Episode Transcript
[00:00:00] Speaker A: From Riverside Health System. This is the Healthy youy Podcast where we talk about a range of health related topics focused on improving your physical and mental health. We chat with our providers, team members, patients and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier you.
All right. I am really excited, excited to have with me in the Healthy youy studio today. Dr. Blesnak, I got it right.
Welcome to the Healthy youy Podcast where we unpack everyday topics and meet the experts guiding our communities in better well being. I'm your host, Franke Myers. Today's conversation is one of many for us as it relates to understanding breast cancer risk and prevention.
Joining me again, a surgical oncologist with Riverside Surgical specialists with extensive experience in Breast Health Care.
Dr. Blesnack, thank you for being here today.
[00:01:07] Speaker B: Thank you for having me.
[00:01:08] Speaker A: It's always a pleasure. Tell me a little bit about how you ended up in this field of medicine.
[00:01:14] Speaker B: After completing surgical residency, I elected to join a practice with a surgical oncologist who had trained at the National Cancer Institute.
I became interested in general surgical oncology, but particularly in breast cancer because the late 1980s, 1990s were a time of tremendous opportunity to put patients, patients with breast cancer and patients at high risk for breast cancer into clinical trials.
[00:01:50] Speaker A: Absolutely.
[00:01:51] Speaker B: And back then we had a number of clinical trial groups, particularly the National Surgical Adjuvant Breast Project, or nsabp, that were doing a lot of really landscape altering trials, including in breast cancer prevention.
[00:02:11] Speaker A: Okay, okay. Well, thank you for what you do and what you bring to that field.
Let's begin with the numbers, because they do matter. According to the American Cancer Society's 2025 projections, an estimated 310,720 new cases of invasive breast cancer will be diagnosed in women in the United States this year alone.
Breast cancer remains the most commonly diagnosed cancer among American women, aside from skin cancers. The good news, thanks to early detection and better treatment, survival rates are steadily improving. Dr. Blesnik, how do these national statistics reflect what you're seeing in our communities and in your practice?
[00:03:06] Speaker B: So, you know, I think we are also seeing an increase in number of women diagnosed with breast cancer. And I think as is a trend for a lot of other malignancies, unfortunately, we're seeing it diagnosed often in younger age women and we are also seeing it in the older population. It's kind of scary to me that the National Institute of Health defines geriatric cancer patients as age 65 and over, because that means that I'm a geriatric patient.
[00:03:38] Speaker A: Right. And I'm not far behind you.
[00:03:41] Speaker B: But so we are really seeing this bimodal distribution and that really impacts our treatment recommendations.
[00:03:49] Speaker A: Absolutely.
Wow. So those screen monthly screenings are important for all women because they might not be in that high risk age range. So for them to detect it early, they need to be diligent about doing that so that they see something, feel something, they can. It's early enough to do something about it.
[00:04:08] Speaker B: Right. I mean, I think for younger women who do not yet meet, have not yet reached age 40, which for the average age woman is when most of the organizations recommend beginning screening mammography, anything abnormal in their breast, any change in their breasts should be brought to the attention of their providers.
[00:04:30] Speaker A: I know in some of my communications with women, some of them have family histories and they still don't start the screening early.
[00:04:41] Speaker B: Right. So there are family histories and there are family histories. I think there's a tendency to conflate family history and genetic predisposition to getting breast cancer. They're actually interrelated, but they are two generally separate things. Someone whose grandmother had breast cancer at age 70 probably is not at an increased risk of developing breast cancer. But anytime you start seeing breast cancer running through two and three generations, especially when it includes a first degree relative, that's something that's really significant and should make sure. If your providers aren't aware of it, as we usually are now through the electronic medical record, but if they're not available, not aware of it, it needs to be brought to their attention.
[00:05:31] Speaker A: Brought to their attention. That's great information.
Let's explore the risk factors a little bit further. When people hear breast cancer risk, they often think, like I said, about the family history, but, and you mentioned a little bit of that, what else plays a role aside from that?
[00:05:47] Speaker B: So one of the things that I think is very frustrating for health care providers is that even in the era of the electronic medical record, we don't have all of a patient's data in front of us all the time.
So I think one of the very important things is that anybody who's had a breast biopsy performed, whether it's a needle biopsy or a surgical biopsy, really should make sure they have a copy of the pathology report, because there are pathologic findings, such as what's called atypical hyperplasia, that can put a woman at a significantly increased risk of developing breast cancer and would change our recommendations for screening the American Cancer Society about a year ago published computer based assessments of lifestyle factors that can increase your risk of getting breast cancer.
