SPEAKER_01 0:01

Hey guys, are you ready to transform your mind so you can transform your life? Coach Mirna brings you one-on-one coaching in expert guest quickly to give you the wrong role. Because happiness is the progressive realization of a worthy goal. Looking for personal growth?

SPEAKER_02 0:20

Let's do it.

SPEAKER_00 0:26

Basically, none of those receptors are present. There is no estrogen, progesterone, or HER2 receptors present. And so those treatments are usually based on chemotherapy. And now we're using things like immunotherapy with the chemotherapy and triple negative breast cancer. And so it's just important to delineate the different subtype of breast cancer because each one is actually treated very differently.

SPEAKER_02 0:53

So why is triple negative considered bad? Sounds good to me. It doesn't have any of the receptors.

SPEAKER_00 1:00

Well, we have up until recently, when we started adding immunotherapy, and there were some newer targets that we use, something called ADCs, which I can explain in a minute. Up until recently, we were only used, we only could use chemotherapy for triple negative cancers. And so they were harder to cure. They were harder to get rid of. And they do tend to grow faster or spread to other places faster than, say, certain hormone receptor positive cancers.

SPEAKER_02 1:29

Welcome back to the Transform Your Mind to Transform Your Life radio podcast and television show. I'm your host, Life Coach Minnie Young. And sitting in the guest today is Dr. Tiffany Trosso, a broad-certified medical oncologist. And Dr. Trosso and I are going to be talking today on the topic breast cancer, why women must speak up for their health. Welcome, Dr. Trosso.

SPEAKER_00 1:56

Well, thank you so much for having me. I'm very honored to be here.

SPEAKER_02 1:59

Yes, I'm very honored to have this conversation in this important Breast Cancer Awareness Month. All right, so as we start off, I want to ask you guys a question. Have you ever been afraid to question your doctor, ask for a second opinion, or speak up when something about your health just didn't feel right? Now imagine facing a cancer diagnosis when your life may depend on those difficult questions. October is breast cancer awareness month, a time when we encourage women to schedule screenings, understand their risk, and recognize the importance of early detection. But today we're going beyond awareness to talk about something really important: the power of becoming your own health advocate. Dr. Tiffany Rosal and I are going to be talking about breast cancer awareness month and going behind the diagnosis. Dr. Trosto has 25 years of experience caring for women with cancer. She's also an author, medical, legal expert witness, and host of the Empowered Cancer Patient Podcast. Her book, Calming the Cancer Chaos, helps women navigate the overwhelming world of cancer treatment with greater clarity, confidence, and control. In today's conversation, you'll discover while being agreeable, a quiet patient isn't always in your best interest. How to move from fear and overwhelm to becoming an informed partner in your cancer care and what women should know about cancer screenings, genetic testing, and asking the right questions. And perhaps more importantly, we'll explore why finding your voice can be one of the most important steps you take after hearing those horrible words. You got cancer. So let's get into it. All right, um, Tiffany, um, as we dive in, why does being a good patient become a problem? You say that the most dangerous thing a woman with cancer can be is agreeable. Why do you believe that? And how can people pleasing or fear of challenging authority affect the quality of care a woman receives?

SPEAKER_00 4:37

Great question. There's a lot to that. So, first, let me just mention that I feel that women in general in our society are so ingrained to become the caregivers. We are the caretakers with a linchpin to everything else that goes on in our family, friends, and workspaces. And oftentimes it is our voices that are helping to manage and control other people. Nevertheless, when people get a very serious diagnosis, such as cancer, you're often overwhelmed, not just by the fear of the diagnosis, fear of death, but also about all of the terminology that you don't understand or know. You're thrust into a world that has its own set of vocabulary that you have to learn rapid fire. And oftentimes women, um, in particular, when they get into the doctor's office, fall back into the roles that they were maybe taught when they were younger, such as being, you know, compliant and being patient and being deferent to the doctor. And so um, I bring this up because it's so important for women to find their voice and to actively participate in their care. And we'll go through some scenarios where that uh will become more obvious. But if you're not an active participant and you are just a passive passenger in your cancer care, you're not going to get your best possible outcome. You're not going to get personalized care that's meant for you. And you may not end up having a complete trust in the system as well as confidence in your treatment plan.

SPEAKER_02 6:16

Well, yeah. So let's dive right in. So, what are some of the questions that so it walk us through scenario? You're um, hopefully it's not, you don't get the diagnosis when it's metastastasized and it's moved someplace. Or let's say if it's a stage one or a stage two, um, what kind of questions should um should come out of your mouth first thing?

