Advancing Breast Cancer Care for Hispanic Women
January 21, 2025ID12642
To CiteDCA Citation Guide
- 00:00Funding for Yale Cancer Answers
- 00:02is provided by Smilow Cancer
- 00:04Hospital.
- 00:06Welcome to Yale Cancer Answers
- 00:08with the director of
- 00:09Yale Cancer Center, doctor Eric Winer.
- 00:12Yale Cancer Answers features conversations with oncologists
- 00:15and specialists who are on
- 00:16the forefront of the battle
- 00:17to fight cancer.
- 00:18This week, doctor Tracy Battaglia
- 00:20is filling in for doctor
- 00:21Winer for a conversation about
- 00:23breast cancer surgery
- 00:25and some of the racial
- 00:26disparities that exist in breast
- 00:27cancer care with doctor Monica
- 00:29Valero.
- 00:30Doctor Valero is an assistant
- 00:32professor of surgical oncology at
- 00:33the Yale School of Medicine.
- 00:35Here's doctor Battaglia.
- 00:37So why don't you tell
- 00:38us a little bit about
- 00:38yourself,
- 00:39your area of expertise in
- 00:41surgical oncology, and what brought
- 00:42you to this field?
- 00:46I am a breast cancer
- 00:47surgeon
- 00:48specialized
- 00:49primarily in breast cancer and
- 00:52lesions of the breast.
- 00:54I have been working as
- 00:56an assistant professor of surgery
- 00:59since twenty nineteen.
- 01:02I'm passionate about the care of
- 01:04breast cancer, specifically because of
- 01:06the multidisciplinary
- 01:08team and multidisciplinary
- 01:09care that is involved.
- 01:11Additionally, I feel like it's
- 01:12a field where
- 01:16research continues
- 01:17to evolve, and I feel
- 01:19very passionate to join breast
- 01:21cancer treatment since I was
- 01:23very young during medical school.
- 01:25And, so thank you for
- 01:27sharing that. I know that
- 01:28our paths crossed in Boston,
- 01:30but you're here in Connecticut
- 01:31now. Can you tell us
- 01:32a little bit about your
- 01:33training and your path to
- 01:34getting to Yale Cancer Center
- 01:36and caring for patients here
- 01:37in Connecticut?
- 01:38Yes. So I did my
- 01:40research in breast cancer and
- 01:42my training in general surgery
- 01:43at Brigham and Women's Hospital
- 01:45in Boston, Massachusetts.
- 01:47During that time
- 01:49I was very lucky to
- 01:50cross path with you. And
- 01:51and then I
- 01:52started my career as an
- 01:54assistant professor
- 01:56at the Beth Israel Deaconess
- 01:57Medical Center, where I spent
- 01:59three years as a
- 02:01junior faculty.
- 02:05Most recently,
- 02:07I have had the
- 02:08privilege to join
- 02:10the Yale Breast Cancer department
- 02:14here where I had the
- 02:15opportunity to
- 02:17circle back and work again
- 02:18with my prior mentors
- 02:21and it has been an
- 02:22amazing
- 02:25time. And it's great to
- 02:27be working with.
- 02:33Well, we're lucky to have
- 02:34you here in Connecticut.
- 02:37I want to go back to a comment
- 02:38that you made about
- 02:39the kind of rapidly
- 02:41evolving field and excitement
- 02:42in the field. NOTE Confidence: 0.9747726
- 02:44Cancer care
- 02:46is a rapidly evolving field
- 02:48in all fields, whether it
- 02:49be surgical oncology, medical oncology,
- 02:52or radiation oncology.
- 02:55Can you tell us a
- 02:55little bit about
- 02:58the innovations in the surgical
- 03:00care of breast cancer patients
- 03:02and what you're most excited
- 03:03about for the future?
- 03:05Tracy, as you
- 03:06know,
- 03:07in breast cancer, we work
- 03:09hand to hand,
- 03:11surgery, medical oncology, and radiation
- 03:13oncology.
- 03:13And as you already mentioned,
- 03:15this field continues to
- 03:17evolve with a growing focus
- 03:19on balancing effective care with
- 03:21quality of life. So the
- 03:23multidisciplinary
- 03:24teams are working towards the
- 03:26deescalation
- 03:27of surgical procedures that are
- 03:29not going to impact
- 03:31additional recommendations or additional
- 03:33treatment.
