WEBVTT

NOTE duration: "01:07:19.840"


NOTE Confidence: 0.9689161

00:00:06.000 --> 00:00:07.460
Alright. Welcome, everyone.

NOTE Confidence: 0.92498195

00:00:07.919 --> 00:00:09.599
This is Milo Shares Breast

NOTE Confidence: 0.92498195

00:00:09.599 --> 00:00:11.039
Cancer Awareness Month. This is

NOTE Confidence: 0.92498195

00:00:11.039 --> 00:00:12.500
the first of three presentations,

NOTE Confidence: 0.9200714

00:00:13.525 --> 00:00:14.985
and this one is called

NOTE Confidence: 0.9200714

00:00:15.045 --> 00:00:17.545
understanding breast health, screening genetics

NOTE Confidence: 0.9200714

00:00:17.685 --> 00:00:18.585
and prevention.

NOTE Confidence: 0.9645146

00:00:19.925 --> 00:00:21.125
And I'm John Lewin. I'm

NOTE Confidence: 0.9645146

00:00:21.125 --> 00:00:22.825
the moderator for this session,

NOTE Confidence: 0.9996225

00:00:23.525 --> 00:00:24.665
and we have

NOTE Confidence: 0.9976756

00:00:26.005 --> 00:00:26.505
three

NOTE Confidence: 0.9662023

00:00:30.560 --> 00:00:31.060
experts.

NOTE Confidence: 0.8134527

00:00:39.920 --> 00:00:41.600
So we have doctor Pris

NOTE Confidence: 0.8134527

00:00:41.600 --> 00:00:42.100
Salafi,

NOTE Confidence: 0.97221607

00:00:42.455 --> 00:00:43.575
who's my colleague in the

NOTE Confidence: 0.97221607

00:00:43.575 --> 00:00:45.115
department of radiology and biomedical

NOTE Confidence: 0.97221607

00:00:45.255 --> 00:00:45.755
imaging,

NOTE Confidence: 0.99881667

00:00:46.614 --> 00:00:47.895
and she will be talking

NOTE Confidence: 0.99881667

00:00:47.895 --> 00:00:48.395
about

NOTE Confidence: 0.79008615

00:00:49.095 --> 00:00:49.595
screening,

NOTE Confidence: 0.9278706

00:00:50.055 --> 00:00:51.354
and Tracy Battaglia,

NOTE Confidence: 0.99708635

00:00:52.055 --> 00:00:53.595
who is professor of medicine

NOTE Confidence: 0.95546746

00:00:54.215 --> 00:00:56.215
and associate director community outreach

NOTE Confidence: 0.95546746

00:00:56.215 --> 00:00:57.335
and engagement for the Yale

NOTE Confidence: 0.95546746

00:00:57.335 --> 00:00:58.235
Cancer Center,

NOTE Confidence: 0.9379923

00:00:59.309 --> 00:01:00.370
and Linda Erwin,

NOTE Confidence: 0.8956978

00:01:00.910 --> 00:01:02.510
who's associate dean of research,

NOTE Confidence: 0.8956978

00:01:02.510 --> 00:01:04.670
and Susan Dwight Bliss professor

NOTE Confidence: 0.8956978

00:01:04.670 --> 00:01:05.330
of epidemiology,

NOTE Confidence: 0.974626

00:01:06.990 --> 00:01:08.590
deputy director of the Yale

NOTE Confidence: 0.974626

00:01:08.590 --> 00:01:09.950
Cancer Center, who will be

NOTE Confidence: 0.974626

00:01:09.950 --> 00:01:11.009
talking about

NOTE Confidence: 0.99872816

00:01:11.310 --> 00:01:12.130
risk modification.

NOTE Confidence: 0.9579723

00:01:13.635 --> 00:01:15.555
And so without any further

NOTE Confidence: 0.9579723

00:01:15.555 --> 00:01:17.155
ado, I will stop sharing

NOTE Confidence: 0.9579723

00:01:17.155 --> 00:01:18.535
my screen, and doctor Lottie

NOTE Confidence: 0.9579723

00:01:18.755 --> 00:01:19.895
can start her presentation.

NOTE Confidence: 0.9990747

00:01:25.075 --> 00:01:25.575
Okay.

NOTE Confidence: 0.99957633

00:01:30.600 --> 00:01:31.960
I hope everyone is having

NOTE Confidence: 0.99957633

00:01:31.960 --> 00:01:32.940
a good evening.

NOTE Confidence: 0.97888434

00:01:33.560 --> 00:01:35.080
I'm gonna briefly talk about

NOTE Confidence: 0.97888434

00:01:35.080 --> 00:01:37.660
breast cancer, current screening recommendations.

NOTE Confidence: 0.94527376

00:01:42.685 --> 00:01:44.125
We all are aware or

NOTE Confidence: 0.94527376

00:01:44.125 --> 00:01:45.745
have heard of the US

NOTE Confidence: 0.90711194

00:01:46.045 --> 00:01:46.545
Preventative

NOTE Confidence: 0.9961201

00:01:47.084 --> 00:01:47.585
Services

NOTE Confidence: 0.8734088

00:01:47.885 --> 00:01:48.785
Task Force.

NOTE Confidence: 0.9769033

00:01:49.725 --> 00:01:51.245
This is a task force

NOTE Confidence: 0.9769033

00:01:51.245 --> 00:01:52.305
that is,

NOTE Confidence: 0.99978137

00:01:53.485 --> 00:01:54.945
assigned by the government

NOTE Confidence: 0.9992325

00:01:55.245 --> 00:01:58.170
to look at medical data

NOTE Confidence: 0.9992325

00:01:58.229 --> 00:01:59.290
and make recommendations

NOTE Confidence: 0.99942887

00:01:59.670 --> 00:02:00.490
for screening

NOTE Confidence: 0.927843

00:02:00.869 --> 00:02:01.369
different,

NOTE Confidence: 0.99990094

00:02:01.909 --> 00:02:02.810
types of

NOTE Confidence: 0.80713016

00:02:04.070 --> 00:02:04.570
diseases.

NOTE Confidence: 0.97713506

00:02:05.190 --> 00:02:07.430
But specific to breast cancer

NOTE Confidence: 0.97713506

00:02:07.430 --> 00:02:09.510
screening, they just modified their

NOTE Confidence: 0.97713506

00:02:09.510 --> 00:02:10.010
recommendation,

NOTE Confidence: 0.9577225

00:02:11.395 --> 00:02:13.014
recently last year,

NOTE Confidence: 0.9942133

00:02:13.395 --> 00:02:15.635
and they lowered the start

NOTE Confidence: 0.9942133

00:02:15.635 --> 00:02:16.775
age for screening.

NOTE Confidence: 0.98700565

00:02:17.235 --> 00:02:19.315
Now they recommend women aged

NOTE Confidence: 0.98700565

00:02:19.315 --> 00:02:21.315
forty to seventy four get

NOTE Confidence: 0.98700565

00:02:21.315 --> 00:02:23.794
screened. However, their recommendation says,

NOTE Confidence: 0.9955578

00:02:24.195 --> 00:02:25.255
every two years.

NOTE Confidence: 0.9958671

00:02:25.770 --> 00:02:27.930
And, women seventy five years

NOTE Confidence: 0.9958671

00:02:27.930 --> 00:02:28.590
or older,

NOTE Confidence: 0.9744242

00:02:29.370 --> 00:02:30.750
they said that there isn't

NOTE Confidence: 0.9744242

00:02:30.810 --> 00:02:31.310
sufficient,

NOTE Confidence: 0.99419886

00:02:32.410 --> 00:02:34.410
evidence to assess the balance

NOTE Confidence: 0.99419886

00:02:34.410 --> 00:02:35.610
of benefits and harms of

NOTE Confidence: 0.99419886

00:02:35.610 --> 00:02:37.550
screening mammography in this population.

NOTE Confidence: 0.9480716

00:02:38.250 --> 00:02:40.010
They also recommended that women

NOTE Confidence: 0.9480716

00:02:40.010 --> 00:02:41.230
with dense breast,

NOTE Confidence: 0.97272134

00:02:42.465 --> 00:02:44.145
that there isn't enough evidence

NOTE Confidence: 0.97272134

00:02:44.145 --> 00:02:45.345
to assess the balance of

NOTE Confidence: 0.97272134

00:02:45.345 --> 00:02:46.485
benefits and harms.

NOTE Confidence: 0.98868084

00:02:47.264 --> 00:02:47.764
Now

NOTE Confidence: 0.9967633

00:02:48.145 --> 00:02:49.585
we can talk about an

NOTE Confidence: 0.9967633

00:02:49.585 --> 00:02:51.185
hour about the data they

NOTE Confidence: 0.9967633

00:02:51.185 --> 00:02:52.485
looked at and

NOTE Confidence: 0.9567433

00:02:54.080 --> 00:02:55.919
what they considered harms and

NOTE Confidence: 0.9567433

00:02:55.919 --> 00:02:57.520
benefits. But one thing they

NOTE Confidence: 0.9567433

00:02:57.520 --> 00:02:59.460
considered a harm of screening

NOTE Confidence: 0.9567433

00:02:59.680 --> 00:03:02.000
was anxiety of women and,

NOTE Confidence: 0.9567433

00:03:02.240 --> 00:03:03.860
potential callback rates.

NOTE Confidence: 0.990177

00:03:05.040 --> 00:03:06.480
Briefly, I just wanna say

NOTE Confidence: 0.990177

00:03:06.480 --> 00:03:07.300
that when

NOTE Confidence: 0.9526587

00:03:07.965 --> 00:03:09.805
screening mammography is the standard

NOTE Confidence: 0.9526587

00:03:09.805 --> 00:03:11.245
of care, and this is

NOTE Confidence: 0.9526587

00:03:11.245 --> 00:03:12.925
going back decades, and we

NOTE Confidence: 0.9526587

00:03:12.925 --> 00:03:13.325
have,

NOTE Confidence: 0.99883276

00:03:14.605 --> 00:03:16.845
extensive research proving that screening

NOTE Confidence: 0.99883276

00:03:16.845 --> 00:03:17.345
mammography

NOTE Confidence: 0.9438533

00:03:18.045 --> 00:03:19.025
saves lives.

NOTE Confidence: 0.9656664

00:03:19.805 --> 00:03:21.325
Women who had a screening

NOTE Confidence: 0.9656664

00:03:21.325 --> 00:03:23.165
mammogram compared to women who

NOTE Confidence: 0.9656664

00:03:23.165 --> 00:03:25.620
didn't definitely live longer, and,

NOTE Confidence: 0.9656664

00:03:25.860 --> 00:03:27.080
that's how we know.

NOTE Confidence: 0.9935157

00:03:28.660 --> 00:03:30.200
Everything else, ultrasound

NOTE Confidence: 0.9684024

00:03:30.500 --> 00:03:31.239
and MRI

NOTE Confidence: 0.95643955

00:03:31.700 --> 00:03:34.260
and other modalities that I

NOTE Confidence: 0.95643955

00:03:34.260 --> 00:03:35.620
will talk about, like contrast

NOTE Confidence: 0.95643955

00:03:35.620 --> 00:03:36.599
enhanced mammography,

NOTE Confidence: 0.9664041

00:03:37.115 --> 00:03:38.395
we don't have enough data

NOTE Confidence: 0.9664041

00:03:38.395 --> 00:03:40.075
to know decades worth of

NOTE Confidence: 0.9664041

00:03:40.075 --> 00:03:41.595
data to know if these

NOTE Confidence: 0.9664041

00:03:41.595 --> 00:03:42.335
are actually

NOTE Confidence: 0.9512812

00:03:43.275 --> 00:03:45.595
making women die less of

NOTE Confidence: 0.9512812

00:03:45.595 --> 00:03:46.495
a breast cancer.

NOTE Confidence: 0.8986184

00:03:49.290 --> 00:03:50.190
So current

NOTE Confidence: 0.91828907

00:03:50.730 --> 00:03:51.230
guidelines,

NOTE Confidence: 0.9700121

00:03:51.850 --> 00:03:53.690
this is a table that

NOTE Confidence: 0.9700121

00:03:53.690 --> 00:03:55.290
is talking about the different

NOTE Confidence: 0.9700121

00:03:55.290 --> 00:03:57.770
societies, medical societies talking about

NOTE Confidence: 0.9700121

00:03:57.770 --> 00:03:58.830
screening guidelines.

NOTE Confidence: 0.9921256

00:04:00.170 --> 00:04:01.370
I talked about the,

NOTE Confidence: 0.9786743

00:04:01.770 --> 00:04:03.210
task force. It says start

NOTE Confidence: 0.9786743

00:04:03.210 --> 00:04:04.910
at forty every two years.

NOTE Confidence: 0.89151824

00:04:05.235 --> 00:04:07.155
And then different societies like

NOTE Confidence: 0.89151824

00:04:07.155 --> 00:04:08.935
ACOG is the OB GYN,

NOTE Confidence: 0.9451038

00:04:09.235 --> 00:04:11.875
society, American Cancer Society, American

NOTE Confidence: 0.9451038

00:04:11.875 --> 00:04:12.935
Medical Association,

NOTE Confidence: 0.9964468

00:04:13.715 --> 00:04:15.075
they all pretty much are

NOTE Confidence: 0.9964468

00:04:15.075 --> 00:04:15.575
recommending

NOTE Confidence: 0.98235893

00:04:15.875 --> 00:04:17.395
starting at forty. And for

NOTE Confidence: 0.98235893

00:04:17.395 --> 00:04:19.154
the most part, annual screening

NOTE Confidence: 0.98235893

00:04:19.154 --> 00:04:19.895
is recommended.

NOTE Confidence: 0.9902033

00:04:20.539 --> 00:04:22.220
For women older than seventy

NOTE Confidence: 0.9902033

00:04:22.220 --> 00:04:23.979
five, it's based on shared

NOTE Confidence: 0.9902033

00:04:23.979 --> 00:04:26.380
decision making. If people are

NOTE Confidence: 0.9902033

00:04:26.380 --> 00:04:27.740
in good health, if women

NOTE Confidence: 0.9902033

00:04:27.740 --> 00:04:28.940
are in good health and

NOTE Confidence: 0.9902033

00:04:28.940 --> 00:04:30.139
they have at least ten

NOTE Confidence: 0.9902033

00:04:30.139 --> 00:04:32.300
more life, years ahead of

NOTE Confidence: 0.9902033

00:04:32.300 --> 00:04:32.800
them,

NOTE Confidence: 0.9901078

00:04:33.354 --> 00:04:34.314
it's a good idea to

NOTE Confidence: 0.9901078

00:04:34.314 --> 00:04:36.235
continue with mammography. But that's

NOTE Confidence: 0.9901078

00:04:36.235 --> 00:04:37.435
a personal choice, and it

NOTE Confidence: 0.9901078

00:04:37.435 --> 00:04:38.955
can be discussed with,

NOTE Confidence: 0.9994931

00:04:39.754 --> 00:04:41.375
their primary care physicians

NOTE Confidence: 0.99016744

00:04:41.995 --> 00:04:43.995
and, come to a decision

NOTE Confidence: 0.99016744

00:04:43.995 --> 00:04:45.935
that's appropriate for that individual.

NOTE Confidence: 0.97190505

00:04:46.830 --> 00:04:48.270
I am a radiologist, so

NOTE Confidence: 0.97190505

00:04:48.270 --> 00:04:50.110
I'm gonna talk about American

NOTE Confidence: 0.97190505

00:04:50.110 --> 00:04:52.110
College of Radiology and Society

NOTE Confidence: 0.97190505

00:04:52.110 --> 00:04:53.650
of Breast Imaging recommendations,

NOTE Confidence: 0.93291306

00:04:54.589 --> 00:04:56.589
which basically says start at

NOTE Confidence: 0.93291306

00:04:56.589 --> 00:04:57.089
forty.

NOTE Confidence: 0.97000974

00:04:57.470 --> 00:04:58.850
Every year, get a mammogram,

NOTE Confidence: 0.97000974

00:04:59.070 --> 00:05:00.190
and there is no age

NOTE Confidence: 0.97000974

00:05:00.190 --> 00:05:00.690
limit.

NOTE Confidence: 0.9971794

00:05:01.065 --> 00:05:02.845
But, obviously, we do consider

NOTE Confidence: 0.9971794

00:05:02.904 --> 00:05:04.365
individual health status.

NOTE Confidence: 0.994789

00:05:06.025 --> 00:05:06.525
So,

NOTE Confidence: 0.9983683

00:05:07.385 --> 00:05:08.925
American College of Radiology

NOTE Confidence: 0.89056134

00:05:09.385 --> 00:05:09.885
recently,

NOTE Confidence: 0.99634224

00:05:10.345 --> 00:05:11.705
in the last few years,

NOTE Confidence: 0.99634224

00:05:11.705 --> 00:05:12.765
changed their recommendations

NOTE Confidence: 0.9863489

00:05:13.305 --> 00:05:14.365
in terms of,

NOTE Confidence: 0.99920624

00:05:14.985 --> 00:05:15.485
breast

NOTE Confidence: 0.9458164

00:05:16.420 --> 00:05:17.240
care. And,

NOTE Confidence: 0.9897278

00:05:18.100 --> 00:05:19.540
they brought to light the

NOTE Confidence: 0.9897278

00:05:19.540 --> 00:05:21.220
importance of having a risk

NOTE Confidence: 0.9897278

00:05:21.220 --> 00:05:21.720
assessment

NOTE Confidence: 0.87445426

00:05:22.100 --> 00:05:22.839
for women,

NOTE Confidence: 0.9952544

00:05:23.140 --> 00:05:24.900
and they're recommending that women

NOTE Confidence: 0.9952544

00:05:24.900 --> 00:05:26.120
get a risk assessment

NOTE Confidence: 0.9747958

00:05:26.820 --> 00:05:28.260
by age twenty five. Every

NOTE Confidence: 0.9747958

00:05:28.260 --> 00:05:29.880
woman should know if they're

NOTE Confidence: 0.9747958

00:05:29.940 --> 00:05:31.435
high risk, low risk, if

NOTE Confidence: 0.9747958

00:05:31.435 --> 00:05:33.595
they're average risk, discuss as

NOTE Confidence: 0.9747958

00:05:33.595 --> 00:05:34.654
far as they know,

NOTE Confidence: 0.9965267

00:05:35.755 --> 00:05:37.435
discuss that with their primary

NOTE Confidence: 0.9965267

00:05:37.435 --> 00:05:39.294
care or, their gynecologist

NOTE Confidence: 0.9956719

00:05:39.755 --> 00:05:40.895
so that they can

NOTE Confidence: 0.9987469

00:05:41.354 --> 00:05:41.854
appropriately

NOTE Confidence: 0.9985872

00:05:42.154 --> 00:05:43.914
be screened starting at that

NOTE Confidence: 0.9985872

00:05:43.914 --> 00:05:44.414
age.

NOTE Confidence: 0.9995734

00:05:45.750 --> 00:05:46.250
So

NOTE Confidence: 0.972624

00:05:46.710 --> 00:05:48.490
high risk women, as determined

NOTE Confidence: 0.9984135

00:05:48.870 --> 00:05:49.850
by the risk

NOTE Confidence: 0.8868446

00:05:50.550 --> 00:05:53.190
assessment models, are deemed high

NOTE Confidence: 0.8868446

00:05:53.190 --> 00:05:53.690
risk.

NOTE Confidence: 0.99599457

00:05:54.550 --> 00:05:56.390
If they desire anything more

NOTE Confidence: 0.99599457

00:05:56.390 --> 00:05:57.290
than a mammogram,

NOTE Confidence: 0.9989006

00:05:58.205 --> 00:05:59.964
because they're high risk, they

NOTE Confidence: 0.9989006

00:05:59.964 --> 00:06:01.664
should get some other supplemental

NOTE Confidence: 0.9989006

00:06:01.884 --> 00:06:02.384
screening.

NOTE Confidence: 0.96956426

00:06:02.925 --> 00:06:04.764
So MRI has been our

NOTE Confidence: 0.96956426

00:06:04.764 --> 00:06:06.764
traditional screening tool for those

NOTE Confidence: 0.96956426

00:06:06.764 --> 00:06:08.284
women. If for some reason

NOTE Confidence: 0.96956426

00:06:08.284 --> 00:06:10.705
they can't undergo MRI screening,

NOTE Confidence: 0.9854987

00:06:11.460 --> 00:06:12.500
and there could be the

NOTE Confidence: 0.9854987

00:06:12.500 --> 00:06:14.120
different reasons for that,

NOTE Confidence: 0.9143202

00:06:14.660 --> 00:06:16.260
definitely ultrasound and,

NOTE Confidence: 0.9947929

00:06:16.820 --> 00:06:18.820
institutions that have contrast enhanced

NOTE Confidence: 0.9947929

00:06:18.820 --> 00:06:19.320
mammography,

NOTE Confidence: 0.9889368

00:06:20.500 --> 00:06:22.440
they should undergo that,

NOTE Confidence: 0.99989104

00:06:22.900 --> 00:06:23.400
procedure.

NOTE Confidence: 0.9987492

00:06:24.275 --> 00:06:25.235
I will talk a little

NOTE Confidence: 0.9987492

00:06:25.235 --> 00:06:26.835
bit more about that, in

NOTE Confidence: 0.9987492

00:06:26.835 --> 00:06:27.415
a bit.

NOTE Confidence: 0.9779237

00:06:28.035 --> 00:06:29.815
Women who have dense breasts

NOTE Confidence: 0.9979947

00:06:30.275 --> 00:06:31.975
and are not necessarily

NOTE Confidence: 0.9616906

00:06:32.355 --> 00:06:34.295
high risk, but they want

NOTE Confidence: 0.9616906

00:06:34.435 --> 00:06:34.935
supplemental

NOTE Confidence: 0.9953747

00:06:35.235 --> 00:06:35.735
screening,

NOTE Confidence: 0.95197695

00:06:36.490 --> 00:06:37.529
they can get a breast

NOTE Confidence: 0.95197695

00:06:37.529 --> 00:06:40.490
MRI. However, sometimes insurances don't

NOTE Confidence: 0.95197695

00:06:40.490 --> 00:06:42.750
cover that. Most insurances don't

NOTE Confidence: 0.95197695

00:06:42.889 --> 00:06:44.750
or the they're cost prohibitive

NOTE Confidence: 0.8485385

00:06:45.370 --> 00:06:46.509
or there's a contraindication

NOTE Confidence: 0.9941139

00:06:46.889 --> 00:06:48.029
for getting an MRI.

NOTE Confidence: 0.98125225

00:06:48.544 --> 00:06:50.305
It's important that these women

NOTE Confidence: 0.98125225

00:06:50.305 --> 00:06:52.165
know they have options. Ultrasound

NOTE Confidence: 0.98125225

00:06:52.385 --> 00:06:54.005
or contrast enhanced mammography

NOTE Confidence: 0.9993016

00:06:54.385 --> 00:06:55.205
should be considered.

NOTE Confidence: 0.9831684

00:06:55.985 --> 00:06:58.245
If someone is intermediate risk,

NOTE Confidence: 0.9831684

00:06:58.464 --> 00:06:59.925
and, again, these are calculated

NOTE Confidence: 0.9831684

00:07:00.145 --> 00:07:02.009
lifetime risks with which my

NOTE Confidence: 0.9831684

00:07:02.009 --> 00:07:03.289
colleagues will talk about,

NOTE Confidence: 0.9942854

00:07:03.690 --> 00:07:04.430
in a minute.

NOTE Confidence: 0.8181908

00:07:06.569 --> 00:07:08.569
The and and have dense

NOTE Confidence: 0.8181908

00:07:08.569 --> 00:07:09.069
breasts.

NOTE Confidence: 0.9507058

00:07:09.449 --> 00:07:10.889
Of course, they should continue

NOTE Confidence: 0.9507058

00:07:10.889 --> 00:07:12.889
with mammography but also get

NOTE Confidence: 0.9507058

00:07:12.889 --> 00:07:14.830
MRI or, ultrasound.

NOTE Confidence: 0.9938572

00:07:17.075 --> 00:07:18.115
So just to talk about

NOTE Confidence: 0.9938572

00:07:18.115 --> 00:07:19.335
mammographic density,

NOTE Confidence: 0.9708342

00:07:20.275 --> 00:07:22.055
mammograms are black and white

NOTE Confidence: 0.9708342

00:07:22.275 --> 00:07:23.895
and gray. And, basically,

NOTE Confidence: 0.9978099

00:07:24.355 --> 00:07:26.035
anything that's gray or black

NOTE Confidence: 0.9978099

00:07:26.035 --> 00:07:26.775
is good.

NOTE Confidence: 0.97010773

00:07:27.635 --> 00:07:28.675
This is the opposite of

NOTE Confidence: 0.97010773

00:07:28.675 --> 00:07:29.475
real life,

NOTE Confidence: 0.9817528

00:07:29.875 --> 00:07:31.980
and white is glandular breast

NOTE Confidence: 0.9817528

00:07:31.980 --> 00:07:32.960
tissue. However,

NOTE Confidence: 0.9814979

00:07:33.340 --> 00:07:33.840
cancer,

NOTE Confidence: 0.91881543

00:07:34.700 --> 00:07:35.200
cysts,

NOTE Confidence: 0.9826143

00:07:35.580 --> 00:07:37.820
benign masses, anything else that

NOTE Confidence: 0.9826143

00:07:37.820 --> 00:07:39.260
is not tracked will also

NOTE Confidence: 0.9826143

00:07:39.260 --> 00:07:40.080
be white.

NOTE Confidence: 0.9886548

00:07:40.540 --> 00:07:42.080
So when we are going

NOTE Confidence: 0.9886548

00:07:42.220 --> 00:07:43.900
from left to right, we

NOTE Confidence: 0.9886548

00:07:43.900 --> 00:07:45.180
are seeing an increase in

NOTE Confidence: 0.9886548

00:07:45.180 --> 00:07:46.560
the breast tissue density.

NOTE Confidence: 0.9620168

00:07:47.365 --> 00:07:49.044
This, the right side is

NOTE Confidence: 0.9620168

00:07:49.044 --> 00:07:51.625
considered an extremely dense mammogram,

NOTE Confidence: 0.9620168

00:07:51.925 --> 00:07:53.125
and you can see that

NOTE Confidence: 0.9620168

00:07:53.125 --> 00:07:55.125
the majority of this breast

NOTE Confidence: 0.9620168

00:07:55.125 --> 00:07:56.824
is white. And if

NOTE Confidence: 0.98474133

00:07:57.365 --> 00:07:58.805
this breast had a small

NOTE Confidence: 0.98474133

00:07:58.805 --> 00:08:00.324
cancer in it, it would

NOTE Confidence: 0.98474133

00:08:00.324 --> 00:08:01.979
be very difficult to see

NOTE Confidence: 0.98474133

00:08:01.979 --> 00:08:03.419
it because it's gonna blend

NOTE Confidence: 0.98474133

00:08:03.419 --> 00:08:04.780
in with the adjacent breast

NOTE Confidence: 0.98474133

00:08:04.780 --> 00:08:06.800
tissue. And this is why

NOTE Confidence: 0.98474133

00:08:06.860 --> 00:08:08.620
it's important that women who

NOTE Confidence: 0.98474133

00:08:08.620 --> 00:08:10.479
have extremely dense breasts

NOTE Confidence: 0.9986797

00:08:11.020 --> 00:08:13.360
should consider additional supplemental

NOTE Confidence: 0.97728413

00:08:13.660 --> 00:08:15.500
screening. This is a fatty

NOTE Confidence: 0.97728413

00:08:15.500 --> 00:08:16.000
breast,

NOTE Confidence: 0.95980585

00:08:16.895 --> 00:08:17.395
and,

NOTE Confidence: 0.97933936

00:08:18.495 --> 00:08:19.455
you can see that if

NOTE Confidence: 0.97933936

00:08:19.455 --> 00:08:20.735
there was a mass this

NOTE Confidence: 0.97933936

00:08:20.735 --> 00:08:22.255
is a normal structure here.

NOTE Confidence: 0.97933936

00:08:22.255 --> 00:08:23.215
But let's say there was

NOTE Confidence: 0.97933936

00:08:23.215 --> 00:08:24.335
a mass, it would be

NOTE Confidence: 0.97933936

00:08:24.335 --> 00:08:25.375
white, and it would be

NOTE Confidence: 0.97933936

00:08:25.375 --> 00:08:25.875
extremely

NOTE Confidence: 0.9991967

00:08:26.575 --> 00:08:28.115
easy to appreciate it.

NOTE Confidence: 0.9544583

00:08:29.615 --> 00:08:30.095
About

NOTE Confidence: 0.97915524

00:08:31.259 --> 00:08:33.100
of the four categories, half

NOTE Confidence: 0.97915524

00:08:33.100 --> 00:08:34.620
are dense and half are

NOTE Confidence: 0.97915524

00:08:34.620 --> 00:08:36.540
not dense. And about half

NOTE Confidence: 0.97915524

00:08:36.540 --> 00:08:37.279
the population

NOTE Confidence: 0.942545

00:08:37.660 --> 00:08:39.100
has dense breasts and half

NOTE Confidence: 0.942545

00:08:39.100 --> 00:08:40.480
the population doesn't.

NOTE Confidence: 0.9601466

00:08:41.500 --> 00:08:43.200
The last one, the extremely

NOTE Confidence: 0.9601466

00:08:43.260 --> 00:08:43.760
dense,

NOTE Confidence: 0.95274353

00:08:44.675 --> 00:08:46.515
category is about ten percent

NOTE Confidence: 0.95274353

00:08:46.515 --> 00:08:48.274
of women. So not very

NOTE Confidence: 0.95274353

00:08:48.274 --> 00:08:50.054
common, but extremely important.

NOTE Confidence: 0.98887014

00:08:51.475 --> 00:08:53.235
Density by itself is also

NOTE Confidence: 0.98887014

00:08:53.235 --> 00:08:54.295
a risk factor.