SPEAKER_00 6:42

First thing you need to do when you go to the doctor's office is to make sure you have someone with you. You need to have a friend, a confidant, a family member who listens well and can take notes for you. Because unfortunately, when you walk into the oncologist's office, usually emotions will take control and your cortisol levels are spiking and your adrenaline is rushing, and you're not learning or really understanding most of what's being said to you. So it's really important to have someone with you to help take notes and so that you can kind of break down the appointment after the fact. I've found that probably less than 30% of my patients will actually remember or understand half of what I tried to explain to them in their first consultation. So taking it from that step forward, the things that are really important to understand, especially in the first uh meeting with your oncologist, is well, what kind of cancer do I have? But not specifically, is it breast cancer or is it lung cancer? You want to know what subtype of cancer it is. Is it hormone receptor positive? Is it HER2 positive, or is it triple negative, for example? But then beyond that, you want to also understand so what is the stage? How far did it spread? Can I understand what the treatment options that are available, not just the one you're recommending, but the others that you are considering before your recommendation? And those things need to be explained to you in terminology and in a way that you can understand. I often teach my patients or my consultings, uh, people that I consult with to use what I call the teach-back method. If the doctor doesn't say to you, what do you understand from what I told you? You should then turn around and say to the doctor, I understand based on what you've told me that I have stage two breast cancer, that it's triple positive, and that you're recommending that I have an oncotype test sent to determine whether or not I need chemotherapy or just hormone therapy. That's just an example. But the thought is that you need to say back to the doctor what you took away from what they've told you so that everyone is sure that they're on the same page. And unfortunately, you know, in medical school these days, they don't necessarily teach physicians to do that. It's something I picked up after, you know, over 25 years and thousands of patients that if I don't check in with the patient to make sure that they're following along, we could be on two completely different planets. Yeah. And so that's, you know, those are some of the basics. But two other really important questions I always want to make sure that my my patients are asking are one, can I have genetic testing done? Should I have DNA testing done for my tumor? And three, if you're pre-menopausal, are there ways to maintain myself from going into prevent myself from going into menopause if that's possible? And or is it possible and feasible for me to have fertility preservation prior to starting any systemic treatment? Because once you've started chemotherapy, for example, we can't go back and retrieve the eggs. We need to do that before we start. And so I like to put that into every conversation for younger patients so that they know to ask that.

SPEAKER_02 9:55

Wow, that that's very, very important. I've heard that with testosterone, I mean, with with prostate cancer, that um uh yeah, preserving the sperm or something like that. But I've never heard that with um breast cancer. But yeah, it makes sense though, that if you're gonna be doing chemotherapy, that that would affect um uh the quality of your eggs. And I assume that's what you're saying. But you just said something that um I would like an explanation because I don't know it, and um I'm sure my listeners would. But I have heard of hormone-positive cancer, and I think maybe most of the people that's that's that's listening would understand that one where is where it's an estrogen dominance um something. But it's really interesting. I'm going to uh an event tomorrow where the the the lady is having a um a breast cancer event, and her daughter, she said, uh was diagnosed with triple negative. And I have actually never heard of that before. So you just mentioned it. And um yeah, it's according to or it's very bad, it's the worst one, and and um uh she's in her 30s or something. So explain to Ernest and others what it what it what are the three types of breast cancer that you just mentioned. I I remember triple negative, I remember hormone positive, but there was a third one. So if you go into the details, sure.

SPEAKER_00 11:27

So, well, first I have to give everyone a little biology background. So the basics are that a cancer cell, like every cell in your body, will have on the outside of them something called receptors. Receptors are proteins. You can almost think of them as like the antennas, the TV antennas on the outside of the the house, right? And the TV antenna is looking for TV waves, radio waves, and to brings the signal into the into the television. That's old school. But if you think of a cancer cell in the same way, there are three particular types of receptors that we look for on the outside of the cancer cells. Estrogen and progesterone receptors are the two hormone receptors. So when we talk about a hormone-positive cancer, usually at least the estrogen receptor, if not both of them, are present on the outside of the cancer cell. And that usually indicates that estrogen is one of the factors that may stimulate the cell to grow and to live. In HER2 positive cancers, the estrogen receptor may or may not be present, so that you could have both ER-posit and HER2 positive. HER2 is a receptor that's looking for a growth factor that's floating around in the bloodstream. Every cell in your body has some form of a HER2 on it, but what happens in certain breast cancers is that that HER2 gene gets amplified. So then the body makes the cells make too many copies. So now you have, you know, 10 antennas on the outside of the cell. And so any of that growth factor that's brought in will amplify its signal and continue to proliferate the cell or grow, right? Um, and so that is one way when they're HER2 positive, we have treatments that target that particular hormone, that particular receptor for HER2. We can get into that detail a little bit later. But um, and then in triple negative, basically none of those receptors are present. There's no estrogen, progesterone, or HER2 receptors present. And so those treatments are usually based on chemotherapy. And now we're using things like immunotherapy with the chemotherapy in triple negative breast cancer. Um, and so it's just it's important to delineate the different subtype of breast cancer because each one is actually treated very differently.

