Dorothy: [00:00:00] What’s in the future for breast cancer treatments? Well, Dr. Raz is here today to talk about microwaving and freezing cancers in the duct. He’s always a wealth of information and we weren’t expecting some of his projections in some of his predictions for the future. Listen and hear what he has to say.
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Let’s Talk About Your Breast, a different kind of podcast presented to you by The Rose, a breast center of excellence, and a Texas treasure. You’re gonna hear frank discussions about tough topics, and you’re gonna learn why knowing about your breast could. Save your life.[00:01:00]
Thank you, Dr. Raz, for joining us again. You know, I tell you that your episodes are always so popular and today we just want you to talk about whatever might be on your mind or what you’d like to. One of the things I do want ask you though, is, you know, probably daily I have someone call me and say, I was just diagnosed. They may not have been diagnosed here.
Dr. Raz: Right.
Dorothy: But your friend or you know, someone I’ve worked with in the past, and they’ll say, and I’m stage this. And what does that mean?
Dr. Raz: Right? So cancer, any form of cancer in the body, we try to figure out, well, how big is the cancer and where has it gone? Because the basic, most simple definition of cancer are these cells are not in our control. So remember, every day the body makes new cells, so Within your gut cells turnover within a few days your nails grow, your hair grows. So skin grows actually. So what is that? That is all [00:02:00] under our control. It’s a control, destruction, and regrowth in our body, right? That’s how the human body is when that system gets messed up, where few of these cells grow independent of whatever homeostasis we have in our body. And they’re just independent from our control, our mind, or the process or the system. And they’re independently just growing and growing and they don’t care about anything else. That is what cancer is.
Dorothy: Right.
Dr. Raz: So in simpl stick terms, that’s what cancer means.
Dorothy: Yeah.
Dr. Raz: A mass or something in the body growing and we cannot control it. And it keeps growing.
Dorothy: Right.
Dr. Raz: Okay. So now that out of the way, you know, as physicians we have to quantify, well, what subtype of cancer it is. Like, you know, there are many cancers that arise from different things in breast. Majority of breast cancer comes from the milk ducts, right? So the breast, the most basic breast anatomy is, well, you have these glands that produce milk, and then it’s carried in these small ducks. The ducts becomes big duct, and then duct opens up into the [00:03:00] nipple, right? So the cancer majority of the breast cancer is called ductal cancer or ductal carcinoma, and arises from these pipelines or ducts, you gonna call it?
So that’s the most basic thing, but then it’s not enough. We need to find out, well, how big is the cancer and where has it gone? And we do not want it to go further than within the breast because once breast cancer in our example, gets to the lymph nodes in the armpit, then it’s like a train station or superhigh. It can then travel to other places in the body. Right. So. So staging is just a scientific or medical way of f finding how far the cancer has gone.
Dorothy: Okay.
Dr. Raz: Or where can we see, um, now in breast imaging, we, uh, you know, it’s, it’s a little bit of complex and they’ve just updated the staging system.
Dorothy: Okay.
Dr. Raz: So I’ll just give you the simple way and it’s, it may get a little bit into the weeds so you don’t have to memorize, but you can listen to podcasts again, I suppose.
Dorothy: Okay.
Dr. Raz: But it’s TNM staging. [00:04:00] T stands for tumor size and it’s for how many lymph nodes are involved, whether they be in axilla and lymph nodes are everywhere. They could be in, in above the collar bone called supraclavicular or infraclavicular just means above or below the collar bone. And they couldn’t be in the medial chest. They’re called internal mammary, uh, lymph nodes. So these are all lymph nodes around the breast, which could get affected by breast cancer. And then the m just stands for metastasis, meaning it has gone beyond this local, regional area to another organ. So breast cancer unfortunately loves to go to liver bone and then brain, um, and then bone meaning, you know, back, back backbone, so your spine. So tumor size, you know, let’s say if the cancer is zero to two cm, so anything under two centimeters in breast imaging considered a small mass.
Dorothy: Okay.
Dr. Raz: So that’s the other thing I hear from women coming in like, Hey, I have this big mass. Really? Not really. Even if you feel the mass is two centimeters or under, it’s considered small mass.
Dorothy: Okay.
Dr. Raz: So it takes hollace in the fact that even if you may have cancer, if it’s under two centimeters, it’s really a T one [00:05:00] cancer.
Dorothy: Okay.