NOTE Confidence: 0.97639054

00:08:54.675 --> 00:08:56.295
So women who have denser

NOTE Confidence: 0.97639054

00:08:56.434 --> 00:08:58.610
breasts have a higher risk

NOTE Confidence: 0.97639054

00:08:58.610 --> 00:09:00.690
for developing breast cancer compared

NOTE Confidence: 0.97639054

00:09:00.690 --> 00:09:01.809
to women who have a

NOTE Confidence: 0.97639054

00:09:01.809 --> 00:09:04.370
fatty breast. For example, one

NOTE Confidence: 0.97639054

00:09:04.370 --> 00:09:05.190
and four,

NOTE Confidence: 0.957653

00:09:05.570 --> 00:09:07.330
the four, which is extremely

NOTE Confidence: 0.957653

00:09:07.330 --> 00:09:08.690
dense breast, has a four

NOTE Confidence: 0.957653

00:09:08.690 --> 00:09:09.190
times

NOTE Confidence: 0.99124944

00:09:09.730 --> 00:09:11.835
more risk of developing breast

NOTE Confidence: 0.99124944

00:09:11.835 --> 00:09:13.355
cancer compared to a fatty

NOTE Confidence: 0.99124944

00:09:13.355 --> 00:09:15.275
breast and about two times

NOTE Confidence: 0.99124944

00:09:15.275 --> 00:09:16.895
higher than an average breast.

NOTE Confidence: 0.99680406

00:09:18.475 --> 00:09:20.715
So when we have, increased

NOTE Confidence: 0.99680406

00:09:20.715 --> 00:09:21.215
density

NOTE Confidence: 0.9807355

00:09:21.995 --> 00:09:23.835
from, again, left to right,

NOTE Confidence: 0.9807355

00:09:23.835 --> 00:09:25.054
we can see the density

NOTE Confidence: 0.9807355

00:09:25.115 --> 00:09:26.120
of the breast or the

NOTE Confidence: 0.9807355

00:09:26.120 --> 00:09:27.740
whiteness is increasing.

NOTE Confidence: 0.99788547

00:09:28.679 --> 00:09:30.700
That lowers our sensitivity

NOTE Confidence: 0.99776936

00:09:31.080 --> 00:09:33.160
of mammography and increases the

NOTE Confidence: 0.99776936

00:09:33.160 --> 00:09:35.320
risk of cancer not being

NOTE Confidence: 0.99776936

00:09:35.320 --> 00:09:35.820
detected.

NOTE Confidence: 0.99594253

00:09:36.440 --> 00:09:37.800
I don't like using the

NOTE Confidence: 0.99594253

00:09:37.800 --> 00:09:39.960
word missing cancer. We're not

NOTE Confidence: 0.99594253

00:09:39.960 --> 00:09:41.295
missing it. We're just not

NOTE Confidence: 0.99594253

00:09:41.454 --> 00:09:42.894
seeing it. We're not detecting

NOTE Confidence: 0.99594253

00:09:42.894 --> 00:09:44.495
it. So as we go

NOTE Confidence: 0.99594253

00:09:44.495 --> 00:09:46.415
from left to right, you

NOTE Confidence: 0.99594253

00:09:46.415 --> 00:09:47.554
can see that,

NOTE Confidence: 0.9897106

00:09:48.095 --> 00:09:50.434
the risk increases for nondetection

NOTE Confidence: 0.9811959

00:09:50.815 --> 00:09:52.654
of breast cancer, and the

NOTE Confidence: 0.9811959

00:09:52.654 --> 00:09:54.095
extremely dense breast has a

NOTE Confidence: 0.9811959

00:09:54.095 --> 00:09:55.800
more than sixty percent risk

NOTE Confidence: 0.9811959

00:09:56.040 --> 00:09:57.260
of, nondetection.

NOTE Confidence: 0.9935711

00:09:59.800 --> 00:10:01.320
So in order to look

NOTE Confidence: 0.9935711

00:10:01.320 --> 00:10:01.820
at,

NOTE Confidence: 0.991106

00:10:03.160 --> 00:10:04.940
dense breast and utility

NOTE Confidence: 0.9553883

00:10:05.399 --> 00:10:07.339
of, additional supplemental

NOTE Confidence: 0.9994323

00:10:07.640 --> 00:10:08.140
screening,

NOTE Confidence: 0.9659328

00:10:08.525 --> 00:10:10.285
there were several trials that

NOTE Confidence: 0.9659328

00:10:10.285 --> 00:10:11.665
were recently published.

NOTE Confidence: 0.91787183

00:10:12.285 --> 00:10:13.885
One was the DENSE trial,

NOTE Confidence: 0.91787183

00:10:13.885 --> 00:10:14.945
which is the

NOTE Confidence: 0.93854594

00:10:15.804 --> 00:10:17.165
the dense tissue and early

NOTE Confidence: 0.93854594

00:10:17.165 --> 00:10:19.325
breast neoplasm screening. This was

NOTE Confidence: 0.93854594

00:10:19.325 --> 00:10:20.445
a very good trial. It

NOTE Confidence: 0.93854594

00:10:20.445 --> 00:10:22.205
was randomized controlled trial. It

NOTE Confidence: 0.93854594

00:10:22.205 --> 00:10:23.265
was in the Netherlands.

NOTE Confidence: 0.9559296

00:10:24.140 --> 00:10:26.220
And they added MRI in

NOTE Confidence: 0.9559296

00:10:26.220 --> 00:10:27.740
a population of fifty to

NOTE Confidence: 0.9559296

00:10:27.740 --> 00:10:29.120
seventy five year olds,

NOTE Confidence: 0.97278005

00:10:29.500 --> 00:10:31.420
women, who had extremely dense

NOTE Confidence: 0.97278005

00:10:31.420 --> 00:10:33.100
breast tissue and had a

NOTE Confidence: 0.97278005

00:10:33.100 --> 00:10:34.080
normal mammogram.

NOTE Confidence: 0.9906828

00:10:34.780 --> 00:10:36.400
And they wanted to see,

NOTE Confidence: 0.9678935

00:10:37.145 --> 00:10:39.304
different things, but one was

NOTE Confidence: 0.9678935

00:10:39.304 --> 00:10:40.665
they wanted to see patients

NOTE Confidence: 0.9678935

00:10:40.665 --> 00:10:42.445
who had that added MRI.

NOTE Confidence: 0.9678935

00:10:42.665 --> 00:10:43.645
Do they have

NOTE Confidence: 0.9655552

00:10:44.184 --> 00:10:45.945
a lower rate of interval

NOTE Confidence: 0.9655552

00:10:45.945 --> 00:10:46.445
cancer?

NOTE Confidence: 0.9724742

00:10:46.825 --> 00:10:48.905
Interval cancers are cancers that

NOTE Confidence: 0.9724742

00:10:48.905 --> 00:10:50.605
develop in between screening,

NOTE Confidence: 0.84577155

00:10:52.940 --> 00:10:53.440
timelines.

NOTE Confidence: 0.9775748

00:10:54.059 --> 00:10:55.420
And for them, it was

NOTE Confidence: 0.9775748

00:10:55.420 --> 00:10:57.260
every two years. They also

NOTE Confidence: 0.9775748

00:10:57.260 --> 00:10:58.620
looked at other things. For

NOTE Confidence: 0.9775748

00:10:58.620 --> 00:10:59.980
example, they wanted to see

NOTE Confidence: 0.9775748

00:10:59.980 --> 00:11:01.420
what is the detection rate

NOTE Confidence: 0.9775748

00:11:01.420 --> 00:11:02.160
of MRI.

NOTE Confidence: 0.97795343

00:11:03.020 --> 00:11:04.320
Are there false positives?

NOTE Confidence: 0.93782026

00:11:04.715 --> 00:11:05.835
What kind of tumors are

NOTE Confidence: 0.93782026

00:11:05.835 --> 00:11:08.075
detected by MR and some

NOTE Confidence: 0.93782026

00:11:08.075 --> 00:11:08.895
other characteristics?

NOTE Confidence: 0.99520665

00:11:10.155 --> 00:11:11.515
They were lucky. They looked

NOTE Confidence: 0.99520665

00:11:11.515 --> 00:11:13.115
at forty thousand women, and

NOTE Confidence: 0.99520665

00:11:13.115 --> 00:11:14.655
about eight thousand of them

NOTE Confidence: 0.99520665

00:11:14.875 --> 00:11:16.495
had the supplemental MRI.

NOTE Confidence: 0.9721481

00:11:17.059 --> 00:11:18.420
And what they saw that

NOTE Confidence: 0.9721481

00:11:18.420 --> 00:11:20.600
the rates of interval cancer

NOTE Confidence: 0.9721481

00:11:20.820 --> 00:11:22.679
was about half in women

NOTE Confidence: 0.9721481

00:11:22.740 --> 00:11:24.500
who had MRI compared to

NOTE Confidence: 0.9721481

00:11:24.500 --> 00:11:25.720
mammogram only.

NOTE Confidence: 0.99275297

00:11:26.020 --> 00:11:27.059
So it was two point

NOTE Confidence: 0.99275297

00:11:27.059 --> 00:11:28.820
five per thousand compared to

NOTE Confidence: 0.99275297

00:11:28.820 --> 00:11:29.320
five.

NOTE Confidence: 0.9974493

00:11:29.925 --> 00:11:30.425
And,

NOTE Confidence: 0.99597424

00:11:30.885 --> 00:11:32.885
basically, this was great news.

NOTE Confidence: 0.99597424

00:11:32.885 --> 00:11:34.885
I should also make a

NOTE Confidence: 0.99597424

00:11:34.885 --> 00:11:36.404
note that these are average

NOTE Confidence: 0.99597424

00:11:36.404 --> 00:11:38.165
risk patients, not high risk

NOTE Confidence: 0.99597424

00:11:38.165 --> 00:11:38.665
patients.

NOTE Confidence: 0.9899289

00:11:39.205 --> 00:11:40.404
And the women who had

NOTE Confidence: 0.9899289

00:11:40.404 --> 00:11:42.184
the MRI, they had about

NOTE Confidence: 0.9899289

00:11:42.404 --> 00:11:43.304
over sixteen

NOTE Confidence: 0.99657947

00:11:43.845 --> 00:11:44.505
per thousand

NOTE Confidence: 0.9474767

00:11:45.670 --> 00:11:47.590
rate of cancer detection, which

NOTE Confidence: 0.9474767

00:11:47.590 --> 00:11:49.290
is great. Again, mammography

NOTE Confidence: 0.88283443

00:11:49.670 --> 00:11:51.429
alone finds if you have

NOTE Confidence: 0.88283443

00:11:51.429 --> 00:11:51.929
tomosynthesis,

NOTE Confidence: 0.9809192

00:11:52.710 --> 00:11:54.150
on average, four or five

NOTE Confidence: 0.9809192

00:11:54.150 --> 00:11:55.450
cancers per thousand.

NOTE Confidence: 0.9281742

00:11:56.950 --> 00:11:59.385
Another trial called BRAID breast

NOTE Confidence: 0.9281742

00:11:59.545 --> 00:12:01.705
Screening Risk Adaptive Imaging for

NOTE Confidence: 0.9281742

00:12:01.705 --> 00:12:02.205
Density

NOTE Confidence: 0.97241646

00:12:02.745 --> 00:12:04.585
wanted to see, in addition

NOTE Confidence: 0.97241646

00:12:04.585 --> 00:12:05.325
to mammography,

NOTE Confidence: 0.99415135

00:12:06.105 --> 00:12:07.005
other supplemental

NOTE Confidence: 0.87995005

00:12:07.385 --> 00:12:08.525
screening imaging,

NOTE Confidence: 0.99228585

00:12:10.025 --> 00:12:10.525
tools

NOTE Confidence: 0.5685766

00:12:10.905 --> 00:12:11.405
effect.

NOTE Confidence: 0.9996073

00:12:11.940 --> 00:12:12.600
For example,

NOTE Confidence: 0.98144954

00:12:13.300 --> 00:12:15.480
ultrasound, contrast enhanced mammography,

NOTE Confidence: 0.99972177

00:12:15.860 --> 00:12:16.760
and MRI

NOTE Confidence: 0.9695965

00:12:17.380 --> 00:12:19.000
in detection of breast cancer.

NOTE Confidence: 0.9409447

00:12:19.380 --> 00:12:21.160
They had about nine thousand

NOTE Confidence: 0.9409447

00:12:21.220 --> 00:12:23.940
patients. Six thousand completed those

NOTE Confidence: 0.9409447

00:12:23.940 --> 00:12:24.440
extra

NOTE Confidence: 0.9416477

00:12:24.980 --> 00:12:25.480
modalities.

NOTE Confidence: 0.99828935

00:12:26.535 --> 00:12:27.015
And,

NOTE Confidence: 0.9973027

00:12:27.335 --> 00:12:29.255
the cancer detection rates were

NOTE Confidence: 0.9973027

00:12:29.255 --> 00:12:30.475
really great,

NOTE Confidence: 0.9994822

00:12:30.855 --> 00:12:31.255
for

NOTE Confidence: 0.9025464

00:12:32.135 --> 00:12:34.295
and more abbreviated MRI is

NOTE Confidence: 0.9025464

00:12:34.295 --> 00:12:36.375
just the shorter version shorter

NOTE Confidence: 0.9025464

00:12:36.375 --> 00:12:38.315
time version of contrast enhanced

NOTE Confidence: 0.9025464

00:12:38.375 --> 00:12:38.875
MRI.

NOTE Confidence: 0.9970659

00:12:39.380 --> 00:12:40.899
And in that population, they

NOTE Confidence: 0.9970659

00:12:40.899 --> 00:12:42.760
had about seventeen per thousand,

NOTE Confidence: 0.97541547

00:12:43.300 --> 00:12:44.279
detected cancers.

NOTE Confidence: 0.99200803

00:12:44.980 --> 00:12:46.279
Contrast enhanced mammography

NOTE Confidence: 0.9689756

00:12:46.580 --> 00:12:48.679
was even higher, nineteen ish,

NOTE Confidence: 0.9689756

00:12:48.820 --> 00:12:49.140
and,

NOTE Confidence: 0.9960326

00:12:49.779 --> 00:12:51.779
ultrasound was only about four

NOTE Confidence: 0.9960326

00:12:51.779 --> 00:12:53.000
point two per thousand.

NOTE Confidence: 0.9999077

00:12:53.754 --> 00:12:54.574
You can see

NOTE Confidence: 0.97622633

00:12:55.194 --> 00:12:56.495
that. And in that population,

NOTE Confidence: 0.98670346

00:12:57.274 --> 00:12:59.754
the, cancer detection rate was

NOTE Confidence: 0.98670346

00:12:59.754 --> 00:13:01.115
eight point four per thousand.

NOTE Confidence: 0.98670346

00:13:01.115 --> 00:13:02.154
So you can actually look

NOTE Confidence: 0.98670346

00:13:02.154 --> 00:13:03.535
at the numbers and appreciate

NOTE Confidence: 0.98670346

00:13:03.675 --> 00:13:05.514
that ultrasound was just slightly

NOTE Confidence: 0.98670346

00:13:05.514 --> 00:13:07.890
better, but MRI and contrast

NOTE Confidence: 0.98670346

00:13:07.890 --> 00:13:09.650
enhanced mammogram more than doubled

NOTE Confidence: 0.98670346

00:13:09.650 --> 00:13:10.150
it.

NOTE Confidence: 0.9814122

00:13:12.290 --> 00:13:13.970
Tumor size was also much

NOTE Confidence: 0.9814122

00:13:13.970 --> 00:13:15.490
smaller. On the average, it

NOTE Confidence: 0.9814122

00:13:15.490 --> 00:13:17.170
was about a centimeter in

NOTE Confidence: 0.9814122

00:13:17.170 --> 00:13:19.010
women who had the MRI

NOTE Confidence: 0.9814122

00:13:19.010 --> 00:13:20.630
and contrast enhanced mammogram.

NOTE Confidence: 0.856616

00:13:21.250 --> 00:13:21.410
And,

NOTE Confidence: 0.9652307

00:13:22.315 --> 00:13:24.315
ultrasound detected tumors were slightly

NOTE Confidence: 0.9652307

00:13:24.315 --> 00:13:25.675
larger, about double the size,

NOTE Confidence: 0.9652307

00:13:25.675 --> 00:13:26.655
twenty two millimeters.

NOTE Confidence: 0.99903053

00:13:27.355 --> 00:13:28.335
These are averages.

NOTE Confidence: 0.99968433

00:13:29.035 --> 00:13:30.235
So you can see that

NOTE Confidence: 0.99968433

00:13:30.235 --> 00:13:31.295
earlier detection

NOTE Confidence: 0.8161725

00:13:31.675 --> 00:13:32.175
is,

NOTE Confidence: 0.99948955

00:13:33.115 --> 00:13:33.615
key

NOTE Confidence: 0.98118055

00:13:34.075 --> 00:13:34.575
with

NOTE Confidence: 0.99976987

00:13:35.440 --> 00:13:36.899
contrast enhanced modalities.

NOTE Confidence: 0.99304104

00:13:37.679 --> 00:13:38.559
Now just to say a

NOTE Confidence: 0.99304104

00:13:38.559 --> 00:13:40.399
little bit about contrast enhanced

NOTE Confidence: 0.99304104

00:13:40.399 --> 00:13:40.899
mammography,

NOTE Confidence: 0.9749879

00:13:42.079 --> 00:13:44.240
the premise is that tiny

NOTE Confidence: 0.9749879

00:13:44.240 --> 00:13:46.000
little tumors, anything more than

NOTE Confidence: 0.9749879

00:13:46.000 --> 00:13:47.620
two millimeter, will demonstrate

NOTE Confidence: 0.92413706

00:13:48.160 --> 00:13:48.660
angiogenesis,

NOTE Confidence: 0.9751584

00:13:49.184 --> 00:13:50.545
and that means that they're

NOTE Confidence: 0.9751584

00:13:50.545 --> 00:13:52.405
gonna grow new blood vessels.

NOTE Confidence: 0.96308404

00:13:52.945 --> 00:13:54.725
These blood vessels are leaky.

NOTE Confidence: 0.96308404

00:13:54.945 --> 00:13:56.225
And when we inject a

NOTE Confidence: 0.96308404

00:13:56.225 --> 00:13:58.565
contrast material through an intravenous,

NOTE Confidence: 0.8510862

00:13:59.745 --> 00:14:00.245
access,

NOTE Confidence: 0.9638945

00:14:01.184 --> 00:14:02.225
they go to the breast,

NOTE Confidence: 0.9638945

00:14:02.225 --> 00:14:03.420
and they accumulate

NOTE Confidence: 0.9978614

00:14:03.720 --> 00:14:05.100
in these tumors.

NOTE Confidence: 0.98637736

00:14:05.880 --> 00:14:07.160
We can detect them with

NOTE Confidence: 0.98637736

00:14:07.160 --> 00:14:08.679
two two ways. One is

NOTE Confidence: 0.98637736

00:14:08.679 --> 00:14:10.679
contrast enhanced mammography, and one

NOTE Confidence: 0.98637736

00:14:10.679 --> 00:14:11.340
is MR.

NOTE Confidence: 0.96526605

00:14:12.520 --> 00:14:14.540
A lot of people, patients,

NOTE Confidence: 0.96526605

00:14:14.760 --> 00:14:17.240
physicians know about, MRI. I

NOTE Confidence: 0.96526605

00:14:17.240 --> 00:14:18.285
won't go into into detail

NOTE Confidence: 0.96526605

00:14:18.285 --> 00:14:20.045
about that. But contrast enhanced

NOTE Confidence: 0.96526605

00:14:20.045 --> 00:14:22.065
mammogram is essentially a mammogram

NOTE Confidence: 0.980617

00:14:22.845 --> 00:14:24.205
that is obtained before and

NOTE Confidence: 0.980617

00:14:24.205 --> 00:14:26.445
after administration of contrast, and

NOTE Confidence: 0.980617

00:14:26.445 --> 00:14:27.505
this is an example

NOTE Confidence: 0.983882

00:14:27.964 --> 00:14:28.545
of that.

NOTE Confidence: 0.94601923

00:14:29.725 --> 00:14:31.170
When patients undergo contrast

NOTE Confidence: 0.80780697

00:14:32.290 --> 00:14:33.410
enhanced mammography, they get a

NOTE Confidence: 0.80780697

00:14:33.410 --> 00:14:35.329
normal mammogram, which is,

NOTE Confidence: 0.8888343

00:14:36.050 --> 00:14:37.730
this image here, and this

NOTE Confidence: 0.8888343

00:14:37.730 --> 00:14:38.930
is another view of the

NOTE Confidence: 0.8888343

00:14:38.930 --> 00:14:40.450
same. It's labeled left CC

NOTE Confidence: 0.8888343

00:14:40.450 --> 00:14:41.510
and left MLL.

NOTE Confidence: 0.9786378

00:14:42.209 --> 00:14:42.950
And then

NOTE Confidence: 0.8696323

00:14:43.490 --> 00:14:44.470
another image,

NOTE Confidence: 0.87231374

00:14:45.175 --> 00:14:47.015
mammogram image is obtained. Those

NOTE Confidence: 0.87231374

00:14:47.015 --> 00:14:48.315
images are subtracted,

NOTE Confidence: 0.99976873

00:14:48.695 --> 00:14:49.755
and what remains

NOTE Confidence: 0.98218143

00:14:50.135 --> 00:14:52.215
is anything that picks up

NOTE Confidence: 0.98218143

00:14:52.215 --> 00:14:53.895
the dye. So in these

NOTE Confidence: 0.98218143

00:14:53.895 --> 00:14:55.255
two images, you can see

NOTE Confidence: 0.98218143

00:14:55.255 --> 00:14:56.695
that there's a tiny little

NOTE Confidence: 0.98218143

00:14:56.695 --> 00:14:58.455
mass that shows up in

NOTE Confidence: 0.98218143

00:14:58.455 --> 00:14:59.515
the left breast,

NOTE Confidence: 0.99366236

00:14:59.980 --> 00:15:02.060
and it's completely obscured. You

NOTE Confidence: 0.99366236

00:15:02.060 --> 00:15:03.500
don't see anything like that

NOTE Confidence: 0.99366236

00:15:03.500 --> 00:15:04.880
because this is an extremely

NOTE Confidence: 0.99366236

00:15:04.940 --> 00:15:05.840
dense mammogram.

NOTE Confidence: 0.9724141

00:15:06.940 --> 00:15:07.440
And,

NOTE Confidence: 0.9964162

00:15:08.940 --> 00:15:10.640
so contrast enhanced mammography

NOTE Confidence: 0.99967664

00:15:11.100 --> 00:15:12.540
is a mammogram that is

NOTE Confidence: 0.99967664

00:15:12.540 --> 00:15:14.300
really not affected by breast

NOTE Confidence: 0.99967664

00:15:14.300 --> 00:15:14.800
density.

NOTE Confidence: 0.99902165

00:15:17.885 --> 00:15:18.385
So

NOTE Confidence: 0.98268396

00:15:18.765 --> 00:15:19.985
let me just oops.

NOTE Confidence: 0.99016714

00:15:21.165 --> 00:15:22.385
I lost my

NOTE Confidence: 0.7181283

00:15:24.045 --> 00:15:24.545
chair.

NOTE Confidence: 0.8318082

00:15:32.680 --> 00:15:33.180
Alright.

NOTE Confidence: 0.9125697

00:15:33.640 --> 00:15:35.240
What we don't have answer,

NOTE Confidence: 0.9125697

00:15:35.240 --> 00:15:37.080
there are several questions with,

NOTE Confidence: 0.9806693

00:15:38.040 --> 00:15:39.720
in general and what these

NOTE Confidence: 0.9806693

00:15:39.720 --> 00:15:41.080
trials that I mentioned have

NOTE Confidence: 0.9806693

00:15:41.080 --> 00:15:41.900
not answered.

NOTE Confidence: 0.99869335

00:15:42.840 --> 00:15:43.980
We know that mammography

NOTE Confidence: 0.99949074

00:15:44.280 --> 00:15:46.460
saves lives by lowering by

NOTE Confidence: 0.99949074

00:15:46.755 --> 00:15:49.095
decreasing mortality from breast cancer.

NOTE Confidence: 0.98713434

00:15:49.715 --> 00:15:51.155
We don't know that about

NOTE Confidence: 0.98713434

00:15:51.155 --> 00:15:53.415
MRI or contrast enhanced mammography.

NOTE Confidence: 0.99700963

00:15:54.435 --> 00:15:54.935
So,

NOTE Confidence: 0.99320686

00:15:55.795 --> 00:15:56.915
there's a lot of research

NOTE Confidence: 0.99320686

00:15:56.915 --> 00:15:58.675
being done about that. Hopefully,

NOTE Confidence: 0.99320686

00:15:58.675 --> 00:16:00.089
we'll have that answer at

NOTE Confidence: 0.99320686

00:16:00.089 --> 00:16:01.449
some point. We also don't

NOTE Confidence: 0.99320686

00:16:01.449 --> 00:16:02.810
know how feasible it is

NOTE Confidence: 0.99320686

00:16:02.810 --> 00:16:03.790
to have these,

NOTE Confidence: 0.99984396

00:16:04.649 --> 00:16:05.470
other supplemental

NOTE Confidence: 0.8855322

00:16:05.930 --> 00:16:06.430
tests,

NOTE Confidence: 0.999207

00:16:08.009 --> 00:16:09.389
in terms of logistics,

NOTE Confidence: 0.96308506

00:16:09.769 --> 00:16:10.750
cost, capacity

NOTE Confidence: 0.9862381

00:16:11.690 --> 00:16:13.470
for women who are not

NOTE Confidence: 0.9862381

00:16:13.769 --> 00:16:14.750
at high risk.

NOTE Confidence: 0.9891214

00:16:15.415 --> 00:16:16.935
As you know, demand for

NOTE Confidence: 0.9891214

00:16:16.935 --> 00:16:18.695
imaging is very high. We

NOTE Confidence: 0.9891214

00:16:18.695 --> 00:16:21.195
have very low, MRI capacities,

NOTE Confidence: 0.9891214

00:16:21.335 --> 00:16:22.795
and contrast enhanced mammography

NOTE Confidence: 0.9996836

00:16:23.415 --> 00:16:25.335
is not available at every

NOTE Confidence: 0.9996836

00:16:25.335 --> 00:16:25.835
institution.

NOTE Confidence: 0.9996926

00:16:26.615 --> 00:16:28.235
At Yale, we are

NOTE Confidence: 0.9928585

00:16:31.009 --> 00:16:33.250
increasing our MRI capacity at

NOTE Confidence: 0.9928585

00:16:33.250 --> 00:16:34.149
different sites.

NOTE Confidence: 0.9789442

00:16:34.610 --> 00:16:36.370
However, we are sharing with

NOTE Confidence: 0.9789442

00:16:36.370 --> 00:16:38.129
other body parts. You know,

NOTE Confidence: 0.9789442

00:16:38.129 --> 00:16:39.329
everybody wants to have an

NOTE Confidence: 0.9789442

00:16:39.329 --> 00:16:41.110
MR. It's a highly utilized,

NOTE Confidence: 0.7509724

00:16:41.889 --> 00:16:42.225
test.

NOTE Confidence: 0.9848963

00:16:42.865 --> 00:16:44.065
And we don't have enough

NOTE Confidence: 0.9848963

00:16:44.065 --> 00:16:46.065
slots to do diagnostic MRs,

NOTE Confidence: 0.9848963

00:16:46.065 --> 00:16:47.425
to do high risk screening,

NOTE Confidence: 0.9848963

00:16:47.425 --> 00:16:49.264
and also average screening of

NOTE Confidence: 0.9848963

00:16:49.264 --> 00:16:50.865
the women who have dense

NOTE Confidence: 0.9848963

00:16:50.865 --> 00:16:51.365
breasts.

NOTE Confidence: 0.97068894

00:16:52.065 --> 00:16:53.345
We will be starting a

NOTE Confidence: 0.97068894

00:16:53.345 --> 00:16:55.584
contrast enhanced mammography program in

NOTE Confidence: 0.97068894

00:16:55.584 --> 00:16:56.625
the next six months or

NOTE Confidence: 0.97068894

00:16:56.625 --> 00:16:58.110
so. We'll be doing it

NOTE Confidence: 0.97068894

00:16:58.110 --> 00:17:00.270
on both, two campuses at,

NOTE Confidence: 0.63882846

00:17:00.670 --> 00:17:01.170
Smilo

NOTE Confidence: 0.93374175

00:17:01.790 --> 00:17:03.810
and at our North Haven

NOTE Confidence: 0.93374175

00:17:03.950 --> 00:17:06.350
campus. And, that'll be great.

NOTE Confidence: 0.93374175

00:17:06.350 --> 00:17:07.170
It'll be,

NOTE Confidence: 0.9980894

00:17:08.350 --> 00:17:10.109
very, very exciting for us

NOTE Confidence: 0.9980894

00:17:10.109 --> 00:17:11.410
to start that program

NOTE Confidence: 0.9919467

00:17:11.815 --> 00:17:12.795
and offer women,

NOTE Confidence: 0.918112

00:17:13.575 --> 00:17:15.355
additional supplemental screening.

NOTE Confidence: 0.99821377

00:17:21.335 --> 00:17:21.835
Alright.

NOTE Confidence: 0.99392176

00:17:25.830 --> 00:17:27.450
Alright. Very nice.

NOTE Confidence: 0.951239

00:17:28.230 --> 00:17:29.050
Doctor Battaglia?

NOTE Confidence: 0.95326364

00:17:30.869 --> 00:17:32.070
I'll pull up my slides.

NOTE Confidence: 0.95326364

00:17:32.070 --> 00:17:33.590
Good evening, everyone. I see

NOTE Confidence: 0.95326364

00:17:33.590 --> 00:17:34.630
there's a couple of questions

NOTE Confidence: 0.95326364

00:17:34.630 --> 00:17:35.350
in the chat, John. I

NOTE Confidence: 0.95326364

00:17:35.350 --> 00:17:36.230
don't know if you wanna

NOTE Confidence: 0.95326364

00:17:36.230 --> 00:17:37.270
take one or two while

NOTE Confidence: 0.95326364

00:17:37.270 --> 00:17:37.520
I'm

NOTE Confidence: 0.9758668

00:17:38.655 --> 00:17:39.775
If you would like, we

NOTE Confidence: 0.9758668

00:17:39.775 --> 00:17:41.055
definitely will have time at

NOTE Confidence: 0.9758668

00:17:41.055 --> 00:17:42.595
the very end for everybody's

NOTE Confidence: 0.9758668

00:17:42.655 --> 00:17:44.735
question. Well, pretty much. So

NOTE Confidence: 0.9758668

00:17:44.735 --> 00:17:45.795
one of our attendees

NOTE Confidence: 0.7907873

00:17:46.494 --> 00:17:47.955
asked, doctor Lottie,

NOTE Confidence: 0.9462609

00:17:48.415 --> 00:17:50.355
about invasive lobular cancer.

