, wow, that really worked. - Yeah, that's excellent. I definitely agree what you shared. I feel like we don't really think about that. There's more that goes into it. Like you said, transportation and childcare and also just your family members checking up on you to give you that reminder. - I don't know how old you are and I wouldn't out you on a podcast, but if you are over the age of 40, which I do not believe you are, but when you are, you should go. And if not, ask your sister or your mom if she had her mammogram. - Yeah, definitely. I'm 23, so not yet, but I'll keep that in mind. That's all the questions that I have. Is there anything else that you would like to add that maybe we didn't get a chance to cover? - I think I just wanted to end by reminding everybody that breast cancer in this country is a very curable disease. Right now, if you are diagnosed with breast cancer, all comers, you have a 90% chance of being cancer-free in the next five years, 90%. And if you catch it early, like on a mammogram, almost 99% chance. So I think that concept of I don't want to get a mammogram because what if they find cancer? 99% of the time, if it's localized in early states, you will be walking this earth in five years. - Yeah, so it's definitely important, especially that early prevention. - Yeah, and then also for our younger patients, you know, between the ages of 40 and 45, you know, a 10% of breast cancers are diagnosed with women in their early 40s or younger. And I think sometimes when we're in our late 30s and 40s, we are so focused on upward mobility in our job. We have young children, we're as busy as busy can be. But it's a sad thing when a young mother is diagnosed with a breast cancer and she hasn't even had her first mammogram and she's 45. We work right next door to the building that does the mammogram and I can't tell you, I've ordered my mammogram and then I'm working, I'm seeing patients, I'm doing research. And then I realized, damn, I didn't show up for my mammogram. And then I said, well, I can't not do it. I'm not a director, but I was late for last year's mammogram. I was. And I went and everything was fine. But it's an easy thing to put off. - Thank you so much for listening to this month's episode of Pharmacy Focus Oncology Edition. I hope you enjoy the updates and tune in next month for some new findings in the oncology pharmacy space. (upbeat music) (upbeat music) (upbeat music) (upbeat music) [BLANK_AUDIO]