Welcome everyone to the Amy and TJ Podcast. It is a very special month. It is October, and that means it is Breast Cancer Awareness Month. And it's an important month because, first of all, it's time to honor those who have been treated for breast cancer. It's time to honor those who are fighting cancer who have metastatic breast cancer.
And almost as important, it's time to raise awareness, to continue to raise awareness about early detection, about reminding women to make those appointments with their ogyns, to get those mammograms scheduled, and to show up for the actual appointment. And just to remind everyone, breast cancer is the most
commonly diagnosed cancer in women in the United States. A woman in this country is diagnosed every two minutes, and great strides have been made with breast cancer research and certainly in treating women and men with this disease, but there is still so much more to do because breast cancer remains the leading cause of cancer death in American women.
And so to get all the latest information on where we are with this disease, on the research being done, and what you can do to prevent breast cancer, or at the very least, if you've been a patient, or you are currently fighting it or someone you know, is what you can do to live a better life, a healthier life, and prevent recurrence and for all of that very important information. TJ and I are so excited to welcome my personal oncologist. She's a star at NYU, doctor
Ruth Ratz. Thank you so much for being with us.
Amy and Tji am really really happy to be back with you in the studio. I always love seeing you and especially here.
Thank you Ruth and doctor Ratz. You know, I think some people roll their eyes up Breast Cancer Awareness Month, the pink ribbons. This is so much more than just this month, But can you explain why this month is actually truly important.
This month is really really important because it represents what women did in the late nineteen seventies and in the nineteen eighties to really speak out and say to the medical profession and to all of the sort of public health officials out there, breast cancer is the single most important cancer that affects women. A lot of people get it, and we want to have more information and we want to have a say about what happens with our treatment.
So in the nineteen seventies, when My mother was diagnosed with breast cancer in her forties because she felt a little lump in her breast. No screening, mammogram or anything like that. She went to her doctor. She was admitted to the hospital and the surgeon came in and said, missus aur so, I'm going to take you to the operating room and we're going to remove the lump. If it's cancerous, I have to do a mestectomy. If it's not cancer, you'll wake up and everything will be great.
So she signed on the dotted line. They put it her sleep in the operating room, and she woke up alone in the recovery room, put her hand on her chest, felt that huge bandage, and that's how she figured out she had cancer. Wow, a lot has changed since then,
but that is a chilling, chilling story. Yeah. So you know, a good friend of mine wrote a book called The Breast Cancer Wars, doctor barn learn her same thing happened to his mother, And the women's movement said, hey, wait a second, no, no, no, no, you can't do this to us anymore, and then the doctors and scientists started listening. It was it is now illegal in New York State and pretty much everywhere else to do surgery for cancer without first doing a biopsy and having a conversation with
that woman. And this was only you know, this is the nineteen seventies. It's not that long ago, and we certainly have made great strides. And I didn't know that story about your mom doctr Ratsky at all, and has that motivated you in so many ways I can only imagine as an oncologist. Yeah, of course. I mean I was in college and I remember my dad calling me. I was on my way home for spring break and he called and said, okay, I'll pick you up at the station. I came down from Boston to you know,
took the train to Penn station. He picked me up and we're heading uptown. I thought he's taking me out to dinner. Next thing, I know, like the taxi cab pulls up in front of a hospital. I said, well, wait a second, like what's going on here? And that's when I went up and saw my mom in the hospital after the surgery.
My goodness.
Yeah. So yes, of course I knew I wanted to be a doctor, but I think that kind of sealed where I was headed in my career.
That makes a lot of sense, a lot of sense. So this month now some what fifty years later, do you see a rise in breast cancer diagnoses this month because women are reminded to come in and get their mammograms, and so then more women are actually diagnosed this month than others.
Yes, Actually we do see that variation during the course of the year, and I think it's fantastic that we have breast cancer Awareness Month. People do go in and schedule their tests. We don't get that many diagnoses over the summer, everyone's on vacation. But back to school, Breast Cancer Awareness Month. Make your checkup appointments, go in, get tested, and if you need us, we're here.
Yeah, you are there. You were there for me, and you still are here for me. In terms of where we are with getting the mammogram, there are different options. Now we've talked about these before, but I'm seeing more and more evidence that three D mammograms are the gold standard, and yet they're not available to everyone. Tell us a little bit about where we are on mammogram technology and what women should be able to ask for.
