How to Treat and Cure Breast Cancer: Alternatives and Traditional Options | Dr. Kristi Funk

00:59:19
https://www.youtube.com/watch?v=qg1zqonIO5U

Zusammenfassung

TLDRIn a conversation led by renowned surgeon Dr. Christy Funk, the episode addresses the significant role lifestyle and dietary changes play in breast cancer prevention, stating that up to 90% of cases could potentially be avoided. The discussion covers the current treatment landscape, including surgery, chemotherapy, and radiation, alongside the importance of personalized care for individual needs. Emphasizing the intersection of prevention and treatment, Dr. Funk advocates for understanding the disease's nuances, making informed choices, and integrating holistic practices whenever possible to enhance patient outcomes. There is a strong focus on the potential impact of diet, exercise, and the identification of personal risk factors in designing effective health strategies against breast cancer.

Mitbringsel

  • 🎗️ Up to 90% of breast cancer cases could be prevented.
  • 🥗 A whole food plant-based diet is essential for prevention.
  • 🏋️‍♀️ Regular exercise can enhance treatment outcomes.
  • 💊 Chemotherapy may not be necessary for 65% of patients.
  • ⏳ Fasting during chemotherapy may reduce side effects.
  • 📊 Ki-67 marker indicates cancer cell division rate.
  • 🏵️ Personalized treatment is crucial for effective care.
  • 🚺 Emotional support is vital in the cancer journey.
  • 🔬 Hormonal receptors play a significant role in treatment decisions.
  • 🩺 Surgery options include lumpectomy and mastectomy, both with similar survival rates.

Zeitleiste

  • 00:00:00 - 00:05:00

    Introduction of the conversation surrounding breast cancer prevention, treatment options, and the importance of lifestyle changes. Dr. Christy Funk, a breast cancer expert, discusses the prevalence of breast cancer and the need for prevention through lifestyle modifications.

  • 00:05:00 - 00:10:00

    Dr. Funk shares statistics that indicate a significant increase in breast cancer incidences and emphasizes the importance of prevention, risk reduction via diet, exercise, and lifestyle choices, aligning with the Let's Beat Breast Cancer campaign.

  • 00:10:00 - 00:15:00

    An overview of common surgical and medical treatment options for breast cancer, including the significance of individualized treatment plans based on unique patient circumstances and the type of breast cancer diagnosed.

  • 00:15:00 - 00:20:00

    The discussion transitions to alternative approaches to treatment and the critical nature of conventional therapies, like chemotherapy and radiation, as part of the treatment toolkit.

  • 00:20:00 - 00:25:00

    Dr. Funk illustrates the effectiveness of radiation therapy in reducing local recurrence rates and outlines potential risks associated with opting out of recommended treatments, necessitating informed discussions between patients and physicians.

  • 00:25:00 - 00:30:00

    Anatomical and procedural insights are provided, explaining the structure of breast tissue and how various forms of cancer originate, primarily in the ducts; this information emphasizes the need for awareness and early intervention.

  • 00:30:00 - 00:35:00

    Discussion on the different stages of breast cancer, especially ductal carcinoma in situ (DCIS), which, while not life-threatening, requires monitoring due to its potential to become invasive if untreated.

  • 00:35:00 - 00:40:00

    The analysis of hormone receptor-positive breast cancers and the importance of understanding the biology behind the cancer cells, which influences treatment effectiveness and patient outcomes.

  • 00:40:00 - 00:45:00

    The conversation highlights the need for exercise, dietary consideration, and the potential benefits of fasting during chemotherapy as methods to mitigate side effects and improve treatment efficacy.

  • 00:45:00 - 00:50:00

    Exploration of surgical options such as lumpectomy and mastectomy, detailing how modern approaches have evolved to ensure equivalent survival rates while minimizing local recurrence through targeted therapies and lifestyle interventions.

  • 00:50:00 - 00:59:19

    Conclusion emphasizing the mission of the Let's Beat Breast Cancer campaign and the importance of utilizing both conventional and holistic strategies for prevention and treatment.

Mehr anzeigen

Mind Map

Video-Fragen und Antworten

  • What percentage of breast cancer cases are preventable?

    Studies suggest that about 50% of breast cancer cases are preventable, with estimates by experts like Dr. Christy Funk suggesting up to 80-90% could be preventable.

  • What are the main treatment options for breast cancer?

    Treatment options include surgery, radiation, chemotherapy, anti-estrogen therapy, and lifestyle changes such as diet and exercise.

  • How important is diet and lifestyle in preventing breast cancer?

    Diet and lifestyle are crucial; a whole food plant-based diet, regular exercise, and maintaining an ideal body weight are emphasized as key factors in prevention.

  • Is it possible to avoid chemotherapy?

    Yes, about 65% of breast cancer patients may not need chemotherapy based on specific criteria such as tumor characteristics and genomic score.

  • What role does fasting play during chemotherapy?

    Fasting during chemotherapy has been shown to reduce collateral damage and may increase the likelihood of achieving a complete pathologic response (PCR).

  • Can breast cancer recur after treatment?

    Yes, between 25-28% of early stage breast cancer patients may experience recurrence.

  • What is the significance of the Ki-67 marker?

    The Ki-67 marker indicates how quickly cancer cells are dividing; a higher percentage suggests a more aggressive cancer and could influence treatment decisions.

  • What is the difference between lumpectomy and mastectomy?

    Lumpectomy involves removing the tumor with some surrounding tissue and is often followed by radiation, while mastectomy involves removing an entire breast. They have similar survival rates.

  • How does estrogen influence breast cancer?

    Estrogen fuels certain types of breast cancer through receptors on cancer cells; targeting these receptors can help manage or treat the cancer.

  • Is emotional support important for breast cancer patients?

    Yes, emotional support and guidance in decision-making are critical for patients coping with their diagnosis and treatment options.