NOTE Confidence: 0.9893535

00:17:50.815 --> 00:17:51.855
How would that show up

NOTE Confidence: 0.9893535

00:17:51.855 --> 00:17:53.475
on a contrast enhanced mammogram?

NOTE Confidence: 0.9963155

00:17:54.169 --> 00:17:55.630
So similar to MRI,

NOTE Confidence: 0.9922103

00:17:56.409 --> 00:17:57.710
it will show up,

NOTE Confidence: 0.9968691

00:17:58.330 --> 00:17:59.869
because lobular cancer

NOTE Confidence: 0.89379245

00:18:00.570 --> 00:18:02.270
also has, neovascularity.

NOTE Confidence: 0.9815482

00:18:04.890 --> 00:18:06.650
As you know, lobular cancer

NOTE Confidence: 0.9815482

00:18:06.650 --> 00:18:07.850
is not a very common

NOTE Confidence: 0.9815482

00:18:07.850 --> 00:18:09.289
cancer. It's about ten percent

NOTE Confidence: 0.9815482

00:18:09.289 --> 00:18:11.554
of our cancers. And, occasionally,

NOTE Confidence: 0.9387631

00:18:11.934 --> 00:18:13.695
it may not enhance. It

NOTE Confidence: 0.9387631

00:18:13.695 --> 00:18:14.655
may not take up the

NOTE Confidence: 0.9387631

00:18:14.655 --> 00:18:16.355
dive similar to MRI.

NOTE Confidence: 0.98981017

00:18:16.895 --> 00:18:18.035
And that's why

NOTE Confidence: 0.8058353

00:18:20.575 --> 00:18:22.446
screening mammography, the two the

NOTE Confidence: 0.8058353

00:18:22.446 --> 00:18:22.527
actual mammogram portion of it

NOTE Confidence: 0.8058353

00:18:22.527 --> 00:18:22.962
is super helpful. We read

NOTE Confidence: 0.8058353

00:18:22.962 --> 00:18:23.190
those

NOTE Confidence: 0.8554492

00:18:34.869 --> 00:18:36.250
based on a

NOTE Confidence: 0.99522364

00:18:37.065 --> 00:18:38.924
previous biopsy or diagnosis

NOTE Confidence: 0.9640901

00:18:39.225 --> 00:18:40.125
or whatever,

NOTE Confidence: 0.9972313

00:18:41.144 --> 00:18:42.664
we can either do contrast

NOTE Confidence: 0.9972313

00:18:42.664 --> 00:18:43.565
enhanced mammography

NOTE Confidence: 0.97496665

00:18:43.865 --> 00:18:45.705
or MRI for extent of

NOTE Confidence: 0.97496665

00:18:45.705 --> 00:18:46.664
disease and,

NOTE Confidence: 0.99454355

00:18:47.625 --> 00:18:49.085
other diagnostic workup.

NOTE Confidence: 0.971243

00:18:51.460 --> 00:18:53.059
Alright. Very good. Let's move

NOTE Confidence: 0.971243

00:18:53.059 --> 00:18:53.940
on to the next talk,

NOTE Confidence: 0.971243

00:18:53.940 --> 00:18:55.640
and I will promise we'll

NOTE Confidence: 0.9772467

00:18:56.020 --> 00:18:57.380
get to everybody's questions at

NOTE Confidence: 0.9772467

00:18:57.380 --> 00:18:59.380
the end. Okay. Great. Thank

NOTE Confidence: 0.9772467

00:18:59.380 --> 00:19:00.500
you so much. Good evening,

NOTE Confidence: 0.9772467

00:19:00.500 --> 00:19:01.460
everyone. It's great to be

NOTE Confidence: 0.9772467

00:19:01.460 --> 00:19:02.260
here with you all to

NOTE Confidence: 0.9772467

00:19:02.260 --> 00:19:03.780
kick off breast cancer awareness

NOTE Confidence: 0.9772467

00:19:03.780 --> 00:19:04.695
month. I see,

NOTE Confidence: 0.9997964

00:19:05.095 --> 00:19:06.154
only one of

NOTE Confidence: 0.98375404

00:19:06.455 --> 00:19:07.734
our panelists has pink on

NOTE Confidence: 0.98375404

00:19:07.734 --> 00:19:09.734
today. So, Melinda, you you

NOTE Confidence: 0.98375404

00:19:09.734 --> 00:19:10.855
have it on. You have

NOTE Confidence: 0.98375404

00:19:10.855 --> 00:19:12.294
it on. So I'm here

NOTE Confidence: 0.98375404

00:19:12.294 --> 00:19:14.455
to, take you, through an

NOTE Confidence: 0.98375404

00:19:14.455 --> 00:19:16.375
overview of high risk breast

NOTE Confidence: 0.98375404

00:19:16.375 --> 00:19:18.054
health care. I'm gonna talk

NOTE Confidence: 0.98375404

00:19:18.054 --> 00:19:19.174
a little bit about risk

NOTE Confidence: 0.98375404

00:19:19.174 --> 00:19:19.674
assessments,

NOTE Confidence: 0.99897075

00:19:20.280 --> 00:19:21.880
risk assessment that was alluded

NOTE Confidence: 0.99897075

00:19:21.880 --> 00:19:22.780
to in the

NOTE Confidence: 0.99071044

00:19:23.160 --> 00:19:24.760
the first presentation on breast

NOTE Confidence: 0.99071044

00:19:24.760 --> 00:19:25.260
imaging

NOTE Confidence: 0.9929729

00:19:25.800 --> 00:19:27.560
and, our approach to risk

NOTE Confidence: 0.9929729

00:19:27.560 --> 00:19:29.320
reduction strategies for those who

NOTE Confidence: 0.9929729

00:19:29.320 --> 00:19:30.460
do have high risk.

NOTE Confidence: 0.9638429

00:19:31.160 --> 00:19:32.600
My background is I'm a

NOTE Confidence: 0.9638429

00:19:32.600 --> 00:19:34.680
general internist, women's health provider,

NOTE Confidence: 0.9638429

00:19:34.680 --> 00:19:35.820
and preventive medicine,

NOTE Confidence: 0.9786648

00:19:36.304 --> 00:19:38.005
physician. And so I'm a

NOTE Confidence: 0.9786648

00:19:38.145 --> 00:19:39.585
practicing clinician in our high

NOTE Confidence: 0.9786648

00:19:39.585 --> 00:19:40.725
risk breast practice.

NOTE Confidence: 0.9786867

00:19:45.184 --> 00:19:46.545
So, you know, what we've,

NOTE Confidence: 0.9998653

00:19:47.105 --> 00:19:47.605
historically

NOTE Confidence: 0.9943296

00:19:47.984 --> 00:19:50.225
approached breast cancer screening is

NOTE Confidence: 0.9943296

00:19:50.225 --> 00:19:52.260
using age based screening.

NOTE Confidence: 0.9916825

00:19:54.000 --> 00:19:54.660
And so

NOTE Confidence: 0.98036426

00:19:55.520 --> 00:19:56.720
many of us are familiar

NOTE Confidence: 0.98036426

00:19:56.720 --> 00:19:58.640
with recommendations for screening based

NOTE Confidence: 0.98036426

00:19:58.640 --> 00:19:59.780
on age alone.

NOTE Confidence: 0.9885221

00:20:00.400 --> 00:20:01.679
And we know now that

NOTE Confidence: 0.9885221

00:20:01.679 --> 00:20:03.539
age based screening really ignores

NOTE Confidence: 0.9885221

00:20:03.600 --> 00:20:04.960
the range, the very sort

NOTE Confidence: 0.9885221

00:20:04.960 --> 00:20:06.315
of broad range of risk

NOTE Confidence: 0.9885221

00:20:06.554 --> 00:20:07.355
factors that,

NOTE Confidence: 0.9737399

00:20:08.875 --> 00:20:11.034
influence our individual risks for

NOTE Confidence: 0.9737399

00:20:11.034 --> 00:20:12.014
future cancer.

NOTE Confidence: 0.984548

00:20:12.475 --> 00:20:13.754
And as we sort of

NOTE Confidence: 0.984548

00:20:13.754 --> 00:20:14.494
have advances

NOTE Confidence: 0.9393019

00:20:14.955 --> 00:20:16.095
in cancer diagnosis

NOTE Confidence: 0.9990201

00:20:16.554 --> 00:20:17.294
and treatment,

NOTE Confidence: 0.82723665

00:20:18.154 --> 00:20:18.794
we are,

NOTE Confidence: 0.9989974

00:20:19.789 --> 00:20:22.109
increasingly providing personalized care to

NOTE Confidence: 0.9989974

00:20:22.109 --> 00:20:23.809
patients based on their individual

NOTE Confidence: 0.9782586

00:20:24.109 --> 00:20:26.270
presentation. And so the age

NOTE Confidence: 0.9782586

00:20:26.270 --> 00:20:28.210
based sort of screening ignores

NOTE Confidence: 0.9782586

00:20:28.350 --> 00:20:29.390
sort of where we are

NOTE Confidence: 0.9782586

00:20:29.390 --> 00:20:31.169
in our understanding of cancer.

NOTE Confidence: 0.97554404

00:20:33.095 --> 00:20:34.534
Twenty twenty two was the

NOTE Confidence: 0.97554404

00:20:34.534 --> 00:20:35.815
first year that one of

NOTE Confidence: 0.97554404

00:20:35.815 --> 00:20:36.315
the,

NOTE Confidence: 0.96253854

00:20:37.095 --> 00:20:39.095
professional organizations called the National

NOTE Confidence: 0.96253854

00:20:39.095 --> 00:20:40.234
Comprehensive Cancer,

NOTE Confidence: 0.8296127

00:20:41.654 --> 00:20:43.274
Cancer Center recommendation

NOTE Confidence: 0.9960756

00:20:43.734 --> 00:20:45.095
made the recommendations for the

NOTE Confidence: 0.9960756

00:20:45.095 --> 00:20:45.755
first time

NOTE Confidence: 0.9893132

00:20:46.429 --> 00:20:48.190
for individual risk assessment by

NOTE Confidence: 0.9893132

00:20:48.190 --> 00:20:49.549
age twenty five, and then

NOTE Confidence: 0.9893132

00:20:49.549 --> 00:20:51.169
the American College of Radiology,

NOTE Confidence: 0.9893132

00:20:51.309 --> 00:20:52.750
as we heard, followed suit,

NOTE Confidence: 0.9893132

00:20:52.750 --> 00:20:53.869
I think, the following year

NOTE Confidence: 0.9893132

00:20:53.869 --> 00:20:55.169
in twenty twenty three.

NOTE Confidence: 0.9990996

00:20:56.109 --> 00:20:57.650
So high risk guidelines

NOTE Confidence: 0.9701064

00:20:58.190 --> 00:21:00.475
now exist from several professional

NOTE Confidence: 0.9701064

00:21:00.775 --> 00:21:01.275
organizations,

NOTE Confidence: 0.98871505

00:21:01.575 --> 00:21:02.935
and they promote the use

NOTE Confidence: 0.98871505

00:21:02.935 --> 00:21:04.695
of risk prediction models to

NOTE Confidence: 0.98871505

00:21:04.695 --> 00:21:05.915
estimate an individual's

NOTE Confidence: 0.97418714

00:21:06.295 --> 00:21:07.655
patient's risk. So we're gonna

NOTE Confidence: 0.97418714

00:21:07.655 --> 00:21:08.615
talk a little bit about

NOTE Confidence: 0.97418714

00:21:08.615 --> 00:21:09.115
that.

NOTE Confidence: 0.9997094

00:21:10.295 --> 00:21:11.435
When we think about

NOTE Confidence: 0.99360496

00:21:11.850 --> 00:21:13.530
high risk breast health care

NOTE Confidence: 0.99360496

00:21:13.530 --> 00:21:15.369
in general, I think about

NOTE Confidence: 0.99360496

00:21:15.369 --> 00:21:16.970
sort of four general areas.

NOTE Confidence: 0.99360496

00:21:16.970 --> 00:21:18.030
The first is

NOTE Confidence: 0.99892646

00:21:19.049 --> 00:21:20.730
identifying whether or not a

NOTE Confidence: 0.99892646

00:21:20.730 --> 00:21:22.510
patient is at high risk.

NOTE Confidence: 0.9993403

00:21:25.244 --> 00:21:25.984
High risk

NOTE Confidence: 0.9998746

00:21:26.365 --> 00:21:26.865
assessment

NOTE Confidence: 0.96415687

00:21:27.165 --> 00:21:28.445
can be made through the

NOTE Confidence: 0.96415687

00:21:28.445 --> 00:21:30.845
identification of pathogenic variants through

NOTE Confidence: 0.96415687

00:21:30.845 --> 00:21:32.205
genetic testing. So, we need

NOTE Confidence: 0.96415687

00:21:32.205 --> 00:21:32.705
to,

NOTE Confidence: 0.9984426

00:21:33.405 --> 00:21:34.945
in the process of identifying

NOTE Confidence: 0.9984426

00:21:35.085 --> 00:21:37.505
risk, ask ourselves if patients

NOTE Confidence: 0.9984426

00:21:37.645 --> 00:21:38.385
are eligible

NOTE Confidence: 0.9977938

00:21:39.119 --> 00:21:41.040
for genetic testing based on

NOTE Confidence: 0.9977938

00:21:41.040 --> 00:21:43.380
a threshold of potential risk

NOTE Confidence: 0.95128536

00:21:43.920 --> 00:21:45.300
based on family history.

NOTE Confidence: 0.9759324

00:21:46.960 --> 00:21:48.640
We also utilize, in the

NOTE Confidence: 0.9759324

00:21:48.640 --> 00:21:50.560
absence of a pathogenic variant,

NOTE Confidence: 0.9759324

00:21:50.560 --> 00:21:52.640
these risk prediction models, which

NOTE Confidence: 0.9759324

00:21:52.640 --> 00:21:55.065
really give a calculated estimate

NOTE Confidence: 0.9759324

00:21:55.065 --> 00:21:56.285
based on a comprehensive

NOTE Confidence: 0.9929416

00:21:56.665 --> 00:21:58.425
list of risk factors for

NOTE Confidence: 0.9929416

00:21:58.425 --> 00:21:59.725
an individual patient.

NOTE Confidence: 0.9815563

00:22:00.425 --> 00:22:01.865
But there's many nuances to

NOTE Confidence: 0.9815563

00:22:01.865 --> 00:22:02.825
this model, so I'm gonna

NOTE Confidence: 0.9815563

00:22:02.825 --> 00:22:03.865
introduce you to a few

NOTE Confidence: 0.9815563

00:22:03.865 --> 00:22:04.525
of them.

NOTE Confidence: 0.99298984

00:22:04.984 --> 00:22:06.105
And then based on this

NOTE Confidence: 0.99298984

00:22:06.105 --> 00:22:08.240
information, we can provide risk

NOTE Confidence: 0.99298984

00:22:08.240 --> 00:22:10.159
reduction strategies to a patient

NOTE Confidence: 0.99298984

00:22:10.159 --> 00:22:12.159
based on what thresholds that

NOTE Confidence: 0.99298984

00:22:12.159 --> 00:22:13.619
they have in their personal

NOTE Confidence: 0.99298984

00:22:13.679 --> 00:22:14.179
risk.

NOTE Confidence: 0.99592865

00:22:15.760 --> 00:22:16.960
So we already heard in

NOTE Confidence: 0.99592865

00:22:16.960 --> 00:22:18.100
the previous presentation

NOTE Confidence: 0.98729837

00:22:18.559 --> 00:22:19.840
the definition of what is

NOTE Confidence: 0.98729837

00:22:19.840 --> 00:22:21.220
considered high risk.

NOTE Confidence: 0.99287826

00:22:21.755 --> 00:22:23.595
So a lifetime breast cancer

NOTE Confidence: 0.99287826

00:22:23.595 --> 00:22:25.355
risk greater than twenty percent

NOTE Confidence: 0.99287826

00:22:25.355 --> 00:22:26.635
is considered to be in

NOTE Confidence: 0.99287826

00:22:26.635 --> 00:22:28.635
the high risk range. So

NOTE Confidence: 0.99287826

00:22:28.635 --> 00:22:29.595
we're gonna hear more about

NOTE Confidence: 0.99287826

00:22:29.595 --> 00:22:30.095
that.

NOTE Confidence: 0.9854471

00:22:32.475 --> 00:22:34.095
So how do we determine

NOTE Confidence: 0.9854471

00:22:34.235 --> 00:22:35.640
who is at high risk?

NOTE Confidence: 0.9854471

00:22:35.720 --> 00:22:36.840
In order to do that,

NOTE Confidence: 0.9854471

00:22:36.840 --> 00:22:38.359
we need to take a

NOTE Confidence: 0.9854471

00:22:38.359 --> 00:22:38.859
comprehensive

NOTE Confidence: 0.9994775

00:22:39.240 --> 00:22:41.260
review of an individual patient's

NOTE Confidence: 0.9994775

00:22:41.320 --> 00:22:42.140
risk factors,

NOTE Confidence: 0.99975604

00:22:43.400 --> 00:22:43.900
including

NOTE Confidence: 0.98602134

00:22:44.200 --> 00:22:45.880
inherited gene mutations. And so

NOTE Confidence: 0.98602134

00:22:45.880 --> 00:22:47.080
we're gonna walk through that

NOTE Confidence: 0.98602134

00:22:47.080 --> 00:22:47.900
in a moment.

NOTE Confidence: 0.9773572

00:22:48.304 --> 00:22:49.424
But I just wanna point

NOTE Confidence: 0.9773572

00:22:49.424 --> 00:22:51.505
out that while we place

NOTE Confidence: 0.9773572

00:22:51.505 --> 00:22:52.725
a large emphasis

NOTE Confidence: 0.9836151

00:22:53.265 --> 00:22:55.905
around genetic pathogenic variants or

NOTE Confidence: 0.9836151

00:22:55.905 --> 00:22:57.105
carrying the gene that puts

NOTE Confidence: 0.9836151

00:22:57.105 --> 00:22:58.304
you at risk for breast

NOTE Confidence: 0.9836151

00:22:58.304 --> 00:22:58.804
cancer,

NOTE Confidence: 0.99942863

00:23:00.145 --> 00:23:01.044
these pathogenic

NOTE Confidence: 0.9997279

00:23:01.345 --> 00:23:01.845
variants

NOTE Confidence: 0.98985845

00:23:03.179 --> 00:23:04.779
are responsible for a very

NOTE Confidence: 0.98985845

00:23:04.779 --> 00:23:06.619
small percentage of breast cancer

NOTE Confidence: 0.98985845

00:23:06.619 --> 00:23:08.460
cases. So the estimates are

NOTE Confidence: 0.98985845

00:23:08.460 --> 00:23:10.059
somewhere between five and ten

NOTE Confidence: 0.98985845

00:23:10.059 --> 00:23:10.559
percent

NOTE Confidence: 0.99247146

00:23:11.259 --> 00:23:13.200
of these harmful variants. And

NOTE Confidence: 0.99247146

00:23:13.340 --> 00:23:14.779
many of us are familiar

NOTE Confidence: 0.99247146

00:23:14.779 --> 00:23:15.195
with

NOTE Confidence: 0.926713

00:23:15.674 --> 00:23:17.514
the high risk penetrance genes

NOTE Confidence: 0.926713

00:23:17.514 --> 00:23:19.034
of the BRCA1 and the

NOTE Confidence: 0.926713

00:23:19.034 --> 00:23:20.255
BRCA2 mutations,

NOTE Confidence: 0.9737717

00:23:21.274 --> 00:23:22.575
but the field of genetics

NOTE Confidence: 0.9737717

00:23:22.715 --> 00:23:24.894
is rapidly expanding and evolving

NOTE Confidence: 0.9737717

00:23:24.955 --> 00:23:26.475
and we now know about

NOTE Confidence: 0.9737717

00:23:26.475 --> 00:23:28.634
many other pathologic variants. And

NOTE Confidence: 0.9737717

00:23:28.634 --> 00:23:29.134
so

NOTE Confidence: 0.9919454

00:23:29.520 --> 00:23:31.920
when we, pursue genetic testing,

NOTE Confidence: 0.9919454

00:23:31.920 --> 00:23:33.280
we often do a sort

NOTE Confidence: 0.9919454

00:23:33.280 --> 00:23:35.760
of expanded panel looking at

NOTE Confidence: 0.9919454

00:23:35.760 --> 00:23:37.300
a number of different variants.

NOTE Confidence: 0.99081737

00:23:37.840 --> 00:23:39.760
The high risk penetrance genes

NOTE Confidence: 0.99081737

00:23:39.760 --> 00:23:40.660
listed here,

NOTE Confidence: 0.7970257

00:23:41.760 --> 00:23:43.244
confer a risk of,

NOTE Confidence: 0.97608656

00:23:43.885 --> 00:23:45.165
a high risk a risk

NOTE Confidence: 0.97608656

00:23:45.165 --> 00:23:46.684
of lifetime risk as high

NOTE Confidence: 0.97608656

00:23:46.684 --> 00:23:48.225
as sixty to eighty percent.

NOTE Confidence: 0.95030636

00:23:49.645 --> 00:23:51.744
Whereas these moderate risk penetrance

NOTE Confidence: 0.95030636

00:23:51.965 --> 00:23:53.905
genes listed on this slide

NOTE Confidence: 0.95030636

00:23:54.045 --> 00:23:55.405
confer risk more in the

NOTE Confidence: 0.95030636

00:23:55.405 --> 00:23:57.005
twenty to thirty percent range.

NOTE Confidence: 0.95030636

00:23:57.005 --> 00:23:58.285
So it helps us sort

NOTE Confidence: 0.95030636

00:23:58.285 --> 00:24:00.210
of categorize a patient's future

NOTE Confidence: 0.95030636

00:24:00.210 --> 00:24:00.710
risk.

NOTE Confidence: 0.9934729

00:24:02.850 --> 00:24:04.290
So as a clinician, one

NOTE Confidence: 0.9934729

00:24:04.290 --> 00:24:05.170
of the first things we

NOTE Confidence: 0.9934729

00:24:05.170 --> 00:24:06.930
do when we're caring for

NOTE Confidence: 0.9934729

00:24:06.930 --> 00:24:08.290
patients, whether this is in

NOTE Confidence: 0.9934729

00:24:08.290 --> 00:24:09.730
primary care or in a

NOTE Confidence: 0.9934729

00:24:09.730 --> 00:24:11.994
specialty practice, is we ask

NOTE Confidence: 0.9934729

00:24:11.994 --> 00:24:14.015
ourselves, is my patient eligible

NOTE Confidence: 0.9934729

00:24:14.075 --> 00:24:15.294
for genetic testing?

NOTE Confidence: 0.9944191

00:24:15.994 --> 00:24:17.275
And because this field is

NOTE Confidence: 0.9944191

00:24:17.275 --> 00:24:19.215
so rapidly evolving and

NOTE Confidence: 0.9928356

00:24:20.315 --> 00:24:21.615
the professional guidelines

NOTE Confidence: 0.99891967

00:24:22.075 --> 00:24:23.215
change rapidly

NOTE Confidence: 0.99823827

00:24:23.835 --> 00:24:25.115
in response to what we

NOTE Confidence: 0.99823827

00:24:25.115 --> 00:24:26.415
understand about genetics,

NOTE Confidence: 0.999431

00:24:27.359 --> 00:24:28.640
we have tools in our

NOTE Confidence: 0.999431

00:24:28.640 --> 00:24:30.400
electronic health record that support

NOTE Confidence: 0.999431

00:24:30.400 --> 00:24:32.559
our providers in making decisions

NOTE Confidence: 0.999431

00:24:32.559 --> 00:24:34.020
about who might be eligible.

NOTE Confidence: 0.995499

00:24:35.440 --> 00:24:36.980
And I share this because,

NOTE Confidence: 0.99452156

00:24:38.400 --> 00:24:39.680
I think it's important to

NOTE Confidence: 0.99452156

00:24:39.680 --> 00:24:40.180
know,

NOTE Confidence: 0.9729258

00:24:40.875 --> 00:24:42.475
as a patient that this

NOTE Confidence: 0.9729258

00:24:42.475 --> 00:24:44.075
is a really complex field

NOTE Confidence: 0.9729258

00:24:44.075 --> 00:24:46.095
that not all providers are,

NOTE Confidence: 0.9858496

00:24:47.675 --> 00:24:48.795
skilled at, and there are

NOTE Confidence: 0.9858496

00:24:48.795 --> 00:24:50.155
tools like this that support

NOTE Confidence: 0.9858496

00:24:50.155 --> 00:24:51.275
our providers. And you can

NOTE Confidence: 0.9858496

00:24:51.275 --> 00:24:52.955
see here that we have

NOTE Confidence: 0.9858496

00:24:52.955 --> 00:24:54.700
tools that have a have

NOTE Confidence: 0.9858496

00:24:54.700 --> 00:24:56.300
a a tab for each

NOTE Confidence: 0.9858496

00:24:56.300 --> 00:24:58.220
disease because the indications for

NOTE Confidence: 0.9858496

00:24:58.220 --> 00:24:58.720
testing

NOTE Confidence: 0.9990328

00:24:59.580 --> 00:25:01.020
differ based on the cancer

NOTE Confidence: 0.9990328

00:25:01.020 --> 00:25:01.520
disease.

NOTE Confidence: 0.99191594

00:25:02.220 --> 00:25:04.220
So, from a breast cancer

NOTE Confidence: 0.99191594

00:25:04.220 --> 00:25:05.740
perspective, if you have a

NOTE Confidence: 0.99191594

00:25:05.740 --> 00:25:07.420
known mutation, there's no need

NOTE Confidence: 0.99191594

00:25:07.420 --> 00:25:08.540
to refer you to a

NOTE Confidence: 0.99191594

00:25:08.540 --> 00:25:09.040
genetic,

NOTE Confidence: 0.9863923

00:25:10.465 --> 00:25:11.845
counseling or testing.

NOTE Confidence: 0.99362797

00:25:13.025 --> 00:25:14.225
But if you've had genetic

NOTE Confidence: 0.99362797

00:25:14.225 --> 00:25:15.905
testing, for example, greater than

NOTE Confidence: 0.99362797

00:25:15.905 --> 00:25:17.265
ten years ago, you may

NOTE Confidence: 0.99362797

00:25:17.265 --> 00:25:19.505
benefit from repeat testing because

NOTE Confidence: 0.99362797

00:25:19.505 --> 00:25:20.625
of the advances in the

NOTE Confidence: 0.99362797

00:25:20.625 --> 00:25:21.605
extended panels.

NOTE Confidence: 0.9859056

00:25:23.870 --> 00:25:24.850
So, this slide,

NOTE Confidence: 0.98839337

00:25:25.470 --> 00:25:26.510
lists for you,

NOTE Confidence: 0.99942666

00:25:27.870 --> 00:25:28.530
the professional

NOTE Confidence: 0.9970567

00:25:28.910 --> 00:25:29.410
organization

NOTE Confidence: 0.9972498

00:25:29.790 --> 00:25:30.290
recommendations

NOTE Confidence: 0.98778063

00:25:30.670 --> 00:25:32.450
around who should be tested

NOTE Confidence: 0.98778063

00:25:32.590 --> 00:25:34.430
or considered for testing for

NOTE Confidence: 0.98778063

00:25:34.430 --> 00:25:35.730
a pathogenic variant.

NOTE Confidence: 0.9467866

00:25:36.345 --> 00:25:37.465
And so I draw your

NOTE Confidence: 0.9467866

00:25:37.465 --> 00:25:38.445
attention to,

NOTE Confidence: 0.9192404

00:25:38.905 --> 00:25:40.345
the underlying text that says

NOTE Confidence: 0.9192404

00:25:40.345 --> 00:25:42.105
personal history and of breast

NOTE Confidence: 0.9192404

00:25:42.105 --> 00:25:43.164
cancer and.

NOTE Confidence: 0.9715673

00:25:44.105 --> 00:25:45.544
So if you have a

NOTE Confidence: 0.9715673

00:25:45.544 --> 00:25:47.625
diagnosis of breast cancer and

NOTE Confidence: 0.9715673

00:25:47.625 --> 00:25:49.005
meet any of the criteria

NOTE Confidence: 0.9715673

00:25:49.225 --> 00:25:50.490
on this list, you should

NOTE Confidence: 0.9715673

00:25:50.490 --> 00:25:53.050
receive genetic testing, ideally, before

NOTE Confidence: 0.9715673

00:25:53.050 --> 00:25:54.810
you initiate any treatment to

NOTE Confidence: 0.9715673

00:25:54.810 --> 00:25:55.310
inform

NOTE Confidence: 0.9998253

00:25:56.010 --> 00:25:57.230
your treatment decisions.

NOTE Confidence: 0.99780744

00:25:58.410 --> 00:25:58.890
So,

NOTE Confidence: 0.9728379

00:25:59.530 --> 00:26:01.290
having breast cancer at a

NOTE Confidence: 0.9728379

00:26:01.290 --> 00:26:02.570
young age under the age

NOTE Confidence: 0.9728379

00:26:02.570 --> 00:26:04.010
of fifty is a red

NOTE Confidence: 0.9728379

00:26:04.010 --> 00:26:05.640
flag for a potential

NOTE Confidence: 0.9971336

00:26:06.345 --> 00:26:08.345
pathogenic variant. So every woman

NOTE Confidence: 0.9971336

00:26:08.345 --> 00:26:09.545
under the age of fifty

NOTE Confidence: 0.9971336

00:26:09.545 --> 00:26:11.145
diagnosed with breast cancer should

NOTE Confidence: 0.9971336

00:26:11.145 --> 00:26:11.885
get tested.

NOTE Confidence: 0.9998171

00:26:13.625 --> 00:26:14.925
There are other indications

NOTE Confidence: 0.99695843

00:26:15.385 --> 00:26:16.125
of genetic,

NOTE Confidence: 0.9843116

00:26:16.825 --> 00:26:18.605
variants, and that also includes

NOTE Confidence: 0.9843116

00:26:18.744 --> 00:26:19.740
the type of cancer that

NOTE Confidence: 0.9843116

00:26:19.740 --> 00:26:20.940
you have. So if you're

NOTE Confidence: 0.9843116

00:26:20.940 --> 00:26:22.940
diagnosed with a breast cancer

NOTE Confidence: 0.9843116

00:26:22.940 --> 00:26:24.140
that is what we call

NOTE Confidence: 0.9843116

00:26:24.140 --> 00:26:25.040
triple negative

NOTE Confidence: 0.9752584

00:26:25.740 --> 00:26:27.200
or hormone negative,

NOTE Confidence: 0.9808122

00:26:28.780 --> 00:26:30.060
then that that is also

NOTE Confidence: 0.9808122

00:26:30.060 --> 00:26:31.600
an indication for testing.

