Speaker 1 0:03

Welcome to the Healthy Matters podcast with Dr . David Hilden , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health healthcare and what matters to you. And now here's your host, Dr . David Hilden .

Speaker 2 0:20

Hey everybody, it's Dr . David Hiin, your host of the Healthy Matters podcast. This is episode 24 in October was Breast Cancer Awareness Month. And so we're gonna talk to an expert about breast cancer. And, and you know, frankly, every month ought to be a month when we're aware of breast cancer. Uh , but in honor of breast cancer Awareness month , we're gonna talk to Dr . Abigail Madden's, a surgeon here at Hennepin Healthcare with me in downtown Minneapolis. Dr. Madden's, good

Speaker 3 0:46

To have you here. Thanks.

Speaker 2 0:47

So you're a breast cancer surgeon. Use the word Plato . Onco , what are you,

Speaker 3 0:52

<laugh>? Um, so I am a breast surgical oncologist and a general surgeon here at Hennepin County. Um, I do practice uncle plastic breast surgery. It's just kind of a way of looking at tumors and the kinds of surgeries you can do to extend breast conserving therapy to more women. The

Speaker 2 1:10

Words breast cancer and the possibility of breast cancer can be stress-inducing in, in lots of people, men and women, but particularly in women. What would you say to women about their risks of getting breast cancer?

Speaker 3 1:22

I think that breast cancer is a really scary reality that we all have to deal with as women. You know, one in eight women , um, on average, just an average risk woman get breast cancer.

Speaker 2 1:33

So already that sounds like a

Speaker 3 1:34

A lot. It's a lot. If you're at a party and there's a hundred people there, you can think about how many women might actually get breast cancer in their lifetime. It's quite a few. So I think that statistic always kind of amazes me. And I still see breast cancer as a major public health problem that needs to be thought about and talked about and strategized around on a daily basis. So

Speaker 2 1:57

How do you talk to your patients or to women in general or whenever you're talking about this topic, to put that risk in context for people? Uh, that one in eight women thing , that would be scary to me, I would think.

Speaker 3 2:10

Yeah, and I think it's one of these topics that I think we like to shy away from as women. We like to come up with reasons why we might not be as high of a risk. You know, maybe we will never get breast cancer because we nursed our children. You know, it does decrease the risk of breast cancer. But I think it's a mistake for women to kind of tell themselves that story. And I think it's a natural thing to do, to deal with the anxiety that we all have to deal with around it.

Speaker 2 2:35

Are there established risks for breast cancer or is it same for everybody?

Speaker 3 2:41

So there are established risks for breast cancer and it's good for people to be aware of them. Some of the, the more modifiable risks would be, you know, postmenopausal women, the higher their body mass indexes or the higher their weight. Um, I just tell my patients, you know, healthy weight is gonna reduce your risk of breast cancer or recurrent breast cancer.

Speaker 2 3:01

Do we know why that is?

Speaker 3 3:02

There are some molecular studies that point to insulin-like growth factor , some things that have to do with our fat and sugar metabolism that are connected to growth patterns in breast cancer cells. So it probably has to do with that.

Speaker 2 3:16

Okay. So maintaining a healthy weights is a

Speaker 3 3:18

Good idea. Maintaining a healthy weight's a great idea. Excessive alcohol consumption, you know, greater than two drinks per day for a woman can increase their breast cancer risk. There are other things that reduce breast cancer risk, like athletic activity, you know, is really important. Exercise is really important. There are some things women can't help. Um, so things like breast density, increased breast density is a risk for breast cancer.

Speaker 2 3:42

What does breast density mean?

Speaker 3 3:43

Yeah, that's a really good question. So some women have more fat contained in their breast tissue and some women have more breast tissue or breast cells. I think that there's a couple different reasons why it's a risk for breast cancer on mammogram. When you have a really dense breast, it just looks like a white breast and you really can't see masses very

Speaker 2 4:04

Well because they're also white.