Weitere Video-Zusammenfassungen anzeigen

Erhalten Sie sofortigen Zugang zu kostenlosen YouTube-Videozusammenfassungen, die von AI unterstützt werden!
Untertitel
en
Automatisches Blättern:
  • 00:00:05
    [Music]
  • 00:00:22
    Studies have shown that half of all
  • 00:00:24
    breast cancer cases are preventable and
  • 00:00:27
    my guest today estimates that the true
  • 00:00:29
    number could be somewhere between 80 and
  • 00:00:31
    even
  • 00:00:33
    90% but what happens when you do
  • 00:00:35
    everything right and you still get the
  • 00:00:38
    diagnosis you have been trying so hard
  • 00:00:41
    to avoid or maybe you're currently in
  • 00:00:44
    the battle already and you're just
  • 00:00:45
    learning about the power of lifestyle
  • 00:00:48
    and diet and the connection there with
  • 00:00:50
    your cancer well for hundreds of
  • 00:00:52
    thousands of women currently battling
  • 00:00:54
    breast cancer today's episode is for you
  • 00:00:57
    because today we are talking about how
  • 00:00:59
    to treat and cure breast cancer what are
  • 00:01:03
    the current methods and then what are
  • 00:01:04
    some effective Alternatives and helping
  • 00:01:07
    guide us on our journey today is our
  • 00:01:09
    friend breast cancer treatment and
  • 00:01:12
    prevention expert renowned surgeon
  • 00:01:14
    best-selling author Dr Christy Funk is
  • 00:01:18
    here with us today Dr Funk thanks so
  • 00:01:19
    much for joining us again as we continue
  • 00:01:22
    our let's beat breast cancer series chff
  • 00:01:24
    thanks for having me I love the exam
  • 00:01:26
    room podcast it's always fun to be here
  • 00:01:28
    with you and it is truly my delight um
  • 00:01:32
    especially in the month of October
  • 00:01:34
    obviously you're welcome anytime but I
  • 00:01:36
    feel like with all of the focus this
  • 00:01:38
    month on breast cancer we really need to
  • 00:01:40
    get this message out because it's never
  • 00:01:42
    lost on me about how many of these cases
  • 00:01:44
    are preventable so today Dr Funk we're
  • 00:01:47
    talking about treating and curing breast
  • 00:01:50
    cancer and I'm curious in your
  • 00:01:53
    estimation how much closer are we today
  • 00:01:55
    to having a cure than when you began
  • 00:01:58
    your career no closer not even an inch
  • 00:02:02
    no yeah no we are better at expanding at
  • 00:02:08
    prolonging the lifespan so in other
  • 00:02:10
    words our treatments are better so
  • 00:02:12
    people are getting cured more often
  • 00:02:15
    there are now over four million American
  • 00:02:18
    women walking around who either have or
  • 00:02:21
    have had breast cancer and when I
  • 00:02:24
    started my career 23 years ago I
  • 00:02:26
    remember quoting that number and it was
  • 00:02:29
    about 1. five million so we are getting
  • 00:02:32
    better at treatment but that's the whole
  • 00:02:36
    like aggravating part right the numbers
  • 00:02:38
    are getting higher the incidence is
  • 00:02:41
    higher the age at which women are
  • 00:02:43
    getting breast cancer is getting lower
  • 00:02:45
    in fact in August 2023 jamama published
  • 00:02:48
    an article online looking at all of the
  • 00:02:50
    cancers in the United States between
  • 00:02:52
    2010 and 19 breast was number
  • 00:02:55
    one but the kicker was there was an
  • 00:02:59
    alarming year aftere increase in women
  • 00:03:02
    under 50
  • 00:03:04
    so you know this we have a lot of work
  • 00:03:07
    to do and a lot of what I like to talk
  • 00:03:11
    about as you mentioned in the opening is
  • 00:03:13
    prevention is maximal risk reduction and
  • 00:03:16
    we have so much more control over this
  • 00:03:18
    disease than people think through diet
  • 00:03:20
    and lifestyle you know that I'm obsessed
  • 00:03:23
    with the let's be breast cancer campaign
  • 00:03:28
    so if you go to Let's beat
  • 00:03:30
    breastcancer.org and sign up for free
  • 00:03:33
    it's free and fun I mean if you don't
  • 00:03:35
    like those two things I don't think we
  • 00:03:37
    can be friends so let's be
  • 00:03:39
    breastcancer.org sign up you will get a
  • 00:03:42
    free e-cookbook and a tutorial on how to
  • 00:03:48
    and why to eat a whole food plant-based
  • 00:03:50
    diet exercise regularly maintain ideal
  • 00:03:53
    body weight and limit alcohol these are
  • 00:03:56
    the four pronged approaches to beating
  • 00:03:59
    breast cancer and this
  • 00:04:01
    year we have hats so get your swag you
  • 00:04:04
    can get the shirt I'm wearing the Hat
  • 00:04:07
    I'm wearing that I now just took off
  • 00:04:09
    because I have to talk about things like
  • 00:04:10
    chemotherapy and it's hard to take
  • 00:04:12
    someone in a baseball hat seriously when
  • 00:04:14
    they're talking chemo um however please
  • 00:04:17
    join the campaign it's fun and
  • 00:04:19
    informative and I think it'll really
  • 00:04:20
    help your transition to a healthier
  • 00:04:23
    lifestyle But Chuck as you were saying
  • 00:04:26
    even when people quote unquote do
  • 00:04:27
    everything right and more often in my
  • 00:04:29
    experience it's the crossroads they
  • 00:04:32
    hadn't been doing anything right because
  • 00:04:33
    they didn't know they were supposed to
  • 00:04:34
    because no one ever told them including
  • 00:04:36
    their own doctors so we have this huge
  • 00:04:39
    intersection the bcac intersection
  • 00:04:42
    before cancer and after cancer and that
  • 00:04:44
    after cancer Road will never be the same
  • 00:04:48
    as the BC road but I'm here to help you
  • 00:04:51
    and encourage you and hold your hand as
  • 00:04:53
    you get into that AC road to help you
  • 00:04:56
    make choices that are going to minimize
  • 00:04:59
    your risk of recurrence but also
  • 00:05:01
    maximize your joy and your fervor for
  • 00:05:04
    life because you
  • 00:05:06
    cannot do and think and eat and drink
  • 00:05:09
    the same way you did on the BC Road and
  • 00:05:13
    think things aren't going to result in a
  • 00:05:16
    recurrence now you might think that the
  • 00:05:20
    things you're employing surgery
  • 00:05:21
    radiation chemo anti-estrogen there's a
  • 00:05:23
    whole bunch of Western medicine stuff
  • 00:05:24
    we're about to dive into and if you
  • 00:05:27
    Embrace some or all of those you might
  • 00:05:29
    think think you're in the clear but
  • 00:05:31
    between 25 and 28% of all early stage
  • 00:05:34
    breast cancer patients eventually recur
  • 00:05:36
    stage four metastatic and do not survive
  • 00:05:38
    their breast cancers I'm here to bring
  • 00:05:40
    that number down with you outstanding
  • 00:05:44
    and so that's the perfect segue to you
  • 00:05:47
    know I would imagine after somebody gets
  • 00:05:50
    that diagnosis the shock wears off
  • 00:05:52
    there's just so many questions that they
  • 00:05:55
    have and chief among them is well what
  • 00:05:58
    is the course of of treatment here so
  • 00:06:00
    can you walk us through what the typical
  • 00:06:03
    course of treatment may be for a breast
  • 00:06:05
    cancer patient or is it really dependent
  • 00:06:08
    upon the individual and each case is a
  • 00:06:10
    little bit different each case is a
  • 00:06:12
    little bit different we have 21 subtypes
  • 00:06:14
    of breast cancer and then we have
  • 00:06:18
    21 million billion types of
  • 00:06:21
    personalities and thought processes and
  • 00:06:23
    feelings that all factor into the
  • 00:06:25
    decision-making process right some
  • 00:06:28
    cancers are biological
  • 00:06:30
    like a little old lady a couch potato
  • 00:06:32
    going nowhere fast so we need to
  • 00:06:34
    recognize which ones those are and be
  • 00:06:38
    wary of over treatments right we don't
  • 00:06:41
    need to tap in a nail using like that
  • 00:06:45
    big Sledgehammer that tries to make the
  • 00:06:47
    ding thing go up at the carnival right
  • 00:06:49
    that is overt treatment and that upsets
  • 00:06:52
    me
  • 00:06:53
    because it has collateral damage every
  • 00:06:56
    single time and it's unnecessary so when
  • 00:06:59
    we think about how to treat and cure
  • 00:07:01
    breast cancer there are seven tools in
  • 00:07:03
    our tool bag all right there is surgery
  • 00:07:09
    radiation
  • 00:07:11
    chemotherapy anti-estrogen therapy
  • 00:07:14
    biologic targeted agents which would
  • 00:07:17
    include drugs like
  • 00:07:19
    herceptin and immunotherapy like
  • 00:07:24
    hruda then there are my two favorites
  • 00:07:27
    diet and lifestyle we're not going to a
  • 00:07:29
    deep dive into those today because
  • 00:07:31
    that's what I normally talk about with
  • 00:07:33
    you and many others so you can research
  • 00:07:37
    that it's all in my book breast the
  • 00:07:39
    owner's manual about how diet and
  • 00:07:41
    lifestyle impact cancer incidents and
  • 00:07:44
    outcome once diagnosed but every once in
  • 00:07:48
    a while more often than not once you're
  • 00:07:50
    diagnosed with
  • 00:07:51
    cancer kale and meditation aren't going
  • 00:07:55
    to kill it so we need to walk on gone
  • 00:07:59
    over to Western medicine and see what
  • 00:08:01
    the offerings are and then be wise and
  • 00:08:04
    thoughtful and individualized about
  • 00:08:06
    which modalities you plan to
  • 00:08:10
    use all right so that's a that's a
  • 00:08:12
    really important conversation and and a
  • 00:08:15
    a delicate one at that because there are
  • 00:08:17
    so many of our viewers and our listeners
  • 00:08:20
    who uh very much would like to go with a
  • 00:08:23
    100% holistic approach to this um
  • 00:08:27
    practical you know medicine here that
  • 00:08:30
    that you you practice yourself here kind
  • 00:08:32
    of tells you that you know maybe a blend
  • 00:08:35
    between the two could be the most
  • 00:08:37
    effective route in a lot of cases but
  • 00:08:40
    how would a person know whether or not
  • 00:08:43
    completely say we'll start with
  • 00:08:45
    radiation treatments how would a person
  • 00:08:47
    know whether or not they would even be a
  • 00:08:49
    candidate to opt not to undergo that
  • 00:08:52
    like what are some Alternatives that
  • 00:08:54
    they may want to try and you know what
  • 00:08:56
    is what is the risk
  • 00:08:58
    there the risk is recurrence and it is
  • 00:09:01
