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Breast Cancer Outcomes and COVID

November 02, 2020
  • 00:00Support for Yale Cancer Answers
  • 00:02comes from AstraZeneca, educating
  • 00:04and empowering metastatic breast
  • 00:06cancer patients and their loved ones
  • 00:08to learn more about their diagnosis
  • 00:11and make informed decisions,
  • 00:12learn more at lifebeyondpink.com.
  • 00:15Welcome to Yale Cancer Answers with
  • 00:18your host doctor Anees Chagpar,
  • 00:20Yale Cancer Answers features the
  • 00:22latest information on cancer care by
  • 00:25welcoming oncologists and specialists
  • 00:26who are on the forefront of the
  • 00:29battle to fight cancer. This week,
  • 00:31it's a conversation about treating
  • 00:32breast cancer patients during the
  • 00:34pandemic with Doctor Elizabeth Berger.
  • 00:36Doctor Berger is an assistant
  • 00:38professor of surgery and oncology
  • 00:40at the Yale School of Medicine,
  • 00:42where Doctor Chagpar is
  • 00:44a professor of surgery.
  • 00:48Elizabeth maybe you can
  • 00:49start off by telling us a
  • 00:51little bit about yourself and
  • 00:54your background and what exactly
  • 00:56you do.
  • 00:58I'd be happy too. I hail from Chicago,
  • 01:00I'm a Midwesterner through and through
  • 01:02and did a lot of my surgical training at
  • 01:05Loyola University in Chicago and decided
  • 01:07that during my general surgery residency,
  • 01:10I wanted to specialize
  • 01:12in breast cancer surgery.
  • 01:14And I was fortunate enough to head out
  • 01:16to New York City to do my training at
  • 01:20Memorial Sloan Kettering in breast
  • 01:22cancer surgery.
  • 01:24As you guys all know this
  • 01:27trying has been a trying year
  • 01:29for us and Covid was a big part
  • 01:33of my fellowship training year,
  • 01:35but during that time I got to explore
  • 01:38many different parts of breast cancer,
  • 01:41learn a lot about breast cancer and
  • 01:44now I'm excited to join the faculty
  • 01:46at Yale University where I just
  • 01:49recently became an assistant professor.
  • 01:52Elizabeth, one of the
  • 01:57things that has often intrigued me is,
  • 02:00what was the covid pandemic
  • 02:02like for people training in various
  • 02:05parts of medicine and surgery,
  • 02:08you must have been
  • 02:11a little bit past
  • 02:13midway through your fellowship
  • 02:15when the pandemic struck.
  • 02:17And what
  • 02:18was that like in terms of your
  • 02:21training and in terms of treating
  • 02:24breast cancer patients?
  • 02:26That's a great question.
  • 02:29I vividly remember early to
  • 02:31mid February hearing about
  • 02:34this and what we thought
  • 02:37was just another flu from China
  • 02:39and thinking that it might
  • 02:42affect things we were doing,
  • 02:44but maybe not much.
  • 02:46And I was quickly proven wrong and by
  • 02:50early March when we essentially
  • 02:52shut down most of what we were doing
  • 02:56with regards to elective surgeries
  • 02:58and even with regards to a lot of
  • 03:02cancer operations at Memorial,
  • 03:04I can say that our volume
  • 03:06dropped by about 80%.
  • 03:08I know that many New York City
  • 03:11hospitals were incredibly hard hit
  • 03:14with taking care of Covid patients.
  • 03:16And the majority of their
  • 03:19elective surgeries and even maybe
  • 03:21not so elective surgeries stopped.
  • 03:24We at Memorial had a little
  • 03:26bit different experience.
  • 03:28We still had
  • 03:29a high number of combinations
  • 03:31in our ICU's and honor floors,
  • 03:33but we don't have an ER so we don't take
  • 03:36any kind of person off the street,
  • 03:40but we did take care of a
  • 03:42lot of our own patients,
  • 03:44which greatly affected my
  • 03:45experience as a fellow.
