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Deborah Howell (Host): Hello, everybody. Welcome to the show. Hope you’re having a great day. You’re listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I’m Deborah Howell. Today’s guest is Dr. Homayoon Sanati, a board-certified medical oncologist who specializes in geriatrics, internal medicine, and palliative care. Dr. Sanati has been honored with numerous awards, including America's Top Oncologist, selected by Consumer's Research Council of America. In addition to being a MemorialCare medical group specialist, Dr. Sanati is Medical Director of the Breast Oncology at the MemorialCare Breast Center at Long Beach Memorial and Orange Coast Memorial Medical Centers. Welcome, Dr. Sanati. Dr. Homayoon Sanati (Guest): Thank you for inviting me. Deborah: Thank you so much for being here. Let’s talk a little bit about some of the advances in the treatment of breast cancer because there are many. First of all, what are the new breast cancer screening tools that our listeners should know about? Dr. Sanati: There are two screening tools that listeners need to be aware of. One they may have heard about is the 3D mammogram, also known as tomosynthesis. This is a new modality that is similar to mammogram, but it takes many pictures of the breast, and it gives a three-dimensional picture of the breast to the radiologist. One of the benefits it has is it reduces the callback rate in patients, especially the patients that have a dense breast. Reducing callback rate usually reduces the anxiety for the patient. Deborah: Let’s answer a question that I think will crop up. What is callback rate? Dr. Sanati: Sometimes the radiologist sees an abnormality on the mammogram, and they ask the patient to come back for more imaging. Normally, one of every ten mammograms, we would see an abnormality, and we would have to call the patient back. Most of those abnormalities are benign. It just adds a little anxiety for the patient. Deborah: Sure, inconvenience and time and all that good stuff. When you’re talking about this, of course the other question that came to mind is do more images mean more radiation, and could you address that? Dr. Sanati: Yes. Actually, this modality has slightly more radiation involved with it. It’s about one and a halt times radiation compared to a regular mammogram, because it takes more pictures. But for some patients, especially the ones that have dense breasts, taking one 3D mammogram may be beneficial because you don’t end up getting more imaging and more additional mammograms. You would save some on radiation that way. Deborah: Would you still get them once a year? Dr. Sanati: Yes, it would be once a year. Deborah: Over 40, right? Dr. Sanati: Over 40, correct. The other modality is an automated whole-breast ultrasound. Basically, it’s an automated ultrasound that takes pictures of the breast through ultrasound. It’s basically an ultrasound probe that circulates throughout the breast and gives a three-dimensional image as well. This modality has recently been FDA-approved. It detects breast cancer at a smaller size, about half of the size of a regular mammogram. And also, it doubles the rate of detection, basically. It doesn’t have any radiation involved with it. It would be very reasonable in woman who has dense breasts and they have intermediate risk of breast cancer. Intermediate risk that we’re talking about may be 10 to 20 percent lifetime risk of developing breast cancer, I think this modality would be very useful. Deborah: Which brings us to our next question, because we hear a lot about genetic testing. Would you say genetic testing is beneficial for all people who have a family history of cancer? Dr. Sanati: It really depends. Probably not for all people, but if there are some red flags, that would be something to consider. Red flags, I mean, if someone has breast cancer younger than age 45, it’s a significant increased risk. Usually, 50 years is our cutoff to consider genetic testing. If there is family history of ovarian cancer or personal history of ovarian cancer, that’s something that a patient needs to look into to get genetic testing. If there’s a really strong family history of breast cancer—and there are some people that had their mother diagnosed with breast cancer at age 85, and usually, those are not genetic—but if there is a mother that’s diagnosed at age 56, then a maternal aunt diagnosed in age 57, these are some of the types we consider. Also, having Ashkenazi Jewish ancestry increases the risk of having genetic mutation. These are some of the red flags. Deborah: What is genomic profiling? How can that help in the treatments of cancer? Dr. Sanati: Recently, there has been a paradigm shift in the treatment of cancer in general, more particular for breast cancer. When you look at the breast cancer tumors under microscope, they look the same. But the genetics that’s driving the tumor might be different. Right now, we have at least two tests that can identify subgroups of breast cancer that we know that probably respond better to hormonal treatment. One subgroup may respond to chemotherapy treatment. Other subgroups may respond to some targeted treatment. It helps us to tailor the treatments for each patient. This information is still new. We have a lot of ground to cover, but it’s a good start. Right now, we have four subgroups for breast cancer which is very simplified. I think there are many more. But it’s a good start. Deborah: It’s a very good start. There’s a huge factor, of course, in the treatment of cancer—chemotherapy, other drug therapies—but has the FDA approved new drugs in the last year? If so, how are these drugs used? Dr. Sanati: Yes, we have at least two drugs that are recently FDA-approved for breast cancer. One is called Trastuzumab, which is a protein antibody that blocks a receptor on breast cancer tumors. That receptor is HER2. It’s Human Epidermal Growth Factor Receptor number 2. We know that about 20 to 25 percent of the breast cancer tumors express that receptor. This protein antibody goes and binds to that receptor and deactivates the receptor. Basically, it blocks the activation of the receptor. It has been FDA-approved in combination with another receptor antibody called [Trastuzumab], which is similar to this antibody but binds to a different side. And one other drug, Docetaxel for treatment of metastatic breast cancer. Being in the same topic with HER2-positive disease, there is another drug on the horizon. It’s called TDM-1. This is a drug that has that Trastuzumab, and they attach a very potent chemotherapy agent to Trastuzumab. That chemotherapy agent basically gets a ride on the Trastuzumab and attaches to the cancer cells, gets inside the cancer cells, and kills the cancer cells. It’s really a very targeted treatment. Deborah: That’s incredible. Do you envision in the future, once these drugs get established and are approved, that a woman can just take some medication to cure her breast cancer? Dr. Sanati: Probably. I think this would be a goal. Probably they are curing a lot of early stage breast cancer with these drugs already. I’m not sure if we can make a cure with metastatic disease. That’s a little harder. Deborah: But as you said, it’s a goal, huh? Dr. Sanati: Right. But these drugs may make it possible. Deborah: Dr. Sanati, I’m so sorry, but our time is through. But thank you so much for finding time to talk to us. Hopefully, you’ll come back on the show again. Dr. Sanati: Okay, thank you. I just want to make a disclosure that I don’t have any personal stocks or any financial interests in any of the modalities we talked about or any of the drugs that we’ve discussed. Deborah: Thank you so much, doctor. Dr. Sanati: Thank you. Deborah: I’m Deborah Howell. Have yourself a great day. Thank you for listening to Weekly Dose of Wellness.