Dr. Raz: And then if you don’t have any lymph nodes, then that’ll be considered stage one cancer. Now, let me begin by saying the stage zero. We, you know, previous podcasts we talked about DCIS. Remember, cancer that’s in the pipeline has not busted out like a frozen pipe that we get the Houston freeze, right? We’re doing all these things. So then you don’t get the freeze busting your pipe. Same thing. The water is frozen, it’s still inside, has not busted out. When it does that, then it becomes a mass. So if it’s still in the duct, then it’s stage zero DCIS.
Dorothy: Okay.
Dr. Raz: Again, why do we do screening? Why do we do breast imaging? Because if you catch cancer stage zero and it’s completely curable, survival rates a hundred percent.
Dorothy: Okay.
Dr. Raz: A hundred percent. Stage one, uh, is also 99% five year survival rate. And this is where it becomes important staging. With studied staging, it becomes predictive or prognostic. And we could figure out, hey, if you are a stage X, Y, and Z, how are you gonna do five [00:06:00] years, 10 years from now?
Dorothy: Okay.
Dr. Raz: And this is why it’s important to stage and screen. Everybody gets your screening mammograms. Um, is because when you get it early, imagine if it catches stage zero, stage one, you are not able to feel these masses. Only I can see them. Then cure rate is very high. Survival rate is near a hundred percent. Right. So again, going back, you know, stage one tends to be masses that are two centimeters are under. And no nodal metastasis, or if you do have nodal metastasis that are micro mets, like very small, um, stage two in breast cancer tends to be masses that are two to five centimeters.
So could we consider two to five medium sized masses? And you probably have one or two or three lymph nodes that are involved, that’s stage two, and then their subtypes, stage two B, et cetera. You don’t have to get into too much detail. And then stage three tends to be bigger masses, so, five centimeters are over and then more lymph nodes are involved in the axilla.[00:07:00]
Uh, so four to nine lymph nodes that are involved. And then stage four, it’s just distant metastasis or cancer has gone beyond the local regional. And the more important thing is it’s not just based on the size. The new guidelines now have incorporated what we call receptor status. So, you know, plenty of patients come in like, Hey, what should I ask my, my surgeon or oncologist, this is the important part.
Where cancer wears different clothes, even breast cancer. And what, what, what I mean by that is every cancer has certain protein on top of it, and, eh, you know, some of these cancers we’ll call estrogen the, the names are estrogen receptor, progesterone receptor, and something called Her2/neu. Which is a growth factor. And why is this important? It’s important because whether you have er, PR cancer or estrogen receptor positive or progesterone receptor positive has implications of how the oncologist will treat you. So there are medications that target this and then reduce and completely [00:08:00] get rid of the cancer.
Uh, and if you don’t have it, then that’s a different type of subtype of cancer. So more high grade, aggressive cancer. So these are relevant questions you should ask. Hey, what’s my receptor setting? And this is the cool part where let’s say like on the traditional metrics, what I just mentioned of masses, let’s say 2.5 centimeters with no, no, classically, if you look up online, it will say this is a stage two a cancer.
But if the woman is ER positive and PR positive, and Her2/neu-, and again, Her2/neu being, this special protein that cancer cells make that you can express or not express. So if you don’t have that, then actually your prognostic, uh, staging is stage one A. You get downshifted, ah, because you have favorable receptor status.
That’s what an oncologist will tell you. So the code word for that is saying, Hey, you have these receptors, we can treat it better. And these medications are tamoxifen, [00:09:00] aromatase. These are, uh, uh, anti hormonal therapies. Um, so, you know, when you, you use these medications, even if it’s a stage two, classically by anatomy, the size of the mass and the node status, or how many nodes are involved.
Even anatomically you may have stage two A or stage three cancer. It’s get down, it gets downgraded into lower stages. And again, what’s the benefit of it? Well, your prognosis is better, right? Right. If you’re stage one, what did I say? Or 99 survival rate at? At five years. That’s excellent.
Dorothy: Before we continue this episode, I have to let you know about something that is happening throughout this month of July. Our Anonymous Donor is at it again, and she wants to match your donation up to a hundred thousand dollars. So think about it, $20 is now $40, a hundred dollars is now $200, and if you’re feeling really generous, a thousand dollars is now $2000. Just think about all the women that we could help with your donation [00:10:00] and our Anonymous Donor match. Please go to therose.org. It’s easy to make your donation there. And as our Donor said, every dollar counts. Now back to the podcast.
So we as women really should wait until we know all that.
Dr. Raz: Correct.
Dorothy: And going to Dr. Internet is not always that, that great of an idea, right?
Dr. Raz: That’s right.
Dorothy: That’s right.