SPEAKER_02 13:43

So, why is triple negative considered bad? Sounds good to me. It doesn't have any of the receptors.

SPEAKER_00 13:50

Well, we have up until recently, when we started adding immunotherapy, and there were some newer targets that we use, um, something called ADCs, which I can explain in a minute. Up until recently, we were only used, we only could use chemotherapy for triple negative cancers. And so they were harder to cure. They were harder to get rid of, and they do tend to grow faster or spread to other places faster than, say, certain hormone receptor positive cancers. HER2 positive cancers also are considered bad actors. But what happened is that, you know, 20 plus years ago, we came up with this antibody called her septin, trestuzimap. And there's another antibody called Pertuzimap or Pergetta. And those two antibodies target the HER2 receptor. And just by the addition of those two antibodies to the actual chemotherapy, we drastically changed the face of treatment for HER2 positive breast cancers, such that if you have this bad marker, so to speak, of HER2, and you get the chemo plus the antibodies to the HER2, your results can be even better than some of the ER-positive cancers that don't have the HER2, if that makes sense. The treatments are so effective. And more or less the same thing has been shown with the triple negatives. Now that we're combining them with immunotherapy, we are getting outstanding responses to the treatments. Oftentimes, triple negative and sometimes HER2 positive cancers are treated with what we call neo-adjuvant treatment. Neo-adjuvant means it comes before the surgery. So, say the patient has a stage two triple negative breast cancer, we may start chemo in immunotherapy first, shrink things down, theoretically clear any systemic disease, anything that could have gotten out already and is in other parts of the body, clear all that, then do surgery, and then do more chemo and immunotherapy afterwards. And so by you know, changing how we treat these diseases, these very bad actors are actually becoming much more curable. Okay.

SPEAKER_02 16:04

So now I understand why we're getting deeper into so it's not just okay, you have breast cancer, we need to cut it or chemo or you know, whatever we need to do, but you need to understand and and and and become the CEO, as you say, because if you study, um, for instance, get your book, I'm sure your book goes into deeper um on what you should be doing, what you should be asking, um, regarding these three, because we're only talking about breast cancer today, but yeah, but during these three types of cancers, because they're treated differently. And um, and I'm glad that you ended off by saying that you know, someone getting a triple negative um diagnosis is not directed is is is getting better and now you know it's treatable. So that's that's amazing. So that's great. So um uh you encouraged women to become the CEO of their cancer care. So, what does that mean in practical terms? And what are the first steps a newity diagnosed woman should take to regulate and regain a sense of control? So you ask the doctor the question, what type of cancer do I have? And then he's gonna line out a treatment. Um, is there something else, the next thing that you should do? Don't say put your house in order.