  • 03:47Our case volume dropped, our in person
  • 03:49conferences stopped.
  • 03:50We went all to virtual.
  • 03:51We weren't allowed to travel to
  • 03:53any academic conferences anymore.
  • 03:55We were constantly updated about
  • 03:57possibly getting reallocated to
  • 03:59help in the ICU's or to help on the
  • 04:01floor or to help in our urgent care.
  • 04:04It seems like every week was different.
  • 04:06It was constantly changing,
  • 04:08constantly evolving.
  • 04:09I will say I
  • 04:11felt so fortunate to be at a place
  • 04:14where we have such a high volume
  • 04:17of Breast Cancer Care because I
  • 04:19was still able to actively engage
  • 04:22in learning about breast cancer
  • 04:24and taking care of breast cancer
  • 04:26patients who needed operations
  • 04:28during this time.
  • 04:30It's hard to tell a breast cancer
  • 04:32patient that
  • 04:34we can't operate on them,
  • 04:37so we definitely triaged
  • 04:38and made decisions based upon who
  • 04:41really needed an operation during
  • 04:43this time and most patients in the
  • 04:46NYC area were quite frightened,
  • 04:48so that was a whole other aspect of
  • 04:51training and going through fellowship
  • 04:53during the pandemic,
  • 04:56where the uncertainty for the patients
  • 04:58was almost worse than for the
  • 05:01uncertainty for our health care providers.
  • 05:04I also actually had the experience
  • 05:06interestingly enough,
  • 05:07of helping out another facility.
  • 05:09with taking care of Covid
  • 05:12patients and that was probably the
  • 05:15most dramatic and tough experience,
  • 05:17medically, for me, ever.
  • 05:19Tell us more about that.
  • 05:22There was a call from our governor
  • 05:28for healthcare providers
  • 05:31throughout the state and really the
  • 05:33country that if we were available
  • 05:36to help that they would
  • 05:39call upon us and I
  • 05:41felt that my responsibility was
  • 05:44absolutely to my breast cancer
  • 05:46patients and I continue to commit
  • 05:49myself to my breast cancer patients.
  • 05:52But I was able to work a few times
  • 05:55in a community hospital trying to help.
  • 06:02What was that like in terms of,
  • 06:06I can imagine that you're
  • 06:09being torn in two directions.
  • 06:11On the one hand, you want to help the
  • 06:14greater society in this pandemic,
  • 06:17and all of these covid patients,
  • 06:19which really you know,
  • 06:21took over many New York hospitals.
  • 06:23And on the other hand you're taking
  • 06:26care of breast cancer patients
  • 06:28who are particularly vulnerable.
  • 06:30Often times with compromised immune system,
  • 06:33if they've already had chemotherapy and
  • 06:37you know the potential of being a carrier of a
  • 06:42highly contagious virus between
  • 06:44one environment and the other.
  • 06:47How did you navigate that and what was that
  • 06:51like?
  • 06:54I was fortunate to be in a situation
  • 06:58where we were tested essentially weekly.
  • 07:01We had the option of being tested
  • 07:04weekly and then as the pandemic
  • 07:07continued to evolve that weekly
  • 07:09testing went to every two week testing,
  • 07:12but suffice it to say,
  • 07:15as the pandemic evolved we got
  • 07:18busier with our surgical volume
  • 07:20at Memorial and again
  • 07:23my attention turned back to mainly
  • 07:25my breast cancer patients,
  • 07:27but it is a emotional time as a
  • 07:31health care provider to think
  • 07:34that as an asymptomatic carrier
  • 07:36you could unfortunately be exposing yourself
  • 07:39to immunocompromised cancer patients,
  • 07:41which is why I felt very fortunate
  • 07:44to be in a situation where I
  • 07:48could get tested very frequently
  • 07:50to have the reassurance that
  • 07:53I had negative tests.
  • 07:57And of course I took all the
  • 08:00other precautions that we possibly
  • 08:02could, wearing masks,
  • 08:04making sure we're doing our hand washing,
  • 08:07making sure we are socially distancing.