    largely a local recurrence local means
  • 00:09:03
    in the breast or in the armpit lymph
  • 00:09:06
    noes so it's kind of all locally where
  • 00:09:08
    the cancer began it then recurs in the
  • 00:09:11
    absence of radiation your average
  • 00:09:13
    recurrence rate is 40% at the 10-year
  • 00:09:16
    Mark kind of high if you radiate that 40
  • 00:09:19
    drops all the way down to four to six so
  • 00:09:23
    radiation is highly effective at staving
  • 00:09:26
    off a local
  • 00:09:27
    recurrence however there are side
  • 00:09:29
    effects to radiation and there are
  • 00:09:31
    limitations to it as well if you have
  • 00:09:33
    underlying significant um cardio or
  • 00:09:37
    pulmonary disease there is some scatter
  • 00:09:40
    do radiation under the ribs especially
  • 00:09:43
    left-sided cancers are going to scatter
  • 00:09:44
    to your heart both both sides of your
  • 00:09:46
    chest have lungs if you didn't know so
  • 00:09:48
    you can always get some pulmonary issues
  • 00:09:50
    but they are few they are very few I
  • 00:09:52
    mean you have to have underlying disease
  • 00:09:54
    to even notice like say getting more
  • 00:09:56
    shorter breath when you walk up some
  • 00:09:58
    stairs so the the bigger considerations
  • 00:10:00
    with radiation sure it is toxic maybe
  • 00:10:02
    you've already had it maybe you had
  • 00:10:04
    lymphoma as a child and already had um
  • 00:10:07
    mantle cell radiation to your entire
  • 00:10:09
    chest wall you can't do external beam
  • 00:10:11
    radiation twice in a lifetime your
  • 00:10:13
    healthy cells can't take it and it will
  • 00:10:16
    probably become mutagenic and create
  • 00:10:18
    something called angio saroma which is
  • 00:10:22
    like it sounds a saroma bad cancer uh
  • 00:10:24
    related to having had
  • 00:10:27
    radiation um who else who else uh
  • 00:10:29
    implants okay so if you have breast
  • 00:10:31
    augmentation and you like the way you
  • 00:10:33
    look radiating a breast o that is over
  • 00:10:36
    an implant is going to result in
  • 00:10:37
    contracture where the capsule around the
  • 00:10:39
    implant gets thickened and fibrotic and
  • 00:10:41
    it just looks a little bit more like a
  • 00:10:43
    coconut shell stuck to your chest wall
  • 00:10:45
    than you would like and that is almost
  • 00:10:48
    inevitable I say almost because some
  • 00:10:49
    people get away without contracture and
  • 00:10:51
    or there are some tricks I know but they
  • 00:10:54
    are medications that have a whole
  • 00:10:56
    regimen to reduce capsular contracture
  • 00:10:59
    if women are getting their implants
  • 00:11:01
    radiated in the world of radiation there
  • 00:11:03
    are choices so the tried and true is an
  • 00:11:06
    external beam where you lay down on the
  • 00:11:08
    table and um you get hit with photons
  • 00:11:13
    every day Monday through Friday it's
  • 00:11:15
    either six and a half weeks long with 33
  • 00:11:18
    treatments or three and a half weeks
  • 00:11:20
    long uh with 18
  • 00:11:23
    treatments but there's some nuances to
  • 00:11:25
    that and new protocols happening I have
  • 00:11:27
    a patient now getting just a slightly
  • 00:11:28
    high dose and focally to where the
  • 00:11:30
    cancer was for 10 treatments one of my
  • 00:11:34
    favorite types of radiation is
  • 00:11:36
    intraoperative it is literally you're
  • 00:11:39
    it's one and done just boom you're
  • 00:11:41
    asleep on the table you don't even know
  • 00:11:43
    what's happening I go in to do the
  • 00:11:44
    lumpectomy then I slip in a little
  • 00:11:47
    balloon catheter I step out so I don't
  • 00:11:49
    get radiated but then we radiate through
  • 00:11:52
    the balloon for 12 minutes so it's this
  • 00:11:54
    spherical radiation that is pounding the
  • 00:11:58
    site where the cancer was and this is
  • 00:12:00
    highly effective I take out the balloon
  • 00:12:02
    I fix up your breast so it looks pretty
  • 00:12:04
    again you wake up and two steps are done
  • 00:12:06
    surgery done radiation done and that is
  • 00:12:11
    really cool but you have certain people
  • 00:12:13
    who don't qualify for it so in order to
  • 00:12:15
    do intraoperative radiation one you have
  • 00:12:17
    to have a team that knows how to do it
  • 00:12:19
    two you have to have a ductal cancer not
  • 00:12:22
    lobular which reminds me you should
  • 00:12:24
    probably just beep beep beep rewind a
  • 00:12:26
    bit and go back to the basics of what
  • 00:12:29
    cancer is in a second okay but we need
  • 00:12:31
    ductal not lobular it has to be under 3
  • 00:12:33
    cm you need clear margins which you're
  • 00:12:35
    actually not going to know until after
  • 00:12:37
    this fancy surgery with the radiation so
  • 00:12:40
    in the event that your margins are not
  • 00:12:42
    clear meaning we have a little cancer
  • 00:12:45
    potentially left behind in one or two or
  • 00:12:48
    more
  • 00:12:49
    directions then uh that interoperative
  • 00:12:52
    radiation is not the one and done we
  • 00:12:53
    wanted it to be but it does count for
  • 00:12:56
    some radiations you get to do less on
  • 00:12:57
    the back end and you cannot have
  • 00:12:59
    positive lymph nodes it is a negative
  • 00:13:02
    thing to have positive lymph nodes I
  • 00:13:04
    know it's confusing positive nodes means
  • 00:13:07
    that there is cancer in the lymph notes
  • 00:13:09
    so that's a little radiation 101 it is
  • 00:13:13
    obviously uh multi-layered in lots of
  • 00:13:15
    choices so a fruitful discussion with a
  • 00:13:18
    radiation oncologist to see what's best
  • 00:13:20
    for you yeah and you know what let's go
  • 00:13:22
    back to what it was you you were talking
  • 00:13:23
    about there you wanted to rewind and and
  • 00:13:25
    talk about what is breast cancer I know
  • 00:13:28
    that you send us a graphic I'm going to
  • 00:13:30
    put that up on the screen there so for
  • 00:13:31
    those of you who are watching on
  • 00:13:33
    Facebook and on YouTube by all means
  • 00:13:35
    you're going to be able to see this so
  • 00:13:36
    if you're listening to the podcast hop
  • 00:13:38
    over there as well and you'll be able to
  • 00:13:39
    see this graphic I've got it up on the
  • 00:13:41
    screen right now Dr Funk tell us what is
  • 00:13:44
    it that we're looking at great so for
  • 00:13:46
    those of you who are only audio let me
  • 00:13:48
    tell you we're looking at a breast in
  • 00:13:50
    cross-section and we see all of these
  • 00:13:52
    milk producing lobules that look like a
  • 00:13:54
    big bunch of grapes and then if you're
  • 00:13:55
    holding Those Grapes by a single stem
  • 00:13:59
    and Look Backwards there's lots of tiny
  • 00:14:01
    little stems going to each of the grapes
  • 00:14:02
    those are the milk Ducks so there are
  • 00:14:05
    about 100 in the breast they all coales
  • 00:14:07
    and 8 to 12 emerge out and through the
  • 00:14:09
    nipple 75% of all breast cancers begin
  • 00:14:12
    inside the Ducks about 15 to 20% begin
  • 00:14:16
    in the lobules and for those of you
  • 00:14:18
    quick at math that leaves us with 5 to
  • 00:14:20
    10% of just weird stuff if you take a
  • 00:14:24
    duct so we'll talk through the most
  • 00:14:26
    common um scenario of ductal cancer but
  • 00:14:29
    the same story holds true for lobular
  • 00:14:31
    but let's take a duct transect it and
  • 00:14:33
    look through it like a telescope for
  • 00:14:35
    those who can see the graphic we're now
  • 00:14:36
    going to the upper right and we've got a
  • 00:14:40
    ring of normal cells this is a duct in
  • 00:14:43
    transsection and we're looking through
  • 00:14:45
    it like a telescope and we have a single
  • 00:14:48
    cell layer of cells that are very
  • 00:14:51
    orderly and are very similar one to the
  • 00:14:54
    next one step down we have what's called
  • 00:14:56
    ductal hyperplasia this is when you get
  • 00:14:58
    a a new layer of cells but they're also
  • 00:15:00
    pretty uniform and orderly we don't care
  • 00:15:03
    about ductal hyperplasia it's kind of
  • 00:15:05
    like saying hey you have a new Freckle
  • 00:15:06
    it's not melanoma and I don't care so
  • 00:15:08
    it's just part of aging and we expect to
  • 00:15:11
    see that next up we have atypical ductal
  • 00:15:14
    hyperplasia so now the new layer is
  • 00:15:17
    angrier it's starting to change its cell
  • 00:15:19
    structure it's growing without control
  • 00:15:22
    or order and it's just a matter of
  • 00:15:25
    degree between atipia and the earliest
  • 00:15:28
    form of breath bre cancer one down on
  • 00:15:30
    our Notch there ductal carcinoma inide
  • 00:15:32
    to so when there's enough of the
  • 00:15:34
    atypical junk growing inside the milk
  • 00:15:36
    duck to widen it by 2 millimeters or
  • 00:15:39
    more Bingo that's when the pathologist
  • 00:15:42
    calls it breast cancer ductal carcinoma
  • 00:15:45
    in citu is our earliest stage zero form
  • 00:15:48
    of breast cancer because these cancer
  • 00:15:51
    cells which are cancer are stuck inside
  • 00:15:54
    an intact tube and therefore they can
  • 00:15:56
    never access lymphatics or bloodstream
  • 00:15:58
    and spread so they are never
  • 00:16:00
    life-threatening and they never need
  • 00:16:03
    chemotherapy and it is our easiest
  • 00:16:05
    cancer to cure so that's ductal
  • 00:16:08
    carcinoma in site to if left to its own
  • 00:16:11
    devices and undiagnosed oh by the way
  • 00:16:13
    let me pause to say if you look at the
  • 00:16:15
    crowding and that there's more oh we
  • 00:16:17
    stay on the picture um we look at the
  • 00:16:20
    crowding of the cells there on the D
  • 00:16:22
    ductal carome and siteu as the central
  • 00:16:24
    cells start to get like all these cells
  • 00:16:26
    around it they lose their blood support
  • 00:16:28
    dieye and spit out a Fleck of calcium it
  • 00:16:32
    is uh the this clustering of calcium
  • 00:16:35
    tightly together in one spot on a
  • 00:16:37
    mamogram different shapes and sizes and
  • 00:16:40
    densities of white and gray that raise
  • 00:16:42
    the alarm for a radiologist reading your
  • 00:16:45
    mamogram they have to be like why why
  • 00:16:47
    are all those cells so busy turning over
  • 00:16:49
    there and just like freckles sometimes
  • 00:16:51
