In an effort to make science and healthcare information accessible, Carbon Health has partnered with Rob Swanda, PhD to answer questions about breast cancer, from actual people (via Dr. Swanda’s Twitter and newsletter followers). Dr. Swanda is joined by Dr. Bayo Curry-Winchell, a physician and medical director at Carbon Health, to speak about the breast cancer related questions below, and many more in the full-length video discussion found near the bottom of this post.
Dr. Swanda: “October is breast cancer awareness month and that's what we'll be discussing today. I want Dr. BCW to just give everyone a brief overview of what even is breast cancer?”
Dr. BCW: “When we talk about breast cancer it is when cells inside the breast have divided without any sort of supervision or restriction. And, so when I say that I mean that there's this abnormal level of division that's happening where cells are no longer acting as they normally should.”
Dr. Swanda: “What could somebody begin to look for related to symptoms of breast cancer if they're experiencing this abnormal growth?”
Dr. BCW: “It's really important to note that some people have no symptoms and so that's something that you have to remind yourself of. You may not have any symptoms. But, some of the things that we have seen associated with breast cancer are a change in the color of the skin on your breast, as well as a change in the texture, as well as dimpling meaning there's a retraction in the skin. Nipple discharge is also one that people forget and so if you are not breastfeeding and you are noticing any sort of substance, blood, or anything coming from your nipple that can also be a sign. Another big thing is if you do have pain that is an important factor to go in. And we want to be thoughtful so that we remind ourselves that it may not just be the breasts it could also be the armpit as well and so if you have any pain in any of those areas definitely go in and be seen.”
Dr. Swanda: “If we begin to think about somebody who does have some of these symptoms, they go in and maybe they begin to get screened, what are some statistics that they're looking at related to would this abnormality definitely be breast cancer or could it not be and just be some type of abnormal tissue growth that isn't related to cancer? Do we have any large-scale statistics related to who's susceptible to this?”
Dr. BCW: “We do. We know that first and foremost It's always important to know that the majority of breast cancer has no association with family history, which is an important thing. That being said, there are those risk factors that are associated with family history. If you have a first degree relative that has been diagnosed with breast cancer before the age of 50. Or if you have had anyone you know in your family that's been diagnosed with breast cancer, it is an important piece as well. If you have a male figure in your family that has been diagnosed with breast cancer that can be another sign. The other thing we forget about is ovarian cancer. If you have a family history of that or have been diagnosed with that, that can also be another risk factor. So when you go in and get your mammogram they're going to ask you these questions because that really helps set the schedule of how we continue to monitor you and what type of tests should we do because there's so many out there. And so when I think about this I think it's a good question to kind of consider how breast cancer evolves, and I'd love to hear from you about the genetics.”
Dr. Swanda: “Sure! When a lot of people think of breast cancer related to genetics they're usually referring to BRCA gene mutations, that's B R C A, and these are specific genes that are found in all of our tissues that are responsible for actually repairing DNA damage. Our DNA is constantly under a lot of pressure. It's being damaged by both internal factors as well as external stimuli that we are receiving on a daily basis, and we probably have DNA damage ongoing right now. But, our cells are actually responsible for fixing those problems. It's kind of like when you have a bump in the road; they're going to come through and they're going to repave it over so it's nice and smooth and BRCA genes or BRCA proteins are actually involved in that pathway. When we start to think about BRCA gene mutations it means that those proteins aren't actually working the way that they're supposed to. They're not fixing that DNA damage that's occurring inside of our cells, and specifically in our breast tissues, so then that can allow for those cells to begin growing uncontrollably just like Dr. BCW said in the beginning, and then causing a tumor or causing cancerous tissue to grow. Those are some of the things we look out for when we're doing genetic testing related to BRCA gene mutations or breast cancer in general because those are just some of the proteins involved and some of the things that we're most aware of in order to look out for.”
Dr. Swanda: “What could treatment options look like for individuals when they come in and they do have a positive case of breast cancer that's detected?”
Dr. BCW: “Great question because there are different types of breast cancer. That type of cancer and the treatment associated is really directed towards the type of breast cancer that you have and so depending upon if there are certain types of hormones such as estrogen, progesterone, certain receptors found that really guides as far as the type of treatment that will be directed for your type of breast cancer. I would love for you to talk about some of the clinical trials, as we have made such progress in the realm of treatments available and clinical trials ongoing towards breast cancer. I would love for you to share some of those factors.”