- 03:34In this way, we reduce
- 03:36the physical and emotional burden
- 03:38of patients while
- 03:39simultaneously,
- 03:41we escalate in adjuvant therapies
- 03:43such as targeted treatments, immunotherapy
- 03:46to achieve optimal outcomes with
- 03:47less invasive approaches.
- 03:49So this has been,
- 03:51you know,
- 03:52great, especially for patients to
- 03:55have better quality of life
- 03:56with better outcomes in terms of decreasing
- 03:59chances of breast cancer
- 04:01recurrence.
- 04:02So you used some terms
- 04:04there that I wanna unpack
- 04:05a little bit, and maybe
- 04:06you can give us some
- 04:07examples
- 04:09of deescalation
- 04:11of surgical approaches because when
- 04:13I was training
- 04:14many, many years ago,
- 04:16you know, surgery was the
- 04:17first line of treatment for
- 04:19breast cancer and
- 04:20some pretty invasive surgical
- 04:22approaches
- 04:24to treat breast cancer. So
- 04:26maybe you can just comment
- 04:27and tell our listeners
- 04:29a little bit more about
- 04:29what you mean by
- 04:30deescalation of surgical approaches?
- 04:33Yes. So as you mentioned,
- 04:34you know, back in the
- 04:35days, it was like one
- 04:36surgery fits all. There was
- 04:38the same surgery for everyone.
- 04:39With more research, we have
- 04:41learned
- 04:42that surgery is going to
- 04:43be targeted to tumor subtypes.
- 04:46And what I'm
- 04:47trying to say, with the
- 04:49deescalation
- 04:49of surgical procedures
- 04:51sometimes there's surgeries
- 04:53that are
- 04:55not going to provide any
- 04:57information that we're going to
- 04:58use
- 04:59to tailor the treatment.
- 05:01And we are avoiding and
- 05:03doing less surgeries, avoiding morbidity,
- 05:07and side effects.
- 05:08For example, right now
- 05:11we have recent
- 05:12data about
- 05:14trials
- 05:15where we are omitting
- 05:16axillary staging or surgery under
- 05:19the arm.
- 05:20And this is in specific
- 05:22cases where
- 05:23the information from the lymph
- 05:25nodes is not going to
- 05:26impact the treatment
- 05:27for those patients.
- 05:29And so what does that
- 05:30translate to from the patient's
- 05:32perspective?
- 05:33Translating less time in the
- 05:34operating room? Less
- 05:37chances for having side effects
- 05:39on the arm, less chances
- 05:40for having arm swelling, better
- 05:42recovery?
- 05:43So it's all
- 05:46with the goal to improve
- 05:47quality of care.
- 05:49So that's really helpful. Those
- 05:51examples, I think, are really
- 05:52helpful for us to sort
- 05:53of get our heads around
- 05:54what we mean.
- 05:58You also mentioned the
- 05:59acceleration or escalation
- 06:01of adjuvant therapy
- 06:04before surgery. Can you talk
- 06:05a little bit about that
- 06:06and how that's different now
- 06:07than it was before?
- 06:08Yes.
- 06:09So with the evolution
- 06:11of medical therapy, systemic therapy,
- 06:14and immunotherapy,
- 06:15now we can target
- 06:17specific cancer with a specific
- 06:18therapist, avoiding giving
- 06:20the one size fits all.
- 06:22So now we know that
- 06:23there are specific medications that
- 06:25are going to be targeted
- 06:26to a specific cancer subtype,
- 06:28and this is going to
- 06:29allow for some cancers
- 06:31to even downgrade or
- 06:33shrink before surgery, allowing for
- 06:36smaller surgeries, not only on
- 06:37the breast, but also under
- 06:38the arm.
- 06:40So perhaps a message to
- 06:42our listeners
- 06:43who perhaps are dealing
- 06:46themselves or family member with
- 06:47a breast cancer diagnosis, understanding
- 06:49your tumor
- 06:50and it's what you call
- 06:52subtype is an important step
- 06:53towards understanding
- 06:55what options you have surgically
- 06:57and otherwise. Is that fair to say?
- 06:58Yes, I think
- 07:00that's totally fair to say.
- 07:01That's great.