NOTE Confidence: 0.99988383

00:26:32.075 --> 00:26:33.035
If you have a family

NOTE Confidence: 0.99988383

00:26:33.035 --> 00:26:33.535
history

NOTE Confidence: 0.9801319

00:26:33.915 --> 00:26:35.755
of a male breast cancer

NOTE Confidence: 0.9801319

00:26:35.755 --> 00:26:37.035
in your family, that's an

NOTE Confidence: 0.9801319

00:26:37.115 --> 00:26:38.095
another indication.

NOTE Confidence: 0.9971673

00:26:40.155 --> 00:26:41.675
But even patients who have

NOTE Confidence: 0.9971673

00:26:41.675 --> 00:26:43.195
not been affected by cancer

NOTE Confidence: 0.9971673

00:26:43.195 --> 00:26:45.295
are eligible for for testing

NOTE Confidence: 0.9971673

00:26:45.434 --> 00:26:47.250
if any of their family

NOTE Confidence: 0.9971673

00:26:47.250 --> 00:26:49.190
members who had breast cancer

NOTE Confidence: 0.99642134

00:26:49.650 --> 00:26:50.710
meet those criteria.

NOTE Confidence: 0.9991247

00:26:52.610 --> 00:26:53.970
So if a patient meets

NOTE Confidence: 0.9991247

00:26:53.970 --> 00:26:54.790
those criteria,

NOTE Confidence: 0.93906623

00:26:55.890 --> 00:26:57.730
their options in our health

NOTE Confidence: 0.93906623

00:26:57.730 --> 00:27:00.115
system are to go on

NOTE Confidence: 0.93906623

00:27:00.115 --> 00:27:02.615
and see a genetics counselor

NOTE Confidence: 0.93906623

00:27:02.675 --> 00:27:03.555
in our Smilogentics,

NOTE Confidence: 0.8933496

00:27:05.555 --> 00:27:06.695
clinic clinic,

NOTE Confidence: 0.9870015

00:27:08.035 --> 00:27:09.555
or we have tools now

NOTE Confidence: 0.9870015

00:27:09.555 --> 00:27:11.075
for our primary care physicians

NOTE Confidence: 0.9870015

00:27:11.075 --> 00:27:12.035
to do what we call

NOTE Confidence: 0.9870015

00:27:12.035 --> 00:27:13.715
point of care genetic testing

NOTE Confidence: 0.9870015

00:27:13.715 --> 00:27:14.695
in their practices,

NOTE Confidence: 0.9889256

00:27:15.530 --> 00:27:17.630
understanding that while we have,

NOTE Confidence: 0.9973103

00:27:18.490 --> 00:27:18.990
over

NOTE Confidence: 0.9866762

00:27:19.929 --> 00:27:22.090
a dozen counselors, we can't

NOTE Confidence: 0.9866762

00:27:22.090 --> 00:27:23.530
always meet the demand of

NOTE Confidence: 0.9866762

00:27:23.530 --> 00:27:24.570
all the patients that get

NOTE Confidence: 0.9866762

00:27:24.570 --> 00:27:25.690
referred to us. So we

NOTE Confidence: 0.9866762

00:27:25.690 --> 00:27:27.049
have new tools to support

NOTE Confidence: 0.9866762

00:27:27.049 --> 00:27:27.549
our

NOTE Confidence: 0.9978112

00:27:28.095 --> 00:27:29.535
primary care providers to do

NOTE Confidence: 0.9978112

00:27:29.535 --> 00:27:31.075
point of care genetic testing,

NOTE Confidence: 0.9998255

00:27:31.535 --> 00:27:32.734
which is often a blood

NOTE Confidence: 0.9998255

00:27:32.734 --> 00:27:33.234
test.

NOTE Confidence: 0.9994291

00:27:34.895 --> 00:27:36.095
In the absence of a

NOTE Confidence: 0.9994291

00:27:36.095 --> 00:27:37.315
pathogenic mutation

NOTE Confidence: 0.97299844

00:27:37.695 --> 00:27:38.895
or if a patient is

NOTE Confidence: 0.97299844

00:27:38.895 --> 00:27:40.815
not deemed eligible for genetic

NOTE Confidence: 0.97299844

00:27:40.815 --> 00:27:41.315
testing,

NOTE Confidence: 0.9876217

00:27:43.080 --> 00:27:45.480
Clinicians rely upon these risk

NOTE Confidence: 0.9876217

00:27:45.480 --> 00:27:47.320
prediction models, and there are

NOTE Confidence: 0.9876217

00:27:47.320 --> 00:27:48.859
many of them out there.

NOTE Confidence: 0.99987006

00:27:49.400 --> 00:27:50.220
This slide

NOTE Confidence: 0.9843942

00:27:50.680 --> 00:27:52.200
provides a table of the

NOTE Confidence: 0.9843942

00:27:52.520 --> 00:27:54.460
probably the top five,

NOTE Confidence: 0.96722823

00:27:54.840 --> 00:27:57.015
most commonly utilized or most

NOTE Confidence: 0.96722823

00:27:57.335 --> 00:27:58.375
validated and and,

NOTE Confidence: 0.94724214

00:28:01.175 --> 00:28:01.675
usable,

NOTE Confidence: 0.99807644

00:28:02.375 --> 00:28:03.755
tools that are out there.

NOTE Confidence: 0.97882956

00:28:04.535 --> 00:28:06.135
And so when we do

NOTE Confidence: 0.97882956

00:28:06.135 --> 00:28:07.895
these risk assessment models, they

NOTE Confidence: 0.97882956

00:28:07.895 --> 00:28:09.515
provide us with two numbers

NOTE Confidence: 0.97882956

00:28:09.655 --> 00:28:11.340
of of interest that guide

NOTE Confidence: 0.97882956

00:28:11.340 --> 00:28:12.880
through the professional organizations'

NOTE Confidence: 0.9778583

00:28:14.859 --> 00:28:17.179
recommendations for risk reduction strategies.

NOTE Confidence: 0.9778583

00:28:17.179 --> 00:28:18.320
We look at a lifetime

NOTE Confidence: 0.9778583

00:28:18.380 --> 00:28:19.820
risk and we look at

NOTE Confidence: 0.9778583

00:28:19.820 --> 00:28:21.659
a five year risk. And

NOTE Confidence: 0.9778583

00:28:21.659 --> 00:28:22.480
those thresholds,

NOTE Confidence: 0.9996541

00:28:22.859 --> 00:28:24.059
if you reach a lifetime

NOTE Confidence: 0.9996541

00:28:24.059 --> 00:28:25.359
risk greater than twenty,

NOTE Confidence: 0.9896532

00:28:25.934 --> 00:28:27.215
you may be eligible for

NOTE Confidence: 0.9896532

00:28:27.215 --> 00:28:29.294
supplemental breast cancer screening with

NOTE Confidence: 0.9896532

00:28:29.294 --> 00:28:31.294
MRI or other modalities as

NOTE Confidence: 0.9896532

00:28:31.294 --> 00:28:32.595
we just talked about.

NOTE Confidence: 0.99869394

00:28:34.414 --> 00:28:35.075
If you

NOTE Confidence: 0.9871166

00:28:36.174 --> 00:28:37.534
reach a risk threshold of

NOTE Confidence: 0.9871166

00:28:37.534 --> 00:28:38.820
greater than one point six

NOTE Confidence: 0.9871166

00:28:39.059 --> 00:28:40.500
seven, you may also be

NOTE Confidence: 0.9871166

00:28:40.500 --> 00:28:42.759
eligible for risk reduction strategies

NOTE Confidence: 0.9871166

00:28:42.899 --> 00:28:45.059
using medications, what we call

NOTE Confidence: 0.9871166

00:28:45.059 --> 00:28:45.559
chemoprevention.

NOTE Confidence: 0.9995

00:28:46.820 --> 00:28:48.179
There are several drugs that

NOTE Confidence: 0.9995

00:28:48.179 --> 00:28:50.039
are available that can

NOTE Confidence: 0.8916789

00:28:50.580 --> 00:28:51.399
act as,

NOTE Confidence: 0.99747086

00:28:53.065 --> 00:28:54.665
that can reduce your future

NOTE Confidence: 0.99747086

00:28:54.665 --> 00:28:56.345
risk of a hormone positive

NOTE Confidence: 0.99747086

00:28:56.345 --> 00:28:57.165
breast cancer.

NOTE Confidence: 0.9968338

00:28:58.825 --> 00:29:00.505
So here's a snapshot of

NOTE Confidence: 0.9968338

00:29:00.505 --> 00:29:01.805
one of the most commonly

NOTE Confidence: 0.9968338

00:29:01.865 --> 00:29:03.625
used tools that you too

NOTE Confidence: 0.9968338

00:29:03.625 --> 00:29:05.325
can can go and calculate

NOTE Confidence: 0.9968338

00:29:05.545 --> 00:29:06.445
on your own.

NOTE Confidence: 0.9517956

00:29:07.040 --> 00:29:08.160
There is the sort of

NOTE Confidence: 0.9517956

00:29:08.160 --> 00:29:09.760
website where you can download

NOTE Confidence: 0.9517956

00:29:09.760 --> 00:29:10.260
this,

NOTE Confidence: 0.9873673

00:29:10.960 --> 00:29:11.460
this,

NOTE Confidence: 0.91251224

00:29:12.160 --> 00:29:13.540
risk prediction model,

NOTE Confidence: 0.98547757

00:29:14.240 --> 00:29:15.200
and this is the kind

NOTE Confidence: 0.98547757

00:29:15.200 --> 00:29:16.400
of output that you will

NOTE Confidence: 0.98547757

00:29:16.400 --> 00:29:17.520
get. What I'm trying to

NOTE Confidence: 0.98547757

00:29:17.520 --> 00:29:18.480
show you on the slide

NOTE Confidence: 0.98547757

00:29:18.480 --> 00:29:20.095
is several things. One is

NOTE Confidence: 0.98547757

00:29:20.095 --> 00:29:21.535
the type of information you

NOTE Confidence: 0.98547757

00:29:21.535 --> 00:29:22.674
need to be able to

NOTE Confidence: 0.9979417

00:29:23.014 --> 00:29:23.514
answer

NOTE Confidence: 0.9950418

00:29:23.855 --> 00:29:25.135
the questions to get an

NOTE Confidence: 0.9950418

00:29:25.135 --> 00:29:25.635
answer

NOTE Confidence: 0.8952469

00:29:26.655 --> 00:29:28.174
and also showing you the

NOTE Confidence: 0.8952469

00:29:28.174 --> 00:29:28.674
results

NOTE Confidence: 0.96534663

00:29:28.975 --> 00:29:29.955
when you change

NOTE Confidence: 0.9555522

00:29:30.255 --> 00:29:32.150
the race of the patient

NOTE Confidence: 0.9555522

00:29:32.150 --> 00:29:33.830
from white to black. And

NOTE Confidence: 0.9555522

00:29:33.830 --> 00:29:34.570
you can see

NOTE Confidence: 0.98314124

00:29:35.190 --> 00:29:36.630
in the same patient who's

NOTE Confidence: 0.98314124

00:29:36.630 --> 00:29:38.150
forty two, had their first

NOTE Confidence: 0.98314124

00:29:38.150 --> 00:29:39.610
menstrual period at ten,

NOTE Confidence: 0.99319625

00:29:40.309 --> 00:29:41.669
had their first baby at

NOTE Confidence: 0.99319625

00:29:41.669 --> 00:29:43.429
thirty five years old, had

NOTE Confidence: 0.99319625

00:29:43.429 --> 00:29:45.110
two prior breast biopsies that

NOTE Confidence: 0.99319625

00:29:45.110 --> 00:29:46.090
were not cancer,

NOTE Confidence: 0.99908125

00:29:47.625 --> 00:29:49.385
had no atypia on those

NOTE Confidence: 0.99908125

00:29:49.385 --> 00:29:50.525
biopsy results,

NOTE Confidence: 0.94898254

00:29:51.225 --> 00:29:53.065
had one first degree relative,

NOTE Confidence: 0.94898254

00:29:53.065 --> 00:29:54.505
so that's mother, daughter, or

NOTE Confidence: 0.94898254

00:29:54.505 --> 00:29:56.525
sister, in this case, one

NOTE Confidence: 0.94898254

00:29:56.745 --> 00:29:58.125
mom with breast cancer,

NOTE Confidence: 0.9664796

00:29:59.730 --> 00:30:01.330
and and we calculate that

NOTE Confidence: 0.9664796

00:30:01.330 --> 00:30:02.710
risk for a black woman.

NOTE Confidence: 0.9664796

00:30:02.850 --> 00:30:03.890
The results are on the

NOTE Confidence: 0.9664796

00:30:03.890 --> 00:30:05.570
left of this screen. So

NOTE Confidence: 0.9664796

00:30:05.570 --> 00:30:06.770
you could see they don't

NOTE Confidence: 0.9664796

00:30:06.930 --> 00:30:08.690
this particular patient who's black

NOTE Confidence: 0.9664796

00:30:08.690 --> 00:30:09.670
with those characteristics

NOTE Confidence: 0.9996659

00:30:10.130 --> 00:30:11.330
does not reach the five

NOTE Confidence: 0.9996659

00:30:11.330 --> 00:30:12.470
year risk threshold

NOTE Confidence: 0.9722414

00:30:13.515 --> 00:30:14.815
for chemo prevention

NOTE Confidence: 0.98516786

00:30:15.195 --> 00:30:16.955
based on this model, nor

NOTE Confidence: 0.98516786

00:30:16.955 --> 00:30:18.395
do they risk reach the

NOTE Confidence: 0.98516786

00:30:18.395 --> 00:30:19.915
high risk threshold for a

NOTE Confidence: 0.98516786

00:30:19.915 --> 00:30:21.775
lifetime risk greater than twenty

NOTE Confidence: 0.9977137

00:30:22.155 --> 00:30:22.895
for MRI.

NOTE Confidence: 0.99788296

00:30:23.675 --> 00:30:25.035
But if you change nothing

NOTE Confidence: 0.99788296

00:30:25.035 --> 00:30:26.015
but the race,

NOTE Confidence: 0.9983886

00:30:26.650 --> 00:30:28.030
this model actually

NOTE Confidence: 0.99678713

00:30:28.410 --> 00:30:30.010
suggests that this patient is

NOTE Confidence: 0.99678713

00:30:30.010 --> 00:30:31.450
eligible for both of those

NOTE Confidence: 0.99678713

00:30:31.450 --> 00:30:31.950
things.

NOTE Confidence: 0.9982246

00:30:32.330 --> 00:30:33.710
And some of this reflects

NOTE Confidence: 0.9982246

00:30:33.770 --> 00:30:35.290
the incidence rates of breast

NOTE Confidence: 0.9982246

00:30:35.290 --> 00:30:37.290
cancer between races, but it

NOTE Confidence: 0.9982246

00:30:37.290 --> 00:30:38.270
also demonstrates

NOTE Confidence: 0.9998293

00:30:39.345 --> 00:30:40.165
how imperfect

NOTE Confidence: 0.96999985

00:30:40.785 --> 00:30:42.065
the models are that we

NOTE Confidence: 0.96999985

00:30:42.065 --> 00:30:44.245
have that sometime contribute

NOTE Confidence: 0.99942493

00:30:45.105 --> 00:30:45.684
to inequities

NOTE Confidence: 0.9973001

00:30:45.985 --> 00:30:47.585
in our ability to care

NOTE Confidence: 0.9973001

00:30:47.585 --> 00:30:49.184
for patients. And so I

NOTE Confidence: 0.9973001

00:30:49.184 --> 00:30:50.645
I I share this

NOTE Confidence: 0.9918

00:30:51.320 --> 00:30:52.520
to also give sort of

NOTE Confidence: 0.9918

00:30:52.520 --> 00:30:54.040
an abundance of caution that

NOTE Confidence: 0.9918

00:30:54.040 --> 00:30:55.480
there are other models that

NOTE Confidence: 0.9918

00:30:55.480 --> 00:30:57.179
don't take race into consideration

NOTE Confidence: 0.9918

00:30:57.320 --> 00:30:58.700
that may be more appropriate.

NOTE Confidence: 0.97827613

00:31:00.600 --> 00:31:01.880
So the other model that

NOTE Confidence: 0.97827613

00:31:01.880 --> 00:31:03.559
is widely used and,

NOTE Confidence: 0.98272794

00:31:04.534 --> 00:31:06.315
and recommended by many professional

NOTE Confidence: 0.98272794

00:31:06.375 --> 00:31:07.975
organizations is something called the

NOTE Confidence: 0.98272794

00:31:07.975 --> 00:31:09.434
Tyra Cusick model.

NOTE Confidence: 0.9342097

00:31:10.375 --> 00:31:11.735
In parentheses, I have the

NOTE Confidence: 0.9342097

00:31:11.735 --> 00:31:13.495
word IBIS there because that

NOTE Confidence: 0.9342097

00:31:13.495 --> 00:31:14.695
in my that is the

NOTE Confidence: 0.9342097

00:31:14.695 --> 00:31:15.654
way that you can find

NOTE Confidence: 0.9342097

00:31:15.654 --> 00:31:16.774
it if you Google it

NOTE Confidence: 0.9342097

00:31:16.774 --> 00:31:17.015
on

NOTE Confidence: 0.9292924

00:31:17.760 --> 00:31:18.800
if you go and Google

NOTE Confidence: 0.9292924

00:31:18.800 --> 00:31:20.240
Tyra Cusick, you're gonna get

NOTE Confidence: 0.9292924

00:31:20.240 --> 00:31:21.780
a bunch of different options

NOTE Confidence: 0.99130577

00:31:22.400 --> 00:31:24.080
with web based version that

NOTE Confidence: 0.99130577

00:31:24.080 --> 00:31:25.520
that are really easy to

NOTE Confidence: 0.99130577

00:31:25.520 --> 00:31:26.980
use because they're pretty

NOTE Confidence: 0.898405

00:31:27.600 --> 00:31:28.880
and they seem really easy

NOTE Confidence: 0.898405

00:31:28.880 --> 00:31:29.620
to answer.

NOTE Confidence: 0.9870054

00:31:30.045 --> 00:31:31.505
But those are not validated.

NOTE Confidence: 0.9870054

00:31:31.725 --> 00:31:33.645
The only validated one is

NOTE Confidence: 0.9870054

00:31:33.645 --> 00:31:35.325
on this, website that I

NOTE Confidence: 0.9870054

00:31:35.325 --> 00:31:36.445
list for you here. You

NOTE Confidence: 0.9870054

00:31:36.445 --> 00:31:37.885
actually have to download the

NOTE Confidence: 0.9870054

00:31:37.885 --> 00:31:39.165
software, and it's a little

NOTE Confidence: 0.9870054

00:31:39.165 --> 00:31:41.245
cumbersome to use. And it's

NOTE Confidence: 0.9870054

00:31:41.245 --> 00:31:42.845
kind of easy to make

NOTE Confidence: 0.9870054

00:31:42.845 --> 00:31:44.525
mistakes and get the wrong

NOTE Confidence: 0.9870054

00:31:44.525 --> 00:31:45.740
answer. So,

NOTE Confidence: 0.98838896

00:31:47.559 --> 00:31:48.920
when I talk about these

NOTE Confidence: 0.98838896

00:31:48.920 --> 00:31:50.120
risk models, I like to

NOTE Confidence: 0.98838896

00:31:50.120 --> 00:31:51.080
say it's sort of like

NOTE Confidence: 0.98838896

00:31:51.080 --> 00:31:52.600
garbage in, garbage out. If

NOTE Confidence: 0.98838896

00:31:52.600 --> 00:31:53.640
you don't put the right

NOTE Confidence: 0.98838896

00:31:53.640 --> 00:31:55.240
information in, you're gonna get

NOTE Confidence: 0.98838896

00:31:55.240 --> 00:31:56.520
an answer that's not really

NOTE Confidence: 0.98838896

00:31:56.520 --> 00:31:57.980
reflective of your risk.

NOTE Confidence: 0.97781235

00:31:59.414 --> 00:32:00.695
So in this case, this

NOTE Confidence: 0.97781235

00:32:00.695 --> 00:32:02.154
model takes into consideration

NOTE Confidence: 0.9978151

00:32:03.014 --> 00:32:04.774
many more risk factors than

NOTE Confidence: 0.9978151

00:32:04.774 --> 00:32:06.534
the the breast cancer prevention

NOTE Confidence: 0.9978151

00:32:06.534 --> 00:32:07.575
tool that I showed you

NOTE Confidence: 0.9978151

00:32:07.575 --> 00:32:08.075
first.

NOTE Confidence: 0.9365523

00:32:08.375 --> 00:32:10.215
It takes into account your

NOTE Confidence: 0.9365523

00:32:10.215 --> 00:32:11.430
height and your weight,

NOTE Confidence: 0.98326457

00:32:12.150 --> 00:32:13.350
whether you're not you have

NOTE Confidence: 0.98326457

00:32:13.350 --> 00:32:15.930
an Ashkenazi Jewish ancestral background,

NOTE Confidence: 0.9888448

00:32:16.390 --> 00:32:17.830
what your breast density is.

NOTE Confidence: 0.9888448

00:32:17.830 --> 00:32:19.030
We just heard about the

NOTE Confidence: 0.9888448

00:32:19.030 --> 00:32:19.530
the

NOTE Confidence: 0.99977374

00:32:20.150 --> 00:32:21.990
how breast density is another

NOTE Confidence: 0.99977374

00:32:21.990 --> 00:32:23.350
additional risk factor that we

NOTE Confidence: 0.99977374

00:32:23.350 --> 00:32:24.650
need to take into consideration.

NOTE Confidence: 0.9998411

00:32:25.534 --> 00:32:27.154
It also takes into account

NOTE Confidence: 0.9970977

00:32:27.615 --> 00:32:29.455
family members outside your first

NOTE Confidence: 0.9970977

00:32:29.455 --> 00:32:31.455
degree relatives and family members

NOTE Confidence: 0.9970977

00:32:31.455 --> 00:32:32.835
with ovarian cancer.

NOTE Confidence: 0.99630266

00:32:33.375 --> 00:32:34.575
It also allows you to

NOTE Confidence: 0.99630266

00:32:34.575 --> 00:32:35.615
say whether or not you

NOTE Confidence: 0.99630266

00:32:35.615 --> 00:32:36.654
or any of your family

NOTE Confidence: 0.99630266

00:32:36.654 --> 00:32:38.015
members who've been affected have

NOTE Confidence: 0.99630266

00:32:38.015 --> 00:32:38.515
had

NOTE Confidence: 0.97205186

00:32:39.240 --> 00:32:40.140
genetic testing.

NOTE Confidence: 0.9626911

00:32:41.560 --> 00:32:42.780
But you can make mistakes.

NOTE Confidence: 0.9348891

00:32:44.440 --> 00:32:45.340
If you don't,

NOTE Confidence: 0.90367126

00:32:48.040 --> 00:32:49.640
use the right age of

NOTE Confidence: 0.90367126

00:32:49.640 --> 00:32:49.880
die

NOTE Confidence: 0.9455178

00:32:50.600 --> 00:32:52.095
of the family members when

NOTE Confidence: 0.9455178

00:32:52.095 --> 00:32:54.015
you enter the information and

NOTE Confidence: 0.9455178

00:32:54.015 --> 00:32:55.135
asks you for an age,

NOTE Confidence: 0.9455178

00:32:55.135 --> 00:32:56.255
if you give their current

NOTE Confidence: 0.9455178

00:32:56.255 --> 00:32:56.755
age

NOTE Confidence: 0.9745702

00:32:57.215 --> 00:32:58.255
and not the age of

NOTE Confidence: 0.9745702

00:32:58.255 --> 00:32:58.995
the diagnosis

NOTE Confidence: 0.9985226

00:32:59.375 --> 00:33:00.255
at the time of their

NOTE Confidence: 0.9985226

00:33:00.255 --> 00:33:01.555
diagnosis of cancer

NOTE Confidence: 0.95082235

00:33:02.655 --> 00:33:04.675
or you don't include unaffected

NOTE Confidence: 0.95082235

00:33:04.975 --> 00:33:05.875
family members,

NOTE Confidence: 0.9767151

00:33:07.390 --> 00:33:08.370
you can overestimate

NOTE Confidence: 0.9996363

00:33:08.750 --> 00:33:09.250
risk

NOTE Confidence: 0.9979187

00:33:09.550 --> 00:33:11.470
or underestimate risk. And so

NOTE Confidence: 0.9979187

00:33:11.470 --> 00:33:12.990
it's really hard to use

NOTE Confidence: 0.9979187

00:33:12.990 --> 00:33:14.270
these models if you don't

NOTE Confidence: 0.9979187

00:33:14.270 --> 00:33:14.930
have experience,

NOTE Confidence: 0.9996704

00:33:15.870 --> 00:33:17.090
utilizing them.

NOTE Confidence: 0.99054223

00:33:18.605 --> 00:33:19.565
So I'll share here with

NOTE Confidence: 0.99054223

00:33:19.565 --> 00:33:20.845
you the results of this

NOTE Confidence: 0.99054223

00:33:20.845 --> 00:33:22.865
model with that same patient

NOTE Confidence: 0.8831709

00:33:23.645 --> 00:33:24.765
putting in some,

NOTE Confidence: 0.9733147

00:33:25.165 --> 00:33:26.765
you know, average sort of,

NOTE Confidence: 0.9733147

00:33:27.085 --> 00:33:28.045
age of first,

NOTE Confidence: 0.9576708

00:33:28.765 --> 00:33:29.265
average,

NOTE Confidence: 0.9836562

00:33:29.725 --> 00:33:31.085
examples of, like, height and

NOTE Confidence: 0.9836562

00:33:31.085 --> 00:33:31.585
weight.

NOTE Confidence: 0.9839725

00:33:32.340 --> 00:33:33.780
And this gives this is

NOTE Confidence: 0.9839725

00:33:33.780 --> 00:33:34.820
a example of what the

NOTE Confidence: 0.9839725

00:33:34.820 --> 00:33:36.419
printout might look like. And

NOTE Confidence: 0.9839725

00:33:36.419 --> 00:33:38.100
so you might remember the

NOTE Confidence: 0.9839725

00:33:38.100 --> 00:33:39.620
last slide, we had a

NOTE Confidence: 0.9839725

00:33:39.620 --> 00:33:41.780
range of lifetime risk between

NOTE Confidence: 0.9839725

00:33:41.780 --> 00:33:43.559
sixteen and twenty something percent.

NOTE Confidence: 0.9724319

00:33:44.100 --> 00:33:45.539
This one suggests the lifetime

NOTE Confidence: 0.9724319

00:33:45.539 --> 00:33:46.500
risk, if you look up

NOTE Confidence: 0.9724319

00:33:46.500 --> 00:33:48.184
in that right upper corner,

NOTE Confidence: 0.9724319

00:33:48.245 --> 00:33:49.684
is twenty six point five

NOTE Confidence: 0.9724319

00:33:49.684 --> 00:33:50.184
percent.

NOTE Confidence: 0.9811389

00:33:50.565 --> 00:33:51.765
And the five year risk

NOTE Confidence: 0.9811389

00:33:51.765 --> 00:33:53.144
on the other was between

NOTE Confidence: 0.98121667

00:33:54.164 --> 00:33:55.524
one point five and three,

NOTE Confidence: 0.98121667

00:33:55.524 --> 00:33:56.725
and this five year risk

NOTE Confidence: 0.98121667

00:33:56.725 --> 00:33:58.164
is two point one. So

NOTE Confidence: 0.98121667

00:33:58.164 --> 00:33:58.985
it just demonstrates

NOTE Confidence: 0.9877361

00:33:59.445 --> 00:34:01.030
sort of, you know, how

NOTE Confidence: 0.9877361

00:34:01.169 --> 00:34:03.169
imprecise these models are even

NOTE Confidence: 0.9877361

00:34:03.169 --> 00:34:04.130
though they are the best

NOTE Confidence: 0.9877361

00:34:04.130 --> 00:34:05.090
that we have to give

NOTE Confidence: 0.9877361

00:34:05.090 --> 00:34:05.750
us guidance.

NOTE Confidence: 0.99848163

00:34:07.809 --> 00:34:09.170
I wanna make a comment

NOTE Confidence: 0.99848163

00:34:09.170 --> 00:34:10.070
about polygenic

NOTE Confidence: 0.9827136

00:34:10.450 --> 00:34:11.985
risk scores, which are risk

NOTE Confidence: 0.9827136

00:34:12.145 --> 00:34:13.585
scores that you may get

NOTE Confidence: 0.9827136

00:34:13.585 --> 00:34:15.205
if you get genetic testing

NOTE Confidence: 0.9827136

00:34:15.345 --> 00:34:16.085
and provide,

NOTE Confidence: 0.9733503

00:34:18.705 --> 00:34:19.985
if you have genetic testing,

NOTE Confidence: 0.9733503

00:34:19.985 --> 00:34:21.765
they're looking at multiple

NOTE Confidence: 0.93338877

00:34:22.305 --> 00:34:23.925
of your genetic variants

NOTE Confidence: 0.9925491

00:34:24.385 --> 00:34:25.745
to try to estimate a

NOTE Confidence: 0.9925491

00:34:25.745 --> 00:34:27.185
score for you. And these

NOTE Confidence: 0.9925491

00:34:27.185 --> 00:34:27.685
often

NOTE Confidence: 0.9987222

00:34:28.359 --> 00:34:28.859
overestimate

NOTE Confidence: 0.9832117

00:34:29.160 --> 00:34:30.599
risk and make people really

NOTE Confidence: 0.9832117

00:34:30.599 --> 00:34:32.040
anxious that they get back

NOTE Confidence: 0.9832117

00:34:32.040 --> 00:34:34.119
during their genetic testing. If

NOTE Confidence: 0.9832117

00:34:34.119 --> 00:34:35.560
they have no pathogenic variant

NOTE Confidence: 0.9832117

00:34:35.560 --> 00:34:36.780
and then they get this,

NOTE Confidence: 0.9989624

00:34:37.400 --> 00:34:38.280
I think we have to

NOTE Confidence: 0.9989624

00:34:38.280 --> 00:34:39.980
be really cautious that these

NOTE Confidence: 0.9689593

00:34:41.435 --> 00:34:43.915
scores actually are overestimate risk

NOTE Confidence: 0.9689593

00:34:43.915 --> 00:34:45.355
and are not really ready

NOTE Confidence: 0.9689593

00:34:45.355 --> 00:34:46.495
for prime time.