Dr. Swanda: “Absolutely! When we think of cancer a lot of times previously it was just take out the tumor, take out the tissue that's affected, and hope for the best. Maybe we have some radiation that can go on, but that's really destroying both the cancerous tissue as well as healthy tissue. So, pushing forward to try to find better treatment options that really just target cancer has been of the utmost importance in the medical and the scientific community, and that includes breast cancer but also for a variety of other cancers as well. We've made a lot of progress related to some types of treatments that could be monoclonal antibodies for example. Maybe you've heard of the drug Herceptin, so that's actually used against Her2+ breast cancer, and there's other antibodies that are being used right now in clinical trials to try to combat different forms of breast cancer, as well as others. We also have small molecules, so those are our typical chemistry made substances that are able to target specific pathways. Maybe they stop the vasculature, or get blood supply to a tumor, and then they can kind of cut it off and starve that tumor of nutrients. Or we've seen the importance of mRNA technology being used in vaccines, but that's actually also being used in cancer treatment. That's something that I was doing in my PhD research as well was using mRNA as a therapeutic for liver cancer, so that's beginning to transcend into a lot of different topics, which I think is just huge and also a breakthrough that we might be able to see within the next couple years for breast cancer, but also other types of cancer too.”
Dr. BCW: “I love when you talk about that Dr. Rob. It really shows the advancements that we're making. The other thing that has also been really helpful for current clinical trials, we know historically in the past the trials were primarily in Caucasian and white women, but now there is a better understanding that we need to include women of color to really understand all of the biological factors, all the things that could be a part of that. We can better treat all people and when I say that I mean anyone who identifies as a woman, anyone who can get pregnant, and that's the goal when we talk about really helping and making change. In breast cancer we have to really be mindful to include everyone.”
Dr. Swanda: “Do you have any statistics related to individuals of color who maybe experience breast cancer at a different rate compared to what some of these general statistics have used in the past several decades?”
Dr. BCW: “I do. So, when we talk about breast cancer and black women versus white women there is a stark difference. Although breast cancer is more common in white women, black women are dying at a disproportionately rate from breast cancer. We are also getting the more aggressive type, meaning triple negative breast cancer, and so when you think about that, the fact that first there are studies that have been shown that we are diagnosed later, and then when you're diagnosed later and then you have a very aggressive type of breast cancer that culmination of the two really increases our risk of dying from breast cancer. That's something that I really encourage any woman of color to really think about your risk factors and get screened. And, currently right now the guidelines for breast cancer screening are different depending upon which type of national organization that you want to follow. One that I like is the American Cancer Society, and they recommend from ages 40 to 45 to really take a personal look at your risk factors and see if you feel that you should get a mammogram. And, that's one thing that I really stress that you don't feel like you have to wait until a certain age to go and get it. The other thing that's important to know when we were talking about family history, if you do have a family history of breast cancer we actually want you to get your screening done about 10 years earlier than the person who was diagnosed in your family. So, those are two things to really think about as far as screening, and I know we're going to delve a little bit deeper into the guidelines but it's just important to really know that if you're a woman of color that you have a higher risk of getting an aggressive type of breast cancer.”
Dr. Swanda: “What are the risk factors related to men or transgender individuals related to breast cancer? Are there any types of statistics we have on those individuals?”
Dr. BCW: “It's so important that we talk about this because men can get breast cancer. We know one out of every 100 cases of breast cancer a man is dying or diagnosed, and so it's so important that we highlight this. And when we talk about symptoms for those who identify as a man or a woman they are the same. It's important that we talk about that if there's any dimpling, any retraction of the skin, nipple discharge. Another thing that is important is if there's any redness or flakiness around the skin, or any moles and so forth that can also be a sign of breast cancer. The other thing is when we talk about family history men should really take note if they have someone in their family that was diagnosed with breast cancer, that increases your risk as well. So, it's not just for women it's also for those who identify as male or men that you take notes and you look at your family history if you can.”
Check out the full conversation posted on October 6, 2022.
Rob Swanda, PhD is an mRNA biochemist and science communicator who obtained his PhD from Cornell University in 2021. Follow Rob Swanda, PhD on Twitter: @ScientistSwanda
Dr. Bayo Curry-Winchell is a regional medical director at Carbon Health and at Saint Mary’s Medical Group in Reno, NV. Follow Dr. BCW on Twitter: @DR_BCW