SPEAKER_00 17:30

Well, yes and no, not put your house health. I'm not sure what you mean by put your house in order, but I do encourage people to organize themselves. And why I do that is because unless you have your own set of records and you're keeping your own notes, you're really at the mercy of whatever's being written in the chart. And so if you call with a question and you know, they didn't document perhaps one of the symptoms that you reported, you have your own records and could say, no, actually, on the week after chemotherapy, I was really nauseous on days two to four. And that specifically can help your doctor and the team to treat your symptoms better. So a patient that has nausea on the day of treatment versus five days later versus two weeks later are treated differently. We have different, you know, ways to manage the symptoms and side effects. Same thing with your bowel movements. If you get very constipated after chemotherapy and then you end up with diarrhea for three days, I did say that on radio, didn't I? Um these types of things can be managed much more precisely if the doctor has more information. So, two things that I recommend are to contain to get a planner, a weekly and a monthly planner. In the monthly component, you're going to mark down all of your treatment days, all of the important family events and things that you need to make sure that you're available for and that you don't want to miss. And make sure that those things don't overlap, right? And then in the weekly pages, you get these nice big boxes where you can write down every day, day one after chemotherapy, what you felt, the symptom you had, what you took. Did it work? Did it not work? How many glasses of water did you take? Don't try to keep all of that data in your head because it's stressful. Put it down on a piece of paper and let it go. And then bring the planner with you to your appointments. And you use that as a communication tool to get better care. The second thing with the binder, I teach in my book and in some of my webinars how to organize your own medical records. And by doing so, you have copies of the most important things that you need. So, should you go to another hospital system for a second opinion and your records didn't arrive, or your CAT scan report didn't get faxed to your doctor and you need to review it with them. You have all of your own records that you can rely on as well. Um, so besides organizing, I also like to talk about your community. And what I mean by that is helping your friends and family and supporters to help you best. And by controlling that and delegating out the things that you don't necessarily personally have to do. Can somebody pick up Johnny from baseball practice for me on Tuesday? I need my daughter, you know, needs to get new shoes for her tap lessons uh before the weekend. And delegate these things out. People are dying to help you, but just don't often know how. And so I often quip that if you don't give people jobs or ask them, like, hey, could could somebody provide dinner for me on Thursday night when I get home from chemo so that family has something to eat, that I don't have to worry about that? And if you don't delegate these things out, people are just gonna guess at what you need and you'll get empty, sort of open, you know, promises like, oh, call me if you need anything. You're not gonna call. Um, or people will just start dropping off lasagnas and blankets and things that, you know, are nice and and thoughtful, but they're doing the best they can to help you and they don't know how. So, you know, other things to think about in, you know, as a cancer patient or as a caregiver, what things can I take off my plate or off my loved one's plate? Can I maybe help follow up on the insurances, the insurance problems, what was rejected, what things have to be called in? Did the doctor get the prior authorization for the MRI I need next week? And those sorts of paperwork type of things are also really great to help uh friends and family with. Um, and then the last part is well, not the last part, but one of the other most important parts we've already started to get into. It's educating yourself enough that you understand the lingo and the playing field. You don't need to become the oncologist, you don't need to be the one that picks the best therapy, but you need to understand enough that you can participate in your decision process and that you can also communicate to your physician and your care team what. It is important to you. For example, if you have a husband who is disabled and you go to Florida every summer, or I'm sorry, every winter, for example, and you got diagnosed in November, maybe it's important that in the very beginning they decide what treatment you're going to get, what specific schedule you're going to have that will work with whatever else you have going on in your life. So that, for example, if I have a patient who told me that she thinks she won't have chemotherapy at all if she's going to lose her hair. And I have she loses her hair, she may choose not to do chemo at all because that is a non-negotiable for her. I may not agree with her, but that's her prerogative. And so how can I work within what's important to her, but still provide great care? So there are things I can do. For example, instead of giving a chemotherapy once as a big dose every two or three weeks, if I break the dose down into smaller doses and she gets it every week, and then she uses one of those cooling cap apparatuses, she most likely won't lose her hair. Now you're trading off convenience and the need to come in every week. But if that, you know, you have to decide what's important to you and what what's important in your life. And so those are just some examples of how taking control and expressing your needs, thoughts, and beliefs will help the doctor help you better.

SPEAKER_02 23:26

Yeah, that's a very important point that you just brought up because it's the it is the pain point of most women um with cancer losing their hair. You know, I don't care much about my hair. So but I I I I mean, I don't I like you said, you don't agree, but yeah, I mean it's it's your identity. It's just to me, it'll be worse than losing your breasts. And sometimes they have to do that. I don't think there's a choice there, right? If they say you have to they have to take the breasts, there's no choice there. Is there?

SPEAKER_00 24:03

Well, sometimes there are. I'd I'd need to learn a little bit more about that particular circumstance to decide whether or not you absolutely needed to lose the breast or not. So, you know, the circumstances for a mastectomy versus lumpectomy usually include whether or not there are multiple different spots in the breast in different areas. So we we break the breast up into quadrants, you know, upper two and then lower two. And if there's breast cancer, say in more than one quadrant, you may need to remove the whole breast to get clean results. Um, or if the tumor is really big and the patient has relatively small breasts, if we have to take out 70% of a size cup A breast, you're not going to have a good cosmetic result. And so you're probably better off with a mastectomy and an implant. Um, and then there's preventative reasons. A lot of times women that either have a breast cancer and know they are at increased risk of having another breast cancer, for example, if they have a genetic predisposition like Braca, they may decide to do preventative bilateral mastectomies so that they remove that future risk as well. I know.

