Session 329: Black Women & Breast Cancer

Published Oct 18, 2023, 7:00 AM

The Therapy for Black Girls Podcast is a weekly conversation with Dr. Joy Harden Bradford, a licensed Psychologist in Atlanta, Georgia, about all things mental health, personal development, and all the small decisions we can make to become the best possible versions of ourselves.

We're continuing to bring attention to breast cancer awareness month by sharing resources and celebrating the experiences of survivors. In Session 327, we heard from Breast Cancer survivor, Marissa Thomas. This week, we're joined by Dr. Ryland Gore, a board certified, fellowship-trained surgeon specializing in breast surgical oncology. Her work focuses on the diagnosis and surgical treatment of benign and malignant breast disease. She is actively involved in studies on breast cancer and serves in community outreach programs as an advocate to help spread breast cancer awareness. 

During our conversation, Dr. Gore breaks down what exactly breast cancer is and what it does to the body, the unique risks of advanced types of Breast Cancer that Black women should be aware of, and small ways we can minimize our lifetime risk of a Breast Cancer diagnosis.

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    Welcome to the Therapy for Black Girls Podcast, a weekly conversation about mental health, personal development, and all the small decisions we can make to become the best possible versions of ourselves. I'm your host, doctor Joy hard and Bradford, a licensed psychologist in Atlanta, Georgia. For more information or to find a therapist in your area, visit our website at Therapy for Blackgirls dot com. While I hope you love listening to and learning from the podcast, it is not meant to be a substitute for a relationship with a licensed mental health professional. Hey, y'all, thanks so much for joining me for session three twenty nine of the Therapy for Black Girls Podcast. We'll get right into our conversation after a word from our sponsors. The reviews for Sisterhood Heels are rolling in and I simply cannot stop smiling at the hot girl books on Instagram shared finish reading this warm hug of a book last night and while it made me once a hug my sister friend so bad, Sisterhood Heels is a beautiful guide on how we as black women can use our community and friends to aid in our healing process. Thank you so much for the beautiful review.

    Have you grabbed your copy yet?

    Get one for yourself and a friend at Sisterhoodheels dot com. We're continuing to bring attention to Breast Cancer Awareness Month by sharing resources and celebrating the experiences of survivors. In Session three twenty seven, we heard from breast cancer survivor Marissa Thomas.

    This week, we're.

    Joined by doctor Ryland Gore, a Board certified, Fellowship trained surgeon specializing in breast surgical oncology. Her work focuses on the diagnosis and surgical treatment of benign and malignant breast disease. She is actively involved in studies on breast cancer and serves in community outreach programs as an advocate to help spread breast cancer awareness. During our conversation, doctor Gore breaks down what exactly breast cancer is and what it does to the body, the unique risks of advanced types of breast cancer that Black women should be aware of. In small ways we can minimize our lifetime risk of a breast cancer diagnosis. If something resonates with you while enjoying our conversation, please share with us on social media using the hashtag TVG in session or join us over in the Sister Circle. To talk more about the episode, you can join us at community dot therapy for Blackgirls dot com. Here's our conversation. Thank you so much for joining me today, doctor Gore. Very exciting to have you. So you are a board certified, fellowship trained surgeon specializing in breast surgical oncology. So I feel like those are a lot of words. It sounds like very very important work. Can you tell us what you do and what oncology actually is.

    Yes, So I am a breast surgical oncologist. Oncologist are physicians involved in cancer care, whether that's medical oncology, surgical oncology, or radiation oncology. So I'm on the surgery side, and all of those words basically mean is After my general surgery residency, I did further training so that I could specialize in breast and take care of women with breast cancer.

    Can you tell us what a typical day looks like for you.

    Yes, So on clinic days, my clinic normally starts at eight am, and so I'm up early every day. I've never been a morning person, but surgery will force you to be a mourning person, and so I'm up early, usually by five thirty six o'clock every day. Most days, two days out of the week, I have my clinic days where I'm seeing patients all day in the office. And what's important for people to know, not everybody comes in with the cancer diagnosis. Some people are high risk, or they have benign tumors or lesions that require surgical care, but not everybody is a cancer patient. Then I have two our days a week, and so I'm literally in the operating room all day taking care of woman after woman after woman, whether it's benign.

    Or malignant disease. And I have a few male patients as well.

    So can you talk to us a little bit more about what breast cancer specifically is what does that mean When we hear that somebody has a diagnosis of a breast cancer.

