S5E35: Expert Insights on Navigating Hormone Therapy after Breast Cancer

Welcome to the Besties with Breasties podcast.

Sarah hall here I am a certified health and wellness coach, athletic trainer, mom and breast cancer survivor.

I help women overcome their own mind drama to make mind shifts that open up the possibility for their most empowered and energetic life.

And I am Beth Wilmes, author, speaker and founder of a human investment organization otherwise known as a nonprofit called Faith through Fire.

Our mission is to reduce the fear and anxiety that breast cancer patients feel and replace it with hope and a path toward thriving.

This podcast is about our experiences with.

Breast cancer and life after as young survivors and moms.

Hey.

Hey.

How's it going?

It's going, it's going.

Today we are going to jump right in.

We've got an interview today.

We're going to be talking to Dr. Katherine Clifton, who is a board certified medical oncologist and associate professor of medicine at the division of oncology at Washington University School of Medicine, which is right here in St. Louis.

And we've actually had Dr. Clifton on before, but she specializes in the treatment and research of breast cancer with a particular focus on hormone receptor positive disease, which is why we're talking to her today.

We want to talk to her specifically about hormone therapy because most women are on some form of hormone therapy and most women find it to be the most difficult part of treatment.

Yeah, I don't know if you feel like that, but I feel like that's a lot of women.

I mean, I don't think it, I don't know if I would say it's the most difficult, but it's like the longest aspect of it because it's like I was told five to 10 years and then I just actually met with my doctor today and she's like, oh, well, I would probably lean more towards 10 if I were you.

And I was like, oh, I had just kind of been thinking 5.

But that's how they always do it.

They always start with maybe five and then they change it to, you might want maybe 10.

Right.

So today we're going to touch on how hormone suppression therapy actually works and whether it's wor the side effects.

We're also going to talk about what to do when side effects feel unmanageable.

Yeah.

And maybe we'll wrap up with the latest research and tools to help you get through treatment without losing your mind.

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Thank you, Dr. Clifton, for being here.

We really appreciate it.

You're welcome.

Thank you for having me.

Absolutely.

Let's start with the big question.

How effective is hormone suppression therapy at reducing recurrence or metastasis for patients?

Yeah, that's a great question.

So we think that these medications reduce the risk of cancer recurrence by about 8, 50% or cut your risk in half.

So it is important to note, though, that the difference between relative and absolute risk reduction.

So if it's a relative risk reduction of 50%, if your risk of the cancer coming back is 10%, then it cuts that risk in half to about 5%.

So that's an absolute benefit of about 5%.

So you can see that you can kind of play with statistics and make these numbers look a little bit different.

And it's really important to discuss with your oncologist, you know, what your risk of recurrence is so that you can kind of better understand how these medications can benefit you.

Okay, Interesting.

Another big thing that comes up for a lot of patients is the difference between tamoxifen and aromatase inhibitors.

Because you talk to one patient and they're on tamoxifen, another one might be on the AI.

Is one better than the other?

What does the data show?

And how do you, as an oncologist or other oncologists make that decision?

Yeah, that's a great question.

So tamoxifen is for our pre menopausal patients, but postmenopausal patients can take take it to the aromatase inhibitors because of the way those drugs Work, you really have to be postmenopausal in order to take those drugs.

So either naturally in menopause or you can be put into menopause either by surgically removing the ovaries or undergoing basically medications that help then put you into menopause.

So when we compare the two drugs head to head, they are both good drugs.

We know that the aromatase inhibitors are slightly, we're talking about very slightly better at reducing the risk of cancer recurrence.

So for our patients who are postmenopausal, usually the aromatis inhibitors are our first choice.

And patients who are premenopausal, tamoxifen is still an excellent option.

We do know that in our premenopausal patients, though, who are at higher risk, and some of those higher risks might be that they needed chemotherapy, they have the cancer involving their lymph nodes.

In those patients who are higher risk, we seem to see more benefit from the aromatase inhibitors in those patients.

So those patients might then be put into menopause in order to be placed on aromatase inhibitors.

Postmenopausal patients, though, they can take tamoxifen, again, it's still a good drug.

