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    Advancing Breast Cancer Care for Hispanic Women

    January 21, 2025
    • 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.
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    • 13:34To learn more, visit smilowcancerhospital
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    • 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.
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    • 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.
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    • 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.