And one of the most significant is smoking. When I first started doing this, we knew smoking was causal for lung cancer, but really didn't think that it was an issue for breast cancer. But it's now very clear that smoking increases your risk of getting breast cancer. Another one is alcohol intake, and that is actually also a much more significant risk factor than we thought of. I heard a presentation last week that anything more than two drinks a week significantly increases your risk of a variety of malignancies. The French, and I think we have to take, whenever the French publish articles on drinking, I think we have to take it very seriously because that's a huge percent of their gross domestic product product.
So there have been French publications that say more than 4 ounces of alcohol a day increases your risk of breast cancer. I mean, you know, that's a sip.
[00:07:44] Speaker A: Absolutely, absolutely.
Great information.
There's also a growing awareness about disparities in breast cancer outcomes. Can you talk a little bit more about that?
[00:08:00] Speaker B: I think disparities impact a number of things. If you look across the country and across races, Caucasian and Oriental women are much more likely to be diagnosed with early stage breast cancer than African American and Latino women.
That has to do with a bunch of societal factors such as availability of screening, availability of primary care providers to do breast exams, and make sure that women get their age appropriate screenings.
It has to do with fear of mammography. When I practiced in Pennsylvania, we had Latino inner city communities where women were just afraid to go and get their mammograms.
But then there's also treatment related differences. And we now know that breast cancer is not a single disease. It's actually a collection of diseases that in general we lump into four categories that align with our treatment recommendations.
What are called luminal A, luminal B, HER two, over expressing and triple negative breast cancer. And African American women, when they get breast cancer, are more likely to get triple negative breast cancer than other races.
Women who have BRCA1 mutations are also more likely to have triple negative breast cancer. And that is the most aggressive form of breast cancer currently. Even though we had tremendous advances in the treatment opportunities, utilizing both chemotherapy and immunotherapy, that has improved outcomes greatly.
[00:09:48] Speaker A: All right, screening saved lives, and we've talked a little bit about that, but there's a lot of confusion around when to start screenings, what's right for each person, what do you recommend?
[00:10:03] Speaker B: So again, another incredibly complex issue that it would be nice to sit at a table with radiologists and primary care doctors and discuss for about two or three hours. But to try and cut to the quick, screening is beneficial.
Okay. Yes, screening saves lives, although probably not as many as it did three decades ago when we did not have effective systemic therapies.
But screening can often result in great outcomes with less treatment if we find earlier stage cancer. So it still has tremendous benefit. The reason there's so much confusion over screening is that there's a cost to screening.
The more we screen, the more things we find.
A percent of these are cancer, but a large number are not cancer.
And going through a screening mammogram, then a diagnostic study, then a biopsy that results in a non cancer diagnosis for some women is tremendously costly in terms of anxiety and potentially financially great costly.
[00:11:15] Speaker A: Absolutely.
[00:11:17] Speaker B: But the current guidelines are that women who are at average risk should begin screening at age 40. There is also some controversy as to whether this should be an annual screen or a semiannual screen that they're getting screened every other year. Because in Europe, screening is often at 18 to 24 month intervals, not 12 month intervals, and the outcomes are essentially the same. But in the United States, American Cancer Society, American College of Radiology, currently recommends screening annually beginning at age 40 for average risk women, and then continuing annually until our estimate is that the patient has fewer than a decade of life left, and at that point in time, one can stop screening.
Now, it's different for women who have a first degree relative diagnosed with breast cancer prior to age 50.
These women should begin 10 years younger than their first degree relative was diagnosed, but no earlier than age 30.
So if your mother was diagnosed with breast cancer at age 45, you should begin screening at age 35.
[00:12:34] Speaker A: Back to one of the previous questions. The more aggressive cancers that are more prone in some ethnicities, is that more genetic?
[00:12:45] Speaker B: So, you know.
Right. So we are still at the very beginning of fully understanding genetics.
[00:12:53] Speaker A: Okay.
[00:12:54] Speaker B: But we certainly know that there are two genes. The BRCA1 gene, first found in the early 1990s, the BRCA2 gene found in the late 1990s, that confer a very high risk of developing breast cancer.
These genetic abnormalities probably account for only about 8% of all breast cancers, which means that over 90% of women diagnosed with breast cancer in the US do not carry an identifiable genetic mutation of significance.
So family history, again separate from a genetic predisposition, still confers an added risk of developing breast cancer.
[00:13:36] Speaker A: Gotcha. Okay, that's very helpful.