NOTE Confidence: 0.9910034

00:34:48.155 --> 00:34:49.275
So I just wanna make

NOTE Confidence: 0.9910034

00:34:49.275 --> 00:34:51.535
one point about atypia. Atypia

NOTE Confidence: 0.9910034

00:34:51.755 --> 00:34:53.355
is a finding on breast

NOTE Confidence: 0.9910034

00:34:53.355 --> 00:34:55.680
biopsy that is another risk

NOTE Confidence: 0.9910034

00:34:55.760 --> 00:34:57.359
factor for future cancer that

NOTE Confidence: 0.9910034

00:34:57.359 --> 00:34:59.200
needs to be taken into

NOTE Confidence: 0.9910034

00:34:59.200 --> 00:34:59.700
consideration.

NOTE Confidence: 0.97750676

00:35:00.319 --> 00:35:01.119
So if you had a

NOTE Confidence: 0.97750676

00:35:01.119 --> 00:35:02.480
biopsy, you wanna know whether

NOTE Confidence: 0.97750676

00:35:02.480 --> 00:35:03.520
or not there was any

NOTE Confidence: 0.97750676

00:35:03.520 --> 00:35:04.660
atypia present.

NOTE Confidence: 0.99885297

00:35:06.719 --> 00:35:08.000
This is an additional risk

NOTE Confidence: 0.99885297

00:35:08.000 --> 00:35:09.700
factor that confers an intermediate

NOTE Confidence: 0.99885297

00:35:09.920 --> 00:35:10.420
risk.

NOTE Confidence: 0.9967835

00:35:11.465 --> 00:35:12.825
This is another tool that

NOTE Confidence: 0.9967835

00:35:12.825 --> 00:35:14.605
we utilize with our providers

NOTE Confidence: 0.9967835

00:35:14.745 --> 00:35:16.185
to help guide them on

NOTE Confidence: 0.9967835

00:35:16.185 --> 00:35:17.465
who should go on for

NOTE Confidence: 0.9967835

00:35:17.465 --> 00:35:19.705
surgery with atypia and or

NOTE Confidence: 0.9967835

00:35:19.705 --> 00:35:20.765
who might be eligible

NOTE Confidence: 0.9997233

00:35:21.465 --> 00:35:23.405
for risk reduction strategies.

NOTE Confidence: 0.9688707

00:35:25.370 --> 00:35:27.450
I wanna highlight that because

NOTE Confidence: 0.9688707

00:35:27.450 --> 00:35:28.750
this is such a complicated

NOTE Confidence: 0.9688707

00:35:28.969 --> 00:35:30.650
area, we get referrals from

NOTE Confidence: 0.9688707

00:35:30.650 --> 00:35:32.330
primary care physicians and OB

NOTE Confidence: 0.9688707

00:35:32.330 --> 00:35:34.090
GYNs and self referrals from

NOTE Confidence: 0.9688707

00:35:34.090 --> 00:35:34.590
patients

NOTE Confidence: 0.97588897

00:35:35.290 --> 00:35:36.570
to support them in helping

NOTE Confidence: 0.97588897

00:35:36.570 --> 00:35:37.930
them estimate their own risk

NOTE Confidence: 0.97588897

00:35:37.930 --> 00:35:39.870
and determine their eligibility for

NOTE Confidence: 0.9977482

00:35:40.275 --> 00:35:41.795
genetic testing. And if you

NOTE Confidence: 0.9977482

00:35:41.795 --> 00:35:42.674
were to come to see

NOTE Confidence: 0.9977482

00:35:42.674 --> 00:35:44.114
any of our providers across

NOTE Confidence: 0.9977482

00:35:44.114 --> 00:35:44.775
our network,

NOTE Confidence: 0.99970317

00:35:45.395 --> 00:35:46.275
this is the type of

NOTE Confidence: 0.99970317

00:35:46.275 --> 00:35:47.875
clinical care and counseling that

NOTE Confidence: 0.99970317

00:35:47.875 --> 00:35:48.775
we would provide.

NOTE Confidence: 0.9416959

00:35:49.395 --> 00:35:50.434
We don't have time to

NOTE Confidence: 0.9416959

00:35:50.434 --> 00:35:52.035
go into to these,

NOTE Confidence: 0.9925087

00:35:52.515 --> 00:35:54.454
all these different strategies, but

NOTE Confidence: 0.9955041

00:35:54.930 --> 00:35:56.950
we talk about prevention strategies

NOTE Confidence: 0.9955041

00:35:57.010 --> 00:35:59.010
and early detection strategies. And

NOTE Confidence: 0.9955041

00:35:59.010 --> 00:36:00.150
based on the individual

NOTE Confidence: 0.9929166

00:36:00.450 --> 00:36:00.950
risk

NOTE Confidence: 0.99914265

00:36:01.650 --> 00:36:02.950
and the patient preferences,

NOTE Confidence: 0.9934012

00:36:03.890 --> 00:36:05.170
we can talk and counsel

NOTE Confidence: 0.9934012

00:36:05.170 --> 00:36:06.609
about lifestyle and behavior that

NOTE Confidence: 0.9934012

00:36:06.609 --> 00:36:07.730
we're gonna hear about from

NOTE Confidence: 0.9934012

00:36:07.730 --> 00:36:08.710
doctor Erwin,

NOTE Confidence: 0.9090837

00:36:09.485 --> 00:36:09.985
chemoprevention

NOTE Confidence: 0.990895

00:36:10.285 --> 00:36:12.045
or medications to reduce your

NOTE Confidence: 0.990895

00:36:12.045 --> 00:36:12.545
risk,

NOTE Confidence: 0.99935645

00:36:13.165 --> 00:36:14.545
risk reduction mastectomy

NOTE Confidence: 0.974182

00:36:14.925 --> 00:36:16.445
for those with lifetime risk

NOTE Confidence: 0.974182

00:36:16.445 --> 00:36:17.825
greater than forty percent,

NOTE Confidence: 0.9671823

00:36:18.605 --> 00:36:20.145
and then their early detection

NOTE Confidence: 0.9671823

00:36:20.205 --> 00:36:22.045
options are not preventing cancer,

NOTE Confidence: 0.9671823

00:36:22.045 --> 00:36:23.325
but finding it early. And

NOTE Confidence: 0.9671823

00:36:23.325 --> 00:36:25.210
that includes self exam, clinical

NOTE Confidence: 0.97766376

00:36:25.829 --> 00:36:27.269
exam, and the breast imaging

NOTE Confidence: 0.97766376

00:36:27.269 --> 00:36:28.309
that we just heard about

NOTE Confidence: 0.97766376

00:36:28.309 --> 00:36:29.289
from doctor Laffey.

NOTE Confidence: 0.98599637

00:36:30.549 --> 00:36:31.989
So I'm gonna stop there

NOTE Confidence: 0.98599637

00:36:31.989 --> 00:36:32.950
because I know I took

NOTE Confidence: 0.98599637

00:36:32.950 --> 00:36:33.910
more time than I should

NOTE Confidence: 0.98599637

00:36:33.910 --> 00:36:35.190
have, and I'm gonna pass

NOTE Confidence: 0.98599637

00:36:35.190 --> 00:36:36.469
it to my colleague, doctor

NOTE Confidence: 0.98599637

00:36:36.469 --> 00:36:36.969
Erwin.

NOTE Confidence: 0.8292215

00:36:44.925 --> 00:36:45.425
Okay.

NOTE Confidence: 0.98952067

00:36:45.805 --> 00:36:46.625
Thank you.

NOTE Confidence: 0.9984153

00:36:47.485 --> 00:36:49.265
And I'm gonna try to

NOTE Confidence: 0.99858445

00:36:52.219 --> 00:36:53.739
get it into the right

NOTE Confidence: 0.99858445

00:36:53.739 --> 00:36:54.239
mode.

NOTE Confidence: 0.9284503

00:37:02.859 --> 00:37:04.300
You could maybe answer a

NOTE Confidence: 0.9284503

00:37:04.300 --> 00:37:06.320
question while I'm doing this.

NOTE Confidence: 0.9975519

00:37:09.395 --> 00:37:10.455
Did I freeze?

NOTE Confidence: 0.90570164

00:37:15.235 --> 00:37:16.915
You're good. You're I think

NOTE Confidence: 0.90570164

00:37:16.915 --> 00:37:18.195
we see the center mode,

NOTE Confidence: 0.90570164

00:37:18.195 --> 00:37:19.635
though. Are you you're not

NOTE Confidence: 0.90570164

00:37:19.635 --> 00:37:20.695
full screen yet?

NOTE Confidence: 0.9642575

00:37:22.590 --> 00:37:24.270
Okay. Good. Switch your screen.

NOTE Confidence: 0.9642575

00:37:24.270 --> 00:37:25.470
I was scared. I thought

NOTE Confidence: 0.9642575

00:37:25.470 --> 00:37:26.370
I froze.

NOTE Confidence: 0.9899753

00:37:27.870 --> 00:37:29.150
I thought I froze, but

NOTE Confidence: 0.9899753

00:37:29.150 --> 00:37:30.450
I'm good. I'm not frozen.

NOTE Confidence: 0.9970223

00:37:32.030 --> 00:37:32.510
Alright.

NOTE Confidence: 0.98692006

00:37:32.910 --> 00:37:34.190
I was thinking maybe we

NOTE Confidence: 0.98692006

00:37:34.190 --> 00:37:35.230
can answer some of the

NOTE Confidence: 0.98692006

00:37:35.230 --> 00:37:36.510
questions in the chat while

NOTE Confidence: 0.98692006

00:37:36.510 --> 00:37:38.085
I'm presenting just in case

NOTE Confidence: 0.98692006

00:37:38.085 --> 00:37:39.125
we don't get to all

NOTE Confidence: 0.98692006

00:37:39.125 --> 00:37:40.425
of the, questions.

NOTE Confidence: 0.9484186

00:37:40.965 --> 00:37:42.265
Good evening, everyone.

NOTE Confidence: 0.95159966

00:37:42.885 --> 00:37:44.405
My name is Melinda Erwin.

NOTE Confidence: 0.95159966

00:37:44.405 --> 00:37:45.445
I'm a professor in the

NOTE Confidence: 0.95159966

00:37:45.445 --> 00:37:46.484
Yale School of Public Health

NOTE Confidence: 0.95159966

00:37:46.484 --> 00:37:47.685
and deputy director in the

NOTE Confidence: 0.95159966

00:37:47.685 --> 00:37:49.305
Yale Cancer Center. And I'm,

NOTE Confidence: 0.9713369

00:37:50.360 --> 00:37:51.800
going to share with you

NOTE Confidence: 0.9713369

00:37:51.800 --> 00:37:53.100
breast cancer prevention.

NOTE Confidence: 0.96996707

00:37:54.040 --> 00:37:55.160
And I'm gonna really focus

NOTE Confidence: 0.96996707

00:37:55.160 --> 00:37:57.320
on beyond individual risk factors

NOTE Confidence: 0.96996707

00:37:57.320 --> 00:37:58.780
and more how the environment

NOTE Confidence: 0.96996707

00:37:58.920 --> 00:38:00.440
and systems shape our risk

NOTE Confidence: 0.96996707

00:38:00.440 --> 00:38:01.580
for breast cancer.

NOTE Confidence: 0.9898103

00:38:03.255 --> 00:38:04.775
Also, I wanna first start

NOTE Confidence: 0.9898103

00:38:04.775 --> 00:38:06.614
with acknowledging that breast cancer

NOTE Confidence: 0.9898103

00:38:06.614 --> 00:38:08.214
mortality rates have decreased by

NOTE Confidence: 0.9898103

00:38:08.214 --> 00:38:09.734
forty four percent since the

NOTE Confidence: 0.9898103

00:38:09.734 --> 00:38:11.734
peak in nineteen ninety. And

NOTE Confidence: 0.9898103

00:38:11.734 --> 00:38:13.835
much of this success in

NOTE Confidence: 0.9350973

00:38:14.214 --> 00:38:16.055
reduced mortality rates is because

NOTE Confidence: 0.9350973

00:38:16.055 --> 00:38:18.020
of what, doctor Laffey said

NOTE Confidence: 0.9350973

00:38:18.020 --> 00:38:19.540
in our early detection and

NOTE Confidence: 0.9350973

00:38:19.540 --> 00:38:21.640
our our ability to screen

NOTE Confidence: 0.9350973

00:38:21.780 --> 00:38:23.219
breast cancer, which results in

NOTE Confidence: 0.9350973

00:38:23.219 --> 00:38:25.080
an earlier stage at diagnosis,

NOTE Confidence: 0.98293847

00:38:25.780 --> 00:38:26.760
and then also,

NOTE Confidence: 0.9993436

00:38:27.460 --> 00:38:27.960
amazing

NOTE Confidence: 0.99957293

00:38:28.260 --> 00:38:28.760
advancements

NOTE Confidence: 0.98442024

00:38:29.060 --> 00:38:30.820
in treating breast cancer. And

NOTE Confidence: 0.98442024

00:38:30.820 --> 00:38:32.260
so those together have really

NOTE Confidence: 0.98442024

00:38:32.260 --> 00:38:32.685
helped,

NOTE Confidence: 0.9976633

00:38:33.645 --> 00:38:35.825
reduce breast cancer mortality rates.

NOTE Confidence: 0.9995749

00:38:36.445 --> 00:38:37.965
But what about preventing breast

NOTE Confidence: 0.9995749

00:38:37.965 --> 00:38:38.465
cancer

NOTE Confidence: 0.9732616

00:38:38.925 --> 00:38:40.125
outright so that,

NOTE Confidence: 0.9956876

00:38:41.085 --> 00:38:42.045
we don't have to deal

NOTE Confidence: 0.9956876

00:38:42.045 --> 00:38:42.864
with treatment?

NOTE Confidence: 0.9919646

00:38:43.325 --> 00:38:44.205
So I know this is

NOTE Confidence: 0.9919646

00:38:44.205 --> 00:38:45.485
a busy slide, but it

NOTE Confidence: 0.9919646

00:38:45.485 --> 00:38:47.080
highlights many of the risk

NOTE Confidence: 0.9919646

00:38:47.080 --> 00:38:49.160
factors for breast cancer. And

NOTE Confidence: 0.9919646

00:38:49.160 --> 00:38:50.119
if you look sort of

NOTE Confidence: 0.9919646

00:38:50.119 --> 00:38:51.400
at the top going to

NOTE Confidence: 0.9919646

00:38:51.400 --> 00:38:51.900
the

NOTE Confidence: 0.99266434

00:38:52.359 --> 00:38:52.859
clockwise,

NOTE Confidence: 0.9995914

00:38:53.880 --> 00:38:54.940
in purple

NOTE Confidence: 0.9859941

00:38:55.640 --> 00:38:57.739
are, the non modifiable

NOTE Confidence: 0.9444016

00:38:58.280 --> 00:38:59.180
risk factors.

NOTE Confidence: 0.8846068

00:38:59.480 --> 00:38:59.980
And,

NOTE Confidence: 0.87023425

00:39:00.414 --> 00:39:02.035
Doctor Battaglia mentioned,

NOTE Confidence: 0.92859507

00:39:02.734 --> 00:39:03.234
germline

NOTE Confidence: 0.9410038

00:39:03.614 --> 00:39:04.114
mutations.

NOTE Confidence: 0.9898074

00:39:05.135 --> 00:39:06.575
And while those aren't sort

NOTE Confidence: 0.9898074

00:39:06.575 --> 00:39:08.015
of modifiable, there are ways

NOTE Confidence: 0.9898074

00:39:08.015 --> 00:39:08.835
that we can,

NOTE Confidence: 0.9987115

00:39:10.094 --> 00:39:11.375
be aware from them and

NOTE Confidence: 0.9987115

00:39:11.375 --> 00:39:13.135
change our screening guidelines. And

NOTE Confidence: 0.9987115

00:39:13.135 --> 00:39:14.755
then the other non modifiable

NOTE Confidence: 0.98226583

00:39:15.135 --> 00:39:17.190
are female sex, older age,

NOTE Confidence: 0.95155066

00:39:17.570 --> 00:39:19.010
certain race and ethnic groups

NOTE Confidence: 0.95155066

00:39:19.010 --> 00:39:20.130
have a higher risk of

NOTE Confidence: 0.95155066

00:39:20.130 --> 00:39:20.870
breast cancer,

NOTE Confidence: 0.997565

00:39:21.570 --> 00:39:22.550
family history,

NOTE Confidence: 0.9302504

00:39:23.170 --> 00:39:24.850
breast density, previous history of

NOTE Confidence: 0.9302504

00:39:24.850 --> 00:39:26.050
breast cancer and age at

NOTE Confidence: 0.9302504

00:39:26.050 --> 00:39:26.550
menarche,

NOTE Confidence: 0.92158306

00:39:27.410 --> 00:39:28.530
or a first period, and

NOTE Confidence: 0.92158306

00:39:28.530 --> 00:39:29.830
then age at menopause.

NOTE Confidence: 0.9400071

00:39:30.555 --> 00:39:32.714
The green factors on sort

NOTE Confidence: 0.9400071

00:39:32.714 --> 00:39:34.555
of from the six P

NOTE Confidence: 0.9400071

00:39:34.555 --> 00:39:35.675
at the bottom to the

NOTE Confidence: 0.9400071

00:39:35.675 --> 00:39:37.135
top of the circle are

NOTE Confidence: 0.9400071

00:39:37.275 --> 00:39:39.135
what we call modifiable factors.

NOTE Confidence: 0.9980985

00:39:39.435 --> 00:39:41.214
And these are primarily related

NOTE Confidence: 0.9980985

00:39:41.355 --> 00:39:42.974
to lifestyle behaviors.

NOTE Confidence: 0.9991331

00:39:43.790 --> 00:39:45.410
So our body composition

NOTE Confidence: 0.9917886

00:39:45.710 --> 00:39:47.710
or, whether we're overweight or

NOTE Confidence: 0.9917886

00:39:47.710 --> 00:39:48.210
obese,

NOTE Confidence: 0.9992821

00:39:48.910 --> 00:39:49.890
physical activity,

NOTE Confidence: 0.8290197

00:39:50.270 --> 00:39:51.489
diet and alcohol,

NOTE Confidence: 0.9437647

00:39:51.869 --> 00:39:53.489
as well as oral contraceptive,

NOTE Confidence: 0.9778184

00:39:53.869 --> 00:39:55.950
contraceptives and hormone replacement therapy

NOTE Confidence: 0.9778184

00:39:55.950 --> 00:39:56.690
in the postmenopausal

NOTE Confidence: 0.9987917

00:39:57.070 --> 00:39:58.635
years. So I'm gonna focus

NOTE Confidence: 0.9987917

00:39:58.635 --> 00:40:00.415
on those for the remainder

NOTE Confidence: 0.9987917

00:40:00.555 --> 00:40:01.375
of the talk.

NOTE Confidence: 0.994598

00:40:04.075 --> 00:40:06.094
Unfortunately, over the past three

NOTE Confidence: 0.994598

00:40:06.155 --> 00:40:07.935
decades, we've seen a significant

NOTE Confidence: 0.994598

00:40:08.155 --> 00:40:09.755
increase in the prevalence of

NOTE Confidence: 0.994598

00:40:09.755 --> 00:40:11.515
obesity, not only in the

NOTE Confidence: 0.994598

00:40:11.515 --> 00:40:13.570
US but globally. In fact,

NOTE Confidence: 0.994598

00:40:13.630 --> 00:40:14.530
every country

NOTE Confidence: 0.99724704

00:40:15.150 --> 00:40:17.070
across the globe has seen

NOTE Confidence: 0.99724704

00:40:17.070 --> 00:40:18.930
increased rates of obesity.

NOTE Confidence: 0.97325593

00:40:19.310 --> 00:40:20.670
Obesity is defined as a

NOTE Confidence: 0.97325593

00:40:20.670 --> 00:40:22.510
body mass index of thirty

NOTE Confidence: 0.97325593

00:40:22.510 --> 00:40:23.950
or greater and body mass

NOTE Confidence: 0.97325593

00:40:23.950 --> 00:40:25.810
index is basically our weight

NOTE Confidence: 0.99070555

00:40:26.195 --> 00:40:28.114
adjusted for height. It's an

NOTE Confidence: 0.99070555

00:40:28.114 --> 00:40:29.955
imperfect measure because it does

NOTE Confidence: 0.99070555

00:40:29.955 --> 00:40:31.475
not take into consideration the

NOTE Confidence: 0.99070555

00:40:31.475 --> 00:40:32.675
amount of muscle you have

NOTE Confidence: 0.99070555

00:40:32.675 --> 00:40:34.195
versus adiposity. And we know

NOTE Confidence: 0.99070555

00:40:34.195 --> 00:40:35.015
muscle weighs

NOTE Confidence: 0.98427373

00:40:35.315 --> 00:40:37.155
more than body fat, but

NOTE Confidence: 0.98427373

00:40:37.155 --> 00:40:38.755
on a population level, it's

NOTE Confidence: 0.98427373

00:40:38.755 --> 00:40:40.055
a pretty good indicator.

NOTE Confidence: 0.98937505

00:40:40.435 --> 00:40:42.170
And what's concerning is seeing

NOTE Confidence: 0.98937505

00:40:42.170 --> 00:40:42.670
that,

NOTE Confidence: 0.90800726

00:40:43.050 --> 00:40:44.489
back in the seventies rates

NOTE Confidence: 0.90800726

00:40:44.489 --> 00:40:45.230
of obesity

NOTE Confidence: 0.9358297

00:40:45.690 --> 00:40:47.930
were, in women's seventeen percent

NOTE Confidence: 0.9358297

00:40:47.930 --> 00:40:49.290
and now they're up to

NOTE Confidence: 0.9358297

00:40:49.290 --> 00:40:50.510
forty two percent.

NOTE Confidence: 0.967298

00:40:51.210 --> 00:40:52.650
And during this same time

NOTE Confidence: 0.967298

00:40:52.650 --> 00:40:53.850
period over the last thirty

NOTE Confidence: 0.967298

00:40:53.850 --> 00:40:54.730
or forty years, we've seen

NOTE Confidence: 0.967298

00:40:54.730 --> 00:40:56.110
a significant reduction

NOTE Confidence: 0.96972775

00:40:56.545 --> 00:40:58.165
in physical activity levels.

NOTE Confidence: 0.9882436

00:40:58.465 --> 00:40:59.985
And much of this is

NOTE Confidence: 0.9882436

00:40:59.985 --> 00:41:01.905
because of technological advances. We

NOTE Confidence: 0.9882436

00:41:01.905 --> 00:41:03.105
can do our work from

NOTE Confidence: 0.9882436

00:41:03.105 --> 00:41:04.485
home, from a laptop,

NOTE Confidence: 0.9982744

00:41:04.864 --> 00:41:06.225
even from an iPhone. So

NOTE Confidence: 0.9982744

00:41:06.225 --> 00:41:07.825
this has created a society

NOTE Confidence: 0.9982744

00:41:07.825 --> 00:41:08.805
that is very

NOTE Confidence: 0.9796849

00:41:09.309 --> 00:41:09.809
sedentary.

NOTE Confidence: 0.9966688

00:41:10.109 --> 00:41:11.150
So it's not so much

NOTE Confidence: 0.9966688

00:41:11.150 --> 00:41:12.690
about doing exercise,

NOTE Confidence: 0.97472584

00:41:13.069 --> 00:41:14.430
but are we sitting too

NOTE Confidence: 0.97472584

00:41:14.430 --> 00:41:15.549
much and how to reduce

NOTE Confidence: 0.97472584

00:41:15.549 --> 00:41:16.609
our sitting time?

NOTE Confidence: 0.99209005

00:41:17.069 --> 00:41:18.670
I present these two slides

NOTE Confidence: 0.99209005

00:41:18.670 --> 00:41:19.869
to make the point that

NOTE Confidence: 0.99209005

00:41:19.869 --> 00:41:21.230
this is not something that's

NOTE Confidence: 0.99209005

00:41:21.230 --> 00:41:22.690
happening on an individual

NOTE Confidence: 0.9845432

00:41:22.989 --> 00:41:24.765
level, but on a societal

NOTE Confidence: 0.9845432

00:41:24.985 --> 00:41:26.525
and global level.

NOTE Confidence: 0.9192915

00:41:26.825 --> 00:41:28.364
And therefore, the interventions

NOTE Confidence: 0.99967

00:41:28.905 --> 00:41:29.405
needed

NOTE Confidence: 0.9874115

00:41:29.705 --> 00:41:31.385
to reverse these trends in

NOTE Confidence: 0.9874115

00:41:31.385 --> 00:41:32.685
obesity and inactivity

NOTE Confidence: 0.99700826

00:41:33.305 --> 00:41:34.585
have to be at the

NOTE Confidence: 0.99700826

00:41:34.585 --> 00:41:35.085
environmental,

NOTE Confidence: 0.99028796

00:41:35.625 --> 00:41:37.565
societal, and policy level.

NOTE Confidence: 0.9982886

00:41:40.080 --> 00:41:40.820
And so

NOTE Confidence: 0.9657643

00:41:41.280 --> 00:41:42.800
discussing that, you you may

NOTE Confidence: 0.9657643

00:41:42.800 --> 00:41:44.260
have heard the term obesogenic

NOTE Confidence: 0.9657643

00:41:44.480 --> 00:41:45.680
environment, and this is the

NOTE Confidence: 0.9657643

00:41:45.680 --> 00:41:47.140
fact that we have widespread

NOTE Confidence: 0.9657643

00:41:47.200 --> 00:41:49.120
availability and marketing of high

NOTE Confidence: 0.9657643

00:41:49.120 --> 00:41:50.820
calorie and processed foods.

NOTE Confidence: 0.98223084

00:41:51.200 --> 00:41:52.640
There is recent research showing

NOTE Confidence: 0.98223084

00:41:52.640 --> 00:41:54.160
that more than fifty percent

NOTE Confidence: 0.98223084

00:41:54.160 --> 00:41:55.460
of the foods people

NOTE Confidence: 0.99803776

00:41:55.785 --> 00:41:57.724
consume per day are highly

NOTE Confidence: 0.99803776

00:41:57.785 --> 00:41:59.244
ultra processed foods.

NOTE Confidence: 0.9761179

00:41:59.625 --> 00:42:00.984
This is partly because that's

NOTE Confidence: 0.9761179

00:42:00.984 --> 00:42:02.924
what available everywhere. It's ubiquitous.

NOTE Confidence: 0.97077346

00:42:04.825 --> 00:42:06.265
It's cheaper and it's easier

NOTE Confidence: 0.97077346

00:42:06.265 --> 00:42:08.344
and access is everywhere. So

NOTE Confidence: 0.97077346

00:42:08.344 --> 00:42:09.704
we have limited access to

NOTE Confidence: 0.97077346

00:42:09.704 --> 00:42:10.204
affordable,

NOTE Confidence: 0.99895453

00:42:10.505 --> 00:42:12.480
healthy foods. We also have

NOTE Confidence: 0.99895453

00:42:12.480 --> 00:42:14.239
an urban design that favors

NOTE Confidence: 0.99895453

00:42:14.239 --> 00:42:16.180
cars over walking and biking

NOTE Confidence: 0.96907526

00:42:16.480 --> 00:42:18.320
and work environments with long

NOTE Confidence: 0.96907526

00:42:18.320 --> 00:42:20.719
sedentary or sitting hours. And

NOTE Confidence: 0.96907526

00:42:20.719 --> 00:42:21.620
then lastly,

NOTE Confidence: 0.9861229

00:42:22.160 --> 00:42:23.360
in our free time, we're

NOTE Confidence: 0.9861229

00:42:23.360 --> 00:42:25.280
consumed with social media, which

NOTE Confidence: 0.9861229

00:42:25.280 --> 00:42:27.164
is leading to more sedentary

NOTE Confidence: 0.99592495

00:42:27.545 --> 00:42:28.045
behaviors.

NOTE Confidence: 0.99929136

00:42:30.184 --> 00:42:31.644
So what are the mechanisms

NOTE Confidence: 0.99929136

00:42:31.785 --> 00:42:33.384
of how, some of these

NOTE Confidence: 0.99929136

00:42:33.384 --> 00:42:33.884
modifiable

NOTE Confidence: 0.9785989

00:42:34.184 --> 00:42:36.184
lifestyle factors related to body

NOTE Confidence: 0.9785989

00:42:36.184 --> 00:42:37.644
weight, physical inactivity,

NOTE Confidence: 0.98926735

00:42:38.105 --> 00:42:39.870
poor diet, and alcohol might

NOTE Confidence: 0.9590233

00:42:40.190 --> 00:42:41.810
increase risk for breast cancer.

NOTE Confidence: 0.9912501

00:42:42.110 --> 00:42:43.230
Well, we know that they're

NOTE Confidence: 0.9912501

00:42:43.230 --> 00:42:44.530
primarily through estrogen,

NOTE Confidence: 0.9567726

00:42:45.150 --> 00:42:47.310
inflammation, and metabolic markers such

NOTE Confidence: 0.9567726

00:42:47.310 --> 00:42:48.050
as insulin.

NOTE Confidence: 0.977576

00:42:49.390 --> 00:42:50.350
Delving down a little bit

NOTE Confidence: 0.977576

00:42:50.350 --> 00:42:51.230
deeper, we know in our

NOTE Confidence: 0.977576

00:42:51.230 --> 00:42:51.730
postmenopausal

NOTE Confidence: 0.93856305

00:42:52.190 --> 00:42:53.890
years when women stop producing

NOTE Confidence: 0.93856305

00:42:53.950 --> 00:42:55.650
estrogen via their ovaries,

NOTE Confidence: 0.85072243

00:42:56.005 --> 00:42:56.825
they continued

NOTE Confidence: 0.9904474

00:42:57.125 --> 00:42:58.645
to produce it in their,

NOTE Confidence: 0.87545174

00:42:59.205 --> 00:43:01.224
adipocytes and their body fat.