And there are various reasons why a patient who's postmenopausal might be placed on tamoxifen.

And if they're on an AI like I was, in order to shut down your ovaries, most of these women are taking like getting a shot, right, to make sure that your ovaries are suppressed.

And it used to be, I'm trying to think of.

Because I went through this nine years ago, but I'm trying to think.

It used to be every.

Was it every month?

I don't know.

I feel like every four years, every month.

And now I feel like they can spread it out now.

Now they're offering it like every three.

Did I make that up or is that an option for some patients?

No.

Yeah, so.

So that is an option for some patients.

It's important to discuss with your oncologist, you know, there.

Because some patients, particularly patients who are young, could potentially have, you know, breakthrough of their ovarian function on the, the every three month.

Every patient, you know, might not, their oncologist might not feel comfortable placing them on the every three month regimen, but that is an option available for some patients.

Interesting.

I was just thinking about myself because I'm on an AI and I have the Zoladex every four weeks.

And I've debated back and forth between the four weeks and the three month and which One's the better option.

I've stuck with four weeks.

I don't really know why, but it.

Just, you just enjoy that massive needle.

I just like driving to the cancer center every four weeks.

You know, it's funny when we talk about those, that needle, it's a very large needle and it's very thick.

The nurses like have actually told me that they don't like giving it to patients.

They don't, they don't like it.

So they always have like the one expert, the deemed expert, right, that's not afraid of the needle.

But at one point I remember just telling my nurse, I'm like, you have to do this Pulp Fiction style.

You can't go in, just timid, right.

And kind of start to inject it because then it gets stuck and it's painful.

I'm like, I know it looks bad, but I'm like, I'd rather you just stab me with it and inject and pull out.

And so once, once I gave her permission, it was great.

Like it was fine.

But that needle, that needle is a turn off to anybody that's like really scared of needles.

Yeah, it's a bit, it's a, it's a big one.

And it can hurt if they, if they don't.

If it's not smooth going in, it can hurt.

Yeah, yeah.

So the breakthrough estrogen, you're just saying that basically, Dr. Clifton, like when you're on three months, you potentially eventually could start producing estrogen again toward the end of that dose or, you know, you could start producing more estrogen toward the end before you get another dose.

And so that's just something to be cognizant of.

Yeah.

You know, something to talk to your oncologist about.

Okay, well here, here's another one that we get faced with quite a bit is the five years versus 10 years.

So when I went through, it was like, oh, it's going to be five years.

But now they're, now they're starting to kind of tell patients like, well, we'd really prefer 10.

What are your thoughts on the 5 versus 10 year rule?

Yeah, so that's a great question.

And this is, this is definitely always up for discussion.

So, you know, I always tell people, we used to think 5 and 5 still is a great landmark for patients to, to get to because we know that unfortunately these hormonally driven breast cancers can recur, come back after five years.

That's really why looking at extended endocrine therapy, so giving these drugs beyond five years started to become studied.

So for the aromatase inhibitors.

Taking the drug for 10 years in comparison to five years, has not been shown to improve overall survival.

So patients have not been shown to ultimately live longer.

But it can in some cases decrease the risk of recurrence.

And that tends to again, be in these higher risk patients.

So again, patients with lymph node involvement, patients potentially who needed chemotherapy.

So there are clinical risk factors like those ones that we just discussed that can sway an oncologist to recommend, recommend 10 years over 5 years.

There is also a test now called the breast cancer index test.

And this test looks at tissue from your actual surgical specimen.

So the labs save these surgical specimens, they're still available.

And then this is sent for this breast cancer index test.

You can kind of think of it similar to the oncotype test, if that's probably a popular one that many people have heard of.

So it's looking actually at genes in the tumor itself, itself.

And based off of those, it answers two questions.

It answers, is the patient likely to benefit from extended endocrine therapy?

And that's either a yes or a no question.

And then what is the risk of distant recurrence?

So the chance of the cancer coming back beyond five years.

And I found that test to be really helpful for making the decision about extended endocrine therapy.

Yeah, I actually remember.

So when I hit the five year mark and my oncologist gently suggested I go another five years, I was like, no.

And I was pretty committed in my brain at that point to stopping just for quality of life issues, which we'll dive into after our next segment.

