Becoming an Empowered and [ACT]IVATED Breast Cancer Patient

Patient Empowerment Network (PEN) is committed to helping educate and empower patients and care partners in the breast cancer community. Breast cancer treatment options are ever-growing with research advancements in treatments and testing, and it’s important for patients and families to educate themselves with health literacy tools and resources on the latest information in breast cancer care. With this goal in mind, PEN kicked off the [ACT]IVATED Breast Cancer program, which aims to inform, empower, and engage patients to stay abreast of up-to-date information in breast cancer care. 

The [ACT]IVATED Breast Cancer program is aimed at newly diagnosed breast cancer patients, yet it is beneficial at any stage of disease. [ACT]IVATED Breast Cancer helps patients and care partners stay in the know about the latest options for their breast cancer, provides patient activation tools to help overcome barriers to accessing care, and powerful tips for self-advocacy, coping, and living well with cancer.

Breast Cancer Disparities

With more focus on disparities in breast cancer outcomes, research studies are starting to reveal actionable information on genetic differences. A recent study uncovered a racial disparity among cancer types that are hormone receptor-negative but HER2-positive. While treatment has been successful in white patient groups, the outcomes have been less successful in Black patient groups. The study also noted key gene mutations in the MAPK pathway occur more frequently in Black patients, which warrants further investigation.

Lisa Hatfield and Dr. Demetria Smith-Graziani

Breast cancer expert Dr. Demetria Smith-Graziani from Emory University School of Medicine shared updates about her breast cancer research. “…what we found is that regardless of the type surgery Black women were reporting more severe pain compared to white women, and so that’s what prompted me to engage in my most recent research project…the reason that I’m looking at those specific set of factors is because there are a number of psychological components to the way that we feel pain, such as anxiety, depression and yes trust that are linked to the way that we experience pain and how severe that pain is and how much that pain affects our lives.

Proactive Steps to Improve Breast Cancer Care

Knowledge gained from research studies can be utilized by patient advocates, and actions can be taken to improve breast cancer care and in the evolution of research efforts for all patients. Dr. Smith-Graziani discussed the importance of clinical trials in driving advancements in breast cancer research and treatments. “…all of the current treatments we have that are FDA-approved were approved because of the results from clinical trials that previous patients participated in…And we won’t get any new advancements in breast cancer treatments and come up with even better, more effective treatments, unless we are able to do more clinical trials with more patients. The other part is that in the past, most of the participants of clinical trials have been pretty much the same, they have been mostly white, mostly have insurance, mostly of a higher socioeconomic status, and those patterns continue today, we are still trying to get the patients in clinical trials to reflect the true population of the United States. And in order to know that clinical trials are effective for everybody, we need to have everybody in those trials.”

Dr. Demetria Smith-Graziani

Dr. Smith-Graziani also explained breast cancer subtypes and why it’s vital for patients to learn about their breast cancer subtype. “When we are looking at the cancer cells under the microscope, we look at specific proteins in these cells, and based on what proteins we see, we designate it as positive or negative for the estrogen receptor, the progesterone receptor, or a protein called HER2. When a cancer expresses the estrogen or progesterone receptor, that means that it feeds off of those hormones that your body makes, and that’s why we refer to it as hormone receptor-positive…And it’s important that we know what subtype of breast cancer you have, because it affects the type of treatment that you can get.”

Learning about family history of cancer is also another key to staying proactive in breast cancer care. Dr. Smith-Graziani explained, “So breast cancer definitely can be hereditary, we are aware of some forms of inherited breast cancers, and we have identified certain mutations in genes that are passed down along family lines, that increase the risk of getting breast cancer…ask your family members about their cancer history so that you’re aware of it, and then ask your oncologist if they recommend genetic counseling or testing.”