You're right, Amy, the technology in imaging has really really changed over the years, Even just the mammogram technology mammogram is just an X ray of the breast, and as anyone who's had it done knows, you get kind of squished between these plates so that the X ray can actually compress the tissue and give us an image of what's going on in the breast tissue if the tissue is very dense, and that's more common in younger women, because as we get older that breast density, the breast
tissue itself becomes a little less active, and really the breast is fundamentally made of fat, and that's easy to see little spots and dotson, But when the breast tissue is active in younger women, more proliferative, sometimes it's hard
to see stuff. So by improving our technology with two D and then three imaging and adding computer assisted detection, which we've had for a long time now, several years, and layering on top of that even more intelligence, both the doctor's intelligence but artificial intelligence, adding that in where our computers can help us see through the background noise and say here's something we really should pay attention to on the mammogram, and then the radiologist might say we
should also add an ultrasound sonogram of the breast or maybe this person also needs an MRI. So it's very individualized. It's not one size fits all.
And you mentioned dense breast tissue. I was just reading and I realized just this month a new regulation is actually in place September tenth, they now have new regulations which allow patients or empower patients, I should say, with the information that they need to make an informed decision about breast cancer screening based on their breast density. Now it actually will show on your mimography report if you have dense breast tissue, and a lot of women don't
realize that they have it. Why is that significant?
You're right Amy that that's now going to be regulated. I think more and more across the country. We've been doing it in New York State for a while. It's very important because if the breast tissue is dense, we may need to add that other modality, whether it's ultrasound or MRI. And don't forget the clinical exam because sometimes we see something or feel something that doesn't show up on imaging. So we kind of need to do a little bit of everything.
And how do you know as a patient what you can ask for, what your insurance will cover. I mean, so much of this has to do with accessibility. It's about information and knowing your rights, but also knowing what you have to pay for and what right your insurance come we'll be willing to pay for.
I think the best thing is for each person to have a dialogue with her doctor. If it's the obg i N, they're usually pretty well informed and can talk to the breast imaging center the radiologist about well, what's going to be best for this patient. If it's a primary care doctor and they may not be as well informed about those options, then have your patient go for a consultation and speak to the radiologist or speak to the obg i N about what the best exam is.
Yeah, you have to know your rights and then use your voice, right, Yeah, that's a huge part of it. This has been a big troubling trend. Yes, we've had great strides made in keeping women alive for those first five years. It's ninety nine percent correct survivor survivor rate. That's phenomenal, and yet we're seeing more and more, in a fairly alarming rate, women under fifty getting breast cancer.
Do doctors know why? I'm really concerned about that. We have seen a trend that more young women are getting diagnosed, So we have to ask the question, is it because more young women are getting screened. Maybe we're picking up little things and people who are a little younger because they're coming in in their early forties to get that screening. But I'm seeing patients even in their thirties and sometimes
late twenties more than we used to see. One factor is that the genetic mutations that can increase the risk of getting breast cancer. People have heard of the BRCA mutations, and there are other ones check two, rip one, a whole bunch of new genes that we know about. But what we're seeing is with each generation, the women getting breast cancer are also getting younger and younger, and we're
not really sure what that's all about. May have to do with our environment and may have to do you know, what we're eating and drinking, what we're being exposed to, not sure.
To what you're saying right there. To that point, big headlines this week specifically, or at least the past couple of weeks that there's a new study out that links not just the food but the food packaging that we're all using to transfer our food to eat, our food with to breast cancer carcinogens. Those are scary headlines and seemingly impossible to deal with because what am I supposed to do about how we package our food as a country, And what would you say to women? What are we
supposed to do with these headlines and this information. It feels like everything could be causing cancer or at least creating these types of carcinogens. Well, I certainly think that over the past fifty years we've seen a really, really enormous change in the whole chain of food production, packaging, and distribution in America and the developed world. So, you know, when my mother was a little girl, everything was fresh, right, You just bought the food for the day that you
were going to eat. By the time I was growing up, we had supermarkets, but yeah, we were still buying stuff pretty much that was fresh, and we didn't have so much in the way of plastic packaging. And now kind of everything is packaged either in styrofoam or plastic, and then we're using plastic utensils and we're keeping it in our fridge for who knows how long. We don't know for sure the absolute cause and effect of that, but
it's really problematic. We're hearing about these forever chemicals which are related to some of these plastic compounds. They stick around in our bodies, they're hanging out in our oceans as we're throwing all this plastic garbage into the oceans, and they're getting into the animals. We also know that the food is processed way more than it was, you know,
a few decades ago, so especially the animal proteins. Animals are being fed with growth hormones and antibiotics and all kinds of stuff just to fatten them up and get more production.