But she said, well, let me, let me send your tumor away to see if you'd benefit, which I'm assuming is exactly this breast cancer index that you're discussing.

And so she did, and she came back and she told me, you know, the test says you're not likely to benefit from another five years.

Which I was like, great, because I was, I wasn't wanting to do another five years anyway.

She, she gracefully and hopefully, you know, probably kept from me the percent percentage chance of my distant recurrence, which, you know, I don't want to know that number anyway, so I would not want to know that.

And I'm glad that she didn't share that with me.

But I do think that a lot more people are doing those tests to kind of see if they'd be a candidate to benefit or not.

My question, though, and I did not ask her this at the time, was if it says I was not likely to benefit from another Five years.

Does that mean that I wasn't likely to benefit from the first five years, or is that a completely different metric?

Yeah, that's a great question.

And that people will often get that result and then get very frustrated or concerned that the last five years of taking this medicine did nothing.

But it is a completely different metric.

So it.

It really does not tell you about the benefit for the first five years.

It's just really looking at your benefit of extended so beyond five years.

So it doesn't have anything to do with the five years that you took the drug.

Oh, that's interesting.

You can rest assured.

Yeah, yeah.

No, that's good to know.

Does every surgeon keep your breast tissue?

Generally, the pathology lab will store these.

These specimens.

Okay.

I just.

I haven't heard.

Are you wondering if you're on ice?

I know.

I'm like, is my tissue somewhere in a. Yeah.

I mean, I didn't think anything of it until she asked me, do you want me to send away your tissue?

And I'm like, you have it?

And she's like, yeah.

I was like, well, that's kind of cool.

Yeah, it is.

You know, I mean, I would imagine it would be very helpful in the future when we have more advances too.

Right, when you're doing more genetic testing and things of that nature.

Yeah.

I want to dive into side effects and long term impact because that's obviously something really important to patients.

But before we do that, you want to do Boobs in the news?

Let's do it.

All right.

Boobs in the News is a fun segment where we read funny tweets by real people or ridiculous news stories.

Boobs in the news.

Boobs in the news.

Boobs in the news.

All right.

The boobs for this stay.

Wow, that's a build up.

What?

That's a buildup.

Well, I was, like, reading it, and I was like, I have to make emphasis on this first word.

His first word is foul play, but it's spelled F O W L. Foul play.

Okay, so there's a bird involved.

Bird?

Yep.

Florida woman charged after allegedly spraying mace at a driver who struck chicken crossing the road.

Wait a minute.

The driver hit a chicken crossing the road?

Which in itself is hilarious.

And then a woman saw it, got mad and maced him.

Well, it was her chicken.

Oh, so it was her chicken that got out and she was following it, and another vehicle came up and ran the chicken over.

On purpose?

Was it a hit and run?

I don't know if it was on purpose.

I. I can't imagine that he's, like, going around purposely killing chickens.

Probably not.

I mean, wouldn't you stop for the chicken?

I mean.

Yes.

Although I am responsible for taking out an entire family of ducks on Highway 270, so.

On Highway 270?

Yes.

Wow.

It was a really hard day.

How many ducks?

Well, I don't know why a Duck was on 270, but you know what 270 is like.

I mean, people are crazy.

You have to do, like, 75 just to stay with, like, the flow of traffic there, or you're gonna get smushed.

There was a mama duck, and you know how all the little baby ducks fall behind?

Yeah.

She was taking them across Highway 2 7.

That is a brave mama duck.

She didn't know.

It did not go well for her because I hit the family of ducks.

All of them.

Did you have feathers everywhere?

I couldn't look.

I. I could not look.

I hit them, and I just burst into tears.

And I did not.

I was like, do not look in the rear view.

Do not look in the rear view.

Do not look in the rear view.

And I just kept going.

And.

But I know I'm responsible for that entire family being gone.

Oh, that's so sad.

I know.

Sorry.

I just totally derailed our duck story.

No, I mean, that's kind of like the same story.

Debbie Downer.

It's like that Saturday night, like, wah, wah.

Yeah.

Okay, so I'm just trying to think about.

And what did the driver do when she maced him?

Because I think I would.