Dr. Raz: Yeah. Googling things. Um, yeah, so, so, but, but you know, you get to the good, get to a good point that, you know, knowing this and asking these questions is, is relevant. Once you have this, you know, behooves you to research this, understand your own stage, and then ask, Hey, is this my stage to your oncologist or surgeon?
And it, it’s a little bit complex. It’s not so straightforward because some women. You know, who are, who have larger masses, let’s say five centimeters, they don’t go directly to, uh, surgery. Sometimes they treat and they use fancy words. You know, they’ll [00:11:00] call it pretreatment or neoadjuvant. These are fancy words.
You don’t need to know that. Just need to know that, hey, I got some therapy before surgery. And the reason they do it is that they shrink the mask down, then they take you to surgery because. Again, the benefit of downshifting or lowering your stages, you have better prognosis. You get rid of cancer, faster treatments better. So asking these questions to your surgeon and oncologist is important.
Dorothy: So you’re asking about your staging.
Dr. Raz: Right. Your receptor status.
Dorothy: You’re asking about your receptor status.
Dr. Raz: Right. And then frankly, what your prognosis is gonna be based on. Yeah. And there are some other things that we look at. You know, how fast, what’s the grade of the cancer? That’s another complicate. Like the grading just means how the cancer looks under the microscope to a pathologist.
Dorothy: Okay.
Dr. Raz: Higher grade just means it’s, the cancer looks more weird, for lack of better word. Okay? You don’t want that, you want lower grade. Um, it also has implications of aggressiveness of the cancer. So [00:12:00] non-aggressive, slow growing cancer or lower grade. Aggressive, triple negative or, you know, luminal B is what we call it. Cancer tends to be grade three. Um, so again, that would be a relevant question to ask, um, and any targeted therapies. So, um, you know, this is, this is the other thing I wanna get into, you know, the future of breast imaging, if you will. Or, or breast treatment is, it’s a lot of individual treatment. So targeted therapy is what the future is.
Dorothy: What does that, what does that really mean?
Dr. Raz: Right. So targeted therapy means that, hey, right now we know, let’s say ER receptor, PR receptor, that’s already targeted because when you take tamoxifen, it’s directly going and blocking those receptors.
Dorothy: Okay.
Dr. Raz: When you take a medication called receptin, It’s directly going and blocking that her two new receptor. When you block it, cancer cells don’t grow as fast. In fact, you get rid of, it’s like magic. If you do imaging on a patient like that in six months, the cancer’s gone. It’s very good to see. So [00:13:00] we find new receptors, new proteins that are messing up. And the reason for which women get cancer and whatever protein they make, or cell abnormality, we try to target that, meaning go in and fix it. So, you know, we’ve been hearing new, you know, gene editing softwares, if you may have heard of these. These are all companies that are working on, and, and a lot of this is not right now targeted to breast cancers, to leukemias and, and all those cancers, but they’re essentially reediting these bad genes and making them normal.
And they go in at this cancer cell level and figuring this out. That’s right. So what we’re I’m trying to get to is every day we find new proteins that are the reasons for which you get this cancer. And instead of just like shotgunning and blasting all your cells with chemotherapy, we just find this one particular receptor and just blocking that with particular medication.
Dorothy: Interesting. And, so we shouldn’t be afraid of this when we hear this genetic [00:14:00] stuff that they’re altering or.
Dr. Raz: No, not at all. Um, not at all. In fact, that’s, it’s almost magic medication because, here’s breast imaging also comes in, you know, we’re trying, and maybe a lot of podcasters don’t know this, but there’s like active research happening. You know how we do mammography, right? To do cancer detection, understand that X-rays are great, but X-rays are ionizing radiation. These are high energy radiation that pass through us. And while there is no like cancer risk, like you’re not gonna get cancer from just doing mammogram or x-rays.
It does increase, let’s say if you were to get like 10 cts in a year, you do run the risk of like causing some abnormality and causing cancer. Right? So high risk radiation, I mean radiation continuously we call cumulative is a risk. Okay. But it’s just mammogram doesn’t have much risk because it’s such low radiation.
Dorothy: Right.
Dr. Raz: But what, what I’m trying to get to is there’s microwave imaging right now. I don’t know if people [00:15:00] exactly. You know, we microwave food.
Dorothy: Microwave energy?
Dr. Raz: That’s right. That’s right. There’s microwave breast imaging.
Dorothy: You’re, you’re gonna do that on a breast!?
Dr. Raz: Right. So we’re not putting it in our microwave. But the energy, I mean, but, but. Um, you know, all of these x-rays, ultraviolet rays, uh, infrared rays, radio waves, microwaves. What are these? This just, I’m getting into too much nerdy science detail, but, or light.