Another fundamental step in proactive breast cancer care is for patients to ask about their treatment plan. Dr. Smith-Graziani shared advice for patients. “…in addition to potential side effects are how long is my treatment meaning how long am I going to have to stay in the infusion center if I’m getting an IV medication? Or how many months of treatment do I need to get? And then how much time do I need to take off of work? Am I going to be able to work while getting my treatment, so it’s those little things which aren’t so little that are important to discuss, so that the patients can get the best overall picture about how each treatment will affect them in the short and the long term.”

Dr. Smith-Graziani stressed the value of getting your questions answered and also the value of additional expert opinions. “I think it’s important for patients to be as informed as possible to make sure that they are getting all of their questions answered by their doctor, and if you don’t feel like your questions are getting answered, if you don’t feel like your concerns are being appropriately addressed or acknowledged, please make sure that you get a second or a third opinion and talk to another doctor to see if they can answer your questions.”

[ACT]IVATED Breast Cancer Program Resources

The [ACT]IVATED Breast Cancer program series informs, empower, and engage both the overall community and breast cancer patient groups who experience health disparities. The series includes the following resources:

[ACT]IVATED Expert Interviews

[ACT]IVATED Resources

Though there are breast cancer disparities, patients and care partners can be proactive in educating themselves to help ensure optimal care. We hope you can take advantage of these valuable resources to aid in your breast cancer care for yourself or for your loved one.

[ACT]IVATION Tip:  

By texting EMPOWER to +1-833-213-6657, you can receive personalized support from PENs Empowerment Leads. Whether you’re a breast cancer patient, or caring for someone who is, PEN’s Empowerment Leads will be here for you at every step of your journey. Learn more.


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What Treatments Are Available for HER2-Positive Metastatic Breast Cancer?

What Treatments Are Available for HER2-Positive Metastatic Breast Cancer? from Patient Empowerment Network on Vimeo.

What are the differences between HR-positive and HER2-negative metastatic breast cancer? Expert Dr. Demetria Smith-Graziani gives a clear breakdown around the differences and encourages patients to  ask what the available standard treatments are for HER2-positive metastatic breast cancer.

Demetria Smith-Graziani, MD, MPH is an Assistant Professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. Learn more about Dr. Smith-Graziani.

[ACT]IVATION TIP

“…ask about the HER2 status of your breast cancer and ask about what the available standard treatments are for HER2-positive metastatic breast cancer, as well as potential clinical trial options.“

Download Guide  |   Descargar Guía en Español

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Related Resources:

Practical Questions About Breast Cancer Treatment Patients Should Ask

Practical Questions About Breast Cancer Treatment Patients Should Ask

An Overview of Breast Cancer Subtypes | Tips for Being Proactive

An Overview of Breast Cancer Subtypes | Tips for Being Proactive

The Role of Immunotherapy for Metastatic Breast Cancer or Relapse
 

Transcript:

Lisa Hatfield:

Dr. Smith, can you explain the difference between HR-positive and HER2-negative metastatic breast cancer? And what promising treatments are available for those types of cancer?

Dr. Demetria Smith-Graziani:

So when we look at the cancer cells under the microscope, we test for different proteins, and one of those proteins is called HER2. Breast cancers that overexpress the HER2 protein are considered to be HER2-positive, and those do not have this overexpression are considered to be HER2-negative.  

For metastatic or stage IV breast cancer, cancers that are HER2-positive, have the option of being treated with HER2-targeted therapy, and that means that we have certain drugs that will seek out the cancer cells that are expressing these HER2 proteins bind to those cells and deliver treatments to those cancer cells that destroy those cancer cells in a more targeted fashion than traditional chemotherapy that tends to destroy all rapidly dividing cells equally.

So my activation tip for patients is ask about the HER2 status of your breast cancer and ask about what the available standard treatments are for HER2-positive metastatic breast cancer, as well as potential clinical trial options. 


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Pain Outcomes Among Black Women With Early Stage Breast Cancer After Mastectomy

Pain Outcomes Among Black Women With Early Stage Breast Cancer After Mastectomy from Patient Empowerment Network on Vimeo.