Speaker 3 4:05

They're all, It's just all white. It's just a , a dense breast tissue that shows up like that on mammogram. But it also, when we look at women who get breast cancers that have really dense breasts, and these are usually thinner women, smaller women, even athletic women, even though that decreases your risk if they have a dense breast, I think that is also a risk factor. Dense breast tissue actually seems to give rise to faster growing, potentially more aggressive cancers.

Speaker 2 4:33

So there's a whole bunch of women who get that letter after your mammogram and there's a sentence or two in there about how dense their breasts are. Yes. Why do we put that sentence in there? And what's a woman supposed to do with that information? Well , yeah . Other than freak out.

Speaker 3 4:47

Yeah. <laugh> . Well, you know, I , every once in a while I have a patient that comes to talk to me about their breast cancer risk and they'll tell me, you know, my doctor told me again , an MRI because I have really dense breasts. So if you see ACR category C or D, especially D, which just means extremely dense, then really that tells me I'm not gonna really see much on your mammogram and you need an mri.

Speaker 2 5:11

Yeah . So it doesn't mean you have breast cancer, it just means that you're , it's a measure of how dense they are and how reliable that mammogram is.

Speaker 3 5:18

Yes. How reliable a mammogram is. And I would say that that's, there's no consensus recommendation for screening women with dense breast with mri. I think that there's a lot of research that's accumulating, and I would expect that in the future. But when I see women that are higher risk for breast cancer, if they have really dense breast, I definitely recommend that.

Speaker 2 5:37

Okay. Are there some misconceptions about who's at risk for breast cancer?

Speaker 3 5:42

I think that the misperceptions sort of come when women tell themselves the story about why they're not gonna get breast cancer. So I hear this a lot, Well, I don't have anybody in my family with breast cancer. Um, so I think that's a misperception. Women that have a sister or a mother or a father or a cousin with breast cancer, they may be at higher risk, but it doesn't mean if you don't have breast cancer in your family that you don't have risk. Another misperception would be something like ovarian cancer, which is also a part of the breast cancer syndromes. But that wouldn't put you at greater risk for breast cancer. But that does. And in fact, women with a , a heavy family history for ovarian cancer probably need genetic testing. So there are , there are those kinds of stories we tell ourselves. I mentioned the one about breastfeeding. Women will say, Well, I breastfed my children for years, you know, so I'm not gonna get breast cancer. Or,

Speaker 2 6:41

Or I've heard about late pregnancies or women who have never had babies. Is there any connections?

Speaker 3 6:46

Well, that actually is a risk.

Speaker 2 6:48

There is a little risk

Speaker 3 6:49

There. There's, it really has to do with estrogen exposure. So that gets more complex. So it has to do how prolonged your estrogen exposure is. So women that don't have children actually have a higher level of estrogen exposure over a longer period of time, cuz they have more ovulation. But that's all somewhat theoretical as well. We do see that when we do population studies, but in certain populations with different birthing patterns, we see different sets of risk factors with them . So

Speaker 2 7:15

Before we get off the topic of risks for breast cancer, let's summarize, what are the things people can do something about and what are the things you can't?

Speaker 3 7:24

Well, you can stay a healthy weight. You can avoid excess alcohol. Uh, you can get your screening mammogram. Um, if you have diabetes, diabetes and , uh, hyperglycemia is a risk factor for breast cancer. You can, you can manage your diabetes well. So those are all things people can control

Speaker 2 7:41

And they're , those are real things that people can do. Okay. So those are things you can do to reduce your risk of breast cancer. What about the things you can't do? There's genetic risks and other things. So what would you say about that?