Dorothy: That’s okay.
Dr. Raz: These are all electromagnetic waves, which are either very strong or not strong.
Dorothy: Okay.
Dr. Raz: Right. So you don’t want to hang out in ultraviolet rays ’cause they’re very high energy causes skin cancer. X-rays are also high energy, just not as high as ultraviolet race. Radio wave, you know, we’re blasting radios all day, um, are very low energy. They pass all through us. That’s why you’re able to hear it’s all around us. It’s not causing us any cancer because they’re very low energy. Microwaves are the same. So do not right now, don’t think of the microwave that we use to, you know, I’m about to eat a burrito in five minutes. Um, I’m just, but it’s a [00:16:00] special type of waves that we use to image the breast. But the cool thing is because it’s microwaved, it’s non-ionizing, not like x-rays. X-rays are ionizing.
So yeah, so there’s active area research where we are going to put microwaves inside the breast and then it reflects it back and we have detectors. That then detects and then we, we make an image out of it. Just like we images out of X-rays. That’s right. So it’s an active area of research. Um.
Dorothy: Wow.
Dr. Raz: So it’ll be non-ionizing. So that’s already very beneficial. And then lots of groups are working on that. Um, lots of groups are also working on something called, um, you know, uh theranos stat. So what that means is, you know, therapy with diagnostics, so think of cryoablation, I dunno if you’ve heard of it. It’s a tumor where you just go in and freeze the tumor.
Dorothy: Right.
Dr. Raz: Um, so that’s part of it where you don’t have to give patient chemotherapy and, and the outcomes in some of the low grade small cancer is better than lumpectomy. [00:17:00] I literally go in with a tiny probe and just freeze the tumor. And that’s it. That was your lumpectomy. You don’t have to go through surgery and a cancer is cured.
Dorothy: Wow.
Dr. Raz: So, so that’s what I’m talking about, the, the targeted therapy where, you know, the way sometimes we do it in liver, you just go in with these microbeads that carry chemotherapy and you’re just directly going to the tumor and injecting it into the tumor so you’re not affecting the tissue around it, right. So you can do the exact same thing, um, in, in breast where we just go in using ultrasound probe and we have the, this targeted therapy and just inject it. And because it will have this special contrast that I can see under ultrasound, I know I’m going the right way, and then I’ll confirm that the chemotherapy has been injected into the lab.
Dorothy: Now is this out yet or is it still?
Dr. Raz: It’s not out yet. These are all, this is, I’m going to the future of breast imaging.
Dorothy: Okay. Okay.
Dr. Raz: Um, so these are all exciting things.
Dorothy: So they’re, they’re not as invasive. They’re not as life altering.
Dr. Raz: Yeah. Yeah. Yeah. Chemotherapy, [00:18:00] big side effects. Right? I mean, you lose your hair, your gut flora is gone. Trouble eating. Yeah. Um.
Dorothy: You feel tired. You.
Dr. Raz: Right. You know, you lose weight, you know, cachexia. Yeah.
Dorothy: So, so many things that happen.
Dr. Raz: Right? Because it’s a generalized, every cell is affected versus here you do targeted therapy. And this is all thanks to, you know, everybody’s heard of ai, it’s everywhere. This is where it comes in where AI is helping us figure out that, hey, what are these proteins speed up our research process. That’s what all in the background, you know, everybody use is using AI to write their essays right now to cheat the system or like generate cool images. Or like a chatbot or like marketing, et cetera. But behind, you know, in the background, AI really is helping a lot of researchers kind of turbocharge and shorten the time to reach their conclusions. And it’s not out there, but a lot researchers and faculty [00:19:00] know of it.
Dorothy: So. That’s amazing. You mean five years from now? That close? We could?
Dr. Raz: Yes.
Dorothy: That would be, that would be how it’s treated?
Dr. Raz: Right. It could be, yes. Five to 10 years. Yes. It’s shortened the time. Yes. Um, so one of the implications Yeah. Of, of AI is this, and then the other is, you know, how do we define risk in, in breast imaging? So. We know. Okay. So what are the risk factors for breast cancer? So being a woman. Um, having advanced age or like if you had radiation or individual risk you had breast cancer. Um, um, you know, or genetic mutation. These are major risk factors for breast imaging. What are the minor risk factors? Well, honestly, like there are lots of papers and strong research and strong data to suggest obesity is one. Right? So. Dr. Melillo comes in, her podcast, talks about sugar. She’s not wrong. Um, you know, when you’re obese, we found that, you know, in postmenopausal women, [00:20:00] especially fat cells are the ones that produce estrogen. And estrogen in postmenopausal is a big no-no, because it’s a, it causes breast cancer or uterine cancer. And that’s where hormone replacement therapy comes in when you’re on it for long.