What do studies show about early breast cancer after mastectomy in Black women? Expert Dr. Demetria Smith-Graziani explains research into discrimination, trust, and pain outcomes in this patient group.

Demetria Smith-Graziani, MD, MPH is an Assistant Professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. Learn more about Dr. Smith-Graziani.

Download Guide  |   Descargar Guía en Español

See More from [ACT]IVATED Breast Cancer

Related Resources:

Is My Breast Cancer Hereditary?
 
Breast Cancer Staging | An Expert Explains
 
Emerging Treatments In Breast Cancer: Are Antibody Drug Conjugates Here to Stay?
 

Transcript:

Lisa Hatfield:

Dr. Smith, you’ve done extensive research in this area. Can you talk a little bit about your recent research investigating the association between discrimination, trust, and pain outcomes among Black women with early stage breast cancer after mastectomy?

Dr. Demetria Smith-Graziani

Sure, so I am very passionate about racial, ethnic and socioeconomic disparities in breast cancer risk treatment and outcomes, and most recently, I’ve been doing research looking at disparities in pain outcomes, so unfortunately, it’s well-documented that Black patients as a whole and women, and then particularly Black women, often have their pain not properly assessed and then not properly treated compared to their white counterparts. So I initially looked at a study of women who were undergoing different types of breast surgery, we compared women who were either getting what we call breast-conserving surgery, which is also called a lumpectomy, compared to those who were getting their entire breast removed, mastectomy.

Compared to those who were getting both breasts removed, what they call a bilateral mastectomy, and we looked at how much pain patients had after that surgery, how long it lasted, and other factors that were associated with their pain and how they felt after surgery. Now what we found is that regardless of the type surgery Black women were reporting more severe pain compared to white women, and so that’s what prompted me to engage in my most recent research project, in which I am looking at the association between perceived discrimination in the healthcare setting, trusting one’s healthcare provider and pain outcomes, particularly the severity of pain and how much that pain interferes with one’s life for Black women after they’ve had a mastectomy surgery to remove the entire breast for the treatment of their breast cancer.

So I have recruited some patients, and I am in the process of getting ready to enroll more patients on this study, and I’m hoping to get some good information about whether or not that discrimination that people receive in the healthcare setting affects the way that…how much their pain interferes with their life and how severe their pain is, and whether part of the reason that the discrimination affects their pain is related to the amount of trust that they have in their oncologist or their oncology team. And the reason that I’m looking at that specific…the reason that I’m looking at those specific set of factors is because there are a number of psychological components to the way that we feel pain, such as anxiety, depression and yes trust that are linked to the way that we experience pain and how severe that pain is and how much that pain affects our lives. 


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How Advancements in Breast Cancer Are Driven by Clinical Trials

How Advancements in Breast Cancer Are Driven By Clinical Trials from Patient Empowerment Network on Vimeo.

Breast cancer clinical trials are a treatment option, but what do patients need to know? Expert Dr. Demetria Smith-Graziani explains the importance of clinical trial participation and shares advice for patients considering clinical trials.

Demetria Smith-Graziani, MD, MPH is an Assistant Professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. Learn more about Dr. Smith-Graziani.

[ACT]IVATION TIP

“…ask your oncologist, ‘Are there any clinical trials that’d be a good fit for me?’ And if they mention some trials, I would ask for a copy of the consent form to read over it, which they need to provide to you anyway, and take so time to read over it on your own and ask any questions that come up so that you completely understand what the clinical trial involves, if there are any cost to the trial, how much time you would have to spend in the clinic or in a hospital getting this special treatment under the trial, and any other concerns that you might have about the trial.”

Download Guide  |   Descargar Guía en Español

See More from [ACT]IVATED Breast Cancer

Related Resources:

Breast Cancer Staging | An Expert Explains
 
What is Node-Positive and Node-Negative Breast Cancer?
 