    That means in their breast, they've had malignant transformation of the cells in the breast. And it can be in the breast ductal cells, the cell that line the milk ducks, or in the lobules, and the lobules are the glands that create the milk, and the ducts transports milk to the nipple. Most cancers start in the milk ducts. Seventy five to eighty percent of them. And so when you have that malignant transformation, whether it's invasive or non invasive, at that point you have cancer. And so with most things, early detection is key, which is why I love October. I love Breast Cancer Awareness Month because I get to really hone in on the fact that early detection is what saves lives. Knowing yourself, knowing your body saves lives, and holding your family, holding yourself, holding your friends accountable, that saves lives, and so I love October.

    I was not aware that seventy five to eighty percent of cancers come from the milk ducks.

    Can you say more about why that is?

    I think because there's so many of them and they all converge and go into the nipple. But I think because of the sheer number of milk ducts that is what increases the commonality.

    We completely honest.

    With you, got it, okay?

    And so you talked about kind of knowing your body and kind of recognizing some of those signs. Can you talk to us about some of the symptoms somebody might be experiencing that would be like a prerequisite or a precursor to needing to get something checked.

    Out, Yes, so my caveat. I tell everybody, most people will not feel anything, and that's why the mammogram is so important. The overwhelming majority of cancers you cannot feel. And it's so important because mammograms can catch cancers up to two years before a patient can feel them, so that's really important to know.

    But other signs.

    If a patient is going to have a physical sign, the most common is the man or woman feeling a lump in their breast or underneath their arm in the armpit. I've seen patients with new weird skin, dimpling, redness of the skin, any new nipple changes, whether it's nipple rashes, nipple inversion, or nipple discharge. Those are the most common sign and symptoms if a patient is going to experience something else.

    So, doctor Glory, you have just blown my mind because all and my team is typing me notes too. We've all been taught to do a monthly breast exam and like, you know, you're supposed to be feeling for stuff, and now you're saying most people won't even ever feel anything.

    Yeah, so most of my breast cancers. The patient is like, how could this happen to me? I didn't feel anything. Good job forgetting your mammogram, because most people don't feel anything. I would say seventy percent of my patients who come in with a breast cancer diagnosis they had no clue that it was coming. They were just getting their annual check up or annual mammogram. But I will say this though, because I think it's important from an education standpoint. I have women who come in sometimes with these large masses or something is obviously abnormal, one breast larger than the other or something like that, and I'm like, did you not feel this? Because I can look at you and tell something is wrong, and they're like, oh, no, I don't touch my breast.

    I don't do that. I don't what is yours? Touch it? Please?

    You need to know what's going on with your body. And some people are like, well, my breast are super lumpy, Like how do I know?

    And I feel like the.

    More comfortable you get with knowing what your breast feels like, the easier it will be for you to pick something out. And so, yeah, most people don't feel anything. But you also have that contention of patients who don't want to touch, don't want to know, because if something were to happen. They don't want to face it, and so there's a whole huge fear component involved with self care, knowing your body and things like that.

    That's interesting that you talk about it as like a fear of if something were to be wrong, I don't want to face it. It also feels like there may be a part I think, even culturally around like this taboo around touching yourself.

    Absolutely, absolutely, and I hear it all the time. Not so much in my younger patients. I do have some very young patients with breast cancer diagnoses, but in my older ladies, not necessarily my white has but certainly in my patients of color, the older generation, there is this taboo still, this taboo around touching your body and is it dirty?

    Am I wrong for doing that?

    Yeah? Yeah?

    So is the recommendation still that people get their first mammogram at around the age of forty or is it something different?

    Thank you for asking that. Absolutely start at forty, and I'm glad that the US government has finally caught up with what medical societies and surgical societies have been saying for a long time before they said you should start at fifty, which is laughable to me. Considering Black women specifically are more likely to be diagnosed with breast cancer before the age of forty, So yes, we're supposed to start at forty. But there has also been this suggestion by several medical societies as well for the last five six years that women of color, not just Black women, but Hispanic women should probably consider getting their mammograms starting at the age of thirty five because of the fact that we are more likely to be diagnosed the age of forty.

    Okay, so I need to hear more about this, doctor Gore. So we do know that, as with a lot of things, women of color, black women specifically, they're disproportionately impacted by a lot of these diagnoses. So what is it about breast cancer that we are seeing higher rates in women of color?