But then in turn, we're eating that stuff and we're getting exposed to the same antibiotics and the same hormones, and that changes what's going on in our bodies metabolically, and the microbiome, which you know you probably have heard about. Also, those healthy bacteria that live in our body, well, they get altered when they're exposed to some of these chemicals. So there's a big chain reaction going on here.
Doctors. I haven't hypothetical, and I hope you take it in the spirit in which it's intended here. I know it's kind of crazy to think this way, but a child born today. You have a daughter today, and you say, I want to give her the best chance of not getting breast cancer at any point in her life. What could you do with that child? Feed that child, expose
that child to to give yourself the best chance? And no matter what you do, sometimes are you just going to be unlucky and nothing you can do about it?
TJ, You're right, I mean, how do we take control over this? And what do we do? I think, you know, just on the personal level, we can pay attention to the kinds of foods we buy. It is a little bit crazy that it costs more money to buy healthier food than to buy junk food. So we've got to address that as a nation and say, how can we get people to have a healthier diet, not just in
terms of cancer, but even cardiovascular health. Everything, More fresh fruits and vegetables into the diet, more fiber, less fat, less junk food of course, less processed food, especially the stuff coming from animal products, so dairy products, milk, eggs, cheese, and then all the meat products chicken and fish, and you know, beef, which we eat a lot of in America, much more than in other places. So if you can buy organic food where the animals are not fed all
those antibiotics and hormones. That's probably healthier. Same with the dairy products, the eggs and the cheese and milk. I think that probably long term might make a difference, hard to say for sure. The other thing is just being healthy in terms of not being obese, doing physical exercise, not smoking, and not drinking excessive amounts of alcohol because all of those things make us sick.
Too, and we need to just grow our own leafy drinks in the backyard, eat those the rest of our life. Don't leave the house, I think, is what you're saying, and we should be fine.
Yeah, you know. And I also just I know some women are scared. They don't want to know. It's like ignorance is bliss. And obviously that is not a good way to deal with a potential cancer diagnosis. Because people are afraid of getting one, they avoid perhaps the tests altogether. But early detection is absolutely the way to save lives
when it comes to breast cancer. And I was hoping you could expound on that because I think some people just think, well, I'll just kick the can down the road to next year.
Don't do that. Early detection is still key. It's a very, very very powerful tool that each woman can have to take control over her own health. And I always tell people that, you know, going for the mammogram doesn't prevent cancer,
but it could prevent you from dying from cancer. So it's really really important if we find a small tumor, even if it's an aggressive subtype, because not all breast cancers are the same, lots of different kinds of breast cancer, but we know that size in this situation still counts, and if it's small and if it hasn't spread too far, we usually have a much better chance of eradicating it completely and eliminating those problems down the road.
Can you give us a good news in trends? We always talk about we see younger women, that's troubling, and all these troubling things. What's the good news you're seeing in trends.
Yeah, the good news is our treatment's way better, way better than it was, so we understand much more about the biology of breast cancer. Basic science research is critically important to pushing this field forward, So we have to keep funding research in the laboratory where the scientists are digging into those molecular mechanisms of why is that cell turning into a cancer cell, what's making it grow, what's
making it travel, what's making it spread? And now our therapies are more and more targeted to the type of breast cancer that someone has, and they work better. The treatments are more effective. We can learn to turn on, switch on, and off all those different pathways in the cell.
It's really really exciting. I've seen that change over the course of my career, and I know there are people alive and well who wouldn't have been when I first went into practice, and that is the greatest, greatest joy in my clinical work.
I would say that brings tears to my eyes just to hear that, yeah, it's.
True, but to that, yes, the advancement's research, advancement's technology advancements and treatment are is it going to be a while though, before those advancements are going to show up in those trends you talk about with Okay, not so many young women are getting it anymore? Okay, not as many? Is that showing up yet?
Well, I think we have reduced breast cancer mortality overall in America, so we have seen that already in terms of the causation thing. I think we have to do a little more work there, but we're definitely doing better on treatment for sure, Doctor Ortsa.
Anyone who's listening to this podcast, I'm sure is familiar with our dear friend Morgan Mitchell, who is stage four metastatic. She is going to be celebrating her seven year anniversary come December. That also brings tears to my eyes and gives me chills because that was unheard of not that long ago, or at least in recent history. Where are we in terms of women who are living with stage four and how they're living and how long they're.