- 07:04I wanna ask you a
- 07:06little bit about
- 07:07the current
- 07:11incidence of breast cancer.
- 07:14And many of us are
- 07:15hearing more and more of
- 07:17cases and colleagues and friends
- 07:19and family members who are
- 07:20developing breast cancer early,
- 07:23younger than before.
- 07:24And I wonder if you
- 07:25can comment a little bit
- 07:26on sort of the rising
- 07:28incidence in younger populations with
- 07:30breast cancer.
- 07:31Yeah. So I think the
- 07:33incidence of breast cancer,
- 07:36there is evidence that it is
- 07:37arising. It continues to
- 07:39rise. And specifically in the
- 07:40younger population, although
- 07:43for the younger population, they're
- 07:44still reminded to be
- 07:46less common compared to the
- 07:47older groups.
- 07:48Breast cancer, the natural history
- 07:51of breast cancer is
- 07:52this is a disease of
- 07:53the older population, not of
- 07:55the younger populations.
- 07:56But I think right now,
- 07:58nowadays, there are several factors
- 08:00that may be contributing
- 08:02to the trend.
- 08:04And I think some of
- 08:05them could be just lifestyle
- 08:06and environmental factors.
- 08:08We know that there is
- 08:09a rise in obesity and
- 08:10sedentary lifestyles.
- 08:12It has been well
- 08:13reported that increased rates of
- 08:15obesity,
- 08:17even at younger ages, is
- 08:18linked to higher risk for
- 08:19breast cancer.
- 08:21Also, as women
- 08:23continue to be in
- 08:25the professional area, we're
- 08:27seeing delay with childbearing.
- 08:30And we're also seeing an
- 08:31increase of alcohol consumption,
- 08:33and a different diet,
- 08:35a more processed diet. So
- 08:36to start, lifestyle and
- 08:37environmental factors that are modifiable,
- 08:40and we have seen
- 08:41a link
- 08:42with an increase in
- 08:43breast cancer.
- 08:45On the other side, I
- 08:46think it's not only
- 08:47increasing the disease, it's also
- 08:49the fact that we
- 08:51have better imaging.
- 08:53Right? So we have improved
- 08:54detection.
- 08:55We're also doing
- 08:57good work in awareness of
- 08:59breast cancer screening. So I
- 09:00think there are more women
- 09:02that are
- 09:04very efficiently getting mammograms on
- 09:06time, and we have better
- 09:08quality of imaging. So I
- 09:10think the combination of those
- 09:11two are allowing us to
- 09:12see
- 09:13and detect more cancers at
- 09:15an earlier stage too.
- 09:17That's great. So it's complicated.
- 09:19It's not too straightforward. So,
- 09:21I wonder, you're
- 09:23a cancer
- 09:25treatment doctor, right? So you
- 09:26see patients after they have
- 09:28a cancer diagnosis.
- 09:29And so, I also know
- 09:31and you mentioned in your
- 09:32opening remarks, that you're passionate
- 09:33about
- 09:35awareness
- 09:35and access to care. So
- 09:37I wonder if you can
- 09:38talk a little bit about
- 09:41cancer screening and
- 09:43sort of any prevention or
- 09:45you mentioned the word modifiable
- 09:47sort of risk factors.
- 09:49What are some messages you
- 09:51can give our audience around
- 09:53breast cancer prevention and early
- 09:55detection and your experience with
- 09:57screening?
- 09:58With screening,
- 09:59right now there are a
- 10:00few guidelines in
- 10:03breast cancer. I will say
- 10:04my practice, I follow the
- 10:07NTCN guideline,
- 10:09which recommends that
- 10:11for an average risk women,
- 10:13and when I say we
- 10:14try to say with average
- 10:16risk women, are those women
- 10:18without personal or strong family
- 10:20history of breast cancer and
- 10:21without any genetic mutation or
- 10:23prior history of breast cancer.
- 10:24So that will be the
- 10:26overall population.
- 10:27And for the overall
- 10:29population,
- 10:30it is recommended that women
- 10:31start with annual screening mammography
- 10:33at the age of forty.
- 10:36There is another group, which
- 10:37is the higher risk women.
- 10:38These are the women that
- 10:41have genetic predispositions.