    So we are more likely to be diagnosed before the age of forty. As I mentioned, we are being diagnosed with breast cancer at the same rates as our white counterparts, but our death rates are forty percent higher than white women. We also know that black women are utilizing mammograms at the same rates as white women, because before the argument was like, oh, black women don't get their mammograms done, Well, that's a lot, and we're actually outpacing white women in mammogram utilization for the first time as of twenty twenty one, so we know that's not it. We're just more likely to be diagnosed with aggressive disease, more aggressive tumors, and we're more likely to be diagnosed at a later stage. And I think the reason for that is multi factor. I've heard everything from you just had your mammogram, there can't be anything going on, your mammogram's fine, or you're too young to have breast cancer come back. And then on top of social things that we have to think about, we're less likely to have private insurance, we're less likely to go to radiology places where we are getting mammograms by trained specialists and the mammograms are being read by trained radiologists. We are behind the ball from screening all the way to survivorship, and so this is a multifactorial situation that needs to be addressed on multiple levels. But Black women we are taking care of our health, and I think now with self care being such a sounding board since COVID, we're even more tapped in. We want to do better, we want to take care of ourselves, we want to have physicians that look like us and believe us, and so we're doing all the things. But as you know, the medical system within itself is a very hard thing to change, and some of the ideas that have been prevalent for a very long time, it's very hard to dismantle some of these outdated beliefs.

    Mm hm. So you mentioned doctor Gore that we are less likely to be going to like radiology facilities with trained people who can read the mammogram. So all mammogram facilities are not created equal.

    Like, what should we be looking for in a facility?

    So where is it? Number one?

    I tell people go to a large center, a large hospital system, or a large academic center. If it is a freestanding radiology facility. I ask for patients to have a discussion with their primary care physician or whoever wrote the order for that mammogram. Is this somebody you trust? Do you know these people here? Do you know that radiologists? It's sad that you even have to ask is there a radiologist there? So I had a patient maybe six months ago with the radiology report. I'm reading the report, and you want to know who read the report and signed it. It was not a radiologist. It was a chiropractor. I had to like, I put the paper down and I walked away. I was like, I've been here a long time, Like maybe I'm going crazy. No, it was a chiropractor. And so these are the things that patients have to think about. And if you don't have a physician that cares, if you don't have a physician that's going to pay attention to the details, then this is the kind of stuff that's trapping people. How can a chiropractor tell you what is or isn't in your breast? And outside of who's reading it, what about the machinery, what about the equipment?

    Is it safe? Is it up to date?

    Is it the newest technology so that everything that needs to be seen will be seen. It sucks that patients have to think about this, especially patients of color, who are more likely to have public insurance or no insurance, and so they are more likely to go to these places because it's usually a flat feed. You know how much it's going to be when you walk through the door.

    Well, thank you for that. I was not away of that either.

    It's absolutely wild some of the things.

    Yeah, now I have heard that black women should seek out specific kinds of mammograms because our breast tissue tends to be denser. Do you know what I'm talking about? Can you help me out on what we're talking about there?

    Yeah, So these are the three D mammograms or you may see your report or the order may say mammogram with tumosynthesis.

    So basically you still get the.

    Same two or three images per breast, but the way that the images are reconfigured it shows multiple slices even though you've only gotten two or three pictures taken, and so it looks almost like a CT scan of the breast. When you roll through the images, it's much easier to parse through what's just thick tissue or denser tissue and what may actually be a mask. Does this look like assist or does this look like a solid tumor I need to be worried about. It's been a game changer because it allows the radiologists to see finer cuts of the breast and really parse through what's abnormal and normal. And it also has cut down on the number of unnecessary biopsies that patients have had to have. And so at this point, three D mammograms are considered standard of care.

    So I know you mentioned that most people won't find anything, but if people are doing like their routine breast exams and they do feel something, what should they do? So is this something that you go to your primary care doctor for?

    Would you go to the er?

    Because we know it sometimes can be difficult to even get an appointment with your primary care doctor.

    So what should you do if you do feel alone?

    I would say go to your PCP or OBEGUID asap or call them asap and say, hey, this is what's going on. And at that point they should order additional breast imaging for you. Even if you just got breast imaging less than a year ago.

    It doesn't matter.

    If you feel something new, then that requires a new work up. And so at this point, it's not screening mammogram. Your mammogram should be diagnostic, and that's important because that means you get your imaging done and the radiologist reads that the same day as soon as it's done and orders additional imaging as needed, and most patients will go ahead and have an ultrasound at the same time to look and see if there's something there that the mammogram did not pick up on.

