Cancer Risks and The Role of Patient Decision Making

Name: Cancer Risks and The Role of Patient Decision Making
Uploaded: 2025-01-06T13:29:01.7866667Z
Duration: 29 min

January 06, 2025

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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 the
00:09Yale Cancer Center, Doctor Eric Winer.
00:12Yale Cancer Answers features conversations
00:14with oncologists and specialists who
00:16are on the forefront of
00:17the battle to fight cancer.
00:19This week, it's a conversation
00:20about some of the decisions
00:22patients are faced with in
00:23the treatment of breast cancer
00:24with doctor Sarah Schellhorn.
00:26Doctor Schellhorn is an associate
00:28professor of medicine and medical
00:29oncology at the Yale School
00:31of Medicine.
00:32Here's doctor Winer.
00:34I know that
00:36over the course of the
00:38past decade plus, you have
00:40taken care of
00:41countless
00:43women with breast cancer.
00:47And some of those are
00:48young women.
00:50As people know, breast cancer
00:52affects women of all ages.
00:53It becomes more common
00:55as women grow older, but
00:57it
00:58is a cancer that's pretty
01:00common in younger women too.
01:03And so issues about fertility
01:06come up.
01:07They sure do.
01:08And,
01:09maybe you could just, you
01:11know, start with a few
01:12thoughts
01:13about
01:14how you approach those conversations
01:16with patients.
01:18It's always a challenge
01:20when you're meeting a patient
01:21for the first time and
01:24they've been given this
01:26new diagnosis of breast cancer,
01:28and there are lots of
01:29things that have to be
01:30talked about regarding the new
01:32cancer, regarding the treatment, regarding
01:34all the options. You've got
01:36surgical options and medication options
01:39radiation options, and it
01:41can all be overwhelming.
01:44But it's really important to
01:46remember
01:47that young women in particular,
01:50may not have completed their
01:52families. They may not have
01:56had children or as many
01:58children as they would want.
01:59They may have
02:01plans, and they may have
02:02been putting things off for
02:03career or other reasons.
02:05And those are NOTE Confidence: 0.9790995
02:06critical lifestyle
02:08pieces
02:09that we have to consider
02:11in the treatment of
02:12breast cancer. So
02:14when I see a new
02:15patient
02:16that I have a little
02:17bit of a mental checklist,
02:19that I go through
02:21that's
02:22certainly talk about the cancer,
02:23talk about the reasons for
02:25various treatments, and the reasons
02:27why things are being recommended.
02:29But we also wanna make
02:30sure that we're taking into
02:31account,
02:32is your family complete? Have
02:34you ever thought about having
02:35children? Because a lot of
02:36the treatments that we use
02:37in the treatment of breast
02:38cancer
02:39can affect
02:41someone's future fertility.
02:43They may prevent someone from
02:45being able to carry a
02:46healthy pregnancy
02:48if they were to become
02:49pregnant while on these medications.
02:51So these are critical conversations
02:53that have to happen.
02:59And they can effect fertility in different ways.
03:01Chemotherapy, for example.
03:03Chemotherapy,
03:05as I think many of
03:06our listeners know,
03:08can
03:09put a woman into menopause.
03:11Yes.
03:12But
03:13that's not always the case,
03:15and it's very much age
03:16related.
03:17Yes.
03:19Talk about that a little
03:20bit. I mean, if
03:21you're a twenty five
03:23year old, are you gonna
03:24go into menopause with chemotherapy?
03:26You may go into
03:27a temporary menopause, and you
03:28may have hot flashes and
03:29be kind of uncomfortable from
03:31a menopausal standpoint
03:33for a short period of
03:34time. But in all likelihood,
03:37a twenty five year old
03:38has very robust ovaries that
03:40are gonna kick it back
03:41into gear
03:42within a few months from
03:44completing chemotherapy.
03:46The older a woman is
03:47and the closer to natural
03:49menopause,
03:50the less likely
03:52that they will regain fertility.