  • 08:15We obviously took our significant precautions
  • 08:18with our cancer patients coming in alone,
  • 08:21unfortunately,
  • 08:21not allowing visitors, testing the
  • 08:24patients before they underwent
  • 08:26surgery so multiple different layers
  • 08:27of precautions to try to avoid
  • 08:30any kind of exposures to our patients
  • 08:32and to our health care providers.
  • 08:35Did patients ask you about whether
  • 08:38you had been treating Covid patients
  • 08:40and was that of concern to them?
  • 08:43Or were they more concerned with getting
  • 08:46their cancer taken care of because
  • 08:48they knew that many patients were being
  • 08:51deferred?
  • 08:56I think there was fear of
  • 08:59the unknown of just what exactly the
  • 09:02pandemic was doing and could do
  • 09:05and how sick it could make people.
  • 09:08I think there was fear of coming into
  • 09:11a hospital, which is why many of
  • 09:14our patients did choose to defer if
  • 09:17they were eligible to defer surgery.
  • 09:20I think there's a lot of fear about
  • 09:22not getting their cancer treated,
  • 09:25so that was another topic of conversation.
  • 09:28And of course, there's fear from every
  • 09:31healthcare provider
  • 09:34just working in a hospital of being
  • 09:36exposed to Covid positive patients and
  • 09:38then taking care of other patients.
  • 09:40So I think we tried as best we could
  • 09:43to alleviate the fears that we knew
  • 09:45how to control and unfortunately there
  • 09:47were some things out of our control,
  • 09:50but again,
  • 09:50I think we try to do as much as
  • 09:53we possibly could to control what
  • 09:55we could control.
  • 09:57Yeah, I think that that's
  • 09:58so true for many patients.
  • 10:00It was really a matter of being
  • 10:02stuck between a rock and a
  • 10:04hard place in a lot of ways.
  • 10:06On the one hand,
  • 10:08I've got this cancer and I've
  • 10:11had my surgery scheduled and I want
  • 10:13the cancer out because it's a cancer.
  • 10:16And on the other hand,
  • 10:18I don't want to get covid and I know
  • 10:21that I'm going to be exposed even at a
  • 10:24cancer hospital like you say at Memorial,
  • 10:27where the majority
  • 10:29of the patients have cancer,
  • 10:31but there still were Covid patients.
  • 10:33So how did you have that
  • 10:36conversation with patients and
  • 10:38how did you and the patients decide
  • 10:41whether to go with the rock
  • 10:43or whether to go with the hard place.
  • 10:46I think in presenting the options
  • 10:49to patients and giving them as
  • 10:52much data and science behind the
  • 10:55options was incredibly important.
  • 10:57We had patients who had early stage disease,
  • 11:02or DCIS, so stage zero or pre invasive
  • 11:06depending upon how you define that where
  • 11:10I think the conversation we had was
  • 11:14that these cancers will not change
  • 11:17drastically in the next six months,
  • 11:20and we can treat them with systemic
  • 11:23hormonal therapy in the interim,
  • 11:26as we continue to navigate the pandemic and
  • 11:29understand it better in the next six months.
  • 11:33And so we have that time on
  • 11:36our side and we have that option.
  • 11:40And I think patients really appreciated
  • 11:42the conversation of explaining the
  • 11:44neoadjuvant treatment options for
  • 11:47early stage disease, the
  • 11:50kind of hard place where patients who
  • 11:53had already gone through neoadjuvant
  • 11:56chemotherapy who needed an operation or
  • 11:59who had worst disease that maybe didn't
  • 12:02have the time option on their side,
  • 12:06and so that was, I think,
  • 12:09a harder conversation at times
  • 12:11because patients were very worried
  • 12:14about their cancer.
  • 12:15Very worried about Covid
  • 12:17and like you said,
  • 12:19there wasn't really a great
  • 12:21option either way,
  • 12:22but I think with our ability to
  • 12:25operate on a lot of our patients in
  • 12:28ambulatory surgery center where no
  • 12:30Covid patients were actually housed,
  • 12:33gave patients a lot of comfort.