    it's benign stuff in fact most of the
  • 00:16:52
    time calcium is just a sign of cell
  • 00:16:55
    turnover and proliferation and benign
  • 00:16:57
    activity every once once in a while
  • 00:16:59
    though especially when there's certain
  • 00:17:01
    ways the calcium can look we go like why
  • 00:17:04
    is everybody dying right there and we
  • 00:17:06
    need a biopsy to see is it atypia is it
  • 00:17:09
    du carcinome and citu or is it just
  • 00:17:11
    something benign but busy in the breast
  • 00:17:13
    right there when you leave dcis alone or
  • 00:17:16
    don't know about it overall it's a 2/3
  • 00:17:21
    oneir probability of invading the duct
  • 00:17:24
    wall or not only onethird of all dcis
  • 00:17:28
    will
  • 00:17:28
    eventually punch through that duct wall
  • 00:17:31
    and invade it the breaking of the duct
  • 00:17:33
    wall right there in your breast where
  • 00:17:34
    this cancer totally entirely started I
  • 00:17:37
    meant to say entirely not totally I grew
  • 00:17:39
    up in the 80s in La what can you say um
  • 00:17:42
    so you break that duct wall That's
  • 00:17:44
    termed Invasion so when you get that
  • 00:17:46
    dreaded phone call and the doctor says
  • 00:17:48
    I'm sorry it came back cancer it's an
  • 00:17:50
    invasive cancer H that word invasive is
  • 00:17:53
    going to send you spiraling
  • 00:17:55
    into a bad place
  • 00:17:59
    but know this it doesn't mean anything
  • 00:18:01
    other than it broke the duct wall inside
  • 00:18:03
    your breast it does not mean it invaded
  • 00:18:05
    your lymph nodes it doesn't not mean it
  • 00:18:07
    invaded lung or liver or bone or brain
  • 00:18:09
    it just means that it broke the wall
  • 00:18:12
    right there and that's the term
  • 00:18:14
    Invasion okay so that's describing the
  • 00:18:17
    Continuum of disease from normal through
  • 00:18:19
    invasive ductal cancer and we can go
  • 00:18:22
    back to not having the picture up and
  • 00:18:24
    then um there are I mentioned 21 types
  • 00:18:28
    of cancer a lot of that subtyping has to
  • 00:18:31
    do with receptors so whether the cancer
  • 00:18:34
    cells are in the duct or outside of it
  • 00:18:37
    they can and often express receptors we
  • 00:18:40
    look at three in particular for estrogen
  • 00:18:42
    progesterone and a growth factor called
  • 00:18:44
    her too estrogen receptors these are
  • 00:18:48
    like little antennas that sit on the
  • 00:18:50
    outside of the cancer and when estrogen
  • 00:18:52
    if you talk about sources there are
  • 00:18:54
    three main sources of estrogen four um
  • 00:18:58
    that when estrogen of any of the sources
  • 00:19:00
    hits this receptor it's going to send a
  • 00:19:02
    signal to the cell to multiply and
  • 00:19:04
    divide all right especially for
  • 00:19:05
    premenopausal woman whose ovaries are
  • 00:19:07
    spewing out High volumes of estrogen all
  • 00:19:09
    day long this sounds awful and not uh
  • 00:19:13
    wanted guess what I love estrogen
  • 00:19:16
    receptors we all do and that is because
  • 00:19:19
    they are associated with less aggressive
  • 00:19:20
    and more curable cancers number two it
  • 00:19:23
    is an absolute necessary musthave to get
  • 00:19:27
    your ticket out of chemo or at least the
  • 00:19:30
    recommendation for chemo um and number
  • 00:19:33
    three ahuh okay so you're saying
  • 00:19:35
    estrogen feeds and fuels this cancer
  • 00:19:38
    what if I get rid of all the estrogen so
  • 00:19:41
    there isn't any fuel flying around what
  • 00:19:43
    if I physically block that receptor with
  • 00:19:47
    like a drug or even a food and then my
  • 00:19:51
    own estrogen can't get in there it's
  • 00:19:52
    like a car in the parking spot that you
  • 00:19:54
    want but this time it's like tamoxifen
  • 00:19:57
    or soy in the parking spot that estrogen
  • 00:20:01
    wanted what if you literally degrade The
  • 00:20:03
    receptors off of the cancer cell so I
  • 00:20:07
    love estrogen receptors because there
  • 00:20:08
    are three definite ways we can come
  • 00:20:12
    after that receptor and stop the fuel
  • 00:20:15
    progesterone receptors same story little
  • 00:20:18
    thing sitting on the outside
  • 00:20:19
    progesterone hits it fuels it but we
  • 00:20:22
    don't have any clear-cut foods and
  • 00:20:24
    certainly no drugs that we aim at
  • 00:20:26
    progesterone receptors so just as a
  • 00:20:28
    trend in terms of aggressiveness know
  • 00:20:31
    this higher is better so the more
  • 00:20:34
    estrogen receptors the higher the
  • 00:20:35
    progesterone receptor the less
  • 00:20:38
    aggressive the cancer third receptor her
  • 00:20:40
    two this is a growth factor it is um
  • 00:20:44
    highly It's associated with a highly
  • 00:20:47
    aggressive cancer so if you
  • 00:20:51
    could self-design your your breast
  • 00:20:53
    cancer you wouldn't add her to however
  • 00:20:56
    uh we don't get to choose so if if it
  • 00:20:58
    shows up her two positive which about 15
  • 00:21:00
    to 20% of cancers do I have to tell you
  • 00:21:04
    the good news there is a silver lining
  • 00:21:05
    we have a drug it is called herceptin it
  • 00:21:09
    goes often hand inand with another one
  • 00:21:10
    called petta and these are missiles
  • 00:21:13
    aimed at that her two receptor so
  • 00:21:16
    effectively so precisely that airr 25
  • 00:21:20
    years ago a her two driven cancer was up
  • 00:21:24
    there with inflammatory breast cancer
  • 00:21:25
    and triple negative as the least curable
  • 00:21:27
    most fatal cancer which we deal with and
  • 00:21:31
    now if you have a hery driven cancer and
  • 00:21:35
    go through these therapies it is among
  • 00:21:37
    the top most curable cancers that we
  • 00:21:39
    deal with that's how effective the
  • 00:21:40
    therapy
  • 00:21:42
    is I would definitely say that qualifies
  • 00:21:45
    as Mega progress that's pretty
  • 00:21:46
    impressive right there I like the way
  • 00:21:48
    that you described that being like
  • 00:21:49
    little missiles that go in there and
  • 00:21:51
    Hyper you know focus on on what they
  • 00:21:53
    what they need to do but I would imagine
  • 00:21:56
    that there are
  • 00:21:58
    a lot of patients who come through your
  • 00:22:00
    doors just as again as we said you know
  • 00:22:02
    a lot of people listening or watching
  • 00:22:05
    this show right now who really just you
  • 00:22:08
    know don't want to have to take a pill
  • 00:22:11
    no matter what you know it I guess it's
  • 00:22:15
    like when when do you have the
  • 00:22:18
    conversation with the person that says
  • 00:22:20
    look you know I I understand and I
  • 00:22:22
    appreciate where you're coming from but
  • 00:22:24
    really given your diagnosis what the
  • 00:22:28
    Alles that we're facing here you know I
  • 00:22:30
    really think it's in your best interest
  • 00:22:32
    to do this so is there a threshold for
  • 00:22:35
    somebody in terms of when they might
  • 00:22:36
    want to explore those Alternatives and
  • 00:22:38
    and when it is time to you know go hard
  • 00:22:41
    with the medicine that is
  • 00:22:43
    available whenever you have an estrogen
  • 00:22:45
    negative cancer so there are no estrogen
  • 00:22:47
    receptors whenever you have a her two
  • 00:22:50
    positive cancer so there's a bunch of
  • 00:22:52
    her two receptors whenever you have a
  • 00:22:54
    high division rate so this is not a
  • 00:22:56
    receptor but it is read on most core
  • 00:22:59
    biopsy path reports um by the
  • 00:23:02
    pathologist if you don't have a
  • 00:23:05
    ki67 on your pathology report from the
  • 00:23:08
    diagnostic core biopsy you can request
  • 00:23:11
    it to be done I love ki67 it answers the
  • 00:23:15
    question hey what percentage of cells
  • 00:23:17
    under the microscope are actively
  • 00:23:19
    dividing here one becoming two it's a
  • 00:23:21
    percent it can be anywhere from one to
  • 00:23:23
    100 and I think I've seen every single
  • 00:23:26
    number so it it's out there you've got
  • 00:23:28
    these wickedly fast dividing cancers I
  • 00:23:31
    would say anything over 30% would give
  • 00:23:35
    me pause for someone to just not do
  • 00:23:38
    anything about the tumor um or anything
  • 00:23:41
    after lumpectomy because that's a fast
  • 00:23:44
    division rate but I have tons
  • 00:23:46
    unfortunately of patients 80 90 even
  • 00:23:49
    100% division rate what does this mean
  • 00:23:51
    the cell is in actively in a phase of
  • 00:23:54
    mitosis uh but the division doesn't mean
  • 00:23:57
    you wake up every morning let's just use
  • 00:23:59
    the example of 10% for easy math on all
  • 00:24:02
    of us uh if 10% of the cells are
  • 00:24:04
    dividing in general it takes between
  • 00:24:07
    three and six months for that cell to
  • 00:24:09
    divide if you are older particularly
  • 00:24:12
    postmenopausal you're more towards six
  • 00:24:14
    months for a cell to divide and if your
  • 00:24:17
    premenopausal it's more toward three
  • 00:24:19
    months for a cell to divide so let's go
  • 00:24:21
    with January you have a 1 cmet cancer
  • 00:24:24
    that you don't know
  • 00:24:26
    about and your
  • 00:24:28
    60 years old in July a 1 cm cancer that
  • 00:24:33
    has a Ki 67 of 10% will be 1.1
  • 00:24:38
    CM okay back up now it's January we have
  • 00:24:42
    a 1 cm cancer in a 40-year-old but that
  • 00:24:46
    cell division rate is
  • 00:24:48
    50% come April that 1 cimeter cancer is
  • 00:24:51
    1.5 cmers that person worries me more if
  • 00:24:57
    they don't get more aggressive at
  • 00:24:59
    attacking this
  • 00:25:00
    cancer does that make sense absolutely
  • 00:25:03
    it does absolutely it does and kind of
  • 00:25:07
    along those same lines did the same
  • 00:25:09
    principles apply when it comes to
  • 00:25:11
    chemotherapy treatments which we've
  • 00:25:13
    talked about radiation we haven't
  • 00:25:14
    necessarily gone directly at chemo yet I
  • 00:25:17
    would assume that some of these same
  • 00:25:19
    principles apply here indeed they do so
  • 00:25:23
    here are the four Hoops that you need to
  • 00:25:26
    safely jump through to land on no chemo
  • 00:25:30
    recommended even from your chemol loving
  • 00:25:32
    medical oncologist so here they are you
  • 00:25:35