NOTE Confidence: 0.99744344

00:43:01.765 --> 00:43:02.724
And this is from the

NOTE Confidence: 0.99744344

00:43:02.724 --> 00:43:04.105
conversion of androgens

NOTE Confidence: 0.9921544

00:43:04.405 --> 00:43:06.505
to estrogens via the enzyme

NOTE Confidence: 0.9921544

00:43:06.724 --> 00:43:07.224
aromatase.

NOTE Confidence: 0.99297816

00:43:08.100 --> 00:43:09.300
We know that this is

NOTE Confidence: 0.99297816

00:43:09.300 --> 00:43:11.460
really important because in women

NOTE Confidence: 0.99297816

00:43:11.460 --> 00:43:13.640
who have estrogen receptor positive

NOTE Confidence: 0.99297816

00:43:13.700 --> 00:43:14.440
breast cancers,

NOTE Confidence: 0.8828208

00:43:14.820 --> 00:43:16.340
they're prescribed a standard of

NOTE Confidence: 0.8828208

00:43:16.340 --> 00:43:17.480
care and aromatase

NOTE Confidence: 0.9857335

00:43:17.860 --> 00:43:18.360
inhibitor,

NOTE Confidence: 0.99779505

00:43:18.900 --> 00:43:20.820
which inhibits the conversion of

NOTE Confidence: 0.99779505

00:43:20.820 --> 00:43:21.320
androgens

NOTE Confidence: 0.99797046

00:43:21.860 --> 00:43:22.520
to estrogens.

NOTE Confidence: 0.99519444

00:43:23.195 --> 00:43:24.395
So this is really showing

NOTE Confidence: 0.99519444

00:43:24.395 --> 00:43:26.015
that estrogen is a primary,

NOTE Confidence: 0.99973613

00:43:26.715 --> 00:43:27.215
mechanism

NOTE Confidence: 0.9766225

00:43:27.675 --> 00:43:29.055
that mediates certain

NOTE Confidence: 0.9997524

00:43:29.355 --> 00:43:29.855
modifiable

NOTE Confidence: 0.9994197

00:43:30.155 --> 00:43:32.235
and other factors related to

NOTE Confidence: 0.9994197

00:43:32.235 --> 00:43:32.975
breast cancer.

NOTE Confidence: 0.9648917

00:43:33.435 --> 00:43:34.955
So research on trying to

NOTE Confidence: 0.9648917

00:43:34.955 --> 00:43:36.895
reduce estrogen levels systemically,

NOTE Confidence: 0.99925125

00:43:37.670 --> 00:43:38.730
as well as reducing

NOTE Confidence: 0.98993987

00:43:39.030 --> 00:43:39.530
inflammation,

NOTE Confidence: 0.990879

00:43:40.710 --> 00:43:42.390
and insulin and other metabolic

NOTE Confidence: 0.990879

00:43:42.390 --> 00:43:42.890
markers

NOTE Confidence: 0.9631665

00:43:43.350 --> 00:43:43.989
is really,

NOTE Confidence: 0.9996929

00:43:44.710 --> 00:43:46.469
important to better understand the

NOTE Confidence: 0.9996929

00:43:46.469 --> 00:43:47.530
right type of intervention

NOTE Confidence: 0.9903581

00:43:47.830 --> 00:43:49.770
for certain types of of

NOTE Confidence: 0.9903581

00:43:49.910 --> 00:43:50.410
people.

NOTE Confidence: 0.9909336

00:43:52.364 --> 00:43:53.825
You've heard a lot recently

NOTE Confidence: 0.9909336

00:43:53.885 --> 00:43:55.985
about alcohol and how alcohol

NOTE Confidence: 0.9909336

00:43:56.045 --> 00:43:58.205
increases breast cancer risk. And

NOTE Confidence: 0.9909336

00:43:58.205 --> 00:43:59.485
the way this works is

NOTE Confidence: 0.9909336

00:43:59.485 --> 00:44:00.785
alcohol or ethanol

NOTE Confidence: 0.9695387

00:44:01.325 --> 00:44:02.765
can, when we drink it,

NOTE Confidence: 0.9695387

00:44:02.765 --> 00:44:03.885
it's more of a focus

NOTE Confidence: 0.9695387

00:44:03.885 --> 00:44:05.585
on there's a dose response

NOTE Confidence: 0.9695387

00:44:05.725 --> 00:44:07.165
effect here. So one drink

NOTE Confidence: 0.9695387

00:44:07.165 --> 00:44:09.290
might be okay and not

NOTE Confidence: 0.9695387

00:44:09.350 --> 00:44:10.390
much of a risk, maybe

NOTE Confidence: 0.9695387

00:44:10.390 --> 00:44:12.230
a a lifetime five percent

NOTE Confidence: 0.9695387

00:44:12.230 --> 00:44:13.510
higher risk, but it's if

NOTE Confidence: 0.9695387

00:44:13.510 --> 00:44:14.630
you have two or three

NOTE Confidence: 0.9695387

00:44:14.630 --> 00:44:15.989
or four in a day.

NOTE Confidence: 0.9695387

00:44:15.989 --> 00:44:17.510
That's where your risk of

NOTE Confidence: 0.9695387

00:44:17.510 --> 00:44:19.290
breast cancer really increases.

NOTE Confidence: 0.99675465

00:44:19.925 --> 00:44:20.905
And that's through,

NOTE Confidence: 0.9882833

00:44:21.364 --> 00:44:23.445
how alcohol or ethanol is,

NOTE Confidence: 0.9882833

00:44:23.765 --> 00:44:25.065
converted in the enzyme,

NOTE Confidence: 0.98122585

00:44:25.925 --> 00:44:27.765
that of ADH that then

NOTE Confidence: 0.98122585

00:44:27.765 --> 00:44:28.825
leads to,

NOTE Confidence: 0.999217

00:44:29.364 --> 00:44:30.984
a chemical that can cause

NOTE Confidence: 0.999217

00:44:31.205 --> 00:44:32.344
chromosome rearrangement

NOTE Confidence: 0.9991711

00:44:32.645 --> 00:44:34.344
and mistakes in our DNA.

NOTE Confidence: 0.9819976

00:44:35.130 --> 00:44:35.630
So,

NOTE Confidence: 0.9320676

00:44:36.329 --> 00:44:37.930
prudent, you know, wanna be

NOTE Confidence: 0.9320676

00:44:37.930 --> 00:44:39.950
modest with our alcohol intake.

NOTE Confidence: 0.99120444

00:44:41.450 --> 00:44:42.489
So I wanna go back

NOTE Confidence: 0.99120444

00:44:42.489 --> 00:44:43.950
to talking about the lifestyle,

NOTE Confidence: 0.98320353

00:44:44.969 --> 00:44:46.430
these factors in the environment.

NOTE Confidence: 0.98320353

00:44:46.489 --> 00:44:47.609
We know that lifestyle risk

NOTE Confidence: 0.98320353

00:44:47.609 --> 00:44:48.890
factors are shaped by the

NOTE Confidence: 0.98320353

00:44:48.890 --> 00:44:50.505
environments we live in and

NOTE Confidence: 0.98320353

00:44:50.505 --> 00:44:52.025
that our lifestyle choices are

NOTE Confidence: 0.98320353

00:44:52.025 --> 00:44:54.105
strongly influenced by the environments,

NOTE Confidence: 0.98320353

00:44:54.105 --> 00:44:55.484
the policies and systems,

NOTE Confidence: 0.91626936

00:44:56.025 --> 00:44:57.704
and that our environments often

NOTE Confidence: 0.91626936

00:44:57.704 --> 00:44:59.805
promote unhealthy eating and sedentary

NOTE Confidence: 0.91626936

00:44:59.864 --> 00:45:01.864
behavior, and that access to

NOTE Confidence: 0.91626936

00:45:01.864 --> 00:45:02.864
places to exercise affordable, healthy

NOTE Confidence: 0.91626936

00:45:02.864 --> 00:45:03.065
food and supportive policies are

NOTE Confidence: 0.91626936

00:45:03.065 --> 00:45:03.815
key to

NOTE Confidence: 0.88387704

00:45:04.469 --> 00:45:06.070
food and supportive policies are

NOTE Confidence: 0.88387704

00:45:06.070 --> 00:45:07.050
key to prevention.

NOTE Confidence: 0.96429944

00:45:07.590 --> 00:45:09.030
And I wanna dig deeper

NOTE Confidence: 0.96429944

00:45:09.030 --> 00:45:10.330
on the the sort of

NOTE Confidence: 0.96429944

00:45:10.550 --> 00:45:11.050
reducing

NOTE Confidence: 0.9969271

00:45:11.350 --> 00:45:12.650
sedentary behavior

NOTE Confidence: 0.9970836

00:45:13.430 --> 00:45:14.869
and making sure you understand

NOTE Confidence: 0.9970836

00:45:14.869 --> 00:45:16.630
the importance of this. This

NOTE Confidence: 0.9970836

00:45:16.630 --> 00:45:18.070
figure here is based on

NOTE Confidence: 0.9970836

00:45:18.070 --> 00:45:18.570
hundreds

NOTE Confidence: 0.98469305

00:45:19.635 --> 00:45:20.455
of prospective

NOTE Confidence: 0.9638175

00:45:20.915 --> 00:45:21.895
cohort studies

NOTE Confidence: 0.92513245

00:45:22.195 --> 00:45:24.275
that have enrolled individuals, let's

NOTE Confidence: 0.92513245

00:45:24.275 --> 00:45:25.975
say at around age forty

NOTE Confidence: 0.92513245

00:45:26.275 --> 00:45:27.875
or thirty or twenty and

NOTE Confidence: 0.92513245

00:45:27.875 --> 00:45:29.715
followed them to fifty, sixty,

NOTE Confidence: 0.92513245

00:45:29.715 --> 00:45:30.835
seventy, eighty years of age

NOTE Confidence: 0.92513245

00:45:30.835 --> 00:45:32.455
one and looked at mortality

NOTE Confidence: 0.94280624

00:45:33.075 --> 00:45:33.975
as the outcome.

NOTE Confidence: 0.9821318

00:45:34.320 --> 00:45:34.820
Cancer,

NOTE Confidence: 0.9727258

00:45:35.360 --> 00:45:36.739
mortality, as well as cardiovascular

NOTE Confidence: 0.9727258

00:45:36.880 --> 00:45:37.380
mortality.

NOTE Confidence: 0.96484756

00:45:37.840 --> 00:45:39.120
And what's really important to

NOTE Confidence: 0.96484756

00:45:39.120 --> 00:45:41.040
recognize in this figure is

NOTE Confidence: 0.96484756

00:45:41.040 --> 00:45:43.360
this drop that going from

NOTE Confidence: 0.96484756

00:45:43.360 --> 00:45:45.200
nothing, being very sedentary to

NOTE Confidence: 0.96484756

00:45:45.200 --> 00:45:46.594
just doing something

NOTE Confidence: 0.9555353

00:45:46.974 --> 00:45:48.035
is where you see

NOTE Confidence: 0.9181227

00:45:49.215 --> 00:45:50.255
the most bang for your

NOTE Confidence: 0.9181227

00:45:50.255 --> 00:45:51.075
buck, the biggest,

NOTE Confidence: 0.9988682

00:45:51.855 --> 00:45:52.355
reduction

NOTE Confidence: 0.96218294

00:45:52.815 --> 00:45:54.655
in breast cancer risk or

NOTE Confidence: 0.96218294

00:45:54.655 --> 00:45:55.155
mortality,

NOTE Confidence: 0.99668527

00:45:56.494 --> 00:45:58.255
implying that just doing something

NOTE Confidence: 0.99668527

00:45:58.255 --> 00:46:00.039
is better than nothing. It

NOTE Confidence: 0.99668527

00:46:00.039 --> 00:46:01.319
doesn't have to be training

NOTE Confidence: 0.99668527

00:46:01.319 --> 00:46:02.219
for a marathon.

NOTE Confidence: 0.96023107

00:46:03.079 --> 00:46:04.680
The goal, the recommended amount

NOTE Confidence: 0.96023107

00:46:04.680 --> 00:46:05.400
is two and a half

NOTE Confidence: 0.96023107

00:46:05.400 --> 00:46:06.839
hours per week of of

NOTE Confidence: 0.96023107

00:46:06.839 --> 00:46:08.839
moderate intensity, such as brisk

NOTE Confidence: 0.96023107

00:46:08.839 --> 00:46:10.359
walking, but it's really important

NOTE Confidence: 0.96023107

00:46:10.359 --> 00:46:11.719
that the research has shown

NOTE Confidence: 0.96023107

00:46:11.719 --> 00:46:13.420
that really just doing something

NOTE Confidence: 0.96023107

00:46:13.480 --> 00:46:14.380
can be beneficial.

NOTE Confidence: 0.99821204

00:46:15.494 --> 00:46:17.174
This same figure comes up

NOTE Confidence: 0.99821204

00:46:17.174 --> 00:46:17.994
time and again

NOTE Confidence: 0.95358026

00:46:18.295 --> 00:46:20.154
in studies looking at walking.

NOTE Confidence: 0.9400374

00:46:20.855 --> 00:46:22.234
And these are from pedometers

NOTE Confidence: 0.9400374

00:46:22.454 --> 00:46:23.815
from iPhones. When you look

NOTE Confidence: 0.9400374

00:46:23.815 --> 00:46:24.934
at how much steps you've

NOTE Confidence: 0.9400374

00:46:24.934 --> 00:46:25.994
taken or Fitbits

NOTE Confidence: 0.96021384

00:46:26.454 --> 00:46:27.974
showing once again a similar

NOTE Confidence: 0.96021384

00:46:27.974 --> 00:46:29.280
curve that going from very

NOTE Confidence: 0.96021384

00:46:29.280 --> 00:46:30.800
little walking less than a

NOTE Confidence: 0.96021384

00:46:30.800 --> 00:46:32.000
thousand steps per day, which

NOTE Confidence: 0.96021384

00:46:32.000 --> 00:46:33.280
is only a half a

NOTE Confidence: 0.96021384

00:46:33.280 --> 00:46:34.820
mile in all of our

NOTE Confidence: 0.97987616

00:46:35.120 --> 00:46:36.480
steps per day, not in

NOTE Confidence: 0.97987616

00:46:36.480 --> 00:46:37.600
kind of going for a

NOTE Confidence: 0.97987616

00:46:37.600 --> 00:46:38.880
walk, but from when you

NOTE Confidence: 0.97987616

00:46:38.880 --> 00:46:39.840
wait till you go to

NOTE Confidence: 0.97987616

00:46:39.840 --> 00:46:41.614
bed at night. So going

NOTE Confidence: 0.97987616

00:46:41.614 --> 00:46:42.515
from a thousand

NOTE Confidence: 0.9643311

00:46:42.895 --> 00:46:44.175
and trying to increase it

NOTE Confidence: 0.9643311

00:46:44.175 --> 00:46:45.614
a thousand steps per day

NOTE Confidence: 0.9643311

00:46:45.614 --> 00:46:46.355
or more,

NOTE Confidence: 0.99901754

00:46:46.815 --> 00:46:47.795
has a significant

NOTE Confidence: 0.9902764

00:46:48.094 --> 00:46:49.555
reduction in risk for

NOTE Confidence: 0.96832156

00:46:50.015 --> 00:46:51.295
all cause mortality, as well

NOTE Confidence: 0.96832156

00:46:51.295 --> 00:46:52.675
as breast cancer mortality.

NOTE Confidence: 0.9805592

00:46:53.500 --> 00:46:55.180
Two thousand steps per day

NOTE Confidence: 0.9805592

00:46:55.180 --> 00:46:56.640
is equivalent to a mile.

NOTE Confidence: 0.9665921

00:46:56.940 --> 00:46:58.060
So if you can kinda

NOTE Confidence: 0.9665921

00:46:58.060 --> 00:46:59.820
think about increasing five hundred

NOTE Confidence: 0.9665921

00:46:59.820 --> 00:47:01.020
or a thousand steps per

NOTE Confidence: 0.9665921

00:47:01.020 --> 00:47:02.620
day throughout your day, then

NOTE Confidence: 0.9665921

00:47:02.620 --> 00:47:03.980
that's gonna really help lower

NOTE Confidence: 0.9665921

00:47:03.980 --> 00:47:04.719
your risk.

NOTE Confidence: 0.9991598

00:47:05.955 --> 00:47:07.895
What about the dietary guidelines?

NOTE Confidence: 0.95432657

00:47:08.355 --> 00:47:09.155
There are a number of

NOTE Confidence: 0.95432657

00:47:09.155 --> 00:47:10.675
guidelines that are listed on

NOTE Confidence: 0.95432657

00:47:10.675 --> 00:47:12.055
the left here, but overall,

NOTE Confidence: 0.99641997

00:47:12.755 --> 00:47:14.515
what's recommended is a,

NOTE Confidence: 0.95245326

00:47:15.155 --> 00:47:15.815
a plant,

NOTE Confidence: 0.99971116

00:47:16.515 --> 00:47:17.655
based diet

NOTE Confidence: 0.9950412

00:47:18.060 --> 00:47:18.560
where,

NOTE Confidence: 0.98042774

00:47:19.660 --> 00:47:21.500
animal products are are maybe

NOTE Confidence: 0.98042774

00:47:21.500 --> 00:47:22.940
one third of what we

NOTE Confidence: 0.98042774

00:47:22.940 --> 00:47:24.400
eat in a a day.

NOTE Confidence: 0.967717

00:47:24.860 --> 00:47:26.140
We really wanna focus on

NOTE Confidence: 0.967717

00:47:26.140 --> 00:47:27.680
increasing our fruits and vegetables

NOTE Confidence: 0.967717

00:47:27.739 --> 00:47:29.100
in our fiber, which is

NOTE Confidence: 0.967717

00:47:29.100 --> 00:47:30.719
in our fruits and vegetables.

NOTE Confidence: 0.9683822

00:47:32.195 --> 00:47:33.315
So we now have a

NOTE Confidence: 0.9683822

00:47:33.315 --> 00:47:34.515
really good food label, as

NOTE Confidence: 0.9683822

00:47:34.515 --> 00:47:35.235
you can see on the

NOTE Confidence: 0.9683822

00:47:35.235 --> 00:47:36.515
right, that tells you how

NOTE Confidence: 0.9683822

00:47:36.515 --> 00:47:38.275
much grams of fiber you

NOTE Confidence: 0.9683822

00:47:38.275 --> 00:47:39.635
get in various foods, as

NOTE Confidence: 0.9683822

00:47:39.635 --> 00:47:40.755
well as how much added

NOTE Confidence: 0.9683822

00:47:40.755 --> 00:47:42.035
sugar, that's new to the

NOTE Confidence: 0.9683822

00:47:42.035 --> 00:47:43.395
food labels. And that was

NOTE Confidence: 0.9683822

00:47:43.395 --> 00:47:44.614
a significant

NOTE Confidence: 0.96080196

00:47:44.915 --> 00:47:46.515
FDA policy change that came

NOTE Confidence: 0.96080196

00:47:46.515 --> 00:47:47.395
out just a couple of

NOTE Confidence: 0.96080196

00:47:47.395 --> 00:47:49.690
years ago, requiring that added

NOTE Confidence: 0.96080196

00:47:49.690 --> 00:47:51.469
sugars be pulled out on

NOTE Confidence: 0.96080196

00:47:51.690 --> 00:47:53.210
the full food label, because

NOTE Confidence: 0.96080196

00:47:53.210 --> 00:47:54.810
it was very confusing to

NOTE Confidence: 0.96080196

00:47:54.810 --> 00:47:55.310
consumers.

NOTE Confidence: 0.9942385

00:47:55.850 --> 00:47:57.050
For example, if you're drinking

NOTE Confidence: 0.9942385

00:47:57.050 --> 00:47:58.489
orange juice and it shows

NOTE Confidence: 0.9942385

00:47:58.489 --> 00:47:59.469
a lot of sugars,

NOTE Confidence: 0.99456686

00:47:59.930 --> 00:48:01.335
but, it might be that

NOTE Confidence: 0.99456686

00:48:01.335 --> 00:48:03.255
that's not added sugars to

NOTE Confidence: 0.99456686

00:48:03.255 --> 00:48:04.775
the orange juice. So more

NOTE Confidence: 0.99456686

00:48:04.775 --> 00:48:05.815
important to look at the

NOTE Confidence: 0.99456686

00:48:05.815 --> 00:48:07.094
amount of added sugars on

NOTE Confidence: 0.99456686

00:48:07.094 --> 00:48:08.535
the food label than than

NOTE Confidence: 0.99456686

00:48:08.535 --> 00:48:09.755
the overall sugars.

NOTE Confidence: 0.9854741

00:48:10.614 --> 00:48:12.775
We wanna, maintain or increase

NOTE Confidence: 0.9854741

00:48:12.775 --> 00:48:13.975
our protein per day to

NOTE Confidence: 0.9854741

00:48:13.975 --> 00:48:15.175
about one point two grams

NOTE Confidence: 0.9854741

00:48:15.175 --> 00:48:15.915
per kilograms.

NOTE Confidence: 0.988178

00:48:17.440 --> 00:48:19.440
Generally, most people eat plenty

NOTE Confidence: 0.988178

00:48:19.440 --> 00:48:21.060
of protein in their diet,

NOTE Confidence: 0.988178

00:48:21.200 --> 00:48:22.480
even though there seems to

NOTE Confidence: 0.988178

00:48:22.480 --> 00:48:23.700
be a lot of advertising

NOTE Confidence: 0.988178

00:48:23.840 --> 00:48:24.960
out there to get more

NOTE Confidence: 0.988178

00:48:24.960 --> 00:48:26.800
protein, but most people eat

NOTE Confidence: 0.988178

00:48:26.800 --> 00:48:27.700
plenty of protein.

NOTE Confidence: 0.9723545

00:48:28.080 --> 00:48:29.200
And in thinking about the

NOTE Confidence: 0.9723545

00:48:29.200 --> 00:48:30.400
type of protein you get,

NOTE Confidence: 0.9723545

00:48:30.400 --> 00:48:31.700
having it from fish,

NOTE Confidence: 0.96219367

00:48:32.355 --> 00:48:34.195
and and maybe poultry and

NOTE Confidence: 0.96219367

00:48:34.195 --> 00:48:36.855
reducing it from processed meat,

NOTE Confidence: 0.96219367

00:48:36.915 --> 00:48:38.035
which in turn will also

NOTE Confidence: 0.96219367

00:48:38.035 --> 00:48:39.395
reduce your amount of sodium

NOTE Confidence: 0.96219367

00:48:39.395 --> 00:48:40.375
and low saturated

NOTE Confidence: 0.99706626

00:48:41.155 --> 00:48:41.655
fat.

NOTE Confidence: 0.97642833

00:48:44.195 --> 00:48:45.810
What about supplements? So the

NOTE Confidence: 0.97642833

00:48:45.810 --> 00:48:47.650
American Institute for Cancer Research

NOTE Confidence: 0.97642833

00:48:47.650 --> 00:48:48.770
as well as the American

NOTE Confidence: 0.97642833

00:48:48.770 --> 00:48:49.830
Cancer Society,

NOTE Confidence: 0.998067

00:48:50.850 --> 00:48:51.750
and NCI

NOTE Confidence: 0.9845598

00:48:52.370 --> 00:48:53.890
do recommend that you do

NOTE Confidence: 0.9845598

00:48:53.890 --> 00:48:55.489
not rely on supplements for

NOTE Confidence: 0.9845598

00:48:55.489 --> 00:48:56.390
cancer prevention

NOTE Confidence: 0.973445

00:48:56.770 --> 00:48:58.515
and, to reduce your risk

NOTE Confidence: 0.973445

00:48:58.515 --> 00:48:59.555
of cancer, to choose a

NOTE Confidence: 0.973445

00:48:59.555 --> 00:49:00.994
balanced diet with a variety

NOTE Confidence: 0.973445

00:49:00.994 --> 00:49:01.654
of foods.

NOTE Confidence: 0.9975229

00:49:02.434 --> 00:49:04.275
And those diagnosed with breast

NOTE Confidence: 0.9975229

00:49:04.275 --> 00:49:05.795
cancer or any cancer, it

NOTE Confidence: 0.9975229

00:49:05.795 --> 00:49:07.255
is critically important

NOTE Confidence: 0.9997673

00:49:07.635 --> 00:49:09.075
to share the supplements that

NOTE Confidence: 0.9997673

00:49:09.075 --> 00:49:10.775
you're taking with your provider

NOTE Confidence: 0.9994327

00:49:11.310 --> 00:49:12.910
because they could interact with

NOTE Confidence: 0.9994327

00:49:12.910 --> 00:49:14.210
the treatments you're receiving

NOTE Confidence: 0.981784

00:49:14.670 --> 00:49:16.270
and reduce the efficacy of

NOTE Confidence: 0.981784

00:49:16.270 --> 00:49:16.930
the treatments.

NOTE Confidence: 0.9860699

00:49:17.469 --> 00:49:18.910
But guidelines are that you

NOTE Confidence: 0.9860699

00:49:18.910 --> 00:49:20.270
should not rely on supplements

NOTE Confidence: 0.9860699

00:49:20.270 --> 00:49:21.550
for cancer prevention. In fact,

NOTE Confidence: 0.9860699

00:49:21.550 --> 00:49:22.750
it's important to recognize the

NOTE Confidence: 0.9860699

00:49:22.750 --> 00:49:23.650
word supplement.

NOTE Confidence: 0.97920126

00:49:24.030 --> 00:49:25.815
If you are low in

NOTE Confidence: 0.97920126

00:49:25.815 --> 00:49:27.335
that level, it helps to

NOTE Confidence: 0.97920126

00:49:27.335 --> 00:49:28.695
supplement. But if many people

NOTE Confidence: 0.97920126

00:49:28.695 --> 00:49:29.515
are already,

NOTE Confidence: 0.9889578

00:49:30.775 --> 00:49:32.535
getting enough vitamins and minerals

NOTE Confidence: 0.9889578

00:49:32.535 --> 00:49:33.895
from their diet and having

NOTE Confidence: 0.9889578

00:49:33.895 --> 00:49:34.395
additional

NOTE Confidence: 0.9638555

00:49:34.935 --> 00:49:36.295
supplements on top of that

NOTE Confidence: 0.9638555

00:49:36.295 --> 00:49:37.815
is not any added benefit,

NOTE Confidence: 0.9638555

00:49:37.815 --> 00:49:38.695
and in fact, it could

NOTE Confidence: 0.9638555

00:49:38.695 --> 00:49:39.435
be harm.

NOTE Confidence: 0.9324513

00:49:40.940 --> 00:49:41.739
So I just wanted to

NOTE Confidence: 0.9324513

00:49:41.739 --> 00:49:42.619
quickly highlight,

NOTE Confidence: 0.9916888

00:49:43.180 --> 00:49:44.779
where the research some of

NOTE Confidence: 0.9916888

00:49:44.779 --> 00:49:46.219
the studies that we've done

NOTE Confidence: 0.9916888

00:49:46.219 --> 00:49:46.719
of,

NOTE Confidence: 0.83149785

00:49:48.140 --> 00:49:49.440
diet and exercise

NOTE Confidence: 0.98326015

00:49:49.980 --> 00:49:51.599
and weight management interventions

NOTE Confidence: 0.9907971

00:49:51.900 --> 00:49:53.660
and the effect on breast

NOTE Confidence: 0.9907971

00:49:53.660 --> 00:49:55.775
cancer risk and outcomes. This

NOTE Confidence: 0.9907971

00:49:55.775 --> 00:49:57.155
was a trial we completed

NOTE Confidence: 0.9706977

00:49:57.614 --> 00:49:57.935
about,

NOTE Confidence: 0.97276187

00:49:58.415 --> 00:49:59.614
ten years ago now, and

NOTE Confidence: 0.97276187

00:49:59.614 --> 00:50:00.835
it was in postmenopausal

NOTE Confidence: 0.96549255

00:50:01.375 --> 00:50:02.835
women without breast cancer.

NOTE Confidence: 0.9492736

00:50:03.215 --> 00:50:04.435
But it was a forearm

NOTE Confidence: 0.9492736

00:50:04.655 --> 00:50:06.495
randomized trial of diet alone,

NOTE Confidence: 0.97970444

00:50:06.975 --> 00:50:08.335
of all the recommendations I

NOTE Confidence: 0.97970444

00:50:08.335 --> 00:50:08.995
just mentioned,

NOTE Confidence: 0.9933623

00:50:09.295 --> 00:50:10.995
exercise, which was basically

NOTE Confidence: 0.9795171

00:50:11.640 --> 00:50:13.559
brisk walking for two hours

NOTE Confidence: 0.9795171

00:50:13.559 --> 00:50:14.839
per week, and then the

NOTE Confidence: 0.9795171

00:50:14.839 --> 00:50:16.380
combination of diet and exercise.

NOTE Confidence: 0.9795171

00:50:16.520 --> 00:50:17.960
And really the takeaway here

NOTE Confidence: 0.9795171

00:50:17.960 --> 00:50:19.880
is all the negative signs

NOTE Confidence: 0.9795171

00:50:19.880 --> 00:50:21.319
you see in all of

NOTE Confidence: 0.9795171

00:50:21.319 --> 00:50:22.219
these markers,

NOTE Confidence: 0.9717487

00:50:22.520 --> 00:50:24.945
biomarkers related to breast cancer.

NOTE Confidence: 0.9717487

00:50:24.945 --> 00:50:26.145
So higher levels of these

NOTE Confidence: 0.9717487

00:50:26.145 --> 00:50:27.425
increase your risk of breast

NOTE Confidence: 0.9717487

00:50:27.425 --> 00:50:27.925
cancer,

NOTE Confidence: 0.97681

00:50:28.465 --> 00:50:29.525
except for SHBG.

NOTE Confidence: 0.99073845

00:50:30.625 --> 00:50:31.344
And so,

NOTE Confidence: 0.9533817

00:50:31.825 --> 00:50:33.265
these inter the diet and

NOTE Confidence: 0.9533817

00:50:33.265 --> 00:50:35.985
exercise interventions, significant reductions in

NOTE Confidence: 0.9533817

00:50:35.985 --> 00:50:36.485
insulin,

NOTE Confidence: 0.89749736

00:50:37.890 --> 00:50:38.390
in

NOTE Confidence: 0.95262307

00:50:38.690 --> 00:50:40.210
CRP, a marker of chronic

NOTE Confidence: 0.95262307

00:50:40.210 --> 00:50:41.910
inflammation, and in our estrogens.