Living, right, And that's where a lot of our research starts in that stage four setting with people who have advanced cancer, because the cancer is right there, so we can see how the treatments are working, and we start there. I lost a patient last week who was very, very dear to me, but I took care of her for twenty seven years wow, and the last ten of those years she had metastatic breast cancer. But she lived a
good life with a really good quality of life. She was able to work and continue her career and be with her family and travel and enjoy herself, and it was only at the very end in the last few months where it got really rough, But that would never have happened in the past. And that's because of all
of these new targeted therapies. Not only are they more effective, but we really, really really work on trying to help people live well and have a good quality of life and do whatever we can to minimize side effects and minimize the toxicity of our treatments. We're moving away from some of the things we used to do all the time because they were just too rough on people, and
now we have things that are working better. Now. I can't tell you it's one hundred percent perfect, and I'm not going to tell you that every treatment comes and people feel fantastic. There are some side effects, there are some tough things we have to go through, but it is our mission to make sure that we keep doing research to get this right and to do it better and better and better.
Can you put in context of how rare that is You talk about your patient that you took care of for all that time and then Morgan seven years with metastatic is do I have it right? I'm not overstating it. That's these days not so unheard of, but that's pretty rare for seven years.
Depends on the subtype of breast cancer. So there are some subtypes where I certainly have patients with stage four disease five, six, seven, eight, nine, ten years. I mean, we're getting that's that's really happening. There are some other subtypes of breast cancer that are tougher to treat, a little bit more aggressive, and you know we're focusing our efforts on those.
Can mindset, can attitude? Can just how you approach your life after a metastatic diagnosis like that. I say this because Morgan is the like the bubbliest, happiest person I've ever been around ever, And I think when I met her she'd already been diagnosed. I've only known her as stage four. She runs half marathons, marathons, She's just this bubbly, this ball of life all the time. Can that have an impact staying active? Can you still? Can you prolong
your life? I guess by changing some things after metastatic diagnosis.
This may not be a scientific answer, but yes, I believe that our heads are connected to our bodies, and when we use the word heart, we're here in this iHeart Studio we use the word heart. Yes, it's that pump that makes the blood go around your body, but it's also the seat of our emotions. So I think these are powerful connections. Our heads and our hearts, everything in our body is interconnected how we feel, how we
live our lives. If we can fill our lives with joy, with hope, with love, and with trying to live in as healthy a way as possible, make the most of each day, be optimistic, maybe have some faith and whatever that is. Yeah, I think it helps. Yeah.
So yes, Morgan is actually via Sarah get expecting she and her husband are expecting a baby in January, and talking about having a reason to live, a reason to have a reason to keep fighting.
Got it? Now? She just got a big one, she sure did, and it's going to be a very powerful, very powerful factor for her.
I wanted to ask you about that, because you are there in the rooms with these women who are fighting for their lives. How big of a deal is and how often are you seeing women who think all hope is lost for starting that family. I was diagnosed at forty I already had two little girls. It was still devastating for me. I remember you told me you're out of the baby making business. You have two beautiful, healthy girls.
You're one of the lucky ones. But how many women now are actually getting the option and seeking that opportunity to have a family in maybe a less conventional way, but still having the option to do so.
Well, Amy, again, you hit it right right on the head, because that's changed too, especially now with all of our
young patients. So before we start treatment in our young patients, we have that conversation about fertility, whether they already have children or don't have children, if they have a partner, don't have a partner, But if someone wants to do fertility preservation where we do a round or two of harvesting eggs and then we can freeze them or get embryos, make sure that we have that in the bank before we do something that might reduce a person's fertility or
may delay the time to when she would have children. I've lots and lots of patients who've had babies after treatment for breast cancer. Sometimes they've carried the pregnancies. Sometimes they've gotten pregnant without the assistance of using an embryo or IVF. Sometimes we have to use a little more technology, but we have all of great new technologies now for
fertility preservation and for getting those babies. Some of my patients also have you surrogates, you know, like Morgan, and the babies are beautiful, they're healthy, and the families are just fantastic to see.
So I know, I know, I can't are saying that more and more. I can't wait for January. According to the World Health Organization, the theme for this month's Breast Cancer Awareness Month is no one should face breast cancer alone. How important is community? As a physician, what you witness when women are diagnosed, How important is it for them to have that support?