Speaker 3 7:52

Right. Well, it's true. You can't really alter your genetic risk for breast cancer. I think that it's really important to just understand what genetic risk means. You know, I really encourage women that have a family history of cancer in general to investigate that because, you know, genetic risk is much more complex than we used to think of it. So, you know, we used to only test for two genes, and that was the BRCA one and the BRCA two gene. Mm-hmm . <affirmative> . And that was really a breast cancer and ovarian cancer syndrome. That's how we used to identify it. But now we know that that involves pancreatic cancer as well. Possibly the BRCA two gene is associated with melanoma. The cancer syndrome has widened, and then now we test for nine genes. Um, so there's other genes that also are involved in breast cancer syndromes. And so it's important if a woman identifies herself as having a significant family history of any kind of cancer, that they investigate that because women are, like, we've talked about at high risk for breast cancer anyway. So when you start adding that genetic risk on top of it, it really needs to be be investigated. Before

Speaker 2 8:56

We get off the genetic risk topic, can you explain how that genetic risk translates into an actual breast cancer? What has to happen? Because it's a risk, but it's not a guarantee you're gonna get breast cancer. Right. If you have one of these nine mutations that we look for, Right. Is do we know who might get it and who's not gonna get it?

Speaker 3 9:14

Well, that's a really good question. So when I have patients that come to me with genetic mutations, I usually take them to a website, which I actually learned about in fellowship. It's , uh, established through Harvard, and it's called the Ask to Me website. And so this is really a powerful tool for people that have genetic mutations. Um, you can go in and plug in a woman's age what kind of cancers they've had, what gene mutation they have, and then you can see their cumulative risk. And this is a really important concept. Risk is cumulative. So if the BRCA two gene gives a woman a 60% chance of breast cancer in her lifetime, well, what does that risk really mean for a 35 year old at , at the age of 35, a woman with a BRCA two mutation may have a slightly increased risk of getting breast cancer in that moment, but that breast cancer risk increases with time . So if a woman, oh , with a mutation like that considers that she might be able to say, you know, by the time I'm 45, that might be when I do a prophylactic surgery to reduce my risk, but do I need to get that right now? No. And so it , I think that that website is really powerful just to kind of show a woman what their cumulative risk is. It's not like you're just gonna get all these cancers at once. You may not get them at all. But ,

Speaker 2 10:28

But that's a helpful way to put it . Yeah , that's that whatever that risk is, that's over your lifetime.

Speaker 3 10:32

It's overlap , not

Speaker 2 10:33

What's gonna happen tomorrow necessarily.

Speaker 3 10:34

Yeah . Right.

Speaker 2 10:35

So let's say a woman has a family member with breast cancer, Abigail, is there any way to quantify what her risk might be?

Speaker 3 10:42

Yeah, I think we have a pretty good tool to do that. So let's say, let's say you don't have a first degree family history of breast cancer, but your aunt had breast cancer at the age of 35. There is a tool called the IBIS score. Um , it's I b I s I b i s that we can use. Uh , we will take all different variables into consideration, including your body mass index. Your breast density, as I said, was a risk factor for breast cancer before family history, including your second degree family history of breast cancer, any previous atypical breast biopsies. Those things all get put into a calculator and that can calculate lifetime risk for breast cancer. And that really helps

Speaker 2 11:20

Us. Do you recommend that all women

Speaker 3 11:22

Do that? You know, I do. I think that if you're approaching 40, you should understand your lifetime risk for breast cancer and if you should be getting high risk screening, which is an annual MRI and mammogram versus just a mammogram every year. So that

Speaker 2 11:35

Sounds like something that people can readily access on your own, getting your IBI score.

Speaker 3 11:39

Yeah, I mean, I, I do recommend they do that, like with the radiology department that they go to for mammogram, things like

Speaker 2 11:46

That. Excellent. Lots of good information here about your risk for getting breast cancer. We've been talking to Dr. Abigail Madden's breast cancer surgeon , uh, here at Hennepin Healthcare in downtown Minneapolis. When we come back from a short break, we'll be talking about other topics around breast cancer, including the importance of early detection. So stay with us.