I would probably call the police.

Yeah, the police were called, and she was arrested.

Oh, good.

Because she missed him.

She, like, got out of her car and, like, was trying to, like, stop the vehicle.

I mean, she, like, had major road.

Road rage and was trying to stop the vehicle, and then she ended up getting arrested.

Yeah, I'm gonna claim mental illness on this one.

Yeah.

Can you imagine the poor driver?

I mean, bear mace.

I don't know if that's, like, worse mace.

Side note, do you know how bear mace works?

I did not know how this works.

I mean, don't you spray it at the bear?

Okay, that's what I thought.

I lived in Wyoming for a summer with my uncle, who was a naturalist for the Yellowstone National Park.

And he used to take me hiking, like, in bear country, which was terrifying.

And I was really nervous about it because he didn't carry a gun or anything.

So I'm like, what are we gonna do if we come across a bear?

And he's like.

I mean, if you're that worried about it.

Here's some bear mace.

So for, like, I was hiking behind him, I was letting him lead, and I was holding this out like I was going to mace a bear in the face.

You put it on yourself to repel bears.

Oh, yeah.

Did not know that.

I feel like I should know this because we went hiking at Gatlinburg.

Or maybe he was messing with me.

Now I want to look it up.

Yeah, I don't know.

I'm looking it up.

Oh, it says, you spray the bear.

Spray at the bear, not on yourself.

So who's the boob now?

I guess I am.

Says it says, do not spray on your body or gear.

It won't prevent an attack and can actually attract bears due to the scent.

What?

So you want to spread it mixed up.

You want to spray the bear.

You want to spray the bear.

But she had bear mace, which is interesting.

Yeah.

So we know that she has bear mace and she owns chickens, and now she has a police record for macing a cab driver.

Right.

Geez.

And he, like, was, like, blinded and disoriented by the spray.

Yeah.

Of course.

That would hurt so bad.

I feel like.

Yeah, I mean, I think that can cause permanent damage, too.

I actually was talking to a retired police officer the other day, and we were talking about training, and they have to, like, take mace, you know, to, like, for training and stuff like that.

And we were talking about the difference between that and him having to take a taser, which he also says is ridiculous.

Like taking a taser, but he's like, the difference is, when the taser's done, it's done.

He's like, with the mace, it lingers.

Yeah.

I'm like, I can't imagine how uncomfortable that is.

Yeah.

I don't know.

I've never been sprayed by Mason.

Thankfully.

I do have mace for when I go for jogs by myself.

You do have mace?

I have one of those, like, whistles, like, where you pull the.

You pull it, and it's like a really sheer, like, shrieking siren.

Yeah.

But I need to get the batteries replaced.

It's, like, doesn't shriek anymore.

Oh, yeah.

That would not be good.

Yeah, I always think that, like, with women running around by themselves, I'm like, oh, my gosh, I hope you're holding something.

Yeah, I know.

It does kind of make me nervous sometimes, Especially when it's, like, real early in the morning.

Yeah.

All right, well, there's your boobs.

That lady's definitely a boob.

Yep.

Bibs.

And then is Bibs and it is babes.

All right, what are the most common short term side effects patients experience?

Yeah, so I think, you know, most short term side effects are symptoms similar to menopause.

So hot flashes, vaginal dryness with the aromatase inhibitors.

Arthralgia, which, you know, basically is joint pain or particularly like a joint stiffness is also often described.

I mean, those are.

Fatigue can be another symptom.

Those are the most common short term side effects that we tend to see.

Yeah, I remember when I was on my AI, I didn't suffer joint pain once I was out moving around, but it was like before my feet hit the ground, you know, like when I'd wake up in the morning and I got out of bed, like when my feet hit the ground, like my feet would be like really?

Like, I don't know.

Joint, Joint pain.

Yeah.

I mean, I feel like even if I'm sitting in the car for a long period of time and I get out, I feel like I'm.

Or hip pain.

Did you.

No, not really hip.

It's more in my legs and my feet.

I feel like.

Yeah.

Was it manageable for you or was it.

Oh yeah, yeah, yeah.

For me it wasn't terrible.

I know some people it can be, you know, significant, but for me it wasn't.