What role does knowing Your body play.
[00:13:43] Speaker B: You know, having done broad based surgical oncology in the past, practiced general surgery, although for the last 20 years, it's really been focused entirely on breast surgery. When a patient tells me something's wrong, I never doubt them.
We used to, back in the 90s, guilt women into doing monthly breast self examinations.
And that actually engendered an incredible amount of anxiety and didn't change the stage of disease at which women are diagnosed. So the American Cancer Society and other organizations have withdrawn that recommendation.
The current term is what's called breast awareness, which means looking at yourself undressed in a mirror at least once a month, once with your arms down, and then putting your arms up above your head and looking to see any change in the breast appearance, any change in the shape, any dimpling of the skin, any retraction of the nipple, any thickening of the skin or change in skin color. And if you see any of those things, then you should present to your primary care provider.
[00:14:53] Speaker A: Okay, that's very helpful. All right, now let's talk prevention.
What can listeners do daily to lower their risk? Now, you already mentioned some of those risk factors. Anything else you want to highlight as it relates to that?
[00:15:07] Speaker B: So again, you can't emphasize not smoking enough. Right. Unfortunately, smoking rates are going up.
[00:15:13] Speaker A: Right, right.
[00:15:14] Speaker B: Especially among the young. And remember what I said, that we're actually seeing a creep in terms of the age of diagnosis of cancers, not just for breast cancer, colon cancer, other malignancies as well.
Alcohol intake, actually, alcohol intake is down in the United States. I guess the mocktails are so good now that people say, why do I need a real drink?
But limiting alcohol intake, there's a lot of estrogen in our food supply, limiting red meat intake, processed meat intake, and dairy intake. And I'm someone who loves cheeses. Yeah.
So we have to limit it, not necessarily eliminate it. Exercise, incredibly important.
I was involved, or I had the opportunity to be involved in the 90s in some early studies on exercise for women getting chemotherapy. But it is much wider than that.
Exercise significantly reduces risk of recurrence of breast cancer, and there's good evidence that it impacts positively the incidence of breast cancer.
Exercising for at least 30 minutes at a time, three times a week, reduces your risk. Maintaining a healthy body mass index, especially below 30, is also beneficial.
[00:16:44] Speaker A: Yes, yes.
And breastfeed, if possible.
[00:16:50] Speaker B: So. Yeah. So there were lifestyle modifications we used to talk about. Right. You can't control when you have your first period. But clearly women who have earlier menses, which again, we're seeing a trend towards that in the country, possibly because of all the estrogen in our food supply, delayed or nulliparity over age 30 or not having any children increases your risk. But I've got to say what we're talking about is a fairly small increase in the relative risk of getting breast cancer. So, no, don't get cancer. No one should run out and get pregnant at age 22 to reduce their risk of breast cancer if they don't want to do that. Otherwise.
Breastfeeding.
The data is still not clear on breastfeeding in terms of prevention. I think what is clear is that there are carcinogens in our environment and there are risks imposed by our lifestyles that seem to have a greater impact prior to complete maturation of breast tissue that does not occur until you're lactate.
[00:18:01] Speaker A: Okay, all right, Great stuff there. There's also the emotional side of how can people manage fear around cancer without ignoring their health?
[00:18:13] Speaker B: The importance of support, be it familial support, be it what we call nurse navigators, be it the providers, nurses, physicians, technicians involved in breast cancer treatment specifically, is incalculable. You know, I mean, I still remember the time where women were afraid to talk about breast cancer as though this was something that they brought on themselves. That's absolutely not the case. Unfortunately, we've moved beyond that.
[00:18:47] Speaker A: Right.
[00:18:48] Speaker B: But that doesn't mean there's not an emotional toll. And it's hard to predict how will that impact any given individual. When you get together at breast cancer meetings, it is amazing. But women with stage zero breast cancer, right, which has essentially 100% cure rate, seem to suffer in some cases a much greater emotional toll than women with more advanced breast cancers. I don't think we can say, yes, you have early stage breast cancer, so you're not going to have an emotional toll, and your friend has stage three breast cancer, and it's going to be terrible. It's just very individualized. And that's why across the country, so many cancer centers are engaging in the resources, oncology, social workers, nurse navigators to support women through that treatment. Sometimes the emotional toll is such that it precludes women from getting key components of their care that really improve their ultimate cure rate.
[00:19:50] Speaker A: Absolutely. Absolutely. Absolutely.
If someone receives a diagnosis, what next? And how has breast cancer treatment evolved?