- 10:43They're well known BRCA one
- 10:45and two mutations
- 10:46or have a strong family
- 10:48history of breast cancer,
- 10:50prior history of chest radiation,
- 10:53between the ages of ten
- 10:55to thirty,
- 10:56or those that have
- 10:58biopsies in their breast that
- 11:00return with high risk lesions.
- 11:02Those women's have a higher
- 11:04risk of developing breast cancer
- 11:05in the future, and they
- 11:06should be managed in a
- 11:07different way. They need
- 11:09increased
- 11:10screening and follow-up.
- 11:11So it is recommended
- 11:13that these women
- 11:16obtain annual mammography,
- 11:19and the majority,
- 11:20specifically for the ones
- 11:22with the genetic predispositions
- 11:23or those that have
- 11:25an increased risk higher than
- 11:26twenty percent, and I can
- 11:28dive into that in a
- 11:28little bit, it is recommended
- 11:30that I alternate the MRIs
- 11:32with the mammograms every six
- 11:33months, meaning
- 11:35these women's will obtain a
- 11:36mammogram
- 11:37and then an MRI six
- 11:39months later. So, one imaging
- 11:40each year. And of course,
- 11:42clinical breast exam follow.
- 11:45So what I'm hearing you
- 11:46say is sort of a
- 11:47really powerful message to our
- 11:48listeners.
- 11:49You know, even
- 11:50if you don't have cancer,
- 11:53understanding your personal risk of
- 11:54developing
- 11:55breast cancer can guide you
- 11:57on the appropriate screening regimen
- 11:59for yourself.
- 12:00And so we can't go
- 12:01through every scenario
- 12:03this evening in our conversation
- 12:05to understand what
- 12:07path
- 12:07individuals might take depending on
- 12:10their risk, but just understanding
- 12:11their risk
- 12:12is an important step forward.
- 12:14You mentioned genetic predisposition, and
- 12:16I wonder if you can
- 12:17talk a little bit about
- 12:19genetic
- 12:20predisposition
- 12:21to breast cancer.
- 12:23Yeah, I will say,
- 12:25the majority of the breast
- 12:26cancers
- 12:27are non genetically driven. So
- 12:29it's a small percentage,
- 12:31about five to ten percent
- 12:33of women's that
- 12:35present with breast cancer that
- 12:37will have a genetic mutation.
- 12:39These cancers
- 12:41usually are seen in women
- 12:42that have a very significant
- 12:44family history of breast cancer
- 12:45or breast cancer diagnosis at a
- 12:47very young age.
- 12:48And the genetic testing would
- 12:50allow us to understand if
- 12:52there is any genetic mutation
- 12:53that is making them more
- 12:54prone to develop another cancer
- 12:56down the road. So that's
- 12:58why these women will have
- 12:59a different and separate type
- 13:00of screening
- 13:02and surveillance
- 13:03down the road.
- 13:05Well, that's certainly a lot
- 13:06of information for us to
- 13:10understand and sort of take
- 13:11in. Unfortunately, we have
- 13:13to take a one minute
- 13:14break.
- 13:15And when we come back,
- 13:16I wanna dive into your
- 13:17work from a disparities
- 13:19perspective and access to care.
- 13:21Funding for Yale Cancer Answers
- 13:23comes from Smilow Cancer Hospital,
- 13:25where the lung cancer screening
- 13:27program provides screening to those
- 13:29at risk for lung cancer
- 13:30and individualized
- 13:32state of the art evaluation
- 13:33of lung nodules.
- 13:34To learn more, visit smilowcancerhospital
- 13:37dot org.
- 13:39There are over sixteen point
- 13:41nine million cancer survivors in
- 13:43the US and over two
- 13:44hundred and forty thousand here
- 13:46in Connecticut.
- 13:47Completing treatment for cancer is
- 13:49a very exciting milestone, but
- 13:51cancer and its treatment can
- 13:52be a life changing experience.
- 13:55The return to normal activities
- 13:56and relationships
- 13:57may be difficult and cancer
- 13:59survivors may face other long
- 14:01term side effects of cancer,
- 14:03including heart problems,
- 14:05osteoporosis,
- 14:06fertility issues, and an increased
- 14:08risk of second cancers.
- 14:10Resources for cancer survivors are
- 14:12available at federally designated comprehensive
- 14:15cancer centers such as
- 14:17Yale Cancer Center and Smilow
- 14:18Cancer Hospital
- 14:20to keep cancer survivors well
- 14:22and focused on healthy living.