Speaker 1 12:05

You're listening to the Healthy Matters podcast with Dr . David Hilden . Have a question or a comment for the doctor, become a part of our show by reaching out to us at Healthy Matters at hc m e d.org . Or give us a call at six one two eight seven three talk. That's 6 1 2 8 7 3 8 2 5 5 . And now let's get back to more healthy conversation.

Speaker 2 12:29

And we're back talking to Dr . Abigail Maddens here at Hennepin Healthcare about breast cancer. Let's talk about early detection. Why does it

Speaker 3 12:37

Matter? Well, breast cancer is a curable disease only if it's detected early.

Speaker 2 12:42

Um , do you mean that, is it a curable disease?

Speaker 3 12:44

I think if you have stage one a breast cancer and it is not spread to your lymph nodes and it's localized and it was found on mammogram as like a small blip or architectural distortion in your mammogram, I think yeah, sometimes you can cure it, it will never come back.

Speaker 2 13:01

I meant that as kind of a provocative question. I know you meant it, but I I wanted to expand on that. That is so important that here's somebody who deals with breast cancer every day . That's how important it is to get screened because it's potentially something they can get rid of.

Speaker 3 13:16

Yeah, it is. It's also, you know, as a caveat to that, it's also important to see breast cancer. I, I view breast cancer as kind of a field defect. The breast is a tissue that's affected by hormone. It changes a lot through life. So even women that have early breast cancers that gets cured, it's possible that that can recur. Mm-hmm . <affirmative> . And it's a different primary breast cancer, so they could cure their earlier breast cancer, but it, it can come back as another new breast cancer.

Speaker 2 13:45

So mammography and x-rays were developed. I think Queen Victoria was still on the crown. I mean, isn't it like a hundred year old technology? Uh , we still doing x-rays,

Speaker 3 13:55

So we are still doing x-rays. It's a pretty inexpensive way to screen for breast cancer. If you don't have a super dense breast and it's got a lot of fat in it, we can see masses , uh, we can see what's called calcifications, which is small calcium deposits on the mammogram. They look like bright white dots. And those can be indicative of cells that are rapidly dividing and dying, leaving these deposits. And that can be representative of cancer. So there are things you can see on mammogram, but it's a really a screening tool. So it's not the tool we use to necessarily characterize the breast cancer. We do other imaging for that, but it's a great screening tool.

Speaker 2 14:31

So I do primary care and I, I order a zillion mammograms. And I , I have to say, it's relatively common for women to say to me, it's awful. Is that, is it awful? I mean, I don't wanna be cynical about it, but from a person who never had it done and never probably will, you know, I try to tell 'em , I , I understand maybe it's not comfortable, but it's short. It's worth doing. How do you respond to people who say, you know, it's a bummer to get that thing done.

Speaker 3 14:56

Yeah, I affirm that it is a bummer to get it done, you know? Mm-hmm . <affirmative> , I think women have bearing , uh, sensitivity and pain in their breasts . Some women have a lot of breast pain and their breasts are very sensitive to compression. For some women, mammogram does not bother them. So it's a mixed bag. Mm-hmm . <affirmative> . But yeah, it's definitely not fun. You know, there's a psychological component to that too , who really wants to be examined in that way. And also, do you really wanna know , you know , that's something a woman has to ask herself. Does she really wanna know if she has breast cancer? Who

Speaker 2 15:29

Should get a mammogram? Uh , I guess I'm trying to say maybe at what age? Yeah . And how often

Speaker 3 15:34

There is some debate about that. So it's important to know that the United States, there's over 20 different societies that have varying recommendations about who should get a mammogram. So for instance, the American Cancer Society recommends women start at the age of 45. The National Comprehensive Cancer Network recommends people start at the age of 40. The U S P S TF recommends that they start at 50. And so there's still some debate

Speaker 2 16:00

About that. That's just in this country there's different, that's , that's

Speaker 3 16:02

There's

Speaker 2 16:02

Different recommendations. There's

Speaker 3 16:03

Lots of different recommendations. We don't really have a consensus at Hennepin County Medical Center. And in a lot of places they do follow the U S P S TF guidelines. Um, insurance really has to pay for that. Um, so that's 50. That's 50. I ,

Speaker 2 16:18

If every woman listening or every man out there pres , well I know somebody, they were 42 and they got their

Speaker 3 16:23

Breast cancer. And I do recommend women start at the age of 40. You know, we, about 20% of breast cancers happen under the age of 50. And I just think that is a large number. It should be argued that maybe different screening recommendations should be used that are more tailored to the risk of a particular woman.