Well, you know, support when we're facing any kind of adversity in life is so important and so helpful. And everyone defines that differently. For some people it's having a loving partner. For some people it's their children, their parents. Not everyone has a family that's nearby. You know, we move all over the place. We have a lot of young single people who are here. I have a lot of older women who you know, are kind of on their own, so we have to help them find that
community in where they are in their space. And there's so much variability across the country. Some people are geographically far away from their loved ones. Other people are living in apartment buildings where they have a close, tight knit group of friends who are supporting them. So I think when we sit down and talk to a person, when I do, I want to know, well, who is there for you. Very often at that first meeting, that significant other person you know will come in, and that's always
an important relationship. I told you about the woman who passed away last week. I knew her husband as well as I knew her well, you know, so that was a long term relationship. But I think we have to help our patients find those connections, even if they are on their own. There's so many resources out there where women can hook up online on the phone in breast
cancer support groups if that's appropriate for them. And at our cancer center at NYU promar To Cancer Center, we have social workers and a liaison psychiatry team who can also help our patients with those aspects.
I don't know if you remember what I was alone when I was diagnosed and the NYU psychiatry team actually came in to help me because I was not well mentally in that moment, and I was so grateful for the staff you had and the people who were there to help someone like me in that moment, who was in fact alone and needed I genuinely needed assistance to even get through that next hour, let alone the tests
I was facing throughout the day. So I was appreciative of that eleven years ago, and I know that I'm sure even more structure has been put in place for women who find themselves in that situation.
And it's important that when the woman comes in to talk to us, they kind of share those concerns with us, because I may not always know what's going on, and I try to ask, but speak up about everything because really that we're here to We are here for you to try to put that whole package together in the treatment plan.
You are definitely there for me and continue to be so I guess just I'm wrapping up here and TJ, if you have anything else.
Please let me know.
But I guess I would love to leave our listeners with what they can do during this month, what women can do and what the people who love them can do. I know men get breast cancer too. We always want to point that out. Anyone who is breast issue can actually get breast cancer. But what are the big takeaways? And what do you want people to remember this month?
I would say for this month and then for every month going forward, but we'll emphasize in this month. Take a moment, do a quick self assessment. Am I trying to live, you know, as healthy a life as I can? Like those New Year's resolutions? What's my self assessment on that? Can I eat a little more healthy? Can I exercise a little bit more? Am I feeding my kids the right stuff? Am I getting enough sleep? Am I drinking too much alcohol? You know all that stuff. Oh, I'm
due for my mammogram. I better make my appointment, go in for that checkup, and have a clinical breast exam, because sometimes something subtle, a change in the skin or the nipple or feeling under the arm, is just as important as having the imaging. So do the clinical exam as well. And then don't be afraid if you notice something or if the mammogram shows an abnormality, don't hesitate follow up on it. Make sure you check it out if you have questions. There are resources all over the country.
I mean, we're here in New York City. We have so many wonderful health care facilities and some patients, and some women across the country don't have access to that. But get on the telephone, go on the internet, reach out and there will be someone who can help you. If you are concerned about something that you know that could be related to breast cancer. Don't let fear stop you, don't let fear stuff.
Yeah, can you give the official recommendation? It seems like they always change. But for a woman, what age, when you should go? How often those things like what is the official You can do a self exam every day if you want to, but what are the official recommendations for age and when you should be in there?
See the official recommendation? My official recommendation. But I think the official recommendation would be for women who are not at increased risk because of either a family history of breast cancer or some other problem they've had, but average risk. You know, you're a healthy person, nothing's been going on,
and no one in your family had cancer. Somewhere around age forty, get that first baseline mammogram, as Amy said, if it shows dense breast tissue, and now they have to tell you that, follow up with your doctor or the radiologist. Hey, this says my breast tissue is really dense. Do I need an ultrasound? Do I need a MRI? Do I need something else? That's Number one. The second thing would be for women who are at increased risk because there's a family history of breast cancer, or they
already know. Let's say they had genetic testing and they know they have a gene mutation that increases the risk of getting breast cancer. They start a little earlier on their screening, so that would be starting around aage forty. And you know when should women stop screening? Right? I think if you're an older person, you're in your seventies,
you're in your eighties. I even have some patience in their nineties if you are healthy and well and otherwise in good shape and living a full act of life. I don't ignore it because even older women get breast cancer. And I do treat women who are in their eighties and nineties as long as they don't have a lot of other health issues that are interfering with that, they can also do very very well and not have that
turn into a big problem for them. So I don't want to neglect our older ladies either.
Yeah, that's very important because I think people probably at some point say yeah, what does it matter anyway? But it does matter, and treatment does help women of all ages. Talk for rats. It is always a pleasure to see you. Thank you so much. I know you're busy treating patients and saving lives, so we appreciate you making the trip here to the iHeart Studios to be with us on this very important month.
Well. I love being here. Thank you for inviting me.