It wasn't that bad.

I would say probably in my opinion, the most.

The side effect I disliked the most was just the painful dry sex.

Like that's five years of gritting your teeth and baring it is what that is.

You know, I mean that's, that's the one that most young, you know, women.

I, I don't.

And it affects not only you, but it affects your husband too.

Right.

Or your partner.

I was kind of a, I was kind of a saint in that department because I didn't tell him how painful it was.

Yeah, I kind of just grinned and grinned and beared it.

Did my wifely duty and kept quiet.

Cuz I was like, I don't want to make him feel bad about it.

I mean, it is what it is, right?

Yeah, yeah, that can be.

That can be a pretty significant one.

I want to know like, what your thoughts are, Dr. Clifton, about long term side effects of, of reducing estrogen, especially premenopausal women.

Because, you know, we hear a lot about estrogen being, you know, bone protective and heart protective and brain protective.

And then, you know, the big joke at Faith Through Fire is women were not meant to raise children in menopause.

Right.

Because you have mood swings and depression and Anxiety.

I mean, what are we thinking?

We know that these drugs are necessary to reduce estrogen in our body to keep cancer away.

But then what about the long term side effects on people?

Yeah, those are great questions.

Probably, you know, one of the biggest ones with these aromatase inhibitors can be the effect on the bones, you know, so we do know that these medications decrease bone density two to three times that of a normal aging.

So, you know, monitoring the DEXA scans are really important.

Trying to do other things, lifestyle changes that can help build your bones back.

So taking calcium and vitamin D, really doing the weight bearing, exercise, and then if needed, if you're, you know, having significant bone loss, discussing bone modifying agents with your oncologist is really important.

Some of the other side effects that can be long term.

So, you know, the effect on the cardiovascular system.

So, you know, we don't think, you know, that these drugs directly cause cardiac toxicity.

Some of our chemotherapies can cause direct cardiac toxicity.

However, these medications do affect our lipid profiles, you know, so our cholesterol levels.

So estrogen generally produces a favorable cholesterol panel.

And when we're depriving our cell levels of estrogen, then you can see, you know, a lot of patients, I'll have, you know, they'll say, my primary care check provider checked my cholesterol panel and it looks much worse this year.

So this can be effect of the aromatase inhibitors.

So it's really important then to work with the primary care providers to make sure that either through lifestyle changes or if, if needed, through additional medications, we help make sure that we are trying to mitigate all of those other cardiac risk factors.

So watching cholesterol, watching blood pressure, monitoring for diabetes, because we know that the most common cause of death in our breast cancer survivors is heart disease, you know, Right.

Because that's common amongst the general population.

So I always tell patients it's important to think about the breast cancer, but it's also important that we work on making sure that we don't develop those cardiac risk factors as well.

We talk about that a lot.

So many women, and it's understandable, are hyper focused on the fact that they've had breast cancer.

And I get it, I get it.

But it's like cardiovascular disease is the number one killer of women.

And now you have this extra risk factor because you've had breast cancer.

So it's like your heart health, I mean, that's where my brain's at all the time, is heart health.

Heart health, heart health.

I will say my parents Warned me.

My parents are very active, very fit, doing great.

But they told me, they said when we turned 40, our cholesterol shot through the roof.

And they're like, so you might want to watch for that.

And sure enough, as soon as I hit 40, it shot through the roof.

And then I had already been through breast cancer and so I have really high cholesterol and I'm always trying to figure out how can I lower this naturally without taking yet another drug.

Because I think a lot of us get fatigued on just a pill for every ill. And we're trying to manage things holistically, but sometimes you need some help.

Isn't there some data, and I don't know, we didn't come prepared to talk about this, but isn't there some data that, that cholesterol lowering medications could be helpful for lowering cancer recurrence?

Or did I make that up?

Yeah, no, that I think maybe the statins perhaps.

Yeah, the statins.

Thinking of.

Yeah, so.

So we don't have good enough evidence unfortunately to say that everyone who has breast cancer should be on a.

But if you need it for another reason, you know, it's, you know, if you need it for your cardiovascular risk, we don't think it's harmful and it could potentially be, you know, helpful in the future.