NOTE Confidence: 0.9549727

00:50:42.450 --> 00:50:43.489
And then the figure on

NOTE Confidence: 0.9549727

00:50:43.489 --> 00:50:45.329
the right shows estrogen levels,

NOTE Confidence: 0.9549727

00:50:45.329 --> 00:50:46.369
which is the most,

NOTE Confidence: 0.80875516

00:50:47.250 --> 00:50:47.750
common,

NOTE Confidence: 0.9917655

00:50:48.690 --> 00:50:49.910
estrogen in postmenopausal

NOTE Confidence: 0.9363885

00:50:50.289 --> 00:50:51.829
women, and you can see,

NOTE Confidence: 0.97316545

00:50:52.565 --> 00:50:54.404
just the significant reduction in

NOTE Confidence: 0.97316545

00:50:54.404 --> 00:50:56.884
estrogen levels with diet, exercise,

NOTE Confidence: 0.97316545

00:50:56.884 --> 00:50:57.704
and the combination

NOTE Confidence: 0.9905394

00:50:58.404 --> 00:50:59.844
of about ten to fifteen

NOTE Confidence: 0.9905394

00:50:59.844 --> 00:51:01.525
percent. And this was within

NOTE Confidence: 0.9905394

00:51:01.525 --> 00:51:03.204
three months of a healthy

NOTE Confidence: 0.9905394

00:51:03.204 --> 00:51:04.904
eating and exercise program.

NOTE Confidence: 0.96984553

00:51:06.609 --> 00:51:08.290
We just completed a trial

NOTE Confidence: 0.96984553

00:51:08.290 --> 00:51:09.969
in women who were receiving

NOTE Confidence: 0.96984553

00:51:09.969 --> 00:51:10.469
chemotherapy

NOTE Confidence: 0.9216192

00:51:10.770 --> 00:51:11.910
for breast cancer,

NOTE Confidence: 0.98191345

00:51:12.450 --> 00:51:13.329
and what we were able

NOTE Confidence: 0.98191345

00:51:13.329 --> 00:51:14.290
to show in working with

NOTE Confidence: 0.98191345

00:51:14.290 --> 00:51:15.510
the registered dietitian,

NOTE Confidence: 0.9705504

00:51:16.290 --> 00:51:17.489
on our team, those who

NOTE Confidence: 0.9705504

00:51:17.489 --> 00:51:19.030
were randomized to receiving

NOTE Confidence: 0.9512163

00:51:19.425 --> 00:51:21.985
receiving counseling of healthy eating

NOTE Confidence: 0.9512163

00:51:21.985 --> 00:51:23.745
and exercise over the year

NOTE Confidence: 0.9512163

00:51:23.745 --> 00:51:25.605
from their diagnosis through chemotherapy.

NOTE Confidence: 0.9291755

00:51:26.065 --> 00:51:27.525
And at one year, we,

NOTE Confidence: 0.9944438

00:51:28.385 --> 00:51:29.665
working with our dietitian, they

NOTE Confidence: 0.9944438

00:51:29.665 --> 00:51:30.785
were able to increase their

NOTE Confidence: 0.9944438

00:51:30.785 --> 00:51:32.165
physical activity levels

NOTE Confidence: 0.97783065

00:51:32.489 --> 00:51:33.050
and the,

NOTE Confidence: 0.989337

00:51:33.610 --> 00:51:35.370
the diet quality, the quality

NOTE Confidence: 0.989337

00:51:35.370 --> 00:51:36.410
of the foods they were

NOTE Confidence: 0.989337

00:51:36.410 --> 00:51:38.030
eating during chemotherapy.

NOTE Confidence: 0.97934705

00:51:38.810 --> 00:51:39.690
And what is,

NOTE Confidence: 0.99947214

00:51:40.170 --> 00:51:42.090
quite remarkable is that this

NOTE Confidence: 0.99947214

00:51:42.090 --> 00:51:42.590
intervention

NOTE Confidence: 0.96610194

00:51:43.290 --> 00:51:44.730
led to a fifty three

NOTE Confidence: 0.96610194

00:51:44.730 --> 00:51:45.230
percent,

NOTE Confidence: 0.9848628

00:51:46.135 --> 00:51:48.615
pathologic complete response rate compared

NOTE Confidence: 0.9848628

00:51:48.615 --> 00:51:50.375
to twenty eight percent in

NOTE Confidence: 0.9848628

00:51:50.375 --> 00:51:52.295
the usual care group. Both

NOTE Confidence: 0.9848628

00:51:52.295 --> 00:51:54.375
groups were receiving chemotherapy, but

NOTE Confidence: 0.9848628

00:51:54.375 --> 00:51:56.235
those that had were randomized

NOTE Confidence: 0.9848628

00:51:56.295 --> 00:51:56.775
to the,

NOTE Confidence: 0.99395174

00:51:57.335 --> 00:51:59.115
exercise and nutrition intervention

NOTE Confidence: 0.9996985

00:51:59.670 --> 00:52:01.530
had less breast cancer

NOTE Confidence: 0.99621207

00:52:01.989 --> 00:52:03.349
at surgery. So this was

NOTE Confidence: 0.99621207

00:52:03.349 --> 00:52:04.630
a group of women receiving

NOTE Confidence: 0.99621207

00:52:04.630 --> 00:52:05.369
new adjuvant

NOTE Confidence: 0.92795455

00:52:05.670 --> 00:52:06.170
chemotherapy

NOTE Confidence: 0.98817325

00:52:07.270 --> 00:52:08.790
and then had surgery. And

NOTE Confidence: 0.98817325

00:52:08.790 --> 00:52:10.069
at the time of surgery,

NOTE Confidence: 0.98817325

00:52:10.069 --> 00:52:11.349
those in the intervention group,

NOTE Confidence: 0.98817325

00:52:11.349 --> 00:52:12.790
there was less evidence of

NOTE Confidence: 0.98817325

00:52:12.790 --> 00:52:13.609
breast cancer.

NOTE Confidence: 0.9883416

00:52:15.285 --> 00:52:16.724
What is the mechanism of

NOTE Confidence: 0.9883416

00:52:16.724 --> 00:52:18.645
that? Well, in this trial

NOTE Confidence: 0.9883416

00:52:18.645 --> 00:52:20.565
also, with women with breast

NOTE Confidence: 0.9883416

00:52:20.565 --> 00:52:21.065
cancer,

NOTE Confidence: 0.94222575

00:52:22.085 --> 00:52:23.525
we showed that really that

NOTE Confidence: 0.94222575

00:52:23.525 --> 00:52:25.204
this intervention led to favorable

NOTE Confidence: 0.94222575

00:52:25.204 --> 00:52:27.125
changes in body composition, but

NOTE Confidence: 0.94222575

00:52:27.125 --> 00:52:27.625
also

NOTE Confidence: 0.9081566

00:52:27.930 --> 00:52:30.329
reduction in c reactive protein,

NOTE Confidence: 0.9081566

00:52:30.329 --> 00:52:31.310
which is inflammation,

NOTE Confidence: 0.9805133

00:52:31.690 --> 00:52:32.750
insulin, and leptin.

NOTE Confidence: 0.9687118

00:52:34.969 --> 00:52:36.489
So I just wanna, touch

NOTE Confidence: 0.9687118

00:52:36.489 --> 00:52:39.290
upon anti obesity medications because,

NOTE Confidence: 0.9687118

00:52:39.609 --> 00:52:41.130
I know that this is,

NOTE Confidence: 0.97432023

00:52:42.035 --> 00:52:43.315
a lot of patients and

NOTE Confidence: 0.97432023

00:52:43.315 --> 00:52:44.915
people, people with and without

NOTE Confidence: 0.97432023

00:52:44.915 --> 00:52:46.835
cancer are very interested in

NOTE Confidence: 0.97432023

00:52:46.835 --> 00:52:48.055
the role of these medications,

NOTE Confidence: 0.97432023

00:52:48.114 --> 00:52:49.815
which are remarkable,

NOTE Confidence: 0.9910668

00:52:50.675 --> 00:52:52.215
really profound in the amount

NOTE Confidence: 0.9910668

00:52:52.355 --> 00:52:54.215
of weight loss and adiposity,

NOTE Confidence: 0.98403275

00:52:55.340 --> 00:52:57.180
loss that occurs with these

NOTE Confidence: 0.98403275

00:52:57.180 --> 00:52:58.480
medications, which are,

NOTE Confidence: 0.9445963

00:52:59.340 --> 00:53:00.860
now sort of called GLP

NOTE Confidence: 0.9445963

00:53:00.860 --> 00:53:01.360
one,

NOTE Confidence: 0.9487881

00:53:01.980 --> 00:53:04.239
glucagon like protein one receptor

NOTE Confidence: 0.9487881

00:53:04.380 --> 00:53:04.880
agonists.

NOTE Confidence: 0.99912757

00:53:05.900 --> 00:53:08.320
There's really limited research

NOTE Confidence: 0.9813668

00:53:08.655 --> 00:53:10.575
on these anti BC medications

NOTE Confidence: 0.9813668

00:53:10.575 --> 00:53:12.415
and breast cancer risk or

NOTE Confidence: 0.9813668

00:53:12.415 --> 00:53:13.935
outcomes among those with breast

NOTE Confidence: 0.9813668

00:53:13.935 --> 00:53:14.435
cancer.

NOTE Confidence: 0.95025736

00:53:14.735 --> 00:53:16.255
It is being conducted now.

NOTE Confidence: 0.95025736

00:53:16.255 --> 00:53:17.935
It's evolving. So in one

NOTE Confidence: 0.95025736

00:53:17.935 --> 00:53:19.535
year and in two, three

NOTE Confidence: 0.95025736

00:53:19.535 --> 00:53:21.295
years, there'll be more research

NOTE Confidence: 0.95025736

00:53:21.295 --> 00:53:22.335
out there. But right now

NOTE Confidence: 0.95025736

00:53:22.335 --> 00:53:23.635
there's very limited

NOTE Confidence: 0.999244

00:53:24.210 --> 00:53:26.290
information about these medications in

NOTE Confidence: 0.999244

00:53:26.290 --> 00:53:27.670
regards to breast cancer.

NOTE Confidence: 0.9807116

00:53:28.290 --> 00:53:29.330
We do know that the,

NOTE Confidence: 0.9807116

00:53:29.890 --> 00:53:31.250
the mechanism is they cause

NOTE Confidence: 0.9807116

00:53:31.250 --> 00:53:32.609
significant weight loss up to

NOTE Confidence: 0.9807116

00:53:32.609 --> 00:53:34.390
about twenty, twenty five percent

NOTE Confidence: 0.88062453

00:53:34.690 --> 00:53:35.190
loss,

NOTE Confidence: 0.97966135

00:53:35.650 --> 00:53:37.594
and metabolic changes such as

NOTE Confidence: 0.97966135

00:53:37.594 --> 00:53:38.875
the ones I just mentioned,

NOTE Confidence: 0.97966135

00:53:38.875 --> 00:53:39.855
all these metabolic

NOTE Confidence: 0.9802575

00:53:40.395 --> 00:53:40.895
markers.

NOTE Confidence: 0.99202275

00:53:42.875 --> 00:53:44.075
Most of the studies that

NOTE Confidence: 0.99202275

00:53:44.075 --> 00:53:45.614
are done are observational,

NOTE Confidence: 0.9591324

00:53:46.635 --> 00:53:48.075
looking at outcomes except for

NOTE Confidence: 0.9591324

00:53:48.075 --> 00:53:49.434
the trials of testing the

NOTE Confidence: 0.9591324

00:53:49.434 --> 00:53:51.090
medication on weight loss. But

NOTE Confidence: 0.9591324

00:53:51.090 --> 00:53:52.850
in regards to cancer, they're

NOTE Confidence: 0.9591324

00:53:52.850 --> 00:53:54.450
observational and so there isn't

NOTE Confidence: 0.9591324

00:53:54.450 --> 00:53:55.670
a cause and effect,

NOTE Confidence: 0.8734665

00:53:56.770 --> 00:53:58.310
relationship yet established.

NOTE Confidence: 0.98819566

00:53:59.250 --> 00:54:01.090
Most important, if you are

NOTE Confidence: 0.98819566

00:54:01.090 --> 00:54:01.590
considering

NOTE Confidence: 0.9952648

00:54:01.890 --> 00:54:02.950
one of these medications,

NOTE Confidence: 0.997561

00:54:03.755 --> 00:54:05.775
discuss it with your provider,

NOTE Confidence: 0.99363375

00:54:06.155 --> 00:54:07.614
especially if you've been diagnosed

NOTE Confidence: 0.99363375

00:54:07.675 --> 00:54:08.655
with cancer.

NOTE Confidence: 0.99543875

00:54:11.915 --> 00:54:13.195
I always get this question.

NOTE Confidence: 0.99543875

00:54:13.195 --> 00:54:14.555
I think it's really important.

NOTE Confidence: 0.9824772

00:54:15.275 --> 00:54:16.875
Many people follow the diet

NOTE Confidence: 0.9824772

00:54:16.875 --> 00:54:18.395
and physical activity guidelines, and

NOTE Confidence: 0.9824772

00:54:18.395 --> 00:54:19.750
they can still develop breast

NOTE Confidence: 0.9824772

00:54:19.750 --> 00:54:21.370
cancer, and it's very frustrating.

NOTE Confidence: 0.9715433

00:54:22.070 --> 00:54:23.030
So it's important to note

NOTE Confidence: 0.9715433

00:54:23.030 --> 00:54:24.870
that a healthy lifestyle lowers

NOTE Confidence: 0.9715433

00:54:24.870 --> 00:54:26.490
risk but does not eliminate

NOTE Confidence: 0.9715433

00:54:26.550 --> 00:54:26.950
it.

NOTE Confidence: 0.99292266

00:54:27.830 --> 00:54:29.110
Whether you like this analogy

NOTE Confidence: 0.99292266

00:54:29.110 --> 00:54:30.150
or not, I think it's

NOTE Confidence: 0.99292266

00:54:30.150 --> 00:54:31.590
simple and can be,

NOTE Confidence: 0.9989664

00:54:31.910 --> 00:54:32.410
helpful.

NOTE Confidence: 0.95576876

00:54:32.825 --> 00:54:33.865
It's like wearing a seat

NOTE Confidence: 0.95576876

00:54:33.865 --> 00:54:35.945
belt, which, lowers your chance

NOTE Confidence: 0.95576876

00:54:35.945 --> 00:54:37.945
of severe injury in a

NOTE Confidence: 0.95576876

00:54:37.945 --> 00:54:38.985
car crash, but it does

NOTE Confidence: 0.95576876

00:54:38.985 --> 00:54:39.885
not guarantee

NOTE Confidence: 0.9304424

00:54:40.185 --> 00:54:41.785
safety, but it lowers your

NOTE Confidence: 0.9304424

00:54:41.785 --> 00:54:42.285
risk.

NOTE Confidence: 0.99763477

00:54:42.585 --> 00:54:43.405
Much like

NOTE Confidence: 0.940294

00:54:43.705 --> 00:54:44.765
screening and,

NOTE Confidence: 0.98837537

00:54:45.305 --> 00:54:47.305
leads to earlier detection and

NOTE Confidence: 0.98837537

00:54:47.305 --> 00:54:47.805
practicing,

NOTE Confidence: 0.97517955

00:54:48.880 --> 00:54:50.080
you know, changing some of

NOTE Confidence: 0.97517955

00:54:50.080 --> 00:54:52.080
the modifiable risk factors, it

NOTE Confidence: 0.97517955

00:54:52.080 --> 00:54:53.219
lowers your risk.

NOTE Confidence: 0.9867704

00:54:53.680 --> 00:54:55.760
But most importantly, breast cancer

NOTE Confidence: 0.9867704

00:54:55.760 --> 00:54:57.360
is influenced by a mix

NOTE Confidence: 0.9867704

00:54:57.360 --> 00:54:58.820
of factors that are genetic,

NOTE Confidence: 0.9867704

00:54:58.880 --> 00:54:59.380
reproductive

NOTE Confidence: 0.98672837

00:54:59.680 --> 00:55:01.219
history, hormones, environment,

NOTE Confidence: 0.9676895

00:55:01.600 --> 00:55:02.864
and chance.

NOTE Confidence: 0.9903571

00:55:03.405 --> 00:55:05.085
And that for women already

NOTE Confidence: 0.9903571

00:55:05.085 --> 00:55:05.585
diagnosed,

NOTE Confidence: 0.9941482

00:55:06.125 --> 00:55:08.625
these modifiable factors might also

NOTE Confidence: 0.9941482

00:55:08.685 --> 00:55:10.925
improve treatment tolerance, reduce recurrence

NOTE Confidence: 0.9941482

00:55:10.925 --> 00:55:12.685
risk, and improve outcomes. So

NOTE Confidence: 0.9941482

00:55:12.685 --> 00:55:14.065
even if you've been practicing

NOTE Confidence: 0.9941482

00:55:14.125 --> 00:55:15.485
these healthy behaviors and you're

NOTE Confidence: 0.9941482

00:55:15.485 --> 00:55:17.425
still diagnosed with breast cancer,

NOTE Confidence: 0.99969876

00:55:18.010 --> 00:55:18.510
maintaining

NOTE Confidence: 0.9990896

00:55:19.050 --> 00:55:21.130
a healthy diet and exercise

NOTE Confidence: 0.9990896

00:55:21.130 --> 00:55:22.830
can help with your prognosis.

NOTE Confidence: 0.98381513

00:55:25.050 --> 00:55:26.489
Okay. I think my last

NOTE Confidence: 0.98381513

00:55:26.489 --> 00:55:27.690
slide here, I just wanna

NOTE Confidence: 0.98381513

00:55:27.690 --> 00:55:28.830
touch upon postmenopausal

NOTE Confidence: 0.98248744

00:55:29.290 --> 00:55:30.970
hormone replacement therapy because there's

NOTE Confidence: 0.98248744

00:55:30.970 --> 00:55:31.950
been a lot

NOTE Confidence: 0.9426306

00:55:33.215 --> 00:55:35.055
of information on this, especially

NOTE Confidence: 0.9426306

00:55:35.055 --> 00:55:36.655
on social media, and it

NOTE Confidence: 0.9426306

00:55:36.655 --> 00:55:38.114
can get very confusing

NOTE Confidence: 0.9907527

00:55:38.735 --> 00:55:39.475
to individuals.

NOTE Confidence: 0.9873455

00:55:40.735 --> 00:55:42.175
HRT, as you might know,

NOTE Confidence: 0.9873455

00:55:42.175 --> 00:55:44.655
replaces estrogen and progesterone hormones

NOTE Confidence: 0.9873455

00:55:44.655 --> 00:55:46.515
that decline during menopause.

NOTE Confidence: 0.99906474

00:55:47.369 --> 00:55:48.190
And HRT

NOTE Confidence: 0.99583805

00:55:48.650 --> 00:55:50.890
reduces menopausal symptoms and also

NOTE Confidence: 0.99583805

00:55:50.890 --> 00:55:52.349
protects against osteoporosis.

NOTE Confidence: 0.96165246

00:55:53.849 --> 00:55:56.009
Breast cancer risk increases with

NOTE Confidence: 0.96165246

00:55:56.009 --> 00:55:57.549
longer use of HRT.

NOTE Confidence: 0.99738246

00:55:58.730 --> 00:55:59.230
Recent

NOTE Confidence: 0.97630346

00:55:59.690 --> 00:56:00.809
research that came out in

NOTE Confidence: 0.97630346

00:56:00.809 --> 00:56:02.170
the last couple years showed

NOTE Confidence: 0.97630346

00:56:02.170 --> 00:56:04.055
that the risk was less

NOTE Confidence: 0.97630346

00:56:04.055 --> 00:56:05.815
in women from age fifty

NOTE Confidence: 0.97630346

00:56:05.815 --> 00:56:07.494
to fifty nine than in

NOTE Confidence: 0.97630346

00:56:07.494 --> 00:56:09.335
women sixty or older. So

NOTE Confidence: 0.97630346

00:56:09.335 --> 00:56:10.934
many women might take HRT

NOTE Confidence: 0.97630346

00:56:10.934 --> 00:56:12.214
in their 50s and then

NOTE Confidence: 0.97630346

00:56:12.214 --> 00:56:13.755
stop it when the menopausal

NOTE Confidence: 0.9623096

00:56:14.055 --> 00:56:15.035
symptoms subside.

NOTE Confidence: 0.99468136

00:56:15.339 --> 00:56:17.099
And research recently has shown

NOTE Confidence: 0.99468136

00:56:17.099 --> 00:56:18.559
that that's a lower risk.

NOTE Confidence: 0.9679429

00:56:19.660 --> 00:56:21.099
It's also really important to

NOTE Confidence: 0.9679429

00:56:21.099 --> 00:56:22.940
note that hormone therapy, which

NOTE Confidence: 0.9679429

00:56:22.940 --> 00:56:24.780
is also called endocrine therapy

NOTE Confidence: 0.9679429

00:56:24.780 --> 00:56:25.760
for breast cancer,

NOTE Confidence: 0.99797624

00:56:26.219 --> 00:56:27.819
should not be confused with

NOTE Confidence: 0.99797624

00:56:27.819 --> 00:56:28.319
HRT.

NOTE Confidence: 0.9983271

00:56:29.075 --> 00:56:31.094
HRT and endocrine therapy produce

NOTE Confidence: 0.9983271

00:56:31.234 --> 00:56:32.214
opposite effects.

NOTE Confidence: 0.9994897

00:56:32.594 --> 00:56:34.515
Endocrine therapy for breast cancer

NOTE Confidence: 0.9994897

00:56:34.515 --> 00:56:36.134
is a medication to lower

NOTE Confidence: 0.9994897

00:56:36.194 --> 00:56:37.174
hormone levels

NOTE Confidence: 0.8798553

00:56:37.474 --> 00:56:39.494
systemically like aromatase inhibitors

NOTE Confidence: 0.9261283

00:56:39.954 --> 00:56:41.315
or block the action of

NOTE Confidence: 0.9261283

00:56:41.315 --> 00:56:42.994
the hormone at the receptor,

NOTE Confidence: 0.9261283

00:56:42.994 --> 00:56:43.974
such as tamoxifen,

NOTE Confidence: 0.98474246

00:56:44.619 --> 00:56:45.980
which in turn lowers risk

NOTE Confidence: 0.98474246

00:56:45.980 --> 00:56:47.440
of breast cancer recurrence

NOTE Confidence: 0.9870576

00:56:47.739 --> 00:56:49.099
and also can be used

NOTE Confidence: 0.9870576

00:56:49.099 --> 00:56:50.719
in women at high risk

NOTE Confidence: 0.9870576

00:56:50.859 --> 00:56:52.239
for for breast cancer.

NOTE Confidence: 0.96088696

00:56:54.060 --> 00:56:55.500
Most important is to discuss

NOTE Confidence: 0.96088696

00:56:55.500 --> 00:56:57.260
the potential benefits and risk

NOTE Confidence: 0.96088696

00:56:57.260 --> 00:56:58.635
of HRT with a health

NOTE Confidence: 0.96088696

00:56:58.715 --> 00:57:00.895
care provider before starting treatment.

NOTE Confidence: 0.9760079

00:57:02.235 --> 00:57:03.755
So in closing, I just

NOTE Confidence: 0.9760079

00:57:03.755 --> 00:57:04.495
want to,

NOTE Confidence: 0.9713916

00:57:05.515 --> 00:57:07.195
kinda remind again that thirty

NOTE Confidence: 0.9713916

00:57:07.195 --> 00:57:08.475
percent of breast cancers could

NOTE Confidence: 0.9713916

00:57:08.475 --> 00:57:10.415
be prevented through lifestyle changes,

NOTE Confidence: 0.9713916

00:57:10.555 --> 00:57:12.395
yet lifestyle is driven by

NOTE Confidence: 0.9713916

00:57:12.395 --> 00:57:14.160
the world around us, the

NOTE Confidence: 0.9713916

00:57:14.160 --> 00:57:16.079
food industry, urban design, and

NOTE Confidence: 0.9713916

00:57:16.079 --> 00:57:16.980
social norms.

NOTE Confidence: 0.9992877

00:57:17.359 --> 00:57:19.059
We know that changing habits,

NOTE Confidence: 0.9594082

00:57:19.440 --> 00:57:21.040
especially in a world full

NOTE Confidence: 0.9594082

00:57:21.040 --> 00:57:22.799
of stress, limited access to

NOTE Confidence: 0.9594082

00:57:22.799 --> 00:57:24.400
healthy foods and environments that

NOTE Confidence: 0.9594082

00:57:24.400 --> 00:57:26.400
don't encourage physical activity is

NOTE Confidence: 0.9594082

00:57:26.400 --> 00:57:27.140
not easy.

NOTE Confidence: 0.99430394

00:57:27.440 --> 00:57:28.825
So, you know, hoping that

NOTE Confidence: 0.99430394

00:57:28.825 --> 00:57:30.425
there'll be policies and systems

NOTE Confidence: 0.99430394

00:57:30.425 --> 00:57:30.925
changes

NOTE Confidence: 0.9991284

00:57:31.225 --> 00:57:32.585
that can make the healthy

NOTE Confidence: 0.9991284

00:57:32.585 --> 00:57:33.085
choice

NOTE Confidence: 0.9025983

00:57:33.385 --> 00:57:34.765
the easy choice.

NOTE Confidence: 0.9959817

00:57:35.785 --> 00:57:37.625
And important to note that

NOTE Confidence: 0.9959817

00:57:37.625 --> 00:57:40.125
progress is uneven across populations

NOTE Confidence: 0.9429616

00:57:40.790 --> 00:57:42.490
and that access to care,

NOTE Confidence: 0.9429616

00:57:42.550 --> 00:57:45.130
socioeconomic status and environmental exposures

NOTE Confidence: 0.9627431

00:57:45.510 --> 00:57:47.609
contribute to disparities. And unfortunately,

NOTE Confidence: 0.975735

00:57:48.230 --> 00:57:49.910
there are disparities in breast

NOTE Confidence: 0.975735

00:57:49.910 --> 00:57:51.450
cancer incidence and mortality.

NOTE Confidence: 0.95299226

00:57:52.230 --> 00:57:53.589
And so lastly, every step

NOTE Confidence: 0.95299226

00:57:53.589 --> 00:57:55.369
we take toward healthier habits

NOTE Confidence: 0.95299226

00:57:55.430 --> 00:57:55.930
matters,

NOTE Confidence: 0.9687022

00:57:56.265 --> 00:57:57.865
Small changes add up such

NOTE Confidence: 0.9687022

00:57:57.865 --> 00:57:59.724
as just focusing on reducing

NOTE Confidence: 0.9687022

00:57:59.865 --> 00:58:02.025
sedentary behavior, and that combined

NOTE Confidence: 0.9687022

00:58:02.025 --> 00:58:03.645
with community level efforts

NOTE Confidence: 0.99826264

00:58:04.025 --> 00:58:05.865
will reduce breast cancer risk

NOTE Confidence: 0.99826264

00:58:05.865 --> 00:58:07.484
and improve overall health.

NOTE Confidence: 0.9969454

00:58:08.530 --> 00:58:10.450
So with that, I will

NOTE Confidence: 0.9969454

00:58:10.450 --> 00:58:11.510
stop sharing.

NOTE Confidence: 0.99947315

00:58:15.570 --> 00:58:16.470
That is great.

NOTE Confidence: 0.91383255

00:58:16.930 --> 00:58:18.310
Thank you, doctor Arun.

NOTE Confidence: 0.99521583

00:58:18.850 --> 00:58:19.650
We do have a few

NOTE Confidence: 0.99521583

00:58:19.650 --> 00:58:20.150
questions

NOTE Confidence: 0.91700304

00:58:21.105 --> 00:58:23.045
that have been submitted and

NOTE Confidence: 0.90322894

00:58:24.545 --> 00:58:26.145
couple of the two that,

NOTE Confidence: 0.90322894

00:58:26.385 --> 00:58:27.345
we've answered a few of

NOTE Confidence: 0.90322894

00:58:27.345 --> 00:58:29.505
them directly, but, couple that

NOTE Confidence: 0.90322894

00:58:29.505 --> 00:58:31.365
are out there radiology questions.

NOTE Confidence: 0.89592487

00:58:31.905 --> 00:58:33.750
So doctor Latvie can take

NOTE Confidence: 0.89592487

00:58:33.750 --> 00:58:34.870
the first one and maybe

NOTE Confidence: 0.89592487

00:58:34.870 --> 00:58:36.090
I'll take the second one.

NOTE Confidence: 0.94456226

00:58:36.870 --> 00:58:38.310
So a questioner asks and

NOTE Confidence: 0.94456226

00:58:38.310 --> 00:58:39.910
she's a breast cancer survivor

NOTE Confidence: 0.94456226

00:58:39.910 --> 00:58:41.290
more than two decades ago.

NOTE Confidence: 0.95684785

00:58:41.830 --> 00:58:43.350
And she says, yes. If

NOTE Confidence: 0.95684785

00:58:43.350 --> 00:58:44.710
mammogram and ultrasound are done

NOTE Confidence: 0.95684785

00:58:44.710 --> 00:58:46.550
and compared to past results

NOTE Confidence: 0.95684785

00:58:46.550 --> 00:58:47.430
and found to be a

NOTE Confidence: 0.95684785

00:58:47.430 --> 00:58:48.790
change, what is the next

NOTE Confidence: 0.95684785

00:58:48.790 --> 00:58:50.025
step? So if there's a

NOTE Confidence: 0.95684785

00:58:50.025 --> 00:58:50.905
change on your mammogram and

NOTE Confidence: 0.95684785

00:58:50.905 --> 00:58:52.265
your ultrasound, what do you

NOTE Confidence: 0.95684785

00:58:52.265 --> 00:58:52.925
do next?

NOTE Confidence: 0.9389723

00:58:56.265 --> 00:58:57.724
And you're muted, Brisa.

NOTE Confidence: 0.9578161

00:58:59.145 --> 00:59:00.345
There we go. Sorry about

NOTE Confidence: 0.9578161

00:59:00.345 --> 00:59:01.860
that. If a patient

NOTE Confidence: 0.9813902

00:59:02.420 --> 00:59:03.620
is found to have a

NOTE Confidence: 0.9813902

00:59:03.620 --> 00:59:06.260
mammographic or sonographic abnormality without

NOTE Confidence: 0.9813902

00:59:06.260 --> 00:59:07.940
any other symptoms, that is

NOTE Confidence: 0.9813902

00:59:07.940 --> 00:59:09.800
called a callback from screening.