    Got it Okay?

    So we do often hear chemotherapy as the treatment that is often suggested after somebody has a breast cancer diagnosis. Can you tell us a little bit about what chemotherapy does and like how it impacts the body.

    Not every patient needs chemotherapy. So for example, patients with non invasive breast cancer, they're not going to get chemotherapy because the cells are still confined to the duct or the lobial and so chemotherapy isn't going to touch it. So most patients who need chemotherapy there are typically stage two or above, and chemotherapy is important. Your regiment will depend on several factors, and so I can't just say, oh, this is your chemo regiment. It just depends on certain things. But it's a systemic treatment. Most patients need to port to deliver the chemotherapy because chemotherapy the medication is strong, so it'll destroy the normal veins in your arm, but it's important it kills any cancer cells that may be traveling throughout the body that have left the breast. Also, if a patient has a large tumor and large lymph notes underneath the arm, the chemotherapy will shrink the lymphnodes shrink the tumor and make surgery easier for the patient, and it helps with given the patient more surgical options, and also it decreases the risk of breast cancer recurrence, and so it's necessary for the overwhelming majority of patients. Unfortunately, but as chemotherapy can be quite harsh and while it's killing cancer cells, it does kill some normal cells also, which is why patients experience some of the things they experience, everything from nausea, vomiting, decrease appetite. We all have seen people with hair that fallen out because it's destroyed, you know, normal hair followbles, normal hair sales. It can cause numbness of the extremities, neuropathic pain. We always check a patient's echo and make sure their heart is functioning properly because it can affect the heart as well, depending on what regimen you're on. And so some patients experience all of the above and chemo is just hard. And then some patients. I have some who have no side effects at all, and they're like, I'm rocking and rolling. Let's just do this so I can move on with my life. Everybody experiences chemo differently, and.

    Does chemotherapy often work in combination with surgery, So you do chemo and then have a surgery, Like, what is the treatment plan?

    There? Good questions.

    So for patients whose tumors are large or they have particularly aggressive tumors, for example triple negative breast cancers, which are more common in black women, we will give their chemo before surgery to facilitate surgery. Some patients will still need additional chemo after surgery, some don't, but we can give it before or after. It just depends on how the patient presents and what the goal is. It is important to say, though, if a patient has stage four cancer out the gate metastatic breast cancer and so we know it's all over the body, surgery is not an option for you typically, so you will be on chemo indefinitely.

    More from our conversation after the break. So something else that I think a lot of us have heard about is family history and genetics in the role of breast cancer diagnosis.

    Can you talk to us a little bit.

    About that and whether that changes how early you should get a mammogram?

    Good question.

    So one thing that I make sure patients know. The overwhelming majority of patients to have a breast cancer diagnosis do not have a family history. Seventy five to eighty percent of patients with a breast cancer diagnosis don't have a family history at all. Yes, I know, sounds crazy, right, This is how common breast cancer. It sounds ridiculous, but it's true. And then of that other twenty to twenty five percent with a family history, five to ten percent of that twenty to twenty five percent with the family history will have a genetic mutation that is responsible for their breast cancer diagnosis.

    The most common.

    Breast cancer mutation or genetic mutation affiliated with breast cancer is the brack of one and brack of two genetic mutations.

    Angelina Joe Lee Jean.

    I remember when she came out and discussed her family history and her diagnosis.

    That's what she has.

    She's brack on one, and so that increases your risk of developing breast and ovarian cancer. You are almost guaranteed a breast cancer or ovarian cancer diagnosis. But we do know that there are other genes associated with breast cancer, and so every breast cancer patient should be offered genetic testing, regardless of if they have a family history or not. And so that's something I'm really diligent about and I've seen all kinds of mutations and it's not something that just affects white women. It's not something that just affects We used to say, oh, bracko wan bracka two only in Oshkaronnazi Jewish patients, But we know that breast cancer mutations, particularly bracken one and brack of two, are just as high in black women as it is in the Oshkonazi Jewish population. So it's important that even before you get to your breast surgeon, if a PCP or OBI guid knows that a patient has a family history, this is something they should be all over and should be offering as well.

    So you've talked a little bit about the surgeries and it seems like maybe two of the most common are lumpectomies and mass sectomies. Can you talk a little bit about like the difference between those two and like what kinds of things would you need to know before making a decision about either of those.