Dorothy: Right.
Dr. Raz: You cause it. Right. So, what am I getting to? Well. Well, now obesity is a risk factor, right? Um, smoking is a risk factor. But let’s say a woman comes in, she has all these complex interactions throughout her life, or maybe she had kid not in her twenties and her thirties. That’s actually a risk factor. Maybe she breastfed, but not fully, not breastfeeding is also a risk factor. So see what I’m going getting to. Right now our medical system’s not equipped but like getting this detailed history. But you know what? It can do it. AI can do it. Imagine your whole life’s on ai. You’re on the phone anyways.
The AI thing knows, Hey, when did you breastfeed? What did you do when you were a teenager? Because let’s be honest, cell phones will still be around these smartphones. 10 years from around, 20 years from Right. So it’s your [00:21:00] life histories there. Um, you know, what did you do at this moment? Did you smoke this amount? No. How much alcohol did you consum, consumed? What’s your body weight, et cetera. It will amalgamate all this information and automatically will generate a risk score for you of developing breast cancer. We cannot do that right now. We have general models like Gale model that input some question or answers or tire cruise model, right? But it’s not to the detail where an AI can come up with your own individual risk that, Hey, Dorothy, you have 13.5% developer risk cancer based on however you lived your life in the past 20 years.
Dorothy: Yeah, that’s kind of scary. Dr. Raz.
No, but
Dr. Raz: that’s how it, that’s how it’s gonna be your, the individual, like. Um. Like targeted therapy is based on this, and how can you achieve that? You need lots of like brainpower and processing. That’s exactly what AI is, right? It’s, it’s not us ringing our, like racking our brains out, but AI is gonna just process all this. [00:22:00] And you know, in math terms, they call it multi regression because it’s taking all these random, small variables.
But they’re all kind of important, but not important enough because they’re not like the major risk factors, but important enough that it still gives you a certain percentage of risk. So how do we quantify that? Well, AI will do that for us, and in the similar vein on the therapeutic pubic side, AI is the one that like protein. It’s literally going through like 200,000 like different types of protein and figuring out, okay, this works. That doesn’t work, this works, doesn’t work. Oh, this works. It would’ve taken us many years to find that one protein, but AI kind of, kind of does it really fast on its own, right? So we’re finding new drugs faster.
So that’s on the therapeutic side, but on the risk factor side, it’s also important because no screening mammogram alone is not just sufficient. It’s, it’s very good. It’s the only study we have found to have mortality benefit, which is also the reason a lot of people don’t want to give it up, and I don’t want to give it up.[00:23:00]
But no, it’s not the best thing for dense breasted women. It’s not, and we already know it’s an independent risk factor. So what should we do for them? There is no good answer. Well, you know what? Once we have all this data, AI will give us a good answer. It will say, you know what? Based on your breast density, even though you’re, you didn’t have first degree relative as breast cancer, you’re at like 74.5% risk. You should do mammogram and ultrasound and try this abbreviated MRI. Or maybe who knows, by then we’ll have the microwave imaging, maybe try this, whichever way we can catch cancer early.
Dorothy: Right.
Dr. Raz: You know, so, so that’s, so.
Dorothy: This is all complicated.
Dr. Raz: Yeah. So a lot of this is complicated, but it’s. It’s all getting to the individual care that I’m hinting to.
Dorothy: Right.
Dr. Raz: So we kind of got from staging to here, but.
Dorothy: Hey, I think that there’s hope, there’s hope on the horizon. And it’s, AI is not the bad guy.
Dr. Raz: No, no. We can utilize it for, for excellent purposes, many, many good things and, and it helps us so. So, [00:24:00] yeah. You know, um, so many exciting things that are coming, coming for us.
Dorothy: See, I learned something else today.
Dr. Raz: And microwave of the breast.
Dorothy: Microwave of the breast. Yes.
Dr. Raz: Microwave imaging.
Dorothy: Oh, well if that’s gonna make it better, we’ve gotta be ready for it.
Dr. Raz: Right.
Dorothy: Thank you so much for joining us today. I know we’re going to get some questions out of this.
Dr. Raz: Absolutely. Happy to do another one.
Dorothy: Thank you so much.
Dr. Raz: You are welcome.
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