  • 12:35I think knowing that health
  • 12:38care providers were getting tested
  • 12:40frequently that the patient before
  • 12:43having surgery was going to get tested.
  • 12:45Give as much comfort as we possibly could
  • 12:49to patients who did need to go through
  • 12:52as you describe,
  • 12:54that hard place choice by coming in and
  • 12:57having surgery.
  • 13:07In the patients who had more
  • 13:10advanced disease, we often
  • 13:12even outside of Covid,
  • 13:14would say
  • 13:16take systemic chemotherapy,
  • 13:18do your neoadjuvant chemotherapy
  • 13:19and then will operate later.
  • 13:22And as you say, for the early stage cancers,
  • 13:25the particularly indolent ones, especially
  • 13:27if their hormone receptor positive,
  • 13:29we know that these can be
  • 13:32well treated with endocrine therapy,
  • 13:35and you can buy yourself some time where
  • 13:38the issue really came in for us here and
  • 13:42I think this is true around the country
  • 13:45as well were in those patients who
  • 13:48you're up against a time jam because
  • 13:51when you treat patients in the
  • 13:54neoadjuvant setting you give them
  • 13:57chemotherapy upfront for what is usually
  • 13:59an advanced cancer you want to
  • 14:01operate within a certain time window.
  • 14:04What I often called the sweet spot,
  • 14:07that 4 to 6 weeks after
  • 14:10their last dose and when that
  • 14:13timing which they've been waiting
  • 14:15for the last four to six months,
  • 14:18happens right during the pandemic,
  • 14:20that puts everybody in a tough spot.
  • 14:24We're going to talk more about the treatment
  • 14:27of patients during Covid
  • 14:29and how that may have changed in
  • 14:32lessons learned right after we take
  • 14:33a short break for a medical minute.
  • 14:35Please stay tuned to learn more
  • 14:37information about breast cancer
  • 14:38surgery and outcomes with my
  • 14:40guest doctor Elizabeth Berger.
  • 14:42Support for Yale Cancer Answers
  • 14:44comes from AstraZeneca,
  • 14:47a global biopharmaceutical company
  • 14:49with a robust oncology pipeline and
  • 14:52FDA approved therapies in lung,
  • 14:55ovarian, pancreatic, breast, and blood cancers.
  • 14:58Learn more at astrazeneca-us.com.
  • 15:02This is a medical minute
  • 15:04about pancreatic cancer,
  • 15:05which represents about 3% of all cancers
  • 15:08in the US and about 7% of cancer deaths.
  • 15:11Clinical trials are currently being
  • 15:13offered at Federally designated
  • 15:15comprehensive Cancer Centers for the
  • 15:17treatment of advanced stage and metastatic
  • 15:20pancreatic cancer using chemotherapy
  • 15:21and other novel therapies,
  • 15:23Folfirinox,
  • 15:24a combination of five different
  • 15:26chemotherapies is the latest advance in
  • 15:28the treatment of metastatic pancreatic
  • 15:30cancer and research continues
  • 15:32in centers around the world
  • 15:34looking into targeted therapies.
  • 15:36And a recently discovered marker
  • 15:38HENT one. This is been a medical
  • 15:41minute brought to you as a public
  • 15:44service by Yale Cancer Center.
  • 15:46More information is available at
  • 15:48yalecancercenter.org. You're listening
  • 15:50to Connecticut Public Radio.
  • 15:52Welcome
  • 15:52back to Yale Cancer Answers.
  • 15:54This is doctor in Anees Chagpar.
  • 15:57I'm joined tonight by my guest
  • 15:59Doctor Elizabeth Berger and we're talking
  • 16:01about breast cancer surgery and outcomes,
  • 16:04and right before the break we
  • 16:06were talking about breast cancer,
  • 16:08particularly in the era of Covid.
  • 16:10So Elizabeth,
  • 16:11you were mentioning that
  • 16:14with some of the early stage cancers
  • 16:17you would
  • 16:19have the conversation,
  • 16:22this is really quite an indolent disease.