    So, lumpectomy is when we remove the cancer rim of healthy tissue around the cancer because we want negative margins negative margins, and we save the breast. Mastectomy is when the entire breast is removed, and that's with or without breast reconstruction. One thing that patients will say to me, doctor Gore, just take it off, just remove the whole breast. I don't want this to ever happen again. Well, that's not quite how it works. And I tell patients when you look at the studies, when you look at all the breast cancer studies, especially the main ones that determine why we do what we do, there's no difference in disease free survival, distant disease free survival, or overall survival between patients who get a lumpectomy with radiation and a patient who gets a mastectomy.

    There's no difference between those groups. They're going to do equally well.

    And so I think it's important for patients to make a surgical decision that's going to work for them and what their goals are. There are some patients who feel very strongly about saving their breasts. So if they have a large tumor, for example, I say, okay, since you feel really strongly about saving your breast, let's do chemo first. Let's shrink this as much as possible, and then go back to the drawing board, repeat, imaging and see where we are and go from there. And then you have patients on the other end of the spectrum who have the tiniest tumor and they're like, I've never been attached to my breasts anyway, take them off. And even after you explain all the risks and benefits, and so people make different decisions for different reasons. If you get a lumpectomy, it is strongly recommended that you get radiation after surgery, and so there are some patients who are like, I'm not interested in radiation, I don't want to do it, and so they'll choose mispect to me for that reason. So I never try to push a patient in one direction or the other. But for patients who have particularly aggressive tumors or large tumors, or tumors close to the nipple, that's when I'll say, listen, i'm offering mistec to me. And so I try not to gate keep and I'm really diligent about making sure the patient feels like they are a part of their care team and not just being told what to do. But there are some instances where you have to draw the line, and.

    I believe this was the case for Angelina Jolie, is that you found out this information and then decided on a mess sectomy to prevent and eat cancer from recurring.

    Correct.

    Yes, And if you have a genetic mutation, you can actually do bilateral prophylactic mistectomies with or without reconstruction to drastically minimize the risk of a breast cancer diagnosis happening. So with the mastectomy, your risk after a mastectomy never falls to zero, but have you drastically reduced the likelihood of it happening again?

    Absolutely?

    So the average person lifetime risk ten to twelve percent after bilateral mastectomies, that may fall the one to three percent over the rest of your lifetime. And so I think those are pretty good odds.

    And you mentioned with or without reconstructive surgery several times.

    What does that mean?

    So if you have to do a mastectomy, I always offer a patient, if they are a good candidate, I always offer them consultation with the plastic surgeon to discuss breast reconstruction, whether it's implant using their own tissue to recreate the breast. Most patients take me up on that offer, and most women want to have breast reconstruction because it's already hard enough going through cancer and deciding on or needing a mastectomy. So most people want to wake up and there is something there that still resembles a breast. But I will say the number of my patients who are choosing not to do reconstruction, those numbers are going up. And if you just google go flat movement, it's a thing right now. There are so many Facebook groups devoted to it, so many forums where people are choosing to not do reconstruction. They just don't want to go through the rigamarole of what plastic surgery and subsequent surgeries entail.

    And so it sounds like often this is happening at the same time, right, So you might go in and do the mistectomy and then the plastic surgeon follows you.

    Absolutely, you can do it immediately.

    And so with my plastic surgeons, we have a great relationship and we work together, and so while I do the mistectomy, the plastic surgeon is reconstructing the breast. And then there are some patients who do choose to do it in a delayed fashion, so six to twelve months later or even longer, and patients will choose that because for some people dealing with the cancer alone is enough for them. They're like, let me just get through my treatments. Let me remove this cancer and get surgery for the cancer, whatever treatments I need, whether it's chemotherapy, radiation, I want to get through all of that first and then once that is done, then focused on the reconstruction part. So there's no wronger right answer. You can do it in whatever order you want to do it.

    So we had a conversation with another position about menopause, and one of the things she mentioned was that not having children and I believe not breastfeeding was a higher risk factor for some breast cancers or some cancers. Is that the case for breast cancer? Is there any connection there related to like having children.