    have to have a cancer strongly driven by
  • 00:25:38
    estrogen you have to have well you
  • 00:25:42
    cannot have per two
  • 00:25:44
    receptors number three you cannot have
  • 00:25:47
    four or more positive lymph nodes so
  • 00:25:50
    that would be that the cancer got into
  • 00:25:51
    the lymphatics of the breast and made
  • 00:25:53
    its way over to the same side lymph
  • 00:25:55
    nodes under the armpit four or more is a
  • 00:25:58
    definite indication for chemotherapy and
  • 00:26:01
    then the final one is extremely
  • 00:26:04
    interesting because it's called genomics
  • 00:26:07
    we have ways to interrogate the cancer
  • 00:26:11
    and the enco Gen that are on or off what
  • 00:26:14
    genes it expresses or doesn't Express
  • 00:26:17
    this is not an analysis of your genome
  • 00:26:19
    as a person like did you inherit braa or
  • 00:26:21
    cheu from Mom or Dad no this is the
  • 00:26:24
    tumor's OWN internal genetics and we can
  • 00:26:28
    analyze it in a number of um company
  • 00:26:32
    tests there are different companies out
  • 00:26:33
    there the two main ones used in the US
  • 00:26:37
    are called enco type and
  • 00:26:39
    mammaprint mamar print looks at 70
  • 00:26:42
    different markers for recurrence onco
  • 00:26:44
    type looks at 21 fiber control so it
  • 00:26:46
    looks at maybe 16 in total but either
  • 00:26:50
    one that you use or one of the more
  • 00:26:53
    esoteric ones that are up and coming um
  • 00:26:55
    whatever your oncologist which wishes to
  • 00:26:58
    use they get your core biopsy they shove
  • 00:27:02
    those cells into this little assay that
  • 00:27:04
    analyzes all of the genomics of the
  • 00:27:06
    cancer and depending on what's good to
  • 00:27:08
    have or bad to have and what your cancer
  • 00:27:10
    you know expresses or doesn't it throws
  • 00:27:11
    it into an algorithm and spits out the
  • 00:27:14
    percent chance that your cancer will
  • 00:27:16
    come back incurable metastatic in the
  • 00:27:19
    next 10 years so hoop number four to
  • 00:27:22
    jump through to safely avoid the
  • 00:27:24
    recommendation for chemo is to have a
  • 00:27:26
    lowrisk
  • 00:27:28
    genomic score be it through anco typ or
  • 00:27:30
    mamar print or other so we have to have
  • 00:27:34
    estrogen receptors we cannot have her
  • 00:27:36
    two receptors we should not have four or
  • 00:27:38
    more positive lymph nodes and we want a
  • 00:27:40
    low genomic assay
  • 00:27:43
    score it seems like a lot of
  • 00:27:45
    qualifications there I mean what
  • 00:27:47
    percentage of cases do you think fall
  • 00:27:50
    into that it's you
  • 00:27:52
    know that don't fall into one of those
  • 00:27:55
    categories I mean there's so many there
  • 00:27:56
    I would imagine that the percentage is
  • 00:27:59
    rather low that don't check any of those
  • 00:28:01
    boxes actually about 65% of cancers will
  • 00:28:05
    check the boxes and just categorically
  • 00:28:07
    not need chemo the other 35% will
  • 00:28:11
    have like half checks or total checks in
  • 00:28:14
    these boxes and then it becomes a
  • 00:28:16
    thoughtful personalized individualized
  • 00:28:18
    discussion of pros and cons for chemo
  • 00:28:21
    for you there's always a percent risk
  • 00:28:24
    reduction of metastatic dis dis
  • 00:28:27
    occurring and that percent is
  • 00:28:31
    extremely different in terms of How It's
  • 00:28:34
    digested by different people if I told
  • 00:28:37
    you okay if you go through chemo you're
  • 00:28:40
    going to take your risk of recurring
  • 00:28:42
    life-threatening Med lung lever brain
  • 00:28:44
    bone we have yet to be able to cure that
  • 00:28:47
    effectively you're going to take your
  • 00:28:49
    risk of having a stage four recurrence
  • 00:28:52
    from 10% to
  • 00:28:55
    2% huh 8% absolutely abolute benefit
  • 00:28:59
    that sounds pretty good let's see how I
  • 00:29:00
    look bald although you could wear a cold
  • 00:29:02
    cap by the way and then not lose your
  • 00:29:03
    hair I also have a whole discussion on
  • 00:29:05
    workarounds for some of the side effects
  • 00:29:07
    and collateral damage that occurs with
  • 00:29:09
    chemo and Other
  • 00:29:11
    Drugs let's say you have
  • 00:29:16
    a uh let's use the same number 10%
  • 00:29:19
    chance of it recurring metastatic and if
  • 00:29:21
    you do the chemo it's
  • 00:29:23
    8% okay let's let's flip that on its
  • 00:29:26
    head I have a 90% chance that this isn't
  • 00:29:29
    coming back if I do chemo I have a 92%
  • 00:29:33
    chance it isn't coming
  • 00:29:35
    back if I do chemo baldness nausea
  • 00:29:38
    vomiting diarrhea neuropathy potential
  • 00:29:41
    leukemia down the road bone loss fatigue
  • 00:29:45
    mouth
  • 00:29:46
    sores I'm gonna go with no no thanks but
  • 00:29:50
    someone else might be like 2% Bring It
  • 00:29:52
    On honestly it I all personalities exist
  • 00:29:56
    and they react to these percentages
  • 00:29:58
    differently and a lot of people aren't
  • 00:30:00
    numbers people they're like yeah I just
  • 00:30:03
    feel like I don't want it or I feel like
  • 00:30:06
    I've got a two-year-old and a
  • 00:30:07
    five-year-old and I just started a new
  • 00:30:09
    job and I don't have time to die Bring
  • 00:30:11
    It On throw them all at me like those
  • 00:30:13
    are not reasons to do chemo but they're
  • 00:30:17
    emotional reasons that drive you toward
  • 00:30:19
    quote unquote doing everything possible
  • 00:30:21
    and I can respect all of it and I love
  • 00:30:24
    talking to women in
  • 00:30:26
    this in moment of like do I do I not
  • 00:30:30
    what if what if not I I love this moment
  • 00:30:33
    so I'm happy to consult with anybody who
  • 00:30:36
    needs some clarity on which path to take
  • 00:30:39
    because it feels so do or die right and
  • 00:30:42
    to some people it becomes that so it's a
  • 00:30:46
    big decision that crossroads is
  • 00:30:50
    serious and and let's say that they do
  • 00:30:52
    opt to go forward with chemo treatment
  • 00:30:56
    what do we know in terms of how diet
  • 00:30:59
    Lifestyle Changes there can help
  • 00:31:01
    mitigate some of those unwanted side
  • 00:31:03
    effects you were just talking about so
  • 00:31:07
    oh this is um interesting in that
  • 00:31:10
    believe it or not I don't want you to go
  • 00:31:13
    crazy on the antioxidant scale during
  • 00:31:16
    chemo why chemo is an oxidant if you're
  • 00:31:19
    going to go through the hell of putting
  • 00:31:20
    that stuff through your veins let it do
  • 00:31:22
    its damaging thing however there are
  • 00:31:26
    some things you can do to limit the
  • 00:31:28
    collateral damage that occurs and
  • 00:31:30
    afterwards we're going to become like
  • 00:31:32
    antioxidant superheroes right I it's
  • 00:31:35
    only in this tiny little window of time
  • 00:31:38
    that it is ill advised to have 18
  • 00:31:41
    teaspoons of turmeric one teaspoon in my
  • 00:31:44
    smoothie awesome it's helpful it's
  • 00:31:47
    supportive of your normal cells that got
  • 00:31:50
    a little hit by the chemo but it's not
  • 00:31:53
    overboard it's not gonna one teaspoon of
  • 00:31:55
    turmeric is not going to outcompete
  • 00:31:58
    taxol the Red Devil um so judicious use
  • 00:32:04
    of healthy Whole Foods um and ramping up
  • 00:32:07
    on some of our herbs and spices that we
  • 00:32:09
    know are like anti-estrogenic anti- um
  • 00:32:13
    angiogenic the blood flow increase that
  • 00:32:15
    cancer brings to itself proapoptosis
  • 00:32:18
    cancer cell suicide there are a ton of
  • 00:32:20
    these Foods you hear me talk about it
  • 00:32:22
    all the time and these foods go into
  • 00:32:25
    every meal that I want you to prepare
  • 00:32:27
    now and going forward and but during
  • 00:32:30
    chemo we just don't want to do like an
  • 00:32:32
    overdose and you know what overdoses you
  • 00:32:34
    not overdose like you know get sick and
  • 00:32:36
    die but too too much more than you could
  • 00:32:39
    ever consume like let's just take a
  • 00:32:41
    phytochemical sulphoraphane and say you
  • 00:32:44
    can't eat enough broccoli or broccoli
  • 00:32:47
    Sprouts to get the amount of sorine that
  • 00:32:49
    maybe you'll get in six capsules of pure
  • 00:32:53
    soramee packaged by your friendly
  • 00:32:55
    neutraceutical guy right so no
  • 00:32:58
    supplements that are like super
  • 00:33:00
    physiologic doses of anything fabulous
  • 00:33:02
    like cumin Etc follow ECG e EC EP epig
  • 00:33:07
    Gallo cak
  • 00:33:09
    egcg who forgets the acronym but knows
  • 00:33:12
    the whole word okay
  • 00:33:13
    so so one diet is supportive but we
  • 00:33:17
    can't go too crazy um with super
  • 00:33:21
    physiologic doses of supplements of
  • 00:33:23
    otherwise lovely good antioxidant Laden
  • 00:33:27
    foods and phytochemicals one number two
  • 00:33:30
    a study actually just came out in
  • 00:33:32
    October 2023 showing that women who
  • 00:33:36
    exercise during
  • 00:33:39
    chemotherapy have twice the PCR rate PCR
  • 00:33:44
    path complete response this is the holy
  • 00:33:46
    Grill this is what we dream about
  • 00:33:47
    happening when you have to do chemo and
  • 00:33:50
    we choose to do it before surgery you
  • 00:33:52
    actually have a lot of tumor that we can
  • 00:33:54
    see and measure and then eventually with
  • 00:33:57
    surgery look under the microscope and
  • 00:33:59
    see it shrink shrink shrink and
  • 00:34:00
    disappear PCR means you have a past
  • 00:34:03
    complete response once the lump atomy or
  • 00:34:05
    myectomy is done the pathologist is like
  • 00:34:08
    huh what cancer it's gone the PCR rate
  • 00:34:12
    in women who exercised was twice as high
  • 00:34:16
    versus the women that didn't it was a
  • 00:34:17
    randomized controll trial just in
  • 00:34:20
    October 23 so exercise is important
  • 00:34:24
    people are like are you serious lady I
  • 00:34:26
    am fatigued and vomiting up a storm you
  • 00:34:28
    know be gentle with yourself maybe you
  • 00:34:31
    can just go for a walk that counts
  • 00:34:33
    that's exercise so to the degree that
  • 00:34:36
    you can please do third up oh no go go
  • 00:34:40
    ahead I was just just move your body no
  • 00:34:42
    matter you know some way somehow any
  • 00:34:45