SPEAKER_02 25:09

A lot of a lot of women are doing that, but I only brought it up to say that I mean, if I if I would have the choice between losing my hair and losing my breasts, I mean, I wouldn't care about the hair. I can wear a wig. I wear wigs all the time anyway. So um, but yeah, I mean, uh it's it's just it is just a bad place to be in, though. I I can I can and I can understand that. So um, but thank you for explaining why the lumptectomy or the mastectomy, and you know, the the girl that was telling me about her daughter, she had to get them both removed with the triple negative breast cancer. She had to get a double mastectomy. So it was yeah, I think it was a stage four, so it's obviously moved. Um, all right. So um let's talk about the emotions. You know, on this show, we spend a lot of time talking about emotional trauma, and there's no harder one or you know, breast or cancer and the whole is obviously right at the top of that list. And um, when you're in this emotional state, like you just mentioned, um, you're in a doctor's office and the doctor's talking and you're just not even hearing because you're emotionally reacting. So when a woman hears the words you have cancer, what happens emotionally? And how can she manage that initial fear so that she can understand her options and participate in decisions? Is there something that brings the fear down?

SPEAKER_00 26:43

I think that understanding and planning helps bring the fear down because a lot of the fear is often of the unknown. And so I think that once people get a plan in place, but oftentimes that doesn't happen until you see your oncologist. But in the moment, I always recommend that you don't jump on a chat group or call all of your friends and maybe sit with the diagnosis for a little bit. Um, because honestly, until you can sort of stomach it or internalize it and get move past the shock to the point where you are able to act as a being that can take action, I think that it's better to not share because as soon as you share, everybody and their brother is going to have a scenario or a story or tell you something that they think or that you need to do or should do. Um, or the things that their family member didn't do and then, oh yeah, they died. And so I a lot of you know, a lot of what you're going to get from the outside, although, you know, well-meaning is not always very helpful. So you know, sort of just noise. It's a lot of noise. And then that becomes very confusing for you as well and overwhelming. Um so I think that, you know, the the best things that you can do is to, you know, cry, scream, hit a pot, what it whatever it takes to help get out that immediate like surge of anger and fear. And then you need to, you know, get to the place, get to the place mentally where you can take action and start to organize and plan. Um, and you know, sometimes that takes time, and sometimes you need to bring somebody in, you know, your your best friend, your husband, your sister, to help you move into that space. And sometimes it'll take, you know, me, I've many times spoken to people since I've started doing my virtual second opinions, um, speak up spoken to family members before I actually spoke to the patient, because the patient wasn't ready to speak or wasn't ready to listen. But the family wanted to help them plan and help them to start moving forward to get things in place for their treatment and and hopefully their recovery, right?

SPEAKER_02 28:59

Yeah. As you were talking, I remembered an interview I did with um a gentleman that had um metastasized, I'm I'm thinking stage four, liver cancer. And nope. Um sorry, it was um colon cancer that spread to his liver.

SPEAKER_00 29:21

Right.

SPEAKER_02 29:22

So um uh he said he went into the doctor's office and a doctor told him that um 87% of people die. And he held on to the fact that okay, there's 13%. I'm gonna be in that 13% that lives. So it is it is the mental way. So let's pull that same kind of conversation into a woman that's just been diagnosed with triple negative stage four that has moved to her bones or something. Um, what is the hope that she can hold on to? Is there is there a statistic that says five percent um survive with this kind of treatment?

SPEAKER_00 30:00

Or you know, I as a clinician, I don't like to give patients those numbers at all. And the reason is that no one patient is going to fit into that statistic perfectly. And the other thing is that a lot of those statistics are old. And as treatments and our, you know, ability to, you know, shrink and potentially cure cancers have improved dramatically over the last even five years. I don't know that some of those older numbers are even relevant. So the way I usually discuss it with patients is to tell them that, yes, that you know, dying from this cancer is a possibility. But how you respond, in other words, how the tumor responds to our first and second sets of treatment is a much better indicator of your life expectancy, of you know, the likelihood that you could go into remission. And I like to table that type of a discussion until after the patient has had a few rounds of treatment and then we reassess to see what's going on. Now, if the patient's cancer doesn't respond to the set of treatments that I've been giving, then obviously the prognosis is not nearly as good. And we will have to, you know, discuss that again. On the other hand, if they're responding really well, then it's a whole different set of circumstances. So I like to look at instead of overall survival, which means how long will I live period, I like to talk about progression-free survival or time to progression, which is a measurement that we look at in terms of if you're getting treatment, how long will it control the cancer for? Or how long until you potentially go into remission, how long until you get a response. And I think that in a day-to-day, that's a much more meaningful set of percentages for a patient than will I be alive in seven years?