    Being Nola paris, not having children, not breast feeding, that will slightly increase your risk because you've increased your overall exposure to estrogen. And so that's where the risk comes from. Exposure to estrogen increase breast cancer risk, and some of it you just can't control. Being a woman, we cannot control that. We cannot control our exposure to estrogen. But in my menopausal women, I feel very strongly about hormone replacement therapy and I get it going through menopause, the hot flashes, the vaginal dryness, the feeling like you're crazy. It's a lot, and they don't want to go through that and they want some relief. But then you have these people who are on hormone replacement therapy for years, I mean years uninterrupted. That will absolutely increase your breast cancer risk. And so I'm not a fan of it, and I do let my menopausal patients have it short bursts. I prefer it be three months or less. But if you're going to do it, you got to get your mammograms and check ups regularly. Also have some patients who like to have it both ways. You can't be on harmone replacement therapy for twenty years and be like I haven't had a mammogram in five years.

    Like that's not gonna work.

    So can we talk about medically induced menopause? Can you talk about how cancer can impact menopause development.

    So the issue with breast cancer and inducing menopause is for the patients who our own chemotherapy, and so, like I said, chemotherapy kills cancer sales, but it kills healthy sales. All sell so unfortunately it does impact the ovaries it can put pre menopausal women into menopause. It can be a touchy thing to talk about because a lot of times too, you still have these women who are child bearing age who haven't had the pleasure or the joy of starting a family yet. And now we're having this discussion about you might go into menopause and you might not ever regain any ovarian function, and so having conversations about family planning, allowing patients to do egg retrieval and egg preservation prior to starting chemotherapy if that's the path they want to go down. I think these are all important conversations. I have had patients also who've had chemotherapy, and it may have taken two or three years, but they're all Veryan function returns and then they go on and have kids and they do just fine.

    But it warrants a conversation.

    So I'm glad you brought that up because you know, I think that you know, maybe a lot of people who are enjoying our conversation will wonder about that. Is there time, like after you get a breast cancer diagnosis to be able to explore these options like egg retrieval or other things. If starting a family is something that you're interested in. Is there typically time for that.

    Yes.

    For my patients who have early breast cancers, they'll typically opt to go ahead and get surgery, get the cancer removed, and before moving on to the next treatment, because you do have time after surgery before starting chemotherapy or radiation, you have a window where it's just planning, nothing is happening, and so during that time, most patients will go ahead. They've had a conversation with their obi guide or a reproductive endochronologist beforehand, after the diagnosis, and so there's that wiggle room where they can get it done and taking care of before starting any additional treatments.

    So, you know, I think for a lot of people, getting this kind of news is very difficult, and I'm sure as the physician, it may be difficult for you to deliver that news. Can you talk a little bit about what kinds of things you are saying to the patient so that they feel empowered and like they understand what the process is like, I.

    Make sure that I go into so much detail. Number One, you just have to be kind and compassionate. You cannot have a patient there who's looking afraid, be like, well, got your results?

    Back. You got cancer.

    So I'm gonna give you a minute and then we need to get it out all right.

    Bye.

    There are patients who go through things like this. I sit down with them, I'm looking them in their eye. I'm not standing over them. I'm like, so, let's have a conversation about your results. And I try to start off, well, the bad news is this, but the good news is this is treatable, or the good news is xyz, and so I try to really frame it in a way where a patient, even with the bad news, they can digest it. I don't use big words when I'm going through results with patients or when I'm explaining what's happening. I'm a drawer, and so I'll say, Okay, let's take a look. This is what a lobbyl is. This is what a milk duth is. This is what happened I go through the stage I go through. Okay, so this is what you can expect from surgery. This is what you can expect after surgery, or if the cancer is too big, you know what, we have a window of opportunity here. It won't be fun, but let's shrink this tumor. Let's do a chemotherapy for it. There's a way to frame things and make it digestible for the patient and make it so that they know you care. I spend a lot of time with patients.

    That's what I would want.

    Right right, Yeah, the kindness and compassion.

    So we've already talked a little bit about, you know, black women and other women of color kind of being disproportionately impacted, and you're talking about you know, more severe mortality rates and all of these things. So we know that black people often have a very tenuous relationship with medical professionals. What kinds of things do you think that the black women listening to our conversation should know about how to advocate for themselves with their medical professionals.

    So one thing I love to do every time I have to give a talk or a lecture or whatever, especially when it's to lay people, regular people, I'll.

    Give them a list.