03:55But a twenty five year
03:56old, a thirty year old,
03:57very likely to be
03:59able to
04:02have menstrual
04:04cycles again, may be able
04:05to become pregnant. And there
04:07are even things that we
04:08can do during chemotherapy
04:10that can help preserve fertility.
04:12And what are those things?
04:16I feel like you might
04:17know the answer to this
04:18question, but
04:20you can actually
04:22use medications
04:24called GnRH agonists. They're
04:26shots, injections that
04:29effectively put the ovaries to
04:31sleep, kind of put them
04:32into a dormant
04:34status so that the chemotherapy
04:36doesn't affect them as much.
04:38And
04:39studies have shown that women
04:41who receive
04:43these additional treatments during chemotherapy
04:46are more likely to go
04:48on and carry healthy pregnancies
04:51in the future.
04:52So we use those a lot
04:53in people who desire future
04:54fertility.
04:55So that's one option
04:57during chemotherapy itself.
05:02But you also have to remember
05:03when someone is
05:05undergoing chemotherapy and their
05:07ovaries are a certain age,
05:09whatever that age is,
05:12those ovaries are not getting
05:13any younger, and any eggs
05:15that are contained in those
05:16ovaries aren't getting any younger.
05:18And so even when we
05:20try to
05:21preserve someone's fertility by using
05:23these injections,
05:25we still may advise
05:27them to preserve eggs or
05:29embryos if they're in a
05:30committed relationship
05:34to enhance the options of
05:36having a healthy baby, healthy
05:38pregnancy
05:39down the line. Because
05:40the older an ovary gets,
05:41the older the egg gets,
05:43the more chances that
05:46genetically, a baby may have
05:48more problems.
05:50Well in
05:52my former institution before I
05:54came to Yale a few
05:55years ago,
05:57we had started a program for
06:00young women with breast cancer,
06:03something that we're actually starting
06:06at Smilow,
06:07for not just young women
06:09with breast cancer, but young
06:10people with cancer in general.
06:12But the reason I bring
06:14this up is that
06:15initially,
06:16we set
06:17the cut point for age
06:19at forty two.
06:22It eventually snuck up a
06:23little bit as the person
06:24who was directing that program
06:27also got a little older.
06:29But the reason we picked
06:31forty two is that
06:33that was probably an
06:35age where there aren't a
06:36lot of people who are
06:38still
06:38thinking about becoming pregnant after
06:41that age.
06:42And while there may be
06:43a few,
06:45our options
06:46are much more limited.
06:48But,
06:50the other complicating
06:52feature is that we also
06:54sometimes
06:55suppress
06:56the function of ovaries
06:58as part of treatment for
07:00breast cancer.
07:01Or we use medications
07:03that are
07:05contraindicated.
07:06They can't be given during
07:07pregnancy because they cause fetal
07:09abnormalities.
07:11And these are
07:12the hormone based treatments or
07:15probably more appropriately anti hormone,
07:17antiestrogens.
07:21So depending on whatever clinical circumstance,
07:23we might put someone into
07:25menopause,
07:26in which case they can't
07:27become pregnant naturally,
07:29if they're in menopause. Their
07:31ovaries are not functioning.
07:33Or we use a drug
07:34called tamoxifen,
07:36which cannot be given during
07:38pregnancy.
07:39And these are given for
07:40a long time. They're given
07:41for at least five years
07:44in many cases,
07:46assuming they're well tolerated.
07:48And that's five years of
07:50time
07:51where ovaries are also getting
07:53older and eggs that are
07:54in the ovaries are getting
07:55older. So it may become
07:57just because of
07:59normal, natural
08:00history of a woman's fertility,
08:02it may be harder to
08:03become pregnant after five years
08:04of endocrine therapy.
08:06So I'm not
08:08sure if this is where
08:09you were pointing
08:10our conversation, but
08:12there's a
08:13study called the positive study,
08:16designed, I think, primarily by
08:18people at your former institution,
08:23that looked at discontinuing
08:25endocrine therapy, tamoxifen
08:27or others,
08:28earlier than the five years.