  • 16:24It's hormone receptor positive,
  • 16:27you can be well treated with endocrine
  • 16:30therapy, but prior to covid,
  • 16:32those were patients that we
  • 16:34often would operate on 1st.
  • 16:36So if you really thought
  • 16:39about the lessons learned from
  • 16:41Covid in terms of changing
  • 16:44paradigms that we once thought
  • 16:47were fixed in stone and do you
  • 16:50think that we've become a little
  • 16:53bit more liberal about how we time
  • 16:56various modalities of treatment?
  • 17:00That's
  • 17:00a great question.
  • 17:02I think the avenue of neoadjuvant
  • 17:05therapy had has been an
  • 17:07amazing option for, like you said,
  • 17:10these early stage indolent
  • 17:12patients because of the Covid era.
  • 17:14I know that in Europe actually they
  • 17:18use neoadjuvant endocrine therapy a
  • 17:21lot more than we have in the past.
  • 17:24But I think it's going to open
  • 17:27many avenues in the future to one
  • 17:30study this more and understand
  • 17:32neoadjuvant endocrine therapy
  • 17:34better for our patients and to
  • 17:38absolutely give people the option.
  • 17:40I think the tricky part of neoadjuvant
  • 17:43endocrine therapy are a couple things.
  • 17:46One is duration of therapy.
  • 17:48We obviously put our patients on
  • 17:53therapy after they have
  • 17:55surgery for anywhere between 5 to 10
  • 17:58years depending upon many factors.
  • 18:00So in the neoadjuvant setting
  • 18:02in the setting before surgery,
  • 18:05you know I'm not sure that we've
  • 18:07all come to a consensus as to
  • 18:10what is the optimal time
  • 18:13for neoadjuvant endocrine
  • 18:14therapy and in addition,
  • 18:16I think there's still some questions
  • 18:19about the management of the auxilia
  • 18:22after neoadjuvant endocrine therapy,
  • 18:24and really,
  • 18:25how we think about treating the auxilia
  • 18:28after neoadjuvant endocrine therapy.
  • 18:31So I see it now
  • 18:34as we now have a wealth of knowledge,
  • 18:38and experience of patients who
  • 18:41receive neoadjuvant endocrine
  • 18:42therapy in the Covid era
  • 18:45I think,
  • 18:46continue to receive neoadjuvant
  • 18:48endocrine therapy,
  • 18:49and I think we'll just have more
  • 18:52data moving forward,
  • 18:53which will only benefit
  • 18:55our patients and us.
  • 18:57Yeah, I think that that's so true.
  • 19:00I think that we've really started to have
  • 19:03a little bit more flexibility in terms of,
  • 19:06you know, the discussions that we have with
  • 19:09patients in terms of therapeutic options.
  • 19:12The other thing that I noticed and I'd
  • 19:15like to get your sense of this as well,
  • 19:18was that even surgical options
  • 19:21during Covid were changed a little bit,
  • 19:24we ended up not
  • 19:27offering patients the huge
  • 19:29reconstructions in the immediate
  • 19:31setting that would require a prolonged
  • 19:34hospital stay and so on which we had
  • 19:37done all the time prior to Covid.
  • 19:39Just because these patients
  • 19:42may or may not require ICU
  • 19:44they may require several
  • 19:47days in hospital.
  • 19:48And we really wanted to make sure that
  • 19:51if they required surgery they were
  • 19:53getting in and out of the hospital as
  • 19:56quickly as possible to minimize their risk
  • 20:00in terms of the virus,
  • 20:02was that the same in your experience
  • 20:06at Memorial as well?
  • 20:08Yes, I think that was a big component of
  • 20:13breast cancerc care that we
  • 20:15were not delivering was big,
  • 20:17autologous reconstruction,
  • 20:17so you know there was no option for
  • 20:21autologous reconstruction during the worst
  • 20:23of the pandemic and just as a caveat,
  • 20:26things were
  • 20:28changing so much week to week.