    I'll be like, Okay, if this happens, these are the kind of questions you need to go to the doctor with. I'm like, take a screenshot if you need to write it down, if you need to. But I find that when patients know what to expect and they know what questions to ask. Sometimes we just get caught up because it's like I don't even know what I don't know, and I don't know what to ask. Even giving them that script helps them to feel empowered. Take a buddy, especially if you know it's probably going to be bad news. Take somebody with you, because then there's accountability. If your doctor is crazy, they're less likely to cut up because there's somebody else there, right, And so you have a springboard. You have somebody that can ask questions for you if you're not able to think straight. And you also have somebody that can take notes for you while you're asking the questions and just having the conversation, because it's sometimes it's just hard to do both. And one thing I'm a fan of and it's just amazing to see businesses like yours, businesses like health in her Hue for example, just completely thrive and take off during COVID, especially if you don't like the way things went with your doctor, or you're getting a bad vibe, or you feel like it's very paternalistic, or they're just condescending. Get a second opinion. I am a big fan of second opinions and just curating a health team that works for you where you feel supported, you feel like you can trust that, and you feel heard more.

    From our conversation after the break, I would imagine, like many medical specialties, there are not a lot of doctor core's.

    Can you talk with.

    Me about like the numbers of black physicians who are like oncological surgeons like you are.

    It's so small because black men and women, we're only I want to say, like five or six percent of physicians. It's a very small number. I don't have the latest data from American Medical Association, but it's a very small number. And then the number of black surgeons about two percent of physicians. Trust me when I say a lot of the black dots, especially surge as we know each other and if you don't know somebody, then you know somebody that knows them, and they're not hard to find. It's a small number. And so even the black female breast surgery group, most of us know each other.

    Yeah. So since we know the numbers aren't increasing fast enough in terms of more black professionals entering the field, what other kinds of things do you think the healthcare system needs to do to provide the kind of support that black women patients need.

    It just needs a complete overhaul, and it starts with our numbers also in making room for more black physicians and other physicians of color. Why is it the highest numbers of black physicians and physicians of color were actually actually in the sixties and seventies, and those numbers continue to dwindle.

    And all of.

    Those old school docs, they're old, they're retiring, they're in their eighties and approaching ninety now. I've met some, and it's disheartening, I think, especially when it comes to medical school and residency programs, getting into medical schools, staying into medical school, making sure that black students have the support they need in residency, making sure they have the support that they need. We're more likely to be kicked out of our residency programs for issues that our other counterparts do, or our counterparts do a lot worse sometimes, but just being under that microscope and not having the support you need. But then it's a trickle down effect, right. We need to make sure that these older docs who pay the way for us, that they're getting into positions where they have a voice also and where they can actually advocate for black physicians and training.

    And so it's multifaceted. It's multifaceted.

    So many DEI programs right that were started during COVID they're gone.

    They're gone.

    And so how do you advocate for your staff, your physicians, for patients without having DEI initiatives and actually having de and I on the DEI committees Because one thing that was one thing that was very disappointing is to see DEI committees and there isn't a single woman or person of color, and so it's just virtue signaling and it's old. And so we just have to continue to speak up, and even if it starts with just one physician, speak up, advocate as much as you can without burning yourself out, and you go from there. And I feel very grateful to know other physicians who care about patients and care about what happens just as much as I do, and so continuing to train people to see people the way they want to be seen and going from there.

    Honestly, thank you for that.

    So you've already given us some excellent tips around like advocating for ourselves with our medical professionals. The other part that I think is important after a breast cancer diagnosis is the community in your support system. Can you talk a little bit about the role that community plays after somebody has a diagnosis, especially as a part of recovery.

    Yeah, my patients who have support, whether it's family, good friends, a good circle, they do better than my patients who have no support at all. And studies have also proven this, And so I think it's important to have your circle. And your circle isn't always family, but having people who can sit with you, having people like I mentioned before, can go to an appointment with you, Having people who can go grocery shopping for you or just listen. Nobody can tell a patient what they need. Sometimes they don't know what they need, but being there is extremely important. And so having your circle, those people that you trust is tantamount.

    So something I realized we didn't talk about was whether there are any prevention measures we can take to prevent breast cancer, Like, is it something that can be prevented?

    Unfortunately, you can't really prevent cancer. I think that you can minimize your risk, So I think it's important. Number One, we touched on family history and so knowing what that family history is, and I know sometimes it's hard, especially in black families and other families of color, where they just don't want to talk about it, but we have to talk about it and know what other family members went through so that we can begin to quantify our own risk. So knowing your family history is absolutely important. Also, I tell patients a healthy diet, healthy mix of fruits, vegetables. Obviously you need your protein, but minimizing processed foods, minimizing junk food is extremely important. Some people say, well, what about sugar, Well, our bodies obviously need carbs and sugar to function, but minimizing the processed food is huge for me.