Speaker 2 16:42

So how often should you get a mammogram?

Speaker 3 16:44

So I would say annual, especially if women decide they wanna get screened at 40. I recommend annual mammogram because younger women have faster growing tumors. They're more aggressive, they're more liable to get an interval tumor, which means one they didn't see on mammogram last year and then it just pops up. So I would say annual.

Speaker 2 17:04

And what about, you know, I, I did medical school roughly 22, 4 years ago. We were taught and women , um, I think expected breast exam in the clinic. And we taught them to do it every month at home. What is the latest guidance on either getting a clinician to do a breast exam or you doing it at home? Because in all honesty, I don't do them anymore.

Speaker 3 17:25

Yeah, that's a really good question. So the guidance on breast exam, I think self breast exam is not necessarily recommended or mandated as a screening tool. And I think clinical breast exam is a really important thing. Obviously I do clinical breast exams on my patients that have breast symptoms. I think women's health providers probably should do clinical breast exam .

Speaker 2 17:47

Should clinical breast exams . Yeah.

Speaker 3 17:48

The reason why is because it's important for women to know what's going on in their body. Are they gonna pick up on necessarily a breast cancer? They may, they may not. But how many women come into my office and say, you know, two months ago I noticed this mass . So if you are in touch with what's going on in your body and the way that your breast tissue changes, you are more likely to notice that mass sooner. So I wouldn't discourage it .

Speaker 2 18:11

That's, that's , uh, great advice. Great advice. So earlier you, you talked briefly about MRIs. Mm . You know, and who should get that?

Speaker 3 18:19

Well, I would say there is some consensus with screening guidelines for women that are high risks . So women that have a first degree family history of breast cancer, they should be getting annual mammogram and MRI at an age 10 years younger than the age of diagnosis of that family member. So there's some consensus about that. Women who have breast biopsies that show a typical cells like something called atypical ductal hyperplasia or lobular carcinoma in iny two , which is not cancer, but it does confer a greater risk. Those people that have those atypical biopsies really should be screened with annual MRI and annual mammogram. So talk

Speaker 2 18:59

To your doctor if you have those things either on a biopsy or if you have that history about me. Cuz I , I think that that isn't as widespread maybe as it ought to be . Do you think, are we getting enough breast MRIs?

Speaker 3 19:10

No, I think high risk screening programs are hard to implement. Mm-hmm . <affirmative> , I think it's a definitely , uh, a goal for me to implement one at Hennepin County Medical Center to where we're really doing that effectively. I think the Ibis tool can also take all of those variables into play. And if you have a lifetime risk of greater than 20 or 25%, you should probably be getting an annual MRI in mammogram two . And insurance will pay for that.

Speaker 2 19:35

Let's shift gears. Dr. Maddens, you are a breast surgeon. Most of us don't get the chance to talk to an actual breast surgeon about what happens. So people have maybe heard about mastectomies, they maybe heard the term lumpectomy. Give us the lay of the land. What is commonly done for breast cancer surgery and what's sort of the future of where your practice is going?