Noted Racial, Ethnic, and Socioeconomic Disparities In Breast Cancer Outcomes

Noted Racial, Ethnic, and Socioeconomic Disparities In Breast Cancer Outcomes 


Transcript:

Lisa Hatfield:

Why is clinical trial participation so important in breast cancer? And what advice do you have for patients considering a clinical trial?

Dr. Demetria Smith-Graziani:

So clinical trials are vitally important to advancements in breast cancer treatments, all of the current treatments we have that are FDA-approved were approved because of the results from clinical trials that previous patients participated in.

And we won’t get any new advancements in breast cancer treatments and come up with even better, more effective treatments, unless we are able to do more clinical trials with more patients. The other part is that in the past, most of the participants of clinical trials have been pretty much the same, they have been mostly white, mostly have insurance, mostly of a higher socioeconomic status, and those patterns continue today, we are still trying to get the patients in clinical trials to reflect the true population of the United States. And in order to know that clinical trials are effective for everybody, we need to have everybody in those trials. So for patients who are considering a clinical trial, my activation tip is to ask your oncologist, “Are there any clinical trials that’d be a good fit for me?” And if they mention some trials, I would ask for a copy of the consent form to read over it, which they need to provide to you anyway, and take so time to read over it on your own and ask any questions that come up so that you completely understand what the clinical trial involves, if there are any cost to the trial, how much time you would have to spend in the clinic or in a hospital getting this special treatment under the trial, and any other concerns that you might have about the trial. 


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Noted Racial, Ethnic, and Socioeconomic Disparities In Breast Cancer Outcomes

Noted Racial, Ethnic, and Socioeconomic Disparities In Breast Cancer Outcomes from Patient Empowerment Network on Vimeo.

What are breast cancer disparities? Expert Dr. Demetria Smith-Graziani explains notable disparities seen in breast cancer risks, treatments, and outcomes – and questions for patients to ask their doctor to help ensure their best care. 

Demetria Smith-Graziani, MD, MPH is an Assistant Professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. Learn more about Dr. Smith-Graziani.

[ACT]IVATION TIP

“…have an open and honest discussion with your physicians about the, your particular breast cancer risk and about the specific treatment recommendations that you receive, why you’re receiving those recommendations, and how people who get those treatments usually do.”

Download Guide  |   Descargar Guía en Español

See More from [ACT]IVATED Breast Cancer

Related Resources:

What is High-Risk Breast Cancer?
 
How Does Hormone Therapy Impact Breast Cancer Treatment?
 
What Treatments Are Available for HER2-Positive Metastatic Breast Cancer?

What Treatments Are Available for HER2-Positive Metastatic Breast Cancer?


Transcript:

Lisa Hatfield:

Dr. Smith, what are the noted racial, ethnic, and socioeconomic disparities seen in breast cancer risk, treatment, and outcomes?

Dr. Demetria Smith-Graziani:

So a lot of work has been done over the years to really understand more about disparities in breast cancer. When it comes to breast cancer risk, we know that while white women are more likely in United States to be diagnosed with breast cancer, Black women are more likely to die from breast cancer. Black women also have a higher risk of triple-negative breast cancer, which is known to be a more aggressive form of breast cancer, and Black women are diagnosed on average at a younger age compared to white women.

When it comes to disparities in treatment and outcomes, we can see that a lot of what affects the type of treatment that you receive and how you end up doing after that treatment are related to not only your race or ethnicity, but also your income, your insurance status, what zip code you live in, and other social factors and structural factors in our country, it’s really important that both patients and providers are aware of the disparities and the causes, because it’s up to all of us, but especially those in the healthcare system, to think about the ways that we can address them.

So, my activation tip for patients is to be aware of the fact that these disparities exist and to have an open and honest discussion with your physicians about the, your particular breast cancer risk and about the specific treatment recommendations that you receive, why you’re receiving those recommendations, and how people who get those treatments usually do. 


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Emerging Treatments in Breast Cancer: Are Antibody Drug Conjugates Here to Stay?

Emerging Treatments In Breast Cancer: Are Antibody Drug Conjugates Here to Stay? from Patient Empowerment Network on Vimeo.