- 14:24The Smilow Cancer Hospital survivorship
- 14:26clinic focuses on providing guidance
- 14:29and direction
- 14:30to empower survivors to take
- 14:31steps to maximize their health,
- 14:33quality of life, and longevity.
- 14:36More information is available at
- 14:37yalecancercenter
- 14:38dot org. You're listening to
- 14:40Connecticut Public Radio.
- 14:42Okay. Welcome back listeners to
- 14:44Yale Cancer Answers.
- 14:46This is Doctor Tracy Battaglia
- 14:47here, and I am thrilled
- 14:49to have been joined tonight
- 14:50by my guest, Doctor Monica
- 14:51Valero.
- 14:53I wanna transition our
- 14:54conversation a little bit to
- 14:56talk about your expertise in
- 14:58cancer inequities or cancer disparities.
- 15:01You came to Connecticut and
- 15:02to Yale Cancer Center to
- 15:04lead the
- 15:06Hispanic Breast Cancer Program,
- 15:08because of your passion for
- 15:09caring for this particular population.
- 15:11So can you tell our
- 15:12listeners a little bit about
- 15:15your program and specifically
- 15:17anything that's important for our
- 15:18listeners to understand about cancer
- 15:20inequity?
- 15:21Yes, Doctor Battaglia, just
- 15:24a little bit of background.
- 15:25We know that the Hispanic
- 15:26population of Hispanic women are
- 15:28less likely to develop breast
- 15:30cancer
- 15:31than when they're compared to
- 15:32non Hispanic white women. However,
- 15:34despite this lower incidence of
- 15:36disease,
- 15:37when the incidence is compared,
- 15:40we have seen that the
- 15:42Hispanic population
- 15:44is usually diagnosed at a
- 15:46advanced stage
- 15:47and sometimes with a worse
- 15:49prognosis.
- 15:50We know that social determinants
- 15:52of health and socioeconomic factors
- 15:54can interfere. So my
- 15:56goal with this program was
- 15:58to meet the needs of
- 15:59a growing and underserved Hispanic
- 16:01population diagnosed with
- 16:03breast cancer
- 16:04and to inform these women
- 16:06about the most important facts
- 16:08about the disease. So this
- 16:09is like an inclusive
- 16:11health care environment that
- 16:12provides service to the Hispanic
- 16:14population, and we we try to
- 16:17allow them to have the
- 16:19entire
- 16:20visit in their native language.
- 16:22Can you talk a little
- 16:23bit more about some of
- 16:24the examples of other access
- 16:26related initiatives to target the
- 16:28population besides offering
- 16:31programs in their native language?
- 16:33Yeah. We're doing community
- 16:35outreach. We also have a
- 16:36mobile mammo van that allows
- 16:39patients to obtain mammograms and
- 16:41ultrasound in their community.
- 16:43We do educational,
- 16:45group support,
- 16:47and we provide a lot
- 16:48of education,
- 16:50making sure patients
- 16:52know of the programs that
- 16:53the state also provides.
- 16:56There are programs that allow patients
- 16:58that are uninsured or
- 17:02live in an underserved area.
- 17:03They allow them for them to
- 17:06obtain mammograms and ultrasound.
- 17:08And this is a well
- 17:09known program that is not
- 17:11specifically in Connecticut,
- 17:13but is available in many other
- 17:15states. So increasing the awareness
- 17:17and making sure patients
- 17:19understand there is a possibility
- 17:20for them to come and
- 17:22have access,
- 17:23is one of our
- 17:25main goals. Can you talk
- 17:27about what's involved in creating
- 17:29a pathway for access
- 17:30for these populations?
- 17:32Yes. So, currently,
- 17:34their health care
- 17:36pathways
- 17:37that allow
- 17:38for physicians and patients
- 17:41to have a more tailored
- 17:42treatment. As as you know,
- 17:44we are working together in
- 17:47streamlining time sensitive referrals,
- 17:50for these patients which the
- 17:51goal is to optimize the
- 17:53time to breast cancer diagnosis
- 17:55in a vulnerable population.