    kind of movement qualifies toward
  • 00:34:47
    exercise in this case right the key is
  • 00:34:49
    just not being 100% sary right
  • 00:34:52
    absolutely just move your body is there
  • 00:34:55
    a song about that so the third one all
  • 00:34:58
    right I'm going to get you in trouble
  • 00:35:00
    with your medical oncologist more likely
  • 00:35:02
    than not but you know me this is super
  • 00:35:05
    research-based evidence-based in humans
  • 00:35:08
    with breast cancer so I'm not talking
  • 00:35:11
    from Petri dishes women with breast
  • 00:35:14
    cancer undergoing chemotherapy were
  • 00:35:16
    randomized to fast or not fast during
  • 00:35:21
    the chemo so in other words getting your
  • 00:35:23
    chemo in that vein in a fasted state
  • 00:35:28
    these people had triple the
  • 00:35:31
    PCR what if we randomized chemo and
  • 00:35:34
    extracise versus okay you're but my
  • 00:35:37
    point is triple the PCR and less
  • 00:35:41
    collateral damage this comes out of the
  • 00:35:43
    work of vter Longo for those of you who
  • 00:35:45
    know that name he is big in the um
  • 00:35:48
    anti-aging space he runs the center for
  • 00:35:50
    longevity at USC University of Southern
  • 00:35:53
    California um he is the creator of
  • 00:35:55
    prolon which is that five-day fasting
  • 00:35:58
    kit that you can use to eat and not be
  • 00:36:00
    crazy hangry but your cells don't really
  • 00:36:02
    know you're eating at all so you get a
  • 00:36:04
    full benefit of a five-day fast as if
  • 00:36:06
    you were just drinking water they even
  • 00:36:09
    did prolon versus water and prolon was
  • 00:36:11
    more effective in the biomarker realm
  • 00:36:14
    when they did blood draws to look at
  • 00:36:15
    certain measurements like C reactive
  • 00:36:17
    protein igf1
  • 00:36:19
    Etc discussion for another day back to
  • 00:36:22
    the fasting though it was the exact same
  • 00:36:25
    thing as prolon they call it
  • 00:36:28
    zenagen it is not yet commercially
  • 00:36:30
    available in
  • 00:36:32
    2023
  • 00:36:34
    however I know everybody there and I can
  • 00:36:38
    assure you it actually zenagen is prolon
  • 00:36:41
    so I create a regimen for my patients
  • 00:36:44
    using prolon plus or minus to save money
  • 00:36:47
    if they want to we can have days of
  • 00:36:49
    broth and tea or black coffee and we
  • 00:36:53
    create a fasting regimen depends on your
  • 00:36:55
    chemo regimen sometimes you get it every
  • 00:36:57
    two weeks that's called dose dense
  • 00:36:58
    sometimes you get it every three weeks
  • 00:37:00
    sometimes you get it every week tax all
  • 00:37:01
    is often given 12 times weekly for three
  • 00:37:04
    months so anyway I figure out your
  • 00:37:06
    regimen and basically we alternate how
  • 00:37:09
    long you're fasting before you get your
  • 00:37:11
    chemo um and give you some breaks if
  • 00:37:13
    you're doing weekly chemo I'm not going
  • 00:37:14
    to have you fast every week long story
  • 00:37:17
    short when you look at the human studies
  • 00:37:19
    on fasting in chemo as I said triple the
  • 00:37:22
    PCR the Holy Grail but also the
  • 00:37:25
    collateral damage is left and really
  • 00:37:27
    quickly why this happen happens is when
  • 00:37:29
    you fast you're not eating the protein
  • 00:37:32
    and the carbs that make your pancreas go
  • 00:37:34
    oh food let's digest it spit out the
  • 00:37:36
    insulin insulin screams at everybody
  • 00:37:39
    like hey guys food's here like Chow down
  • 00:37:41
    do your thing whatever you do in this
  • 00:37:43
    body like do that right here's your fuel
  • 00:37:46
    here's your glucose and you need to use
  • 00:37:49
    it or store it and the cells get busy
  • 00:37:53
    now you're fasting okay there's no
  • 00:37:55
    insulin there's been no insulin for six
  • 00:37:57
    hours for eight hours for 20 hours your
  • 00:38:01
    body's like hey
  • 00:38:03
    guys I don't know when this lady's going
  • 00:38:05
    to eat again not sure what she's doing
  • 00:38:07
    but there's no food so you need to calm
  • 00:38:09
    down stop dividing so fast that's the
  • 00:38:13
    key let me repeat it stop dividing so
  • 00:38:17
    fast just lay and wait when she eats
  • 00:38:20
    again I'll let you know I'll throw out
  • 00:38:22
    some insulin your way
  • 00:38:24
    okay two points
  • 00:38:27
    guess who doesn't get the
  • 00:38:30
    memo cancer it's deranged it's not
  • 00:38:33
    following the body signals that's the
  • 00:38:35
    definition of cancer it is a mutated
  • 00:38:37
    cell that no longer is subject to the
  • 00:38:40
    regulation and rules of the body so this
  • 00:38:43
    cell is like and everybody else is like
  • 00:38:45
    sh it's a surprise party and guess who's
  • 00:38:48
    gonna get the surprise cancer the chemo
  • 00:38:50
    is going to be
  • 00:38:52
    like that guy's moving too fast it's
  • 00:38:55
    gone and this brings me to point number
  • 00:38:57
    two so point one cancer doesn't follow
  • 00:38:59
    the rules when you fast all of your body
  • 00:39:02
    does follow the rules if it doesn't have
  • 00:39:04
    cancer in it so point two chemo super
  • 00:39:09
    dumb not smart not aimed at receptors
  • 00:39:12
    the way herceptin Missle to a receptor
  • 00:39:14
    chemo no receptors what is chemo doing
  • 00:39:18
    what is this poison in your vein doing
  • 00:39:20
    it's just flying around in your
  • 00:39:22
    bloodstream literally looking for one
  • 00:39:24
    and only one thing what moves fast
  • 00:39:27
    around here oh your hair you that grows
  • 00:39:29
    fast follicles bald your nails you clip
  • 00:39:32
    them every week right brittle and wonky
  • 00:39:34
    your GI tra you turn over your stomach
  • 00:39:36
    cell lining every 24 hours nausea
  • 00:39:39
    vomiting diarrhea your nerves pum pum
  • 00:39:41
    really fast at firing neuropathy
  • 00:39:43
    numbness and tingling in your fingers
  • 00:39:45
    and toes
  • 00:39:47
    okay cancer with a high
  • 00:39:51
    ki67 the higher the ki67 silver lining
  • 00:39:55
    for having a bad de cancer quick
  • 00:39:58
    divider annihilated by the
  • 00:40:01
    chemo if you are fasting when the poison
  • 00:40:05
    goes in your cells are quiet so again
  • 00:40:08
    back to the work of Longo back to the
  • 00:40:10
    studies less collateral damage and by
  • 00:40:13
    that I mean less nausea vomiting
  • 00:40:15
    diarrhea less fatigue fewer mouth sorce
  • 00:40:18
    less
  • 00:40:19
    neuropathy brilliant right freaks your
  • 00:40:22
    medical oncologist out for the most part
  • 00:40:24
    sorry I know they don't know yet but I
  • 00:40:27
    promise you I'm not steering you wrong
  • 00:40:29
    we need to be mindful of your parameters
  • 00:40:32
    you know what I mean like if you're
  • 00:40:33
    severely underweight maybe this is just
  • 00:40:36
    a bad idea altoe um we just have to be
  • 00:40:39
    mindful of like your potassium levels
  • 00:40:41
    and things like that but um it's not
  • 00:40:43
    hard to do and it's free well unless you
  • 00:40:45
    buy the prolong kit it costs a little
  • 00:40:47
    money but the point is uh not eating is
  • 00:40:49
    generally
  • 00:40:51
    free that's that's one way to put it um
  • 00:40:54
    a serious question though let's say that
  • 00:40:57
    you know somebody has kind of opted to
  • 00:41:00
    um not go through chemo or radiation
  • 00:41:03
    they wanted to try the more holistic
  • 00:41:05
    things maybe you know fasting is a part
  • 00:41:07
    of it who knows whatever their their
  • 00:41:09
    treatment plan that they crafted looks
  • 00:41:11
    like um but it's you know that doesn't
  • 00:41:15
    seem to be working as well as it should
  • 00:41:19
    and let's say that the cancer is now
  • 00:41:22
    getting worse maybe it's spreading at
  • 00:41:24
    what point does that person have to have
  • 00:41:27
    a I would imagine a rather difficult
  • 00:41:29
    conversation with not just themselves
  • 00:41:31
    but also with their Health Care
  • 00:41:33
    Professionals and that maybe it's time
  • 00:41:35
    to Pivot over to the things that we were
  • 00:41:37
    trying to avoid in the first
  • 00:41:40
    place this is a really gentle and loving
  • 00:41:44
    space that I love to invite women into
  • 00:41:46
    because I am so non-judgmental I you
  • 00:41:50
    have probably not seen what I have seen
  • 00:41:53
    I mean if you just fungating ble leading
  • 00:41:56
    to just yesterday I got a phone call
  • 00:41:58
    from a patient in that situation but her
  • 00:42:02
    tumor is out in the room little alien it
  • 00:42:04
    it it looks like raw meat and she said
  • 00:42:07
    that that it was bleeding really badly
  • 00:42:09
    and she got Kleenex on it and the
  • 00:42:10
    kleenex was stuck to it she do want to
  • 00:42:12
    pull it off because she knows she's just
  • 00:42:13
    going to start gushing blood again and I
  • 00:42:15
    was like yeah come to the office let me
  • 00:42:16
    stop that bleeding for you um tumors get
  • 00:42:20
    really bad some tumor subtypes right we
  • 00:42:23
    talked about they it's all types the
  • 00:42:25
    fast of fighers the estrogen negatives
  • 00:42:28
    the herto positives if you do literally
  • 00:42:31
    nothing like if your alternative
  • 00:42:32
    approaches
  • 00:42:34
    are here and there I have people they're
  • 00:42:36
    well intentioned they want to follow
  • 00:42:38
    that path but even they fall off their
  • 00:42:40
    little wagon and they're not exercising
  • 00:42:42
    and they're not
  • 00:42:43
    eating they're not even eating
  • 00:42:45
    plant-based let alone like raw
  • 00:42:46
    plant-based which might be um the best
  • 00:42:48
    choice in that moment anyway on and on
  • 00:42:50
    right so the tumor grows and it's burst
  • 00:42:52
    out into the room and it's bleeding it's
  • 00:42:54
    like a it can be I mean tiny like a
  • 00:42:56
    grape just like a little ugly protrusion
  • 00:42:59
    through the skin or it can overtake the
  • 00:43:01
    entire breast like there is no breast
  • 00:43:03
    there is no nipple there's nothing it's
  • 00:43:05
    just a tumor stuck on there um and I see
  • 00:43:09
    it often honestly and people are so
  • 00:43:13
    relieved that I don't even make a face
  • 00:43:16
    and sometimes these things smell like
  • 00:43:17