SPEAKER_02 32:00

Yeah, seven years, right? Yeah, yeah, yeah.

SPEAKER_00 32:04

Because can any of us say if we're gonna be alive in seven years? I mean, honestly. Correct.

SPEAKER_02 32:08

Yeah, nobody can say that, even when you're healthy, right? Yes, yes. So that's pretty good. I like that. Because yes, I have heard um nobody's interviewed, I think, a movie or something in that of watching when they say, Yeah, your your cancer is not responding to treatments, or there's nothing we can do. So I I understand what you're saying. I mean, whether it's responding or not, that's a great indicator. But that's good though, because what we're talking about is the fear that you go into when you get the diagnosis and there, and you're thinking that, okay, hey, I'm um, I'm not gonna see my kids grow up or something. But then you you you what you're saying is that yeah, those numbers are old, you know, technology has come so much further. And um uh let's see how it responds first and think positively. Absolutely you know, go into the mindset of I will fight this to the death, you know. That's pretty good.

SPEAKER_00 33:06

Well, let me just give you an example. Um, this weekend I'm actually going to the birthday party, 70th birthday party of one of my patients. This lady um came to me maybe five to seven years ago. And at that time, immunotherapy was not standard of care. We were still, it was still in clinical trials. And she had been treated elsewhere, and she um was in extraordinary pain. She was on a lot of narcotic pain medicine and was very, you know, sluggish when she came in in a wheelchair with her son. And they had told her at the last um facility that she should get her affairs in order and that she was dying and should go on hospice. And so it happens that we tested her tumor and she had the particular type of endometrial cancer that responds to immunotherapy. So we put her on the trial, she gets the immunotherapy, she goes into remission, and she's now over five, maybe seven years out now since her diagnosis, and she's having a birthday party, and she this weekend. The point is that things are changing very, very quickly, and that you know, there are things that if I had had, you know, 10 years ago, I could have treated other patients and that may they may still be alive today if I had had those other treatments. But the the point is that you need to stay on top of your disease as well. And especially if a drug is not working, for example, you need to ask your doctor, what other options are there besides a standard of care? Are there clinical trials that are available for me? Do you have anything here? If not, can you refer me to an academic medical center? Do you know of anything else? Because at the end of the day, getting a second opinion, especially if something is not working, is it's very valuable.

SPEAKER_02 34:55

Yeah, yeah. I think I read somewhere once where I said the most beautiful words you can hear is um, we've gone to the end of this treatment, but there's a clinical trial that you can you can get on to, but it's just the fact that there is hope. There's something else that we can do. And he said that that's the most beautiful words that you can hear. Yeah, yeah. Yes, yes, yes. They're not saying, yeah, going, you know, when I said originally, go get your house in order is when they say there's nothing more we can do for you than make sure you get your house in order. But I like the way you put it. Go get organize yourself and not necessarily, yeah. So that's beautiful. All right. So this is October breast cancer awareness month, and we want to encourage screening. So, what should a woman understand about mammograms, personal risk factors, family history, and the importance of individualized screening recommendations? And maybe you can comment. I think I heard somewhere along the lines that mammograms are not the best way to screen for cancer. Maybe there's some new thing on the horizon that is better, but yeah, just talk about screenings for a minute.

SPEAKER_00 36:15

Sure. So there's a lot to it. Um, one is knowing your own family history and your own personal risk of cancer and when you should begin screening. So some of the different organizations have different dates or um ages at which you should begin screening. I've generally been recommending, based on a conglomeration of these um recommendations, that women should get screening at least a baseline around age 35, and then should start regular screening at age 40. There are different regimens, but that's what I've been recommending. And you also need to make sure that you're taking note of your bone, your breast density. And breast density has become increasingly more important in terms of what other secondary screening you need to have done. So there's the screening mammogram that's the standard test. And screening mammograms can also be improved by, if necessary, to increase sensitivity by using a 2D or even a 3D mammogram. They also have contrast-enhanced mammograms that are being looked at with versus MRIs of the breast, particularly when we need to do a second-level screening for women that have very dense breasts, where a screen, a plain screening mammogram may not pick up smaller tumors. And um the other thing is sometimes women will get ultrasounds with their mammograms as well, particularly if they have dense breasts and they are not eligible to receive either a higher level mammogram or an MRI.