    There has been a.

    Link between alcohol usage and developing breast cancer and other cancers, and so those who binge drink or drink more than two to three drinks a day are more likely.

    To develop breast cancer.

    They have an increased risk, and so that is something that can absolutely help you prevent breast cancer. I also tell patients minimizing outside hormones, so whether it's tossed aroone, hormone replacement therapy, things like that, because that will absolutely increase your risk as well. And physical activity has been shown to decrease your risk of developing breast cancer, so it's recommended that you do thirty minutes per day for at least five days a week.

    And so while you.

    Can't really prevent cancer, there are things you can do to mitigate your risks.

    Got it?

    Can you say more about the link between alcohol and breast cancer?

    So, alcohol, and we've seen alcoholics too, Alcoholics liver dysfunction, deliver dysfunction more likely to have increased estrogen. But particularly alcohol, it has some properties that can change normal cells to abnormal or even malignant cells. There is a definite link between alcohol use and developing breast cancer. And some people ask about smoking. Also nicotine and some of the chemicals that are in cigarettes and other things like that non carcinogens will increase the risk of abnormal cells. And so yes, lung cancer is more likely with smoking, but there are other things that we could do to decrease the risk of developing cancers in different areas of the body.

    Got it.

    We often hear people talking about they are in remission. What happens when you're in remission from cancer?

    So when people typically say in revision, that means they have been shown to be cancer free for at least five years, usually minimum five years. I don't like to say cancer free honestly, because if you were cancer free, this never would have happened in the first place. And honestly, once the tumor becomes invasive, you cannot control where those cancer cells go. They may just be asleep. You don't know if they'll stay sleep or if something will happen in the future. So I do you prefer in remission instead of cancer free? Just because again, I've seen so many crazy things happen, but usually that five year mark that's when we can do a happy dance and celebrate.

    So I'm also aware, doctor Gord, that you have blown my mind with all these misconceptions I think that I had about breast cancer. Is there anything else that I have not asked you about that you really feel like is important for people to know about their risk and taking care of themselves.

    I kind of touched on it, but I really think it's important for men to know, or for the women who are looking at this informing their men that they are not exempt because they are men. And men actually comprise one percent of breast cancer cases each year, so approximately it's gone up, so almost three thousand cases will be diagnosed in men this year, and it's important to know that the numbers for black men mirror the numbers for black women, and so black men are more likely to have more aggressive tumors later stage at diagnosis and also more likely to have an increased mortality compared to their white male counterparts. And so it's important that across the board we're holding each other accountable and looking out for each other.

    So what suggestions would you give for men, because it's typically not suggestion that they have mammograms, correct, So what kinds of things would they be on the lookout for.

    They should do breast self examinations also, and I tell every patient man or woman or whatever pronow you go by, if you feel something, say something and let somebody know a sap so that we can get it worked up. But typically it's much easier for them to examine themselves, so to do examinations in the shower or when they're lying on the bed.

    Also, got it?

    And would you say that men are more likely to feel something or is it the same case where they often won't feel anything.

    Either, it's easier.

    For them to feel something because there's less tissue and they get the same symptoms women get. So I had one patient he presented with nipple discharge that would happen sporadically, like every two to three months, it ended up being cancered. So pay attention to those signs and don't ignore them.

    So where can we stay in touch with you, doctor Gore? What is your website as well as any social media handles you'd like to.

    Share across the board on all socials, so you can find me at Ryland Gore md R Y L A N D G O.

    R E M D.

    Thank you for adding that. I appreciate it. I'm so glad doctor Gore was able to share her expertise with us today. To learn more about her and her work, visit the show notes at Therapy for Blackgirls dot Com slash Session three twenty nine, and don't forget to text two of your girls right now to encourage them.

    To check out the episode.

    If you're looking for a therapist in your area, check out our therapist directory at Therapy for Blackgirls dot Com slash directory. And if you want to continue digging into this topic or just be in community with other sisters, come on over and join us in the Sister Circle. It's our colzy corner of the Internet designed just for black women. You can join us at Community dot Therapy for Blackgirls dot com. This episode was produced by Frida Lucas, Elise Ellis, and Zaria Taylor. Editing was done by Dennison Bradford. Thank y'all so much for joining me again this week. I look forward to continuing this conversation with you all real soon.

    Take good care.

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