    from outside the door I already know
  • 00:43:19
    because I could smell it's some smell of
  • 00:43:21
    tumor but uh yeah this face not going to
  • 00:43:25
    I'm not going to make face I'm not going
  • 00:43:27
    to judge you uh we're just going to talk
  • 00:43:29
    about what do you want to do now and
  • 00:43:32
    that is that should be a safe
  • 00:43:34
    conversation for a woman usually surgery
  • 00:43:36
    is waiting do now in that big you know
  • 00:43:40
    exophytic bleeding Advanced tumor no
  • 00:43:43
    drugs going to shrink that down
  • 00:43:44
    effectively and it's an infection issue
  • 00:43:47
    and a hygiene issue so we just get rid
  • 00:43:49
    of it um but thankfully most people
  • 00:43:53
    don't wait that long they just feel this
  • 00:43:55
    little marble under their skin they try
  • 00:43:57
    their things and the marble becomes an
  • 00:43:59
    apricot or a peach and then it's still
  • 00:44:02
    the skin is out normal over it and it's
  • 00:44:04
    just inside the breast um but they know
  • 00:44:06
    it's getting bigger and they come to me
  • 00:44:08
    and then we figure out what to do so
  • 00:44:10
    cheuck what we haven't talked about did
  • 00:44:12
    anybody remember that I am a surgeon we
  • 00:44:15
    didn't talk surgery like this is my
  • 00:44:17
    favorite topic sh we talk chema we
  • 00:44:20
    touched radiation we touched on touched
  • 00:44:22
    on
  • 00:44:23
    anti-estrogens yeah let's let's dive
  • 00:44:25
    into we've got about 10 minutes left
  • 00:44:27
    here so let's talk surgery right so
  • 00:44:30
    surgery is usually step number one we do
  • 00:44:34
    Neo adant chemotherapy or Neo adant
  • 00:44:37
    endocrine therapy Neo adant is fancy way
  • 00:44:40
    of saying before surgery chemo is
  • 00:44:43
    obvious endocrine refers to taking
  • 00:44:45
    anti-estrogen pills so you can do these
  • 00:44:47
    things before surgery to shrink a tumor
  • 00:44:50
    down so that what was a definite
  • 00:44:53
    mastectomy given the tumor size can
  • 00:44:55
    shrink it down down to make a lump
  • 00:44:57
    ectomy possible which allows you to keep
  • 00:44:59
    your breast another reason is you're
  • 00:45:02
    part of a trial and there's a new trial
  • 00:45:04
    drug this was like especially sexy and I
  • 00:45:07
    would push people to please do neoag
  • 00:45:09
    when they had triple negative Cancers
  • 00:45:11
    and imuno theapy was just being
  • 00:45:13
    introduced on the scene turns out
  • 00:45:15
    immunotherapy is a miracle drug when it
  • 00:45:17
    comes to treating triple negatives and
  • 00:45:20
    even our early stage Cancers get to have
  • 00:45:22
    everybody with triple negative gets
  • 00:45:23
    immunotherapy now back in the early days
  • 00:45:26
    when the trials were starting I was like
  • 00:45:27
    please go do the trial because I want
  • 00:45:29
    you to have this immunotherapy it's
  • 00:45:30
    going to be amazing and it's going to
  • 00:45:31
    make you have that coveted PCR way more
  • 00:45:34
    readily than without it but one of the
  • 00:45:37
    trial um uh requirements was that you
  • 00:45:41
    had to keep the tumor intact in your
  • 00:45:42
    breast right so that's another reason is
  • 00:45:44
    to join attractive trials that require
  • 00:45:47
    the cancer to be in your breast another
  • 00:45:50
    good reason to do these treatments be it
  • 00:45:52
    chemo or anti-estrogen therapy before
  • 00:45:54
    surgery um it's just to give your CH
  • 00:45:57
    your self a chance to calm down and
  • 00:46:01
    really contemplate your options without
  • 00:46:03
    a sense of urgency like I'm not doing
  • 00:46:05
    anything this thing is growing while I'm
  • 00:46:06
    sleeping and I'm not doing anything and
  • 00:46:08
    I got to make a decision just take my
  • 00:46:10
    breast off like whoa I don't want you
  • 00:46:11
    ever to make such an irreversible huge
  • 00:46:14
    decision in a moment of sheer panic and
  • 00:46:17
    doing something that we know is
  • 00:46:19
    eventually needed anyway and will be
  • 00:46:21
    effective at staving off tumor
  • 00:46:22
    metastases and probably shrink this
  • 00:46:24
    thing down a bit
  • 00:46:26
    gives you that room to Exhale and more
  • 00:46:30
    levelheaded contemplate your options so
  • 00:46:33
    those are three good reasons the
  • 00:46:35
    surgical choices there's two ways to get
  • 00:46:37
    a tumor out of a breast lumpectomy
  • 00:46:39
    removes the cancer with the rim of
  • 00:46:40
    healthy tissue around it you can kind of
  • 00:46:42
    think about it although it may not be
  • 00:46:43
    this big of a lump ectomy think about it
  • 00:46:46
    like a hard-boiled egg don't eat that
  • 00:46:48
    egg uh we don't eat eggs but a
  • 00:46:50
    hard-boiled egg has a yoke that's the
  • 00:46:52
    cancer the white would be the margin so
  • 00:46:56
    the margin of normal breast tissue is
  • 00:46:58
    what we're after around a cancer to not
  • 00:47:01
    have a positive margin which means I
  • 00:47:03
    slic through the Yol there's a little
  • 00:47:04
    bit of yellow at the edge of what I took
  • 00:47:07
    out which means there's probably some
  • 00:47:08
    yellow I.E cancer left on the other side
  • 00:47:11
    which is still in you in your breast so
  • 00:47:13
    lumpectomy with a clear margin versus
  • 00:47:16
    mastectomy mastectomy does not have to
  • 00:47:19
    be a big gory
  • 00:47:23
    demoralizing horrific slash across your
  • 00:47:25
    chest nipple missing it pictures abound
  • 00:47:29
    on the internet of particularly bad
  • 00:47:32
    operations currently but a lot that
  • 00:47:34
    hearkened back to the 70s when we did
  • 00:47:36
    something literally radical called the
  • 00:47:38
    Hallstead radical myectomy in the 20s
  • 00:47:41
    and Beyond you know when we were really
  • 00:47:44
    taking off the entire breast the muscle
  • 00:47:46
    like a skin on rib we only super
  • 00:47:48
    Advanced cancers end up with that right
  • 00:47:50
    now um everybody else oh mastectomies
  • 00:47:53
    can be actually for someone women a
  • 00:47:57
    cosmetic upgrade not always
  • 00:47:59
    though whenever possible and whenever a
  • 00:48:02
    patient wants to keep her nipple I'm
  • 00:48:04
    game I love nipple sparing mastectomy it
  • 00:48:07
    is probably my favorite operation to do
  • 00:48:09
    with or without reconstruction so let's
  • 00:48:12
    just go first through the why the
  • 00:48:15
    choices so we've got three groups of
  • 00:48:18
    surgery um lumpectomy alone egg with the
  • 00:48:23
    white lumpectomy followed by breast
  • 00:48:26
    radiation of which there are several
  • 00:48:28
    types versus myectomy okay doc stop
  • 00:48:31
    talking I just want to do whatever's
  • 00:48:32
    going to make me live
  • 00:48:33
    longer listen to this in the 1980s there
  • 00:48:37
    were six huge randomized studies
  • 00:48:39
    throughout the world throwing women into
  • 00:48:43
    these three groups of treatment
  • 00:48:44
    lumpectomy lumpectomy plus radiation
  • 00:48:46
    myectomy now it's been 40 years we know
  • 00:48:48
    who lived who died who had to come back
  • 00:48:49
    who didn't and this can inform you right
  • 00:48:52
    now about your choices in a way that's
  • 00:48:54
    very statistically driven and it's going
  • 00:48:56
    to blow your mind because in the 80s the
  • 00:48:58
    results of all Six studies were
  • 00:49:00
    basically identical the results of all
  • 00:49:03
    Six studies forever transformed how we
  • 00:49:06
    treat and cure breast cancer from a
  • 00:49:08
    surgical perspective two shocking things
  • 00:49:12
    shock number one
  • 00:49:14
    survival all three groups
  • 00:49:19
    identical identical so that's why I feel
  • 00:49:22
    so confident in my patients who are like
  • 00:49:26
    I'll let you take the tumor out but I'm
  • 00:49:27
    doing anything else you said or anything
  • 00:49:29
    else anybody else say I got my own plan
  • 00:49:31
    I just lump back to me and I'm like okay
  • 00:49:36
    because survival's the same lumpectomy
  • 00:49:40
    alone you don't have to radiate you
  • 00:49:41
    don't have to take your whole breast off
  • 00:49:43
    what I care about most sister is that
  • 00:49:47
    you don't die from this thing and so far
  • 00:49:49
    as we can stop death I want to stop it
  • 00:49:52
    and lumpectomy accomplishes that but
  • 00:49:56
    there is a butt what about local
  • 00:49:58
    recurrence local recurrence is breast
  • 00:50:00
    cancer as I already talked about coming
  • 00:50:01
    back again generally it comes back
  • 00:50:03
    within a centimeter or two of exactly
  • 00:50:05
    where it was in your breast so if you
  • 00:50:07
    have an upper outer quadrant cancer
  • 00:50:10
    that's why focal radiation like the
  • 00:50:12
    inoperative shot I was talking about
  • 00:50:14
    works so effectively because it it's
  • 00:50:15
    going to come back in the upper outer
  • 00:50:17
    quadrant if it comes back locally at all
  • 00:50:19
    or it can come back in the same side
  • 00:50:21
    armpit lymph nodes a local recurrence is
  • 00:50:23
    definitely disappointing because got to
  • 00:50:25
    deal with this thing all over again um
  • 00:50:28
    except in rare inst instances it doesn't
  • 00:50:31
    uh portend a worse prognosis at all
  • 00:50:33
    remember uh all three groups had same
  • 00:50:35
    survival so what it is is disappointing
  • 00:50:39
    and nobody wants to deal with cancer
  • 00:50:41
    again lumpectomy alone back to the 1980s
  • 00:50:45
    had a recurrence rate of on average 40%
  • 00:50:48
    if you radiated that dropped down to as
  • 00:50:51
    I once mentioned with the radiation talk
  • 00:50:52
    4 to 6% that's my modern numbers um back
  • 00:50:57
    in the 80s the recurrence was a little
  • 00:50:58
    higher but the radiation wasn't as good
  • 00:51:01
    here's the key here is shock number two
  • 00:51:04
    you're like I got a pluses all
  • 00:51:07
    throughout High School lady there's no
  • 00:51:09
    four to six% recurrence for me I want
  • 00:51:11
    zero take that breast
  • 00:51:13
    off four to six% recurrence maybe three
  • 00:51:16
    to five in some studies statistically
  • 00:51:18
    not significantly different in other
  • 00:51:21
    words in
  • 00:51:23
    summary lumpectomy plus radi ation
  • 00:51:26
    versus myectomy identical survival