NOTE Confidence: 0.98794836

00:59:10.500 --> 00:59:12.340
Generally, women are asked to

NOTE Confidence: 0.98794836

00:59:12.340 --> 00:59:14.920
return for additional specific dedicated

NOTE Confidence: 0.98794836

00:59:15.060 --> 00:59:16.180
diagnostic imaging,

NOTE Confidence: 0.9861844

00:59:17.225 --> 00:59:19.805
which means additional mammographic views,

NOTE Confidence: 0.9987358

00:59:20.265 --> 00:59:21.325
targeted ultrasound

NOTE Confidence: 0.95035726

00:59:21.785 --> 00:59:24.105
with, generally presence of the

NOTE Confidence: 0.95035726

00:59:24.105 --> 00:59:24.605
radiologist

NOTE Confidence: 0.95939225

00:59:24.985 --> 00:59:25.885
who can assess.

NOTE Confidence: 0.93407273

00:59:26.425 --> 00:59:26.665
And,

NOTE Confidence: 0.984245

00:59:27.305 --> 00:59:28.285
then the radiologist

NOTE Confidence: 0.91177493

00:59:28.740 --> 00:59:29.220
can,

NOTE Confidence: 0.9998543

00:59:29.780 --> 00:59:30.280
determine

NOTE Confidence: 0.9421054

00:59:30.580 --> 00:59:31.860
if there is a need

NOTE Confidence: 0.9421054

00:59:31.860 --> 00:59:33.640
to perform a neal biopsy,

NOTE Confidence: 0.99767184

00:59:34.260 --> 00:59:35.960
follow-up, or do nothing.

NOTE Confidence: 0.94827974

00:59:39.220 --> 00:59:40.580
Yep. So that yeah. So

NOTE Confidence: 0.94827974

00:59:40.580 --> 00:59:41.700
that's a great answer. I

NOTE Confidence: 0.94827974

00:59:41.700 --> 00:59:43.160
hope that answers your question.

NOTE Confidence: 0.96189797

00:59:43.845 --> 00:59:44.805
You'll get called back, and

NOTE Confidence: 0.96189797

00:59:44.805 --> 00:59:46.165
we'll do additional workup with

NOTE Confidence: 0.96189797

00:59:46.165 --> 00:59:47.365
other images. So the other

NOTE Confidence: 0.96189797

00:59:47.365 --> 00:59:49.525
radiology question is what is

NOTE Confidence: 0.96189797

00:59:49.525 --> 00:59:50.744
molecular breast imaging?

NOTE Confidence: 0.9903348

00:59:52.325 --> 00:59:54.425
And so, molecular breast imaging

NOTE Confidence: 0.9903348

00:59:54.645 --> 00:59:56.665
is a nuclear medicine study.

NOTE Confidence: 0.9911101

00:59:57.160 --> 00:59:58.620
So there's a radioactive

NOTE Confidence: 0.97698873

00:59:59.000 --> 01:00:00.300
substance called technetium

NOTE Confidence: 0.6401178

01:00:00.920 --> 01:00:01.420
and

NOTE Confidence: 0.9753185

01:00:02.200 --> 01:00:03.800
and it's and a form

NOTE Confidence: 0.9753185

01:00:03.800 --> 01:00:05.000
of it is used very

NOTE Confidence: 0.9753185

01:00:05.000 --> 01:00:06.680
commonly in different medical tests,

NOTE Confidence: 0.9753185

01:00:06.680 --> 01:00:07.800
especially a test of the

NOTE Confidence: 0.9753185

01:00:07.800 --> 01:00:09.684
heart. And what they found

NOTE Confidence: 0.9753185

01:00:09.684 --> 01:00:11.125
when they were testing people's

NOTE Confidence: 0.9753185

01:00:11.125 --> 01:00:12.565
hearts is that breast cancers

NOTE Confidence: 0.9753185

01:00:12.565 --> 01:00:13.464
would light up

NOTE Confidence: 0.977221

01:00:13.925 --> 01:00:15.545
in this test. So the

NOTE Confidence: 0.9832914

01:00:15.925 --> 01:00:17.045
the substance that they were

NOTE Confidence: 0.9832914

01:00:17.045 --> 01:00:17.545
giving

NOTE Confidence: 0.9759635

01:00:18.085 --> 01:00:18.964
to look at the heart

NOTE Confidence: 0.9759635

01:00:18.964 --> 01:00:20.085
would go to breast cancers.

NOTE Confidence: 0.9759635

01:00:20.085 --> 01:00:21.125
So they realized they could

NOTE Confidence: 0.9759635

01:00:21.125 --> 01:00:22.244
turn this into an imaging

NOTE Confidence: 0.9759635

01:00:22.244 --> 01:00:24.010
test, and it's a it's

NOTE Confidence: 0.9759635

01:00:24.010 --> 01:00:25.130
an imaging test that has

NOTE Confidence: 0.9759635

01:00:25.130 --> 01:00:25.950
good sensitivity.

NOTE Confidence: 0.9986376

01:00:26.650 --> 01:00:28.250
It finds cancers at a

NOTE Confidence: 0.9986376

01:00:28.250 --> 01:00:29.230
similar level

NOTE Confidence: 0.9852706

01:00:29.930 --> 01:00:31.790
to MRI and contrast mammography.

NOTE Confidence: 0.9852706

01:00:31.930 --> 01:00:32.970
It hasn't been studied as

NOTE Confidence: 0.9852706

01:00:32.970 --> 01:00:34.590
much. It has some downsides,

NOTE Confidence: 0.9852706

01:00:34.650 --> 01:00:35.770
though, as opposed to a

NOTE Confidence: 0.9852706

01:00:35.770 --> 01:00:37.610
contrast mammogram, which takes about

NOTE Confidence: 0.9852706

01:00:37.610 --> 01:00:39.285
five minutes or an MRI

NOTE Confidence: 0.9852706

01:00:39.285 --> 01:00:40.345
which takes about

NOTE Confidence: 0.95497006

01:00:40.645 --> 01:00:41.865
ten to twenty minutes,

NOTE Confidence: 0.99887395

01:00:42.484 --> 01:00:43.385
every image

NOTE Confidence: 0.9339189

01:00:43.685 --> 01:00:45.445
on molecular breast imaging is

NOTE Confidence: 0.9339189

01:00:45.445 --> 01:00:47.224
about fifteen minutes, five zero.

NOTE Confidence: 0.9339189

01:00:47.445 --> 01:00:49.045
It has gone down with,

NOTE Confidence: 0.93837464

01:00:49.525 --> 01:00:50.345
better equipment,

NOTE Confidence: 0.95619905

01:00:50.820 --> 01:00:52.280
but it's a longer scan,

NOTE Confidence: 0.9809385

01:00:53.380 --> 01:00:54.660
and it doesn't quite give

NOTE Confidence: 0.9809385

01:00:54.660 --> 01:00:55.400
the anatomy.

NOTE Confidence: 0.9992552

01:00:55.700 --> 01:00:57.060
It doesn't give it doesn't

NOTE Confidence: 0.9992552

01:00:57.060 --> 01:00:58.120
show us the anatomy

NOTE Confidence: 0.9510577

01:00:58.820 --> 01:01:00.600
like MRI or contrast mammography

NOTE Confidence: 0.9510577

01:01:00.660 --> 01:01:01.880
does. So it hasn't,

NOTE Confidence: 0.8616938

01:01:03.220 --> 01:01:04.600
been as widely accepted.

NOTE Confidence: 0.93035406

01:01:05.155 --> 01:01:06.595
But, it's a test. Basically,

NOTE Confidence: 0.93035406

01:01:06.595 --> 01:01:07.795
you get injected with a

NOTE Confidence: 0.93035406

01:01:07.795 --> 01:01:09.155
radioactive substance, and then you

NOTE Confidence: 0.93035406

01:01:09.155 --> 01:01:09.815
get damaged.

NOTE Confidence: 0.99681026

01:01:13.155 --> 01:01:13.975
So we

NOTE Confidence: 0.7502117

01:01:14.755 --> 01:01:15.255
are,

NOTE Confidence: 0.99137795

01:01:17.635 --> 01:01:19.335
there's no more questions on

NOTE Confidence: 0.99137795

01:01:19.475 --> 01:01:20.855
the chat. We can

NOTE Confidence: 0.999804

01:01:21.210 --> 01:01:21.950
stay for

NOTE Confidence: 0.84351844

01:01:22.570 --> 01:01:24.030
another five minutes or

NOTE Confidence: 0.9388372

01:01:24.650 --> 01:01:25.690
if one of our panelists

NOTE Confidence: 0.9388372

01:01:25.690 --> 01:01:26.750
would like to

NOTE Confidence: 0.9523876

01:01:28.410 --> 01:01:30.250
add something, I'd be happy

NOTE Confidence: 0.9523876

01:01:30.250 --> 01:01:31.290
to listen or I can

NOTE Confidence: 0.9523876

01:01:31.290 --> 01:01:32.030
ask questions.

NOTE Confidence: 0.9891029

01:01:36.704 --> 01:01:38.065
Actually, one of our listeners

NOTE Confidence: 0.9891029

01:01:38.065 --> 01:01:39.204
had a question about

NOTE Confidence: 0.9334132

01:01:39.505 --> 01:01:40.484
the risk models.

NOTE Confidence: 0.872528

01:01:41.505 --> 01:01:41.904
And,

NOTE Confidence: 0.7646749

01:01:42.305 --> 01:01:43.285
so, Tracy,

NOTE Confidence: 0.8744294

01:01:43.664 --> 01:01:44.164
yes.

NOTE Confidence: 0.947757

01:01:45.184 --> 01:01:45.585
So,

NOTE Confidence: 0.95172817

01:01:46.144 --> 01:01:47.444
and don't forget to unmute.

NOTE Confidence: 0.97065115

01:01:48.880 --> 01:01:50.740
You mentioned two websites,

NOTE Confidence: 0.96987456

01:01:51.119 --> 01:01:52.100
one of which,

NOTE Confidence: 0.90786594

01:01:54.640 --> 01:01:55.680
you know, that one of

NOTE Confidence: 0.90786594

01:01:55.680 --> 01:01:56.480
which is web based, and

NOTE Confidence: 0.90786594

01:01:56.480 --> 01:01:57.119
the other one you had

NOTE Confidence: 0.90786594

01:01:57.119 --> 01:01:58.800
to download software. Can anybody

NOTE Confidence: 0.90786594

01:01:58.800 --> 01:01:59.840
download that software, or do

NOTE Confidence: 0.90786594

01:01:59.840 --> 01:02:00.880
you have to get permission?

NOTE Confidence: 0.90786594

01:02:00.880 --> 01:02:01.460
It's free.

NOTE Confidence: 0.99141157

01:02:02.835 --> 01:02:04.035
It's free. It's just the

NOTE Confidence: 0.99141157

01:02:04.035 --> 01:02:05.734
interface is not very intuitive.

NOTE Confidence: 0.99141157

01:02:05.955 --> 01:02:07.175
It's kinda complicated.

NOTE Confidence: 0.99988127

01:02:07.635 --> 01:02:08.775
It's not clear

NOTE Confidence: 0.9794855

01:02:09.075 --> 01:02:10.535
exactly what they're asking.

NOTE Confidence: 0.9331215

01:02:11.234 --> 01:02:12.355
So I I think it's

NOTE Confidence: 0.9331215

01:02:12.355 --> 01:02:13.955
easy to make mistakes using

NOTE Confidence: 0.9331215

01:02:13.955 --> 01:02:14.695
that model.

NOTE Confidence: 0.9997175

01:02:15.980 --> 01:02:16.720
There are

NOTE Confidence: 0.96319973

01:02:17.099 --> 01:02:17.599
other,

NOTE Confidence: 0.96778715

01:02:18.299 --> 01:02:19.339
versions of it on the

NOTE Confidence: 0.96778715

01:02:19.339 --> 01:02:20.779
web that are, like, pretty

NOTE Confidence: 0.96778715

01:02:20.779 --> 01:02:22.559
interface and clear questions,

NOTE Confidence: 0.97680134

01:02:23.260 --> 01:02:24.380
but I don't think that

NOTE Confidence: 0.97680134

01:02:24.380 --> 01:02:26.140
they're validated, and so I

NOTE Confidence: 0.97680134

01:02:26.140 --> 01:02:26.960
wouldn't necessarily

NOTE Confidence: 0.9868564

01:02:27.260 --> 01:02:28.779
encourage using them. So, I

NOTE Confidence: 0.9868564

01:02:28.779 --> 01:02:29.579
mean, I think you could

NOTE Confidence: 0.9868564

01:02:29.579 --> 01:02:30.765
go ahead and assess assess

NOTE Confidence: 0.9868564

01:02:30.765 --> 01:02:31.885
your own risk and print

NOTE Confidence: 0.9868564

01:02:31.885 --> 01:02:33.005
out your results and bring

NOTE Confidence: 0.9868564

01:02:33.005 --> 01:02:33.984
it to your provider.

NOTE Confidence: 0.9933556

01:02:35.164 --> 01:02:36.525
Anytime I see a patient

NOTE Confidence: 0.9933556

01:02:36.525 --> 01:02:37.484
and they bring me a

NOTE Confidence: 0.9933556

01:02:37.484 --> 01:02:38.545
risk model

NOTE Confidence: 0.99669087

01:02:38.845 --> 01:02:39.345
result

NOTE Confidence: 0.9857774

01:02:39.885 --> 01:02:41.404
without the information of what

NOTE Confidence: 0.9857774

01:02:41.404 --> 01:02:42.684
went into it, I just

NOTE Confidence: 0.9857774

01:02:42.684 --> 01:02:43.885
repeat it because I don't

NOTE Confidence: 0.9857774

01:02:43.885 --> 01:02:45.030
know what went into that

NOTE Confidence: 0.9857774

01:02:45.270 --> 01:02:46.970
calculation to give the result.

NOTE Confidence: 0.98801416

01:02:48.870 --> 01:02:50.310
So I I think the

NOTE Confidence: 0.98801416

01:02:50.310 --> 01:02:51.430
the message I would give

NOTE Confidence: 0.98801416

01:02:51.430 --> 01:02:51.930
is

NOTE Confidence: 0.9652572

01:02:52.790 --> 01:02:53.910
these are not easy to

NOTE Confidence: 0.9652572

01:02:53.910 --> 01:02:54.410
interpret

NOTE Confidence: 0.9221306

01:02:54.710 --> 01:02:56.230
and don't panic. If you

NOTE Confidence: 0.9221306

01:02:56.230 --> 01:02:57.370
get a very high

NOTE Confidence: 0.9447367

01:02:58.150 --> 01:02:59.430
risk, you should review it

NOTE Confidence: 0.9447367

01:02:59.430 --> 01:03:00.865
with a a a provider

NOTE Confidence: 0.9447367

01:03:00.865 --> 01:03:02.225
who has experience using the

NOTE Confidence: 0.9447367

01:03:02.225 --> 01:03:02.725
models.

NOTE Confidence: 0.95879364

01:03:04.305 --> 01:03:05.585
Yeah. So someone who's used

NOTE Confidence: 0.95879364

01:03:05.585 --> 01:03:06.865
the models, I would definitely

NOTE Confidence: 0.95879364

01:03:06.865 --> 01:03:08.465
concur. There are little things

NOTE Confidence: 0.95879364

01:03:08.465 --> 01:03:09.425
that can make a big

NOTE Confidence: 0.95879364

01:03:09.425 --> 01:03:09.925
difference.

NOTE Confidence: 0.9571514

01:03:11.025 --> 01:03:12.305
Height and weight are one.

NOTE Confidence: 0.9571514

01:03:12.305 --> 01:03:13.185
You have to put those

NOTE Confidence: 0.9571514

01:03:13.185 --> 01:03:14.405
in to be accurate.

NOTE Confidence: 0.99671805

01:03:14.760 --> 01:03:16.040
And if you're so if

NOTE Confidence: 0.99671805

01:03:16.040 --> 01:03:17.320
you're tall, it increases your

NOTE Confidence: 0.99671805

01:03:17.320 --> 01:03:18.600
risk of breast cancer, which

NOTE Confidence: 0.99671805

01:03:18.600 --> 01:03:19.960
is not intuitive, but it's

NOTE Confidence: 0.99671805

01:03:19.960 --> 01:03:21.320
in the model. One thing

NOTE Confidence: 0.99671805

01:03:21.320 --> 01:03:22.360
that seems to drive it

NOTE Confidence: 0.99671805

01:03:22.360 --> 01:03:22.860
for

NOTE Confidence: 0.9964601

01:03:23.400 --> 01:03:24.440
a lot of our patients

NOTE Confidence: 0.9964601

01:03:24.440 --> 01:03:25.560
is having a first child

NOTE Confidence: 0.9964601

01:03:25.560 --> 01:03:26.840
after thirty, which has become

NOTE Confidence: 0.9964601

01:03:26.840 --> 01:03:27.820
extremely common.

NOTE Confidence: 0.9354259

01:03:28.885 --> 01:03:30.565
And so, yeah, then would

NOTE Confidence: 0.9354259

01:03:30.565 --> 01:03:31.285
you like to comment on

NOTE Confidence: 0.9354259

01:03:31.285 --> 01:03:32.745
that, doctor Taglia?

NOTE Confidence: 0.9791856

01:03:34.325 --> 01:03:35.445
Yeah. I mean, I think,

NOTE Confidence: 0.9791856

01:03:35.765 --> 01:03:36.485
you know, we take a

NOTE Confidence: 0.9791856

01:03:36.485 --> 01:03:37.225
lot of,

NOTE Confidence: 0.99686366

01:03:38.965 --> 01:03:39.945
of the reproductive

NOTE Confidence: 0.99355936

01:03:42.320 --> 01:03:44.340
history into account for,

NOTE Confidence: 0.96257764

01:03:44.960 --> 01:03:46.160
breast cancer risk. And the

NOTE Confidence: 0.96257764

01:03:46.160 --> 01:03:46.880
way that I like to

NOTE Confidence: 0.96257764

01:03:46.880 --> 01:03:47.680
think about it is it's

NOTE Confidence: 0.96257764

01:03:47.680 --> 01:03:48.980
really just to sort of,

NOTE Confidence: 0.998733

01:03:50.160 --> 01:03:50.660
the

NOTE Confidence: 0.99031043

01:03:51.040 --> 01:03:52.320
the amount of time an

NOTE Confidence: 0.99031043

01:03:52.320 --> 01:03:52.820
individual

NOTE Confidence: 0.99888474

01:03:53.120 --> 01:03:53.620
has

NOTE Confidence: 0.9959364

01:03:55.065 --> 01:03:57.165
exposure to estrogen unopposed.

NOTE Confidence: 0.99710125

01:03:57.945 --> 01:03:59.805
And so when you have

NOTE Confidence: 0.99710125

01:04:00.025 --> 01:04:01.565
your period very early

NOTE Confidence: 0.9730797

01:04:02.105 --> 01:04:03.065
and you don't go through

NOTE Confidence: 0.9730797

01:04:03.065 --> 01:04:04.765
menopause until very late

NOTE Confidence: 0.92444414

01:04:05.545 --> 01:04:06.744
and you don't have a

NOTE Confidence: 0.92444414

01:04:06.744 --> 01:04:07.244
child

NOTE Confidence: 0.98550767

01:04:07.809 --> 01:04:09.329
at all or have a

NOTE Confidence: 0.98550767

01:04:09.329 --> 01:04:11.109
child at an older age,

NOTE Confidence: 0.98550767

01:04:11.329 --> 01:04:12.930
you're not opposing any of

NOTE Confidence: 0.98550767

01:04:12.930 --> 01:04:14.609
the natural hormones of sort

NOTE Confidence: 0.98550767

01:04:14.609 --> 01:04:16.390
of your normal cycles

NOTE Confidence: 0.97601837

01:04:16.770 --> 01:04:18.450
that interfere sort of that

NOTE Confidence: 0.97601837

01:04:18.450 --> 01:04:19.569
may sort of be,

NOTE Confidence: 0.9996497

01:04:19.970 --> 01:04:21.910
contributing to breast cancer risk.

NOTE Confidence: 0.9911491

01:04:22.695 --> 01:04:24.295
So having children younger for

NOTE Confidence: 0.9911491

01:04:24.295 --> 01:04:24.795
whatever

NOTE Confidence: 0.98370326

01:04:26.455 --> 01:04:28.375
reason, having any children is

NOTE Confidence: 0.98370326

01:04:28.375 --> 01:04:29.895
protective. Having children at a

NOTE Confidence: 0.98370326

01:04:29.895 --> 01:04:31.415
younger age probably has something

NOTE Confidence: 0.98370326

01:04:31.415 --> 01:04:32.535
to do with the breast

NOTE Confidence: 0.98370326

01:04:32.535 --> 01:04:33.035
development

NOTE Confidence: 0.99806315

01:04:33.415 --> 01:04:34.855
and the opposition of the

NOTE Confidence: 0.99806315

01:04:34.855 --> 01:04:35.355
hormones.

NOTE Confidence: 0.8808293

01:04:38.430 --> 01:04:39.550
Great. And,

NOTE Confidence: 0.95182085

01:04:44.190 --> 01:04:45.950
that's I've yeah. I have

NOTE Confidence: 0.95182085

01:04:45.950 --> 01:04:47.730
no other questions to ask.

NOTE Confidence: 0.85547477

01:04:51.055 --> 01:04:52.335
Oh, and doctor Laffey is

NOTE Confidence: 0.85547477

01:04:52.335 --> 01:04:53.315
typing an answer,

NOTE Confidence: 0.9705217

01:04:53.695 --> 01:04:55.055
looks like, to one last

NOTE Confidence: 0.9705217

01:04:55.055 --> 01:04:55.555
question.

NOTE Confidence: 0.9083961

01:04:56.175 --> 01:04:57.775
Anything else anybody would like

NOTE Confidence: 0.9083961

01:04:57.775 --> 01:04:58.895
to add? Oh, I see.

NOTE Confidence: 0.9083961

01:04:58.895 --> 01:05:00.415
If any if anyone's still

NOTE Confidence: 0.9083961

01:05:00.415 --> 01:05:00.895
on,

NOTE Confidence: 0.9825729

01:05:01.215 --> 01:05:02.575
and does have questions, feel

NOTE Confidence: 0.9825729

01:05:02.575 --> 01:05:04.015
free to email me directly

NOTE Confidence: 0.9825729

01:05:04.015 --> 01:05:05.375
at melinda dot erwin at

NOTE Confidence: 0.9825729

01:05:05.375 --> 01:05:07.069
yale dot edu. I'm happy

NOTE Confidence: 0.9825729

01:05:07.069 --> 01:05:08.950
to answer questions later on

NOTE Confidence: 0.9825729

01:05:08.950 --> 01:05:09.609
as well.

NOTE Confidence: 0.86362296

01:05:09.910 --> 01:05:11.029
And I I have one

NOTE Confidence: 0.86362296

01:05:11.029 --> 01:05:12.170
question, doctor Erwin.

NOTE Confidence: 0.932489

01:05:14.549 --> 01:05:16.009
So exercise we know

NOTE Confidence: 0.82749444

01:05:16.630 --> 01:05:17.130
and

NOTE Confidence: 0.96112317

01:05:18.549 --> 01:05:20.069
being thinner reduces your risk

NOTE Confidence: 0.96112317

01:05:20.069 --> 01:05:21.815
of postmenopausal breast cancer. Does

NOTE Confidence: 0.96112317

01:05:21.815 --> 01:05:22.934
the same thing apply to

NOTE Confidence: 0.96112317

01:05:22.934 --> 01:05:23.434
premenopausal

NOTE Confidence: 0.99948496

01:05:23.734 --> 01:05:24.474
breast cancer?

NOTE Confidence: 0.9698454

01:05:25.734 --> 01:05:27.974
So for exercise, yes. It

NOTE Confidence: 0.9698454

01:05:27.974 --> 01:05:29.815
lowers your risk from you

NOTE Confidence: 0.9698454

01:05:29.815 --> 01:05:31.595
know, if you exercise childhood,

NOTE Confidence: 0.9698454

01:05:31.894 --> 01:05:32.394
premenopausal

NOTE Confidence: 0.89693594

01:05:32.775 --> 01:05:34.234
years, later on is

NOTE Confidence: 0.8962019

01:05:34.615 --> 01:05:36.375
a significant lower risk for

NOTE Confidence: 0.8962019

01:05:36.375 --> 01:05:36.875
developing

NOTE Confidence: 0.9998033

01:05:37.230 --> 01:05:38.130
breast cancer.

NOTE Confidence: 0.9695919

01:05:38.670 --> 01:05:40.190
The research with obesity is

NOTE Confidence: 0.9695919

01:05:40.190 --> 01:05:41.630
a little confusing because it's

NOTE Confidence: 0.9695919

01:05:41.630 --> 01:05:43.890
related to estrogen and and,

NOTE Confidence: 0.96191436

01:05:44.510 --> 01:05:45.710
whether you have a twenty

NOTE Confidence: 0.96191436

01:05:45.710 --> 01:05:47.630
eight day cycle. And so

NOTE Confidence: 0.96191436

01:05:47.630 --> 01:05:49.710
sometimes if you have high

NOTE Confidence: 0.96191436

01:05:49.710 --> 01:05:50.990
amounts of body fat, you

NOTE Confidence: 0.96191436

01:05:50.990 --> 01:05:52.704
might not have a a

NOTE Confidence: 0.96191436

01:05:52.704 --> 01:05:53.925
menstrual cycle that's,

NOTE Confidence: 0.97198945

01:05:54.305 --> 01:05:55.825
every twenty eight days. And

NOTE Confidence: 0.97198945

01:05:55.825 --> 01:05:57.425
so it kinda confounds the

NOTE Confidence: 0.97198945

01:05:57.425 --> 01:05:59.525
relationship with breast cancer risk.

NOTE Confidence: 0.97198945

01:05:59.665 --> 01:06:01.105
However, with that said, we

NOTE Confidence: 0.97198945

01:06:01.105 --> 01:06:02.484
know that weight gain

NOTE Confidence: 0.9440117

01:06:02.785 --> 01:06:04.724
from adolescence through adulthood,

NOTE Confidence: 0.9997017

01:06:05.770 --> 01:06:06.270
independent

NOTE Confidence: 0.97576714

01:06:06.650 --> 01:06:07.950
of your BMI,

NOTE Confidence: 0.99330884

01:06:08.410 --> 01:06:10.010
is associated with increased breast

NOTE Confidence: 0.99330884

01:06:10.010 --> 01:06:10.830
cancer risk.

NOTE Confidence: 0.992337

01:06:11.130 --> 01:06:12.410
So I think two messages

NOTE Confidence: 0.992337

01:06:12.410 --> 01:06:13.770
I always like to to

NOTE Confidence: 0.992337

01:06:13.770 --> 01:06:14.730
tell people is to try

NOTE Confidence: 0.992337

01:06:14.730 --> 01:06:16.510
to prevent weight gain

NOTE Confidence: 0.99324846

01:06:16.890 --> 01:06:18.250
and to try to reduce

NOTE Confidence: 0.99324846

01:06:18.250 --> 01:06:18.750
sedentary

NOTE Confidence: 0.9991354

01:06:19.370 --> 01:06:19.870
behaviors.

NOTE Confidence: 0.99853903

01:06:23.075 --> 01:06:24.835
Alright. Well, I'd like to

NOTE Confidence: 0.99853903

01:06:24.835 --> 01:06:25.335
thank

NOTE Confidence: 0.9910019

01:06:25.795 --> 01:06:27.335
our panelists again

NOTE Confidence: 0.59898245

01:06:28.355 --> 01:06:28.835
and,

NOTE Confidence: 0.9727932

01:06:30.355 --> 01:06:32.435
let everyone know that we

NOTE Confidence: 0.9727932

01:06:32.435 --> 01:06:33.415
have two more

NOTE Confidence: 0.9878773

01:06:33.970 --> 01:06:35.170
of these webinars. The next

NOTE Confidence: 0.9878773

01:06:35.170 --> 01:06:36.850
one is October ninth, and

NOTE Confidence: 0.9878773

01:06:36.850 --> 01:06:37.350
it's

NOTE Confidence: 0.9242297

01:06:38.050 --> 01:06:39.650
entitled early stage breast cancer,

NOTE Confidence: 0.9242297

01:06:39.650 --> 01:06:41.090
what patients and families should

NOTE Confidence: 0.9242297

01:06:41.090 --> 01:06:41.590
know.

NOTE Confidence: 0.9731258

01:06:42.450 --> 01:06:43.650
And the one after that

NOTE Confidence: 0.9731258

01:06:43.650 --> 01:06:45.410
is October sixteenth, so these

NOTE Confidence: 0.9731258

01:06:45.410 --> 01:06:47.350
are all on Thursday nights.

NOTE Confidence: 0.9349147

01:06:47.765 --> 01:06:49.445
And October sixteenth is progress

NOTE Confidence: 0.9349147

01:06:49.445 --> 01:06:51.365
in metastatic breast cancer research

NOTE Confidence: 0.9349147

01:06:51.365 --> 01:06:53.045
and treatment. Talk about the

NOTE Confidence: 0.9349147

01:06:53.045 --> 01:06:54.025
ways we are,

NOTE Confidence: 0.99777454

01:06:54.645 --> 01:06:55.845
have improved the treatment of

NOTE Confidence: 0.99777454

01:06:55.845 --> 01:06:57.865
metastatic breast cancer. It's,

NOTE Confidence: 0.9992109

01:06:58.805 --> 01:07:00.245
it's been quite astonishing over

NOTE Confidence: 0.9992109

01:07:00.245 --> 01:07:01.065
the past decade

NOTE Confidence: 0.87187713

01:07:01.365 --> 01:07:03.125
what has the advances we've

NOTE Confidence: 0.87187713

01:07:03.125 --> 01:07:04.160
had. So,

NOTE Confidence: 0.9865295

01:07:07.579 --> 01:07:09.420
that is all. Looks like

NOTE Confidence: 0.9865295

01:07:09.420 --> 01:07:10.559
we're good. Okay.

NOTE Confidence: 0.87384415

01:07:12.220 --> 01:07:13.119
Thanks, everyone.

NOTE Confidence: 0.99427414

01:07:13.980 --> 01:07:15.819
And, Eliza, unless you have

NOTE Confidence: 0.99427414

01:07:15.819 --> 01:07:17.260
any other things, we will

NOTE Confidence: 0.99427414

01:07:17.260 --> 01:07:17.920
say goodbye.