SPEAKER_02 37:50

Okay. So I'm gonna throw this one in because I want uh this is my personal experience. So at one point in time, 10 years ago, um, I went for mammogram and they said they saw calcifications, which is a stage zero breast cancer, and they did um uh they took out the the cells by um biopsy, and then I also had to get um radiation. So how does that fit in? Is is this calcification? Because I thought it was a bunch of bull at the time, and I'm almost sorry that I went through all that, but can you so yeah, yeah, let me let me just clarify a little bit.

SPEAKER_00 38:35

So calcifications is the visual um equivalent of what we're seeing on the mammogram. So when they do the mammogram, they look at it and they'll see little white spots in clusters, and that's calcifications, and they follow those calcifications over time to see if they change. And oftentimes they will do a biopsy to make sure that there's no cancer associated with the calcifications. So what you're describing is you probably had an in city cancer, meaning either a ductal carcinoma in cite two or a lobular carcinoma in cite two, DCIS or LCIS. And in that case, yes, they do remove that area with a biopsy, and then oftentimes we'll do radiation to the rest of the breast to prevent further cancers from forming. Does that explain?

SPEAKER_02 39:23

Well, not really. It was just a calcification, and they said it can turn into something. And my family recommended that I get rid of it because they don't want it turning into anything. So, but you just said they, you know, they didn't watch it. I will, you know, I they went in and took it out immediately.

SPEAKER_00 39:43

But it sounds like you had DCIS. That's stage zero. Yeah. So that's that's stage zero. That's like a precancerous lesion. And if you do leave it, it can highly likely form into a cancer. So that's great that they caught it at such an early stage. It's often like when they do a um colonoscopy and they find a polyp, remove it because some polyps can also turn into colon cancer. So it's the same kind of scenario.

SPEAKER_02 40:10

Okay, good. All right, so I feel better.

SPEAKER_00 40:12

I think you did the right thing.

SPEAKER_02 40:14

I just thought they were trying to sell me stuff. All right. So all right, so let's talk about your book. Um, your book is called Common the Cancer Chaos. Beyond Medical Treatment, women may struggle by with anxiety, changes in dense identity story, menopause symptoms, and uncertainty about a future. What advice would you give a woman who wants to move beyond simply surviving and being feeling confident about her life again? So tell us why you wrote the book and and what um you were sharing in the book to help women with that.

SPEAKER_00 40:50

Sure. So, you know, the first third of the book is about organizing yourself and understanding a lot of the vocabulary. And then part two is where I get into the different types of surgeries that are available, the different types of radiation and all the different things that the medical oncologists will offer, what chemotherapy is, what hormone therapy is, immunotherapy, et cetera. And then the next section of the book is about getting treatment and what to expect on the day of your treatment, what to expect on the time between your treatment, and how to manage, in general, a lot of the most common side effects. And then part four is about how to regain your footing and start to feel more like yourself, which is probably not going to be the same self that you were before, but perhaps a newer and better self who has weathered through the storm. And, you know, I talk about things like how to improve your environment to decrease the risk of recurrence, how to um, you know, what supplements the patients often will talk to me about. And those chapters I had to do quite a bit of research on because they're ever shifting. And there's not a lot of strong clinical data on a lot of these supplements. But I can tell you that as a clinician, having seen thousands of patients, that that's probably the number one thing that people would ask me, like, well, what can I take? What supplement should I take to live longer, to feel healthier, to help boost my immune system? And so, you know, I wanted to include all that in the book so that people had a a valuable reference so that they could understand about when Aunt Tilly calls you and tells you that you should be taking curcum, what that actually means.

SPEAKER_02 42:31

So Yeah, well, that's great. You know, my my sister had non Hodgkin's lymphoma, and you're right, she, you know, she's cancer free now and she's a changed person. She has come through that. She's weathered at storm. Right. Yeah, I will get a copy of your book for her because I mean, you you you want to, I mean, regardless of the cancer, you want to be able to um uh you know protect your immune system and and and and and make sure you're living a quality life because I'm understanding that um we didn't get into that today, but lifestyle is a big indicator of um where do you get cancer in the first place. So once you've gotten it and you don't want it to come back, um, it's really good that you're sharing some ways to prevent that, even though nothing's guaranteed. But at least you can do what you can do to prevent that. Yeah.

SPEAKER_00 43:22

Yep. Yep. And I agree with you. Lifestyle is extremely important, not just in preventing, but also in surviving cancer. It's important to get your exercise, get your heart rate up, drink water, don't eat processed foods, all the things, you know, don't microwave in plastic containers. I mean, there's so many little things that are out there that each one on their own, don't drink alcohol. Each one on their own may not specifically individually prevent your cancer, but as a group, if you start peering peeling away, peeling away all those different toxins that you're otherwise, you know, retaining within your body or being um uh in. Involved with, then you definitely will have a better outcome than if you left all those potential risks in in place. That's good.