What’s the latest breast cancer news from research studies? Expert Dr. Demetria Smith-Graziani shares research updates she’s most excited about and proactive advice for patients to stay knowledgeable about care options. 

Demetria Smith-Graziani, MD, MPH is an Assistant Professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. Learn more about Dr. Smith-Graziani.

[ACT]IVATION TIP

“...ask their oncologist what the recent updates in medical advancements and oncology treatments are.”

Download Guide  |   Descargar Guía en Español

See More from [ACT]IVATED Breast Cancer

Related Resources:

Eliminating Disparities in Breast Cancer | Tips for Navigating Inequities
 
The Role of Immunotherapy for Metastatic Breast Cancer or Relapse
 
What Treatments Are Available for HER2-Positive Metastatic Breast Cancer?

What Treatments Are Available for HER2-Positive Metastatic Breast Cancer?


Transcript:

Lisa Hatfield:

Dr. Smith, what breast cancer data or studies are coming out of major medical conferences like ASCO that you’re most excited about? And can you speak to the challenge and promise or hope of these emerging treatments?

Dr. Demetria Smith-Graziani:

Sure, so it’s been a really exciting past few years for breast cancer, there have been a lot of new treatments that have developed quite recently, I am particularly excited about hearing about the newest, what we call antibody drug conjugates, and those are medications that have an antibody that can bind to specific proteins found on cancer cells, so they can target cancer cells. But they also have chemotherapy attached to them, and that way they’re able to deliver that chemotherapy specifically to the cancer cells in a more targeted fashion as opposed to delivering chemotherapy to all the cells in your body. 

We’ve already had a number of approvals for very effective antibody drug conjugates for different types of breast cancer, and I look forward to seeing newer versions of antibody drug conjugates and also new uses for already existing antibody drug conjugates.  I’m also excited to see what new information we have about ways to reduce or eliminate disparities in breast cancer outcomes, because we have done a lot in recent years of describing the issues with disparities, of acknowledging that they exist, but what’s still left to be done is figuring out what are the best strategies to actually get rid of those disparities. So I’m looking forward to seeing what people propose as possible solutions to that problem, and my activation tip for patients is to ask their oncologist what the recent updates in medical advancements and oncology treatments are. 


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The Role of Immunotherapy for Metastatic Breast Cancer or Relapse

The Role of Immunotherapy for Metastatic Breast Cancer or Relapse from Patient Empowerment Network on Vimeo.

Breast cancer treatment may involve immunotherapy or targeted therapy, but what do patients need to know? Expert Dr. Demetria Smith-Graziani discusses the roles of immunotherapy and targeted therapy and shares questions for patients to ask their doctor about immunotherapy.

Demetria Smith-Graziani, MD, MPH is an Assistant Professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. Learn more about Dr. Smith-Graziani.

[ACT]IVATION TIP

“…ask your oncologist about the standard of care or clinical trial options for the use of immunotherapy for your cancer, and if it would be beneficial to do any testing on your cancer to assess the benefit of immunotherapy.”

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See More from [ACT]IVATED Breast Cancer

Related Resources:

How Is Breast Cancer Explained to Newly Diagnosed Patients?
 
Emerging Treatments In Breast Cancer: Are Antibody Drug Conjugates Here to Stay?
 
Pain Outcomes Among Black Women with Early Stage Breast Cancer After Mastectomy

Pain Outcomes Among Black Women with Early Stage Breast Cancer After Mastectomy


Transcript:

Lisa Hatfield:

Dr. Smith, what is the role of immunotherapy or targeted therapy in breast cancer, specifically those whose cancer has relapsed or is in advanced stages?

Dr. Demetria Smith-Graziani:

Currently, we are using immunotherapy mostly for triple-negative breast cancer, for early stage breast cancer, that is not stage IV breast cancer,  we use immunotherapy sometimes in combination with chemotherapy for higher risk, triple-negative breast cancers to help reduce the risk of it coming back in the future.