08:30So women had to be
08:31on that medication for
08:34at least eighteen months, but
08:36could be longer.
08:38And the medication was
08:39discontinued in an effort to
08:41have them achieve
08:43a normal pregnancy, either
08:45through natural
08:47means or through
08:49additional fertility treatments.
08:51And so far, the results
08:53from that study have been
08:54incredibly
08:56positive, incredibly
08:58optimistic
08:59that women can
09:01stop endocrine therapy,
09:03have a pregnancy, deliver a
09:05baby, even breastfeed for a
09:06little bit, and then go
09:08back on endocrine therapy with
09:10no detrimental effects to their
09:12ultimate outcome, although we're still
09:13waiting for long term
09:15follow-up of this study.
09:17And and, of course, we
09:18couldn't do the ultimate study,
09:21which would be to randomize
09:22patients because it's pretty hard
09:24to
09:25randomize someone to get pregnant
09:27or you don't get pregnant.
09:28That's a tough thing to do.
09:31That's not one
09:32that can be done.
09:34What was interesting about the
09:36results from the study too
09:37is that,
09:39about three quarters of the
09:41women, if I remember correctly,
09:43actually
09:44were able to become pregnant
09:46and deliver a child,
09:48which is a remarkably
09:50high percentage.
09:52It is, especially given that
09:54a fair number of those
09:55women got chemotherapy,
09:57so really reassuring,
09:59and I think opens a
10:01lot of doors
10:02that we previously would have
10:04considered closed
10:06for younger women with breast
10:08cancer.
10:10It does seem that
10:12as complicated as this dance is around
10:16breast cancer treatment and pregnancy,
10:18that there's often a way
10:20to navigate
10:22a result that is gonna
10:24both be optimal
10:26in terms of treating the
10:27cancer and will also give
10:29somebody the chance to have
10:30a child if that's what
10:31they really wanna do.
10:33It's a careful conversation.
10:36It's a long conversation.
10:39It can be a really
10:40emotional and intense conversation,
10:43because
10:44pretty
10:45far reaching ramifications for a
10:47woman's future. But
10:50we are often able to
10:52navigate
10:54chemotherapy,
10:55fertility treatments prior to chemotherapy.
10:58And even when someone needs
10:59to be on endocrine therapy
11:00long term,
11:03getting a woman to a
11:04point where she can try
11:06to naturally
11:07have a child or
11:09with some medical help have
11:11a child.
11:12And for our listeners,
11:15it is worth pointing out
11:16that years ago, meaning twenty,
11:18thirty years ago,
11:20it was
11:21widely assumed that getting pregnant
11:24after breast cancer
11:25was something that you always
11:27wanted to avoid because the
11:28pregnancy could stimulate a recurrence.
11:31And that really doesn't seem
11:33to be the case.
11:34In the data we have
11:38it has never really been shown. In fact, it
11:40hasn't been shown.
11:42That's right. So I think
11:43we're in a
11:44much better place. We
11:46also now
11:47can not only preserve embryos,
11:50but if someone doesn't have
11:51a partner,
11:52we can save
11:54eggs, eggs or pieces
11:56of ovarian tissue, all kinds
11:58of different things,
12:00that fertility specialists have at
12:02their fingertips to be able to help.
12:06Again, nothing's a
12:07hundred percent, but lots of
12:09options that can be explored.
12:11And I think this
12:12is another example of the
12:13fact that
12:14you often need
12:16doctors
12:18and nurses and others from
12:19many different fields to provide
12:21optimal care.
12:23And as medical oncologists,
12:26we're not the ones prescribing
12:28fertility treatments
12:30and we need to work
12:31with our our colleagues in
12:34OB GYN.