  • 00:51:30
    identical recurrence with some very tiny
  • 00:51:34
    uh exceptions based on tumor
  • 00:51:37
    biology and if you choose to take an
  • 00:51:39
    anti-estrogen pill so tamoxifen which is
  • 00:51:41
    an estrogen decoy uh that blocks the
  • 00:51:44
    receptor aromatase Inhibitors go out
  • 00:51:46
    into your fat cells if you're
  • 00:51:48
    postmenopausal your ovary is done your
  • 00:51:51
    only self-created source of estrogen is
  • 00:51:53
    coming from your fat cells aromatase is
  • 00:51:56
    the enzyme in there making estrogen out
  • 00:51:58
    of adrenal gland hormones so you take an
  • 00:52:01
    aromatase inhibitor you might recognize
  • 00:52:03
    names like Arimidex aromasin anastrozol
  • 00:52:06
    letrozol famara those are aromatase
  • 00:52:09
    Inhibitors so you take those drugs and
  • 00:52:12
    all of our recurrence
  • 00:52:14
    numbers in this 1980s study World get
  • 00:52:18
    cut in half the 40% lumpectomy alone
  • 00:52:21
    becomes 20% and equally so lumpectomy
  • 00:52:24
    with radiation or myectomy go from 4 to
  • 00:52:26
    6% recurrence to 2 to 3% recurrence if
  • 00:52:29
    you add the anti-estrogens which also
  • 00:52:32
    Stave off a distant metastatic
  • 00:52:35
    recurrence um by varying numbers but the
  • 00:52:38
    numbers I'm giving you are for local
  • 00:52:40
    recurrence not metastatic that number
  • 00:52:42
    you get from genomics like enco type or
  • 00:52:44
    mamar print I know it gets confusing
  • 00:52:46
    it's a lot but there you have it in a
  • 00:52:49
    nutshell your surgical choices uh there
  • 00:52:52
    are three of them with two of them being
  • 00:52:54
    Lumpa but when planning to add radiation
  • 00:52:57
    afterwards so all right now I'm hearing
  • 00:53:00
    you all things being equal between
  • 00:53:02
    lumpectomy and radiation versus m why
  • 00:53:05
    would a woman take one or both breasts
  • 00:53:06
    off if she doesn't get any points at all
  • 00:53:09
    no survival points no local recurrence
  • 00:53:11
    points like
  • 00:53:13
    why I'm going to give you four reasons
  • 00:53:16
    one gene mutation so if you have brca
  • 00:53:19
    for example and you have breast cancer
  • 00:53:21
    on average there's a 65% chance you will
  • 00:53:23
    get another breast cancer in your
  • 00:53:25
    lifetime it is not a recurrence of this
  • 00:53:27
    one it is a new one so gene mutation
  • 00:53:30
    carriers depending on their age and
  • 00:53:32
    their own mindset about things they're
  • 00:53:33
    like you know what I I would I didn't
  • 00:53:36
    know I had this gene or I knew and now I
  • 00:53:38
    got bitten by it so I'm done take both
  • 00:53:40
    breasts please next person big tumor
  • 00:53:43
    small breast sometimes we can shrink the
  • 00:53:45
    tumor down using alternative strategies
  • 00:53:47
    using anti-estrogens using chemo I
  • 00:53:48
    talked about Neo adimin therapies one of
  • 00:53:50
    the reasons for that is to take a big
  • 00:53:52
    tumor that would yeah you could do a
  • 00:53:54
    lump back to me but then you'd be
  • 00:53:56
    leaving like this banana rim of breast
  • 00:53:58
    behind and then you should radiate it
  • 00:54:00
    and it just will look prettier to do a
  • 00:54:02
    myectomy and put in a breast shaped
  • 00:54:05
    implant or use your own body fat and
  • 00:54:06
    tissues or go flat and fabulous but it
  • 00:54:10
    will look a little weird to do a
  • 00:54:12
    lumpectomy because the tumor is so big
  • 00:54:14
    okay that's person two person three is
  • 00:54:17
    like oh you know what I love that four
  • 00:54:19
    to six% number that you got going on
  • 00:54:21
    there but ain't no way no how I'm doing
  • 00:54:24
    radiation maybe they've had it before
  • 00:54:26
    maybe they're just categorically opposed
  • 00:54:27
    to it um uh maybe they don't live in an
  • 00:54:31
    area that readily offers it they got to
  • 00:54:32
    drive four hours to and from every day
  • 00:54:36
    you don't want radiation whatever your
  • 00:54:38
    reason but you don't want a 40%
  • 00:54:40
    recurrence even 20 with the pills mctom
  • 00:54:44
    is an excellent choice you get that low
  • 00:54:46
    number no radiation needed with some
  • 00:54:49
    exceptions I mean can I stop having
  • 00:54:51
    exceptions people who choose myectomy
  • 00:54:54
    will still be advised to have radiation
  • 00:54:57
    to their chest wall in lyph nodes after
  • 00:55:00
    myectomy for sure if they have a tumor
  • 00:55:04
    over five centimeters an invasive tumor
  • 00:55:06
    dcis you get away with invasive tumor
  • 00:55:09
    over five centimeters positive margins
  • 00:55:11
    which sometimes I just deal with
  • 00:55:12
    directly like if your skin margin is
  • 00:55:14
    positive after mastectomy rather than
  • 00:55:16
    radiate if I know exactly where that is
  • 00:55:18
    I'd rather just take off that skin and
  • 00:55:20
    have you get radiation but that's not
  • 00:55:22
    always possible four or more positive
  • 00:55:24
    nodes is absolute for radiation one to
  • 00:55:27
    three positive nodes after myectomy is
  • 00:55:30
    wiggle room for discussion of pros and
  • 00:55:32
    cons and the final one is called
  • 00:55:35
    extensive lymphovascular Invasion the
  • 00:55:38
    lymphatics and the blood vessels that
  • 00:55:40
    are in all the other tissue that's not
  • 00:55:41
    the actual breast tissue feed and
  • 00:55:44
    nourish the skin too so it is highly
  • 00:55:47
    possible if there was a ton of tumor
  • 00:55:49
    like the 4053 and la like just tumor
  • 00:55:52
    everywhere in these tubes that it's also
  • 00:55:54
    in the lymphatics and the vessels that
  • 00:55:56
    have been left behind on purpose to
  • 00:55:58
    nourish and keep the skin alive after
  • 00:55:59
    Mist so there are caveats to not needing
  • 00:56:03
    radiation to needing radiation after
  • 00:56:06
    mastectomy so not wanting radiation you
  • 00:56:09
    should have also you should know like if
  • 00:56:11
    you're going to fall in that category
  • 00:56:12
    anyway and finally the most common
  • 00:56:15
    reason for which I do
  • 00:56:16
    myectomy a woman wants it she's like you
  • 00:56:19
    know what I'm not a numbers person or I
  • 00:56:22
    get it I don't have a gene but my mom
  • 00:56:23
    had it my sister had it now I have it I
  • 00:56:26
    don't I don't want the these things
  • 00:56:27
    they're trying to kill me and I don't
  • 00:56:29
    watch them or she is at Baseline like an
  • 00:56:33
    anxious person and she can admit like
  • 00:56:35
    you know what I hear you but showing up
  • 00:56:37
    every six months for a mamogram and
  • 00:56:39
    ultrasound and MRI you to examine me a
  • 00:56:42
    biopsy every time there's a blip on the
  • 00:56:43
    radar like I'm having a panic attack
  • 00:56:46
    just thinking about that future for me
  • 00:56:47
    if you take these off do I have to do
  • 00:56:49
    any of it not really I do chest wall
  • 00:56:52
    exams after myectomy every six months
  • 00:56:54
    for five years and I ultrasound the
  • 00:56:55
    armpit to make sure there's no node
  • 00:56:58
    happening deeper than I can feel but
  • 00:57:00
    that's it there are no squishy
  • 00:57:02
    mammograms there's no MRI um and so that
  • 00:57:05
    can really emancipate a woman and make
  • 00:57:07
    her feel like she's the Conqueror over
  • 00:57:09
    this disease so there are solid reasons
  • 00:57:11
    to choose myectomy over lump ectomy and
  • 00:57:14
    those are the main
  • 00:57:16
    ones boy there is a lot to talk about
  • 00:57:20
    there a lot of numbers certainly a very
  • 00:57:22
    personal decision no matter what and so
  • 00:57:25
    I wish that we had more time to unpack
  • 00:57:28
    that a little bit but the numbers again
  • 00:57:31
    that I want to kind of wrap up today
  • 00:57:33
    with go to what it was we were talking
  • 00:57:35
    about right at the beginning of the show
  • 00:57:38
    and that is the fact that half of all
  • 00:57:40
    breast cancer cases undisputedly are
  • 00:57:44
    preventable and in your estimation
  • 00:57:46
    perhaps even as many as 82 90% of the
  • 00:57:50
    cases and that is what is at the heart
  • 00:57:52
    of our let's beat breast cancer campaign
  • 00:57:54
    this year and every year I love the hat
  • 00:57:56
    you rock it so well let's beat
  • 00:57:59
    breastcancer.org is the website to visit
  • 00:58:01
    to get your hat take the pledge learn
  • 00:58:03
    all about our four prongs our four-step
  • 00:58:06
    approach to preventing and beating
  • 00:58:08
    breast cancer absolutely get involved
  • 00:58:11
    there the free ecook book and speaking
  • 00:58:13
    of books you got to go if you don't
  • 00:58:15
    already have it get Dr funk's book
  • 00:58:17
    breasts the owner's manual there's a
  • 00:58:19
    link to pick up your copy right now in
  • 00:58:21
    the show description and in the episode
  • 00:58:23
    notes and of course all of this
  • 00:58:25
    information and a whole lot more you can
  • 00:58:27
    find at pinklotus.com as well Dr funk's
  • 00:58:30
    website there so Dr Funk thank you so
  • 00:58:33
    very much for your time and walking us
  • 00:58:35
    through this is definitely a different
  • 00:58:37
    approach than what we usually take on
  • 00:58:39
    the show but I love that we're getting
  • 00:58:41
    all of the information out there because
  • 00:58:43
    it's so critical to paint the entire
  • 00:58:45
    picture of what a breast cancer battle
  • 00:58:47
    looks like and I think you did a
  • 00:58:48
    phenomenal job doing that with us today
  • 00:58:51
    thanks it was my pleasure bye
  • 00:58:53
    everyone
  • 00:58:57
    if your health IQ was a couple of points
  • 00:58:59
    higher than it was a few minutes ago go
  • 00:59:01
    ahead and like this video or subscribe
  • 00:59:03
    to the YouTube channel and to take it
  • 00:59:06
    even higher head over to Apple podcast
  • 00:59:08
    or wherever you get your favorite shows
  • 00:59:10
    look for the exam room by The Physicians
  • 00:59:12
    committee hit the Subscribe button there
  • 00:59:14
    as well and help to make your world a
  • 00:59:17
    healthier place
Tags
  • breast cancer
  • prevention
  • treatment
  • lifestyle changes
  • Dr. Christy Funk
  • chemotherapy
  • radiation
  • holistic approach
  • nutrition
  • research