Okay.

So there's a little bit of data out there suggesting that it might help with cancer recurrence, but it's not indicated right now.

It's just kind of sitting out there as a maybe.

So you wouldn't want to take it unless you had another reason.

Just because you've had breast cancer isn't necessarily a reason you should be on those drugs.

Okay, interesting.

But if you need it for other reasons, it can be important.

Okay.

And then, you know, as far as, like for me, when I got off of my AI, I would say the majority of my side effects, you know, diminished will most of the time women's side effects diminish as they come off the therapy or is this, is there long term, Are they going to have some of these for the long term if they're on these, you know, especially 10 years.

Yeah.

So.

So we do think that a lot of the, the day to day side effects should improve after going off the medication.

It's, you know, probably the long lasting one can be that the, the effect on the bones that we discussed and then again making sure that you're managing these cardiovascular risk factors as well.

Yeah.

So I want to talk about women that quit early because it feels like a lot of women, do they just feel like they can't do the side effects anymore?

Do we know how many people are.

Are, you know, adhering to their medications?

Do you guys have any good data on how many patients are abandoning their hormone therapy and how many are sticking to it?

Yeah, unfortunately, it looks like it's quite high.

The study suggests anywhere from 20 to 50% of patients do not complete five years of therapy.

And what do you.

What do you see in your practice?

What is the main reason for women?

Like, what side effect is the one that's really just causing them to say, I can't do this anymore?

Yeah, that's.

That's a great question.

I think that the joint pain can be a big one.

That can be pretty debilitating.

Hot flashes.

We usually are able to manage hot flashes with other medications and other therapies.

So I would say joint pain tends to be the biggest one that I see.

But there can be a host of.

Of other reasons.

You know, fatigue, the mood changes that you were talking about.

Do you guys have any idea why some joint pain could be so horrible for one person and then not that bad for somebody else?

It just seems like there's such a wide spectrum of, you know.

Yeah, there is such a wide spectrum.

I think it can be hard to.

In our older patients who maybe already have some underlying joint issues like arthritis.

Right.

And then these drugs can further exacerbate it.

I know you're like you were saying, it seems to help when you were, you know, we're more active.

Right.

Actually, one of the biggest recommendations we have to help with these.

This pain is exercise and physical activity.

And for some patients, unfortunately, maybe due to underlying arthritis or other medical conditions, they might not be able to participate in.

In that kind of activity that we're hoping for.

So I think there can be a whole host of how these, these drugs present.

Some people do great and really don't have side effects with these medications.

It can.

It can really vary.

What do you think?

I've heard a lot of doctors, like, patients will say, I just have just had it, and I'm com.

You know, they're.

They're sick of it.

And then their doctor will suggest that they take a break.

What is the purpose of a break?

Is it to kind of just mentally help them, or is it.

Is it the thought that maybe they'll subside the side effects and then when they go back on it, it won't be as bad?

What is the purpose of a break?

Break?

And do most patients come back once they take A break?

Because that would be my worry.

Yeah, yeah, definitely.

So I, I will suggest that sometimes patients take a break, but usually I recommend a short break, like two to three weeks.

And I think that can be helpful really in trying to figure out are the side effects that they're experiencing, are they from this drug or are they potentially from something else?

So with some side effects, you know, especially like fatigue, that there can be so many reasons that a patient could experience fatigue, you know, or joint pain when they start to happen maybe two, three years into the medication.

And we're a little bit unclear, is it from this medication, are they experiencing a side effect that's maybe from another medication that they're on?

You know, did they develop a separate arthritis, wear and tear arthritis?

So I think when the picture gets a little bit confusing, that's where I think a break can be helpful to really try to tease out what symptoms are from the medication and what symptoms are maybe from something else else.

And then if after two or three weeks their symptoms really are significantly improved, that's when then we can talk about maybe trying a different medication or trying to see if they can restart and we could potentially add on a different medication or strategy to help with our side effects.

That raises an interesting question for me because isn't, isn't there emerging research that says with tamoxifen, I thought it was in particular that lower doses can be just as effective as the higher doses.

Where are we on that kind of, of research?

Is, are you a believer in that?