- 17:57What I'm trying to say
- 17:58is when patients obtain
- 17:59an imaging or a mammogram,
- 18:01sometimes
- 18:02something abnormal can be seen,
- 18:04and additional imaging or biopsies
- 18:06are required afterwards.
- 18:08This is not usually a
- 18:09smooth
- 18:10process because it requires multiple
- 18:12visits. As we know, it's
- 18:13hard with our busy life.
- 18:14It's very hard to take
- 18:15time off work. And, you
- 18:17know, if you have kids,
- 18:18so there are many factors
- 18:19that
- 18:20may make
- 18:22a woman take longer
- 18:24and obtain subsequent images and
- 18:26biopsies. And this time
- 18:28or this lag
- 18:29allows for
- 18:30late diagnosis. And when we have
- 18:32late diagnosis
- 18:33usually the disease is
- 18:35technically more advanced and
- 18:37the outcomes are better the
- 18:39earlier the stage
- 18:40and the sooner we
- 18:41can treat the cancer.
- 18:44So with this
- 18:45pathway,
- 18:46where we are trying
- 18:48to navigate patients
- 18:49and make sure if
- 18:50there's any barriers or challenges
- 18:52that they're facing
- 18:53to get to the diagnosis
- 18:55point, and then from there
- 18:56to see a surgeon
- 18:57or a provider,
- 18:59we try to
- 19:00overcome those barriers.
- 19:02So I wanna
- 19:03talk a little bit more
- 19:04about the navigation piece in
- 19:06a minute, but, I just
- 19:07wanna reiterate
- 19:09some of the points that
- 19:10you made, that
- 19:11mammography
- 19:12is the best test that
- 19:13we have to identify cancer
- 19:15before we have symptoms.
- 19:17And that's why we promote
- 19:18mammography, right, in average risk
- 19:20populations at forty and for,
- 19:22you know, high risk populations,
- 19:23maybe sometimes earlier.
- 19:25But mammography, like any screening
- 19:27test, is not a perfect
- 19:28test. So as you point
- 19:29out,
- 19:30I think it's important for
- 19:31our listeners to understand that,
- 19:33you know, once an abnormality
- 19:35is detected on a mammogram,
- 19:37your screening test is not
- 19:38over. You need to really
- 19:40be diligent about following up
- 19:41in a timely way to
- 19:42make sure that initial problem
- 19:45that was identified in the
- 19:46mammogram is either cleared or
- 19:48further testing is done to
- 19:49make sure
- 19:50that there is or is
- 19:51not a cancer. So critical
- 19:54point for our listeners to
- 19:55understand
- 19:56and as you
- 19:57point out, it's not easy
- 19:59for any of us to
- 20:00follow-up on sort of that
- 20:01cascade of care that's needed
- 20:02to get to a cancer
- 20:04diagnosis or to rule out
- 20:05cancer
- 20:06and navigation or patient navigation
- 20:08is a
- 20:09care delivery model that I'm
- 20:10very passionate about as you
- 20:12know in our prior work
- 20:13together.
- 20:14Can you talk about what
- 20:15navigation means after an abnormal
- 20:17mammogram and how it can
- 20:18help a patient?
- 20:20Yeah, so navigation,
- 20:22has been well defined as
- 20:25an amazing tool to guide
- 20:27patients and to make sure
- 20:29that if there is any
- 20:30challenge, we can help them
- 20:31to overcome those and to
- 20:33obtain a timely diagnosis.
- 20:35As we all
- 20:37know, we have navigation
- 20:40support at some of our
- 20:42sites
- 20:43where we practice.
- 20:44However, this navigation support
- 20:46starts after the patients are
- 20:48diagnosed. And what I mean
- 20:49with navigation support is,
- 20:51every time we meet a
- 20:52patient with breast cancer,
- 20:54they have the opportunity to
- 20:55meet one of our nurse
- 20:56navigators.
- 20:57We'll walk with
- 20:58them through the process of
- 20:59the breast cancer diagnosis, not
- 21:01only through the surgical portion,
- 21:03but also through the medical
- 21:04oncology and radiation oncology because
- 21:06this is a process
- 21:08that takes many months. So
- 21:09the navigators are able
- 21:12to identify if there is
- 21:13any specific
- 21:14factor that will,
- 21:16you know, impact the patient's
- 21:19care and treatment.