[00:20:00] Speaker B: You know, we used to say biologically it wasn't important to see somebody as quickly as possible, but it was emotionally for them, important that we get them in. We actually now know that's not true. For whatever reason, there seems to be time constraints over which we can subtly improve the outcomes. But remember, a lot of the treatments that we do only provide an incremental improvement to outcomes. What we try and do is get people in as timely a fashion as possible after their biopsy has shown there that they in fact do have breast cancer. And it doesn't matter if they have stage zero breast cancer or if they have stage three breast cancer.
So I think being an advocate for getting seen in a timely fashion.
Unfortunately, the Internet is replete with both good and bad information.
There are certain websites. The American Cancer Society, I think, has a lot of reliable information.
The National Cancer Institute website has a lot of information. The National Comprehensive Cancer network, which are 19 NCI designated comprehensive cancer centers like Mayo Clinic, Cleveland Clinic, University of Pennsylvania, where I was before I came here, Fox Chase Memorial, Sloan Kettering, M.D. anderson, all contribute to the NCCN guidelines. Those are available to patients. So there's a lot of good information.
[00:21:35] Speaker A: Out there for them.
Good stuff. Thank you. Survivorship looks different for everyone.
What support systems matter most post treatment?
[00:21:45] Speaker B: So again, I think it really varies by the individual. The treatments that we give have side effects.
They all have an emotional side effect and they can have physical side effects, lymphedema, breast edema, side effects from chemotherapy or systemic therapies.
Again, I think cancer programs, and we're a comprehend.
I'm sorry, an integrated network program of the Commission on Cancer are required to have a survivorship program with a team, a survivorship leader, and to work, offer an array of survivorship programs that meet the needs of their patients and on an annual basis to evaluate the effectiveness of those programs. Right. We know things can always be improved. And so we want to look at what we're doing, the impact of what we're doing, and how we can improve what we're doing.
[00:22:47] Speaker A: Absolutely, absolutely.
Let's empower our listeners with a toolkit. What are the top three actions someone can take today?
[00:22:58] Speaker B: Okay, so I think knowledge is number one. So as I said, if you've had a breast biopsy, make sure you know what that biopsy showed.
Know your family history, know it accurately. Right. The not only whether a family member had cancer, but knowing what kind of cancer. For example, a family member with ovarian cancer significantly increases your risk of having breast cancer. A family member with endometrial or uterine cancer has a lower impact.
A family member with cancer of the cervix doesn't have any impact on your risk of getting breast cancer. So knowing your family history and understanding that if you've had Family members diagnosed with breast cancer, many of them would have had genetic tests testing.
So knowing the results of their genetic testing, which can help your practitioners determine whether you warrant genetic testing. So that's so knowledge is number one. Number two, prevention. Right. Our cure rates for breast cancer have gone from a 50, 50 chance at five years back in the 1980s to 85% at 10 years in, in the 2000s.
But the only way to get to 100% is to prevent breast cancer. So the lifestyle interventions we talked about that the American Cancer Society estimates can reduce the risk of breast cancer in the United States by 30%.
So at 300,000 cases a year, that's preventing 90,000 breast cancer a year.
So the second one would be prevention.
The third one would be to remember what Lincoln said, the only thing we have to fear is fear itself. So to not let your concerns prevent you from doing practicing breast awareness, seeing your primary care provider for an exam a year and having screening studies done at the appropriate intervals.
[00:25:05] Speaker A: Okay, great stuff there.
What would be your message to anyone feeling overwhelmed or afraid?
[00:25:12] Speaker B: I think we have to recognize that. I mean, I think all of us have things we worry about, but nothing's as bad as regret.
One of the things that's most difficult for me to help patients through is if they haven't gotten their mammograms and then they're diagnosed with late stage breast cancer, the regret that things could have been differently had they followed through with recommendations.
[00:25:37] Speaker A: Absolutely. Well, this is definitely going to make a difference. So thank you for all that you do to help not only treat, but to help educate our communities in this space. It's a pleasure to have you.
[00:25:51] Speaker B: It was nice to be here. Thank you very much for your time.
[00:25:54] Speaker A: Please come back anytime. Thank you so much for shining a light on breast cancer risk, prevention and hope these conversations can truly save lives to our listeners. If this episode helped you think differently about your health or reminded you to book that mammogram, share it with a loved one, Visit Riverside's blog for more expert guidance and stories on survivorship. Until next time, stay healthy.
Thank you for listening to this episode of Healthy Youth. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideau online.com.