Speaker 3 19:54

What happens in breast surgery? A lot of it, a lot of the decisions are made in the clinic prior. Right. So we really have to understand what the stage of the breast cancer is. How big is this tumor relative to the breast size? That's kind of how we make our decisions about what surgery is appropriate. So if I'm able to catch that breast cancer early, we can do a smaller surgery. So lumpectomy is really the preferred approach. We know that , uh, women have in general a higher quality of life after breast conserving therapy, they

Speaker 2 20:25

Can , That's what a lumpectomy is . Breast

Speaker 3 20:26

Conserving? Yeah . Breast conserving. So lumpectomy is just taking the tumor and getting negative margins. And breast conserving therapy also involves treating the rest of the breast with radiation therapy to kind of clean up any cancer cells that might be there that we can't see on imaging, but that we know are there some of the time. So radiation therapy is used as an adjunct to that lumpectomy.

Speaker 2 20:47

When when might you do a mastectomy?

Speaker 3 20:50

So if I don't think I can safely get the cancer out and achieve a cosmetic outcome for a patient, then we will consider mastectomy in either mastectomy with or without reconstruction. Now there are techniques, oncoplastic techniques where I work with a plastic surgeon. We plan surgeries where we can rearrange the breast tissue itself to create a cosmetic result. And that kind of allows us

Speaker 2 21:15

To extend, Say what? You rearrange the tissue.

Speaker 3 21:17

Yeah. We rearrange the breast tissue to create a breast shape. Oh , that is acceptable. Um, sometimes we preserve the nipples , sometimes we don't. But we can maintain that breast shape just using a patient's own tissue and that can extend breast conserving therapy to more women. I think that's a really great approach.

Speaker 2 21:36

That's a great approach. Does that happen at the same time as the lumpectomy or is that a second surgery down the road?

Speaker 3 21:41

It happens at the same time. So usually I do the lumpectomy , uh, work with a plastic surgeon to have the right incision markings and then he will often do the breast that does not have cancer in it. And we work together to get that done.

Speaker 2 21:54

Do you ever have women come in and say, that just doesn't, the lumpectomy and breast conserving surgery, I would like all that, but I'm more afraid that you didn't get it all. Do take the whole thing off. In fact, take 'em , take both breasts off. Do you get that much and how do you , how do you respond to

Speaker 3 22:08

That? Yeah, absolutely. And this is a really significant discussion that I have with my breast cancer patients. It's with a lot of ambiguity and a lot of subtlety mm-hmm. <affirmative>. So anybody with a genetic mutation should consider a bilateral mastectomy. And that's a formal recommendation because you know, their risk of contralateral breast cancer is really high.

Speaker 2 22:29

So you, you recommend mastectomy on both sides if you have the genetic mutation Yeah. But before you got cancer.

Speaker 3 22:35

Yeah. If you get cancer, you get tested for genetic mutation, you have that, then definitely we have that conversation. Hey, you know, you have a 60% risk of getting breast cancer either in this breast, you're gonna do a lumpectomy in or in the opposite breast. And you know, we should really consider a risk reducing surgery if that genetic mutation is not happening. But a woman finds herself too anxious. Mm-hmm . <affirmative> , like she just cannot live with the idea of having breast tissue, then yeah, we can consider a risk reducing surgery. A woman who gets breast cancer has about a 0.5% chance per year risk of getting a contralateral breast

Speaker 2 23:11

Cancer in the other breast.

Speaker 3 23:12

In the other breast. So, you know, if a woman is really young, then that risk can add up Right. To let's say

Speaker 2 23:19

0.5 per year.

Speaker 3 23:19

Per year 0.5 per year. Yeah . Per year, every year. But even then, even if the risk is acceptable, sometimes it's just not tolerable. And I think that's okay. So, you know, you have to work with women to know what their priorities are. Um, some women with genetic mutations don't do a risk reducing surgery and they choose surveillance. You know, so they really need annual MRI and mammogram. I'm gonna support them in that. Mm-hmm. <affirmative>, just with the education that it's likely we might find another cancer at some point and they may have to go through this process

Speaker 2 23:53

Again. And I think it might be more likely than not for somebody with that

Speaker 3 23:56

Mutation. It may be more likely than not. And I've definitely seen women later on in their high risk surveillance with genetic mutations that 20 years later they've never gotten another breast cancer.