12:37The treatment of breast cancer,
12:38the treatment of any cancer,
12:39requires a lot of
12:40hands on deck,
12:42and close connections with
12:44lots of different disciplines and
12:45fields,
12:47to be able to provide
12:48truly comprehensive
12:50whole patient care.
12:52I just wanna come
12:53back in our
12:55last
12:56few seconds before the break
12:58and
12:59just touch very briefly on
13:01the fact that
13:03we all recognize this is
13:04an emotionally charged
13:06experience. I mean, having cancer
13:08is hard enough. Having cancer
13:10and worrying about wanting to
13:12become pregnant or maybe even
13:14being pregnant at the time
13:15just makes it that much
13:16harder.
13:20It's hard enough,
13:22to have to have these
13:23conversations about treatment. And you
13:25throw
13:27fertility and families
13:28into it,
13:30it is that much harder.
13:31Well, we're gonna take just a
13:34very brief break, and I'll
13:36return in
13:38just a minute with doctor
13:39Sarah Schellhorn,
13:41associate professor at Yale School
13:43of Medicine, and we'll continue
13:45our conversation about
13:48other issues related to breast
13:49cancer.
13:50Funding for Yale Cancer Answers
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13:54where the lung cancer screening
13:56program provides screening to those
13:57at risk for lung cancer
13:59and individualized
14:00state of the art evaluation
14:02of lung nodules.
14:03To learn more, visit smilowcancerhospital
14:06dot org.
14:08The American Cancer Society estimates
14:10that over two hundred thousand
14:12cases of melanoma will be
14:13diagnosed in the United States
14:15this year, with over a
14:16thousand patients in Connecticut alone.
14:19While melanoma
14:20accounts for only about one
14:22percent of skin cancer cases,
14:24it causes the most skin
14:26cancer deaths, but when detected
14:28early it is easily treated
14:29and highly curable.
14:31Clinical trials are currently underway
14:33at federally designated comprehensive cancer
14:35centers such as Yale Cancer
14:37Center and at Smilow Cancer
14:39Hospital
14:40to test innovative new treatments
14:41for melanoma.
14:43The goal of the Specialized
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14:46skin cancer grant is to
14:48better understand the biology of
14:50skin cancer with a focus
14:51on discovering targets that will
14:53lead to improved diagnosis and
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14:56More information is available at
14:58yale cancer center dot org.
15:00You're listening to Connecticut Public
15:02Radio.
15:04Hello again. This is Eric
15:06Winer from the Yale Cancer
15:08Center here with Yale Cancer Answers.
15:11And I'm joined tonight by
15:13doctor Sarah Schellhorn, associate professor
15:15of medicine
15:16and a breast cancer expert.
15:19We spent the last
15:21fifteen minutes or so talking
15:22about pregnancy and breast cancer.
15:25We're gonna move on and
15:26talk about other hormonal aspects
15:28of breast cancer or in
15:30particular,
15:31hormonal or anti hormonal treatments.
15:35These are given to
15:37a large number of women
15:39with breast cancer
15:40because
15:41somewhere in the range of
15:43in excess of seventy
15:46five percent of all breast
15:47cancers
15:49are sensitive to female reproductive
15:51hormones.
15:53Sarah,
15:54maybe you could
15:56just talk about
15:58generally the benefits
16:00of
16:01these anti hormonal treatments and
16:04perhaps describe the two most
16:07common ones that we use
16:09to help prevent recurrences.
16:10Sure.
16:12So it's really interesting.
16:13I think there's a kind
16:14of an interesting historical piece to
16:19the treatment of breast cancer.
16:20If you think back, and
16:21I can't give you
16:22an exact date, but many
16:24decades
16:25ago,
16:27the treatment of breast cancer
16:29was pretty morbid, lots of
16:30big surgeries. There were some
16:32studies of chemotherapy. But what
16:34was discovered was some
16:37in many women with breast
16:38cancer,
16:39taking out their ovaries and
16:41putting them into menopause seemed
16:43to be a pretty good
16:43treatment for breast cancer. And
16:45it was on that
16:47further studies showed that
16:50many breast cancers, as you
16:52said,
16:53probably more than three
16:54quarters of all breast cancers,
16:56express
16:57the estrogen receptor or the
16:59progesterone receptor.