We also use immunotherapy for metastatic or stage IV triple-negative breast cancer, specifically those cancers that are positive for a protein called PD-L1, we are also doing a number of clinical trials across the country and the world to figure out other situations in which we can use immunotherapy, whether without chemotherapy to treat other types of breast cancer, and my activation tip for patients is ask your oncologist about the standard of care or clinical trial options for the use of immunotherapy for your cancer, and if it would be beneficial to do any testing on your cancer to assess the benefit of immunotherapy.


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Is My Breast Cancer Hereditary?

Is My Breast Cancer Hereditary? from Patient Empowerment Network on Vimeo.

What do breast cancer patients need to know about hereditary breast cancer? Expert Dr. Demetria Smith-Graziani explains hereditary breast cancer and genetic testing and shares questions for patients to ask their doctor and family members.

Demetria Smith-Graziani, MD, MPH is an Assistant Professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. Learn more about Dr. Smith-Graziani.

[ACT]IVATION TIP

“…ask your family members about their cancer history so that you’re aware of it, and then ask your oncologist if they recommend genetic counseling or testing.”

Download Guide  |   Descargar Guía en Español

See More from [ACT]IVATED Breast Cancer

Related Resources:

Breast Cancer Staging | An Expert Explains
 
How Advancements in Breast Cancer Are Driven By Clinical Trials
 

Transcript:

Lisa Hatfield:

Dr. Smith, can breast cancer be hereditary? And should patients suggest that their family members undergo genetic testing?

Dr. Demetria Smith-Graziani

So breast cancer definitely can be hereditary, we are aware of some forms of inherited breast cancers, and we have identified certain mutations in genes that are passed down along family lines, that increase the risk of getting breast cancer, people who have a significant family history of breast cancer or certain other cancers such as prostate cancer, pancreatic cancer, melanoma or ovarian cancer. They may have a higher risk of getting breast cancer in the future.

And so, my activation tip for patients is to ask your family members about their cancer history so that you’re aware of it, and then ask your oncologist if they recommend genetic counseling or testing.


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How Does Hormone Therapy Impact Breast Cancer Treatment?

How Does Hormone Therapy Impact Breast Cancer Treatment? from Patient Empowerment Network on Vimeo

For breast cancer patients who have been on hormone therapy, what do they need to know? Expert Dr. Demetria Smith-Graziani explains how hormone therapy works, when it’s  most often used in the treatment process, and recommended questions for patients to ask their doctor.

Demetria Smith-Graziani, MD, MPH is an Assistant Professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. Learn more about Dr. Smith-Graziani.

[ACT]IVATION TIP

“…ask how long their formal and therapy is recommended and what potential side effects there are of their treatment.”

Download Guide  |   Descargar Guía en Español

See More from [ACT]IVATED Breast Cancer

Related Resources:

An Overview of Breast Cancer Subtypes | Tips for Being Proactive
 
Pain Outcomes Among Black Women with Early Stage Breast Cancer After Mastectomy

Pain Outcomes Among Black Women with Early Stage Breast Cancer After Mastectomy


Transcript:

Lisa Hatfield:  

Dr. Smith, many women are on or have been on hormone therapy. How does hormone therapy play into breast cancer treatment?

Dr. Demetria Smith-Graziani:

Okay, so for breast cancers that feed off hormones in your body, specifically breast cancers that are positive for the estrogen and progesterone receptors, we use anti-estrogen therapy to treat the breast cancer. And these are medications that lower the amount of estrogen in your body so that it no longer provides that food source to be cancer cells, and they will not grow and develop in the same way as if there is estrogen present.

We usually use this hormone therapy or anti-estrogen therapy after you’ve had treatment such as surgery or radiation or chemotherapy, and we usually keep patients on those medications for anywhere from five to 10 years to help reduce the risk of their breast cancer coming back up to 50 percent.

We also use hormone therapy for patients with stage IV or metastatic breast