Are you still kind of waiting, Is the jury still out?

So it's a great question.

So there is this, this lower dose called baby tamoxifen.

So it's a, it's a lower dose and it kind of goes back to how really how our drugs are developed.

So many of our drugs have historically been developed where we kind of will at this, they're in the development phase.

We study them to kind of the maximum tolerated dose.

So the dose that patients, patients start experiencing symptoms and toxicity and then sometimes we'll then kind of end up going with the dose directly below that.

So we ultimately though think that many of our drugs could actually be.

The doses might be too higher, not as we don't really don't need that high of a dose to see the efficacy.

So that's where this dose of the baby tam, that's kind of the rationale for studying this dose, where it came into play.

And we have data already from the non invasive setting, so from patients with high risk breast lesions or ductal carcinoma in situ.

So that DCIS or stage zero breast cancer.

And in those patients, it looks like the lower dose of the tamoxifen is just as effective but has less side effects.

So currently there is a large study and we have it open at our institution right now that's looking at this low dose of tamoxifen in the invasive breast cancer setting.

So I think it's very promising, you know, right now for patients with invasive breast cancer.

I tell them, you know, the jury is still out.

We don't have that data yet whether the lower dose of tamoxifen will be just as effective in the invasive cancer setting.

But I think it's a really exciting study and I think we're kind of eagerly anticipating the results of that.

That study.

Interesting.

Okay, well, that's cool.

All right.

I want to kind of close out with if there are any other exciting things on the horizon, research wise, and then get your final thoughts for patients.

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Okay, so you kind of talked a little bit about the low dose tamoxifen and the potential there.

Are there anything, is there anything else going on research wise that has you excited about, you know, maybe improving the quality of life for women that are diagnosed with breast cancer?

Yeah, I think, I think one of probably the most exciting frontiers in oncology now is what we would call minimal residual.

These residual disease testing.

So, you know, our whole kind of rationale for giving any adjuvant treatment, which is any of the treatment that we give after surgery.

Right.

Is in case the patient has that micro metastatic disease or those floating cancer cells, we want to try to kill off those floating cancer cells so that ultimately the cancer does not come back.

But, you know, as you know, right now, we can't really tell if those cancer cells still, those tiny microscopic cancer cells are present.

Our imaging is not good enough, and we really previously have not had blood tests that were good enough to monitor for that or not.

So we are just really in the beginning stages of having better tests to see if patients have that, you know, micro metastatic disease or minimal residual disease.

And so I think it is really.

This is a.

These are tests that patients are asking for.

They're not yet in the guidelines.

And, you know, we're still very much in the research and kind of development phase of these tests.

I think we still have a lot to learn about how we best use these tests.

But ultimately, you know, in the future, the hope is that we're really able to tailor adjuvant treatment, make sure that we're giving the right treatment to patients who really need it.

Yeah, that's been a huge hot button topic within the community, these CTDNA tests, because the question is, okay, I find out I have residual disease floating around in my blood.

What can you do to prevent it from turning into a tumor?

And if they're already on everything that's available, it kind of becomes a no man's land, and then it becomes a question of mental health.

So what are your thoughts on that?

I could see it being beneficial if somebody's dcis and it's like, no further treatment needs needed or, you know, super early disease and you forego chemotherapy or radiation and now you see their cells.

I could see there being some maybe options, but it just feels like for all of us who got the book thrown at us, where's the benefit?

Exactly.

I think that's where it's important to remember.

Although these, these tests are very exciting and very encouraging, I think they're really not ready for prime time yet.

I think that's where it's really important that these be done in a research setting, so in clinical trials, so that we can better really discover how we can use these tests to benefit patients.

But right now, that's where I think getting them or asking for them a standard of care is probably a little premature because we really, at this point, don't know how to best use these tests.

So I think it's very exciting for the the future.

But I would encourage people to try, if able, to, you know, have these tests performed in a research setting rather than standard of care, because again, we just still are trying to discover how best to use these tests.

Awesome.

Thank you so much for coming on and talking to us about this topic.

It's so important to patients, and we really appreciate your perspective.

You're welcome anytime.

Thank you for having me.

Absolutely.

Until next time, guys.

See ya.

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