SPEAKER_02 44:07

Excellent.

SPEAKER_00 44:08

All right.

SPEAKER_02 44:09

So tell our listeners where they can um uh you know connect with you after this interview, your website, your social media handles. You also have a podcast, so you can talk about that here.

SPEAKER_00 44:18

I do. So I try to make it easy for everyone. My website and my handle on Instagram are dr Tiffany Troso. And then the website is dot com. So drtiffanytroso.com. Um, and you can also find me on LinkedIn. I'm on, I'm on all the places. I'm on I have a very big Facebook following. Um, so you can find me there as well, Dr Tiffany Troso. Um and yes, I do have a podcast that you can see on YouTube that's called The Empowered Cancer Patient. And I try to interview people that can bring me a perspective that is slightly outside of the, you know, traditional conventional medicine that I've practiced for so many years because I know that there's so much out there in the world of cancer treatments and support. And so I have geneticists come on, I have nutritionists, I have functional medicine doctors, and we have some really interesting conversations. So, yeah, you can everything is linked through my website, um, including my cancer store. I have a great store that I have compiled of things that you can purchase either for yourself or for a loved one who has cancer. Um, they're all things that I have gathered over the years that my patients have found useful and things that I I think are very helpful for patients. So um, including, you know, the binder and the planner and specific pads that you can wear after surgery of your breasts when they're swollen. There's all sorts of things there. Um and then the book, of course, is it's linked through my website, but you can get it on Amazon and Barnes and Noble. You have to look for it calming the cancer chaos, and then with my name, Dr. Tiffany Trosso, and then it usually comes up.

SPEAKER_02 46:02

So okay. Well, um uh I will have links to um your book and uh your website and your YouTube channel, your podcast on uh the show notes, which will be on my website, which is myhelps.us. So yeah, I mean that's one of the benefits of of linking it out. But sounds like you're offering an excellent service. Um I congratulate you what you're doing. You're not only helping the patients that you see, you know, face to face, but you're you have a global community. And um, it's great when we're trying to, you know, we have uh the purpose of um helping others and um you know, breast cancer and you know, the cancers that women get, like you talk about endometriosis, things like that. It's it's great to um to have someone in this space that is helping people through that. And your story is excellent. Um yeah, I'll I'll refer right now if she's the only person in our family that I know personally that's yeah, she's cancer free now, but I will send her there because it's always good to um to stay up to up to date on um uh on these things and and learn. And we're talking today about getting behind the diagnosis and asking questions, but one of the things that we do is knowledge. Knowledge is very important, being knowledgeable. I mean, I know so much about cancer because I I talk to people all the time about it on the show, and I'm thinking, I hope I'm not preparing for something. I worry, am I am I inputting too much? Well, yes, I'm very knowledgeable in the subject. I've been interviewing people on the cancer on this show for you know years now.

SPEAKER_00 47:50

Wow, that's great.

SPEAKER_02 47:51

All right, Dr. Tristle, thank you so much for joining me today and reminding us that being an empowered patient doesn't mean knowing everything about medicine. It means having the confidence to ask questions, understand our options, and participate in decisions about our health. As we recognize breast cancer awareness month, I want to remind every woman listening that your voice matters, your questions matter, your help matters. Whether you're navigating a diagnosis, supporting someone you love, or simply being proactive about your health, don't allow fear or intimidation to silence you. And remember, empowerment doesn't mean facing cancer alone, it means building a trusted medical team and becoming an active participant in your care. To everyone listening, thank you for joining us today on the Transform Your Mind. Remember, transformation begins when you recognize you have the power to change how you respond to life challenges. All right. So that was my end summary. Um, Dr. Toso, do you have any last words?

SPEAKER_00 48:56

No, I I I'm actually honored you summarized that all very, very well. And so thank you. Yes, always remember to participate in your care and that at the end of the day, you as the patient, you're the most important one in the room. And so you need to make sure that you're getting the information that you need and making the decisions based on your own education and understanding.

SPEAKER_02 49:18

Yes, and go pick up a copy of Calming the Chaos Right, so that you can be more informed. And that's it there. Yes, yes, awesome, awesome, awesome. Love it, love it. All right, Transformers. Thank you for tuning in to this week's episode. Thank you, Dr. Trozo, for being on the show. Until next, until next time, keep transforming your mind so you can transform your life. Namaste.