  • 20:30I don't want to make broad generalizations,
  • 20:33but when I say the height of the pandemic,
  • 20:37March April,
  • 20:39May, we really limited even implant
  • 20:42or tissue expander reconstruction.
  • 20:43That was pretty much halted as well,
  • 20:46because if you think about the need for
  • 20:50expansion and such after the operation
  • 20:53that had required would require a lot
  • 20:56of contact in and out of the office.
  • 20:59So we really tried to not do any
  • 21:02of that kind of reconstruction.
  • 21:06We also stopped prophylactic surgery.
  • 21:08A lot of our patients come
  • 21:11in with genetic mutations.
  • 21:12They come in wanting a prophylactic
  • 21:15contralateral mastectomy.
  • 21:16And that really was something that
  • 21:18we did not offer during the height
  • 21:22of the pandemic thinking it
  • 21:24was something that we could safely delay.
  • 21:28It's you know 6 to 8 months and
  • 21:31then any high risk lesion that those
  • 21:35were operations that we also stopped.
  • 21:39So as you stopped autologous
  • 21:44reconstruction, you stopped
  • 21:47the prophylactic surgery for
  • 21:50genetic mutation carriers,
  • 21:54contralateral prophylactic
  • 21:55mastectomiesvand so on.
  • 22:00Pre Covid these
  • 22:04were things that patients demanded
  • 22:06and
  • 22:09in fact we know that
  • 22:13the Women's Health Act, for example,
  • 22:16mandates that private insurers must
  • 22:18cover reconstruction as part of a cancer
  • 22:21operation because it makes women feel whole.
  • 22:24So how did you kind of square
  • 22:27that in your own mind?
  • 22:29Did you feel that
  • 22:31we were delivering suboptimal care.
  • 22:34Did patients embrace the idea
  • 22:36that we were trying to do?
  • 22:39It was in their best interest in
  • 22:42terms of minimizing risk to the virus,
  • 22:45or did some of them feel like
  • 22:48they were really shafted in
  • 22:50terms of the timing because they
  • 22:52really wanted that reconstruction or
  • 22:55wanted that prophylactic mastectomy?
  • 22:58I'm sure everyone had their own
  • 23:02thoughts and opinions on it.
  • 23:05I think it's hard to say general consensus,
  • 23:10but I would say that most were
  • 23:14either understanding or
  • 23:18were quite scared of the pandemic and so
  • 23:21whatever motivated them to understand
  • 23:23that they couldn't undergo
  • 23:26maybe the prophylactic side
  • 23:27that they wanted or the have the
  • 23:30reconstruction that they wanted.
  • 23:32I honestly didn't feel as though those
  • 23:35conversations were that difficult
  • 23:37and what I would like to also believe is,
  • 23:40a lot of it was
  • 23:43for the greater good of society.
  • 23:46In New York City
  • 23:49we were struggling with
  • 23:50resources we were struggling with ventilators
  • 23:53we were struggling with space in hospitals.
  • 23:58I think a lot of patients
  • 24:03recognized
  • 24:05that and understood that at this
  • 24:08point we really needed to
  • 24:10save resources or protect resources
  • 24:13that we needed for really sick
  • 24:17Covid patients and that it wasn't
  • 24:20that we were saying no forever.
  • 24:23We were just saying we need to temporarily
  • 24:28delay because of the magnitude of
  • 24:32the healthcare strain during the pandemic.
  • 24:35I think that
  • 24:36that's so right.
  • 24:37I think that you know, yes, that does
  • 24:40mean a second operation in the future.
  • 24:43Yes, we would have preferred to
  • 24:45do everything at all at once.
  • 24:47Yes, we would have liked to have
  • 24:49given you the reconstruction
  • 24:51that you would have liked,
  • 24:53but I really do think that you know,
  • 24:56for all of its negatives,
  • 24:58one thing that the pandemic did do
  • 25:01for many of us was really kind of bind
  • 25:04us together in a common humanity.