- 21:20And what we're trying to
- 21:22do right now, as you
- 21:23mentioned before,
- 21:24screening mammography
- 21:26is not the only portion
- 21:27of the studies, right, for
- 21:29detecting breast cancers. So when
- 21:31additional procedures are
- 21:33required afterwards,
- 21:35it is important that patients
- 21:37understand that the sooner we
- 21:38obtain the additional recommended
- 21:41imaging or biopsies is going
- 21:42to be beneficial for them.
- 21:44So this is where
- 21:45navigation, upstreaming navigation
- 21:48to the time of
- 21:49the abnormal imaging
- 21:50will allow, so that's our
- 21:52thought, will benefit patients in
- 21:53decreasing the time from
- 21:55the abnormal imaging to the
- 21:57definitive diagnosis.
- 21:59So, you know, nurse navigation
- 22:01is a pathway to ensure
- 22:03equal access to services.
- 22:06When we talk about equity
- 22:08and ensuring we meet the
- 22:09specific needs of patients,
- 22:12specifically
- 22:13the Hispanic population that you're
- 22:14working with,
- 22:16how do we tailor navigation
- 22:17to these populations to really
- 22:19meet their needs? Can you
- 22:20give some examples?
- 22:22Yeah. I think, there are
- 22:23many,
- 22:25challenges that we can see
- 22:27not only in the Hispanic
- 22:28populations that are applicable to
- 22:31many,
- 22:32you know, ethnic groups.
- 22:34However, I will say that,
- 22:36you know, the fear of,
- 22:38the mistrust in
- 22:41the health care
- 22:42system,
- 22:44the lack of insurance or
- 22:47or sometimes the immigrational status,
- 22:52and the fear to miss
- 22:54work or childcare.
- 22:56Those are the main
- 22:58factors where we could see
- 22:59not only the Hispanic population,
- 23:01but many women
- 23:03face,
- 23:04challenges to come for their
- 23:06follow-up imaging and also
- 23:08the copays. We know like
- 23:09right now, that's
- 23:11a very, very important part
- 23:12of the
- 23:13healthcare system.
- 23:15And so your navigation program
- 23:17tries to understand those needs
- 23:18from the patient's perspective
- 23:20and connect them with resources
- 23:22to help address them.
- 23:23We have multiple programs that
- 23:25help those patients to connect
- 23:27with
- 23:28tools that will allow them
- 23:31a better follow-up.
- 23:33I imagine coming to see
- 23:34a provider like you who's
- 23:36linguistically
- 23:37con congruent with a population
- 23:39where English
- 23:41is not necessarily their first
- 23:42language is also a way
- 23:44of sort of overcoming some
- 23:45of those challenges.
- 23:47Yeah, I agree. I feel
- 23:48like in the
- 23:49ideal world,
- 23:50every patient should be able,
- 23:51specifically due to the breast
- 23:53cancer process, which is a
- 23:54very complex and
- 23:56difficult time for our patients.
- 23:58It must be really hard
- 23:59to try to express yourself
- 24:01and understand and absorb all
- 24:03the information that you are
- 24:04given.
- 24:06It is very in-depth information and
- 24:09I think that will be
- 24:10ideal. NOTE Confidence: 0.9760034
- 24:16I wanna
- 24:17ask you about
- 24:19you mentioned earlier in your
- 24:20comments about research and clinical
- 24:22trials. And I wonder if
- 24:24you can speak a little
- 24:25bit about the role of
- 24:26research and clinical trials
- 24:28in breast cancer care, either
- 24:30through your own program or
- 24:32otherwise.
- 24:33Yes.
- 24:34So research and clinical trials,
- 24:37you know, are key
- 24:39on finding
- 24:41and learning more about better
- 24:43options for our patients.
- 24:45So here we have the
- 24:47option of offering
- 24:50patients a lot of clinical
- 24:51trials that are available
- 24:53across the country.
- 24:55And I will say,
- 24:57we really encourage our patients,
- 24:59the ones that qualify for
- 25:00them, to participate.
- 25:02And specifically,
- 25:04given that
- 25:05the Hispanic population is not
- 25:06well
- 25:07represented in clinical trials, that's
- 25:09also one of my areas
- 25:11or goals
- 25:12is to allow for these
- 25:13women to understand
- 25:15their options to participate
- 25:17and to understand better the
- 25:18trial so they feel
- 25:20more comfortable about joining.
- 25:22And when I say
- 25:24that they're not well represented,
- 25:25it's like the majority of
- 25:27these trials
- 25:28have a small percentage of
- 25:29Hispanic population. So when you
- 25:31obtain data and results,
- 25:33sometimes
- 25:34they are not totally applicable
- 25:36to every ethnic group.
- 25:38So the more diverse
- 25:40population that we have for
- 25:41these trials is, the better.
- 25:43And you are very
- 25:44lucky to work with the
- 25:46medical oncology group
- 25:47where we have
- 25:49many,
- 25:51clinical trials,
- 25:53that will allow for
- 25:54new and advanced
- 25:57therapies.
- 25:59That's really helpful to sort
- 26:00of help framing the message
- 26:02to our listeners that
- 26:05cancer clinical trials
- 26:08are
- 26:09a form of quality care
- 26:11treatment.
- 26:11Sometimes,
- 26:13especially in
- 26:15specific areas that we don't
- 26:17know what the best treatment
- 26:18might be for a particular
- 26:19subtype of a tumor,
- 26:21having access to a clinical
- 26:23trial sometimes gives you access
- 26:24to the most
- 26:26cutting edge
- 26:27treatment options.
- 26:29Can you talk a little
- 26:30bit about that?
- 26:31Yes. I think
- 26:32you said it right.
- 26:34I think sometimes,
- 26:36we know that there
- 26:37are therapies that
- 26:40will provide better outcomes,
- 26:41but it needs to be
- 26:42proven. So in order to
- 26:44be proven, right, we,
- 26:47organize and lead
- 26:49and develop these
- 26:50clinical trials.
- 26:52And, you know, we're very
- 26:53passionate about that because nowadays,
- 26:55with all the
- 26:57evolution in the therapy
- 26:58of breast cancer,
- 27:00we
- 27:01have a lot of options
- 27:02for our patients.
- 27:04Amazing.
- 27:06Well,
- 27:07I wonder if, as we're
- 27:09sort of closing out on
- 27:10our time together,
- 27:12if there are any other
- 27:13sort of
- 27:15pearls of wisdom that you
- 27:17might have for our listeners
- 27:19around
- 27:20breast cancer care and specifically
- 27:23the population of patients that
- 27:24you're caring for, or anything
- 27:25we didn't touch on that
- 27:26you think is important?
- 27:29I think what is really
- 27:30important is for patients to
- 27:32understand or understand that in
- 27:33this new era,
- 27:35we're open about
- 27:37breast cancer diagnosis. I feel
- 27:39like back in the days,
- 27:40this was like a very,
- 27:42kind of, like, taboo,
- 27:44thing that
- 27:46patients did not feel comfortable
- 27:48sharing with family members. So
- 27:50I feel like now the
- 27:51more we know and the
- 27:52more
- 27:53we empower ourselves,
- 27:55understand and learn about breast
- 27:57cancer
- 27:58diagnosis, awareness, and we're
- 28:00very efficient about obtaining mammograms
- 28:02and understanding understanding our risk.
- 28:05You know, it's going to
- 28:06allow for women
- 28:07to be healthier and feel
- 28:09better with their care.
- 28:10So I really would
- 28:12like to empower
- 28:13women.
- 28:16And it's not easy, go
- 28:18for mammograms. Even I think
- 28:19it's even more difficult if
- 28:21you already went through diagnosis
- 28:23or have a lot of
- 28:24family history.
- 28:25But I will empower women
- 28:26to go and continue with
- 28:27their screening mammograms and
- 28:29not be afraid of
- 28:30sharing or asking
- 28:32when they have questions to
- 28:33any providers or the health
- 28:35care system.
- 28:37Dr. Valero is an assistant professor
- 28:39of surgical oncology at the
- 28:40Yale School of Medicine.
- 28:42If you have questions, the
- 28:43address is cancer answers at
- 28:45yale dot e d u,
- 28:46and past editions of the
- 28:47program are available in audio
- 28:49and written form at yale
- 28:50cancer center dot org. We
- 28:52hope you'll join us next
- 28:53time to learn more about
- 28:54the fight against cancer.
- 28:55Funding for Yale Cancer Answers
- 28:57is provided by Smilow Cancer
- 28:59Hospital.