Speaker 2 24:06

Are there differences in survival or all the , all the outcomes between breast conserving surgery and mastectomy?

Speaker 3 24:14

So that's a really interesting question. So I think the general consensus is that there's not, So you can remove all the breast tissue from the breast that has cancer in it and you're not gonna see an increase in survival. The thing that worse in somebody's survival is the presence of microscopic metastatic disease. Okay. When they initially get diagnosed, that may be there and we don't

Speaker 2 24:38

Already can't see it already spread somewhere,

Speaker 3 24:40

You know , And , and maybe 10 years later, maybe five years later, depending on the type of breast cancer a woman has and how fast it's growing, then you see that disease come back elsewhere. You know, and that's really what takes a woman's life or you know, a man's life that has breast cancer. It's not based on that local disease. So it doesn't seem to depend on what kind of surgery we do. Now, there are some more recent studies, prospective studies, but no randomized clinical trials that show maybe an increased slightly increased survival with breast conserving therapy. And that might be the effect of radiation, but it's newer data and it's still, still in its infancy.

Speaker 2 25:20

That's fascinating. Mm-hmm . <affirmative> , we have learned so much. We have learned about risk factors for breast cancer, the importance of early screening. There's some things you can and cannot do. My biggest take on from what you've said today is the amazing treatments that are available and the actually the pretty good outlook, if you find it early, there's some really pretty good outcomes.

Speaker 3 25:41

Yeah. I consider the primary care physician's office, the place where breast cancer treatment starts. So it is that early detection where breast cancer treatment starts. I see early screening as breast cancer treatment, not just screening because I can't treat some breast cancers. If a woman comes into my office with a big palpable mass , then you know, it gets really hard to treat it at all. But you know, if you come in with an early , uh, breast cancer stage one A, one B, you know, your five year , 10 year survival might be over 95%,

Speaker 2 26:13

Which is great. Mm-hmm. <affirmative>. Okay. Before I let you go, Dr. Manns , what gives you hope about the state of breast cancer detection and treatment?

Speaker 3 26:20

Yeah, there's a lot of emphasis on deescalation and treatment now, which I think is really great at reducing the complications and the hardships that women go through with breast cancer treatment. So, you know, the better our chemotherapy gets and the better our immunotherapy gets, which is really a burgeoning field, then we can deescalate. So I have women that get chemotherapy and immunotherapy now for advanced breast cancers, and when I take out their tumors, there's nothing left. Wow. And that is an amazing thing for me. And I love giving that report to women and the state of the art of the chemotherapy and immunotherapy is really helping me as a surgeon do less to my patients, create less pain. And so that really gives me hope.

Speaker 2 27:09

That is absolutely terrific. Um, you mentioned the Ask to Me website, where do people access

Speaker 3 27:14

That? Yeah, it's a s k , the number two m e dot o g .

Speaker 2 27:19

That's the site that , uh, Dr . Madden's talked about out of Harvard. And we will put a link to that in the show notes. Abigail, thank you for what you do. Thank you for coming and talking to us. Knowledge is power and I think you've given us a whole lot of information to think about. I appreciate what you do for our patience and for being on the show with us today.

Speaker 3 27:37

You're welcome. Thanks for having me. And

Speaker 2 27:39

To you, our listeners, thank you for tuning in. I hope you have picked something up. Uh, if you like the episode, please tell your friends about it and maybe leave us a positive review wherever you get your podcast. Be sure to tune in for our next episode and in the meantime, be healthy and be well.

Speaker 1 27:56

Thanks for listening to the Healthy Matters podcast with Dr . David Hilden . For more information on Healthy Matters or to browse the archive, visit our website@healthymatters.org. And if you have a question or comment for the doctor, email us at Healthy Matters hc m e d.org or give us a call at six one two eight seven three talk. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota. An engineered by John Lucas at Highball Executive producers are Jonathan Camino and Christine Hill . Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your personal physician if you have more serious or pressing health concerns. Until next time, be healthy and be well.