  • 25:07Where we really were going through this
  • 25:10all together and one of the things
  • 25:12that struck me was how people really
  • 25:15did get this concept of, you know,
  • 25:18I need to do my part for society,
  • 25:21which is something that I
  • 25:23don't think we always see.
  • 25:27I agree, I think it
  • 25:29was challenging times for all individuals.
  • 25:33I can't imagine what cancer patients
  • 25:35were going through at that time.
  • 25:38Knowing my myself
  • 25:40who was, you know, a healthy young
  • 25:44person being scared at times so
  • 25:46I think understanding that like you said,
  • 25:50we're all in this together.
  • 25:54Experiencing our own different stressors and
  • 25:57situations and doing the best that we could.
  • 26:01I think that's really the message
  • 26:04that we tried to send
  • 26:08our patients, our colleagues.
  • 26:13And I think the other question now is,
  • 26:17we're still not
  • 26:19out of the woods yet.
  • 26:22But as we start to vaguely see a glimmer
  • 26:26of light at the end of the tunnel,
  • 26:30many patients had delayed not
  • 26:32only their surgical care in terms of
  • 26:35reconstruction or prophylactic mastectomy,
  • 26:37many patients had actually delayed
  • 26:39getting their usual screening
  • 26:41mammography because many of them,
  • 26:43the imaging facilities,
  • 26:44had also shut down, and so on,
  • 26:47and so now, what is your anticipation?
  • 26:50Do you anticipate that we're going
  • 26:53to have like this huge influx of
  • 26:55cancer patients who haven't
  • 26:58had a mammogram in the last six
  • 27:00months and they are now getting
  • 27:03their mammograms and finding things?
  • 27:05People who hadn't had their
  • 27:07reconstruction now presenting
  • 27:08for that people who wanted their
  • 27:11prophylactic now coming back.
  • 27:12Do you kind of anticipate
  • 27:15a wave of breast cancers now
  • 27:17and what's the system doing
  • 27:20to prepare itself for that?
  • 27:25I read somewhere recently that
  • 27:27people were very worried about
  • 27:29obviously cancer patients coming back
  • 27:31with more advanced stages because of
  • 27:33lack of screening colon cancer people not
  • 27:35getting their colonoscopies, breast cancer,
  • 27:37not getting their mammograms.
  • 27:39And, you know, I actually asked a lot of
  • 27:42people I was working with in New York City
  • 27:45what their opinions were and
  • 27:48I know I personally feel that we absolutely
  • 27:51will see probably an uptick in terms of
  • 27:54patients coming in now I think the bigger
  • 27:57question it begs to be asked is are those
  • 28:01patients coming in going
  • 28:03to have more advanced disease?
  • 28:05And I would like to think no because
  • 28:08I think you know mammography does
  • 28:11such a good job at catching cancers early,
  • 28:15and you know if a woma felt a lump,
  • 28:19I think there was still access
  • 28:22to get imaging during the pandemic.
  • 28:25If there was any kind of symptom
  • 28:28or concern in a womans breast,
  • 28:31so I think the verdict is still out.
  • 28:35It's really hard to say what we're going
  • 28:39to see now in the next 6 to 12 months.
  • 28:43In terms of more cancers, worst cancers.
  • 28:47But I do think there still is probably
  • 28:51a lot of high risk lesions that
  • 28:53need to be taken care of.
  • 28:58Maybe patients who didn't get
  • 29:00reconstructed coming back in
  • 29:02and wanting reconstruction or
  • 29:03contralateral surgery and such.
  • 29:05Doctor Elizabeth
  • 29:06Berger is an assistant professor
  • 29:08of surgery and oncology at
  • 29:10the Yale School of Medicine.
  • 29:12If you have questions,
  • 29:14the address is canceranswers@yale.edu
  • 29:16and past editions of the program
  • 29:18are available in audio and written
  • 29:20form at yalecancercenter.org.
  • 29:22We hope you'll join us next week to
  • 29:25learn more about the fight against cancer.
  • 29:28Here on Connecticut public radio.