17:01And these are
17:02hormone
17:04receptors that require
17:06kind of seeing the hormone,
17:07estrogen or progesterone,
17:09that leads to cells,
17:11cancer cells in particular,
17:13getting the signals they need
17:15to grow and divide.
17:16And so these cancers are,
17:18in essence, fueled by hormones.
17:21And
17:23a number of different types
17:25of drugs have been developed
17:26that work on that interaction
17:31between the hormone and its
17:32receptor.
17:33The oldest is a drug
17:35called tamoxifen,
17:36which
17:38is a competitive
17:40antagonist in the breast
17:41of estrogen. All that means
17:43is if we think about
17:44a receptor kind of like
17:45a baseball glove
17:47and we think about the
17:48hormone like a baseball and
17:49the glove catches the
17:51baseball,
17:52tamoxifen
17:53is kind of like a
17:54grapefruit.
17:55And if you're holding it running
17:57around in the outfield of
17:58a baseball field, holding a
17:59grapefruit in your baseball glove,
18:00you're never gonna be able
18:01to catch a baseball. It's
18:02kind of how I describe
18:03it to patients.
18:06But
18:07Tamoxifen blocks that as the result.
18:08Great way of describing
18:10it and for listeners it actually even
18:12works without seeing your hands.
18:15I've got some
18:16really great hand gestures going
18:17on right now.
18:18It then leads into a big conversations about
18:20baseball teams
18:22and Yankees and
18:23Red Sox, but I won't
18:25go there. But,
18:27tamoxifen,
18:28when it's given for
18:30five years, maybe longer,
18:32has been shown to reduce
18:34the chances of a breast
18:35cancer coming back by about
18:38half, by a
18:40relative
18:41risk reduction of fifty percent.
18:44And if we can just
18:45say for a minute what
18:46that means in people's
18:48terms.
18:49So if you have a
18:52ten percent chance of having
18:53a recurrence, it goes down
18:55to about five. If
18:56you have a twenty five
18:58percent chance of having a
19:00recurrence of your cancer, because
19:01it's a higher risk cancer,
19:03it would go down to
19:04twelve and a half percent.
19:06Right.
19:07It's pretty powerful treatments.
19:11Arguably it is the first
19:12real personalized
19:14targeted therapy in cancer.
19:18So tamoxifen's been around for
19:20years and years and years.
19:24And it's got sort of
19:25a bad rap.
19:27Why is that?
19:28I think
19:29with the advent of social
19:31media and online
19:33web based
19:34chat groups, there's a lot
19:36of information sharing.
19:38And
19:39tamoxifen does have some potential
19:41side effects. It can cause
19:43hot flashes. It can cause
19:44mood changes. It can cause
19:46fluid retention and weight gain
19:48and cause people to not
19:49feel
19:50terribly normal, causes headaches.
19:52Lots of things that
19:55are maybe not horrible from
19:57a medical standpoint, but from
19:59a lifestyle
20:00quality of life standpoint can
20:02be really
20:03problematic.
20:05But many women
20:07tolerate the pill just fine.
20:09And
20:10when we think about who
20:12are the
20:13loudest people on these web
20:15based chat groups, often it's
20:17the people who are having
20:18the problems,
20:20that
20:22appropriately,
20:23are asking for help and
20:24asking for advice.
20:27And the people who are
20:27doing just fine
20:29are living their lives and it
20:33tends to be a little
20:35bit more problematic in younger
20:36women than older women. So
20:39you put
20:40a thirty five year old
20:41woman on Tamoxifen,
20:43and at least in
20:44my practice,
20:45I tend to expect a
20:47few more symptoms than I
20:49would in somebody twenty years
20:50older.
20:51And I think it's
20:53important to remember
20:54that estrogen and progesterone
20:57really do serve a purpose
20:58in women.
21:00And
21:01messing around,
21:03manipulating
21:04hormones,
21:06can cause problems and
21:08and big ones that really
21:10impact somebody's
21:13day to day.
21:14Hot flashes, if they happen
21:16only once every few days,
21:17probably not that big a
21:18deal. But hot flashes that
21:20are happening ten times a
21:21night and preventing somebody from
21:22sleeping and
21:24leads to chronic fatigue and
21:26mental fogginess, that's
21:28really a big deal.
21:30And so a lot of
21:31the conversations that we have
21:32in clinic
21:34relate to that absolute
21:36benefit
21:37conversation
21:38and the relative
21:39benefit. So, yes, while tamoxifen
21:41reduces the chances of a
21:42cancer
21:43recurring by fifty percent,
21:46if someone's risk of a
21:47cancer recurring is really small,
21:50the benefit of tamoxifen is
21:52also really small.
21:54And for many women,
21:55it may not be enough to
22:00warrant staying on a medication
22:01that makes them miserable.
22:03Absolutely, and
22:05there are alternatives to
22:07tamoxifen as well.
22:10So there's another class of
22:12medicines called aromatase inhibitors.
22:16Going back to my baseball
22:17analogy,
22:18aromatase inhibitors basically remove all
22:20the baseballs. So you can't
22:21catch a baseball
22:23if there are no baseballs
22:24to be caught. It
22:26basically prevents
22:28a woman from being able
22:30to make estrogen.
22:32It has to be given
22:34in conjunction with other medicines
22:36in very young women who
22:38have ovarian function.
22:41So that gets a little
22:42bit more complicated.
22:44But
22:45these medicines reduce estrogen levels
22:48from
22:49a low level
22:50to a very low level,
22:52almost
22:53undetectable level.
22:56I was just gonna jump
22:57in and say, you use
22:58the baseball,
23:00metaphor. I typically
23:02describe
23:03giving one of these
23:05medicines
23:06along with suppressing ovarian function,
23:09which is what we have
23:09to do when we do
23:10it in a young woman,
23:13as
23:14entering menopause by jumping off
23:16the high dive
23:18instead of instead of wading
23:19into the water.
23:21It's not
23:22a slow process. It's not
23:24a natural process.
23:25That's not what normally happens.
23:29So the side effects of
23:30those aromatase inhibitors
23:32is just kind of like
23:33menopause only more so.
23:36And you think about
23:38putting somebody
23:40who has normal
23:42ovaries, whose
23:44normal ovarian function has
23:47fluctuating levels of hormones
23:49and has normal menstrual cycles
23:51into menopause
23:52is like
23:54jumping in from the high
23:55dive or going from sixty
23:56miles an hour down to
23:58zero,
23:58it can be very jarring.
24:00And what's funny is for
24:01some people,
24:02it's associated with almost no
24:04symptoms.
24:05And for other people
24:07and I don't know
24:08how to predict this, it's
24:10just miserable.
24:11I hope someday we
24:14get to a point where
24:15we're able to
24:17predict how someone is going
24:19to feel. And I don't
24:20know what we'll use to
24:21predict that. Maybe
24:23there will be some
24:25smart
24:26genome technology. Maybe there will
24:28be some prior menstrual history
24:30piece to all of this,
24:31but that's a
24:33hard conversation to have. The
24:35only way to know if
24:35someone's gonna have side effects
24:37is for them to try
24:38it and see what happens.
24:40And I think the
24:41point you made that, you
24:42know, we give these medicines
24:44for a long time. So
24:45these are symptoms that may
24:47not be life threatening, but
24:48they're pretty annoying. And so
24:51putting up with them for
24:53a number of years for
24:54many women is often
24:56challenging
24:57to say the least.
24:58Now,
25:00on the other hand, these
25:02hormonal,
25:03antihormonal,
25:04endocrine therapies, they're called all
25:06of these different things,
25:08sometimes,
25:09are far more beneficial than
25:11treatments like chemotherapy,
25:13and it all depends on
25:14the tumor.
25:16That's exactly right.
25:19Breast cancer isn't one disease.
25:21And it's this big spectrum
25:24of diseases,
25:26each of which is treated
25:28a little bit differently
25:29or even a lot bit
25:30differently.
25:32We make decisions based on
25:34a few things that the
25:34pathologist tells us when they
25:36look at the cancer under
25:37the microscope. We look at
25:38the grade of the cancer.
25:40That's a measure of how
25:41aggressive the cells look under
25:42the microscope.
25:43We look at the
25:45percent of cells that have
25:46the estrogen receptor or the
25:47progesterone receptor.
25:49And then there's this may
25:50be where you were going
25:51with this question, but
25:53there's this test called the
25:55Oncotype test,
25:57which is
25:59a test of a patient's
26:01individual cancer.
26:03It looks at twenty one
26:05cancer
26:06related genes,
26:08and it looks at the
26:08levels of those genes and
26:10what levels they're expressed at.
26:12And based on the
26:13levels of those genes, it
26:14goes into this very complicated
26:17algorithm,
26:18that some very smart people
26:19developed many years ago. And
26:21then it spits
26:23out
26:24a number. And so you
26:26often,
26:27in breast cancer circles, you
26:29may have people saying, well,
26:30what was your number? What
26:31was your number?
26:32The recurrent score is a
26:33number, and it's on a
26:34scale of zero to a
26:36hundred.
26:37Most breast cancers
26:39have low numbers under fifty.
26:42And then depending on that
26:44recurrent score,
26:45we can help
26:47decide whether somebody
26:49needs chemotherapy or benefits from
26:51chemotherapy or really doesn't benefit
26:53from chemotherapy.
26:54And a
26:55couple of major studies
26:57that have been published in
26:58the last
26:59five, seven years,
27:02have shown that
27:04oncotype recurrence scores of
27:06twenty five or lower
27:08are not associated
27:10with much benefit to
27:12chemotherapy. There are some caveats
27:13to that. There are
27:15some questions
27:16in young women in particular.
27:18But in most women,
27:20low oncotypes,
27:23then don't benefit
27:24much from chemotherapy, if at
27:26all.
27:27And it's so different from
27:29the way it was thirty
27:30years ago where, in fact,
27:32it was one size fits all.
27:34Right. And, you know,
27:35we didn't differentiate between different
27:38cancers. We gave everybody
27:40essentially the same treatment,
27:42and
27:43it's
27:44come
27:45so very far. And at
27:48the same time,
27:50not only are we able
27:51to
27:53allow people to live with
27:54fewer side effects,
27:56but
27:57we're certainly doing no worse
27:59in terms of overall outcomes.
28:00And
28:01I think just as a
28:03sort of
28:04give people a general sense,
28:06what proportion of women who
28:08have breast cancer go on
28:09and live a normal
28:11life afterwards?
28:13A large proportion,
28:15eighty, eighty five percent go
28:17on and never
28:18hear back from this cancer,
28:20from their original cancer.
28:21And even women
28:23who do hear back from
28:24the cancer,
28:26whose cancer comes back
28:27whether in the breast or
28:29somewhere else, go on to
28:30live
28:31many, many years because of
28:33the advances in treatment.
28:35Doctor Sarah Schellhorn is an
28:36associate professor of medicine and
28:38medical oncology at the Yale
28:39School of Medicine.
28:41If you have questions, the
28:42address is canceranswersyale
28:44dot edu, and past editions
28:46of the program are available
28:48in audio and written form
28:49at yale cancer center dot
28:51org.
28:51We hope you'll join us
28:52next time to learn more
28:53about the fight against cancer.
28:55Funding for Yale Cancer Answers
28:57is provided by Smilow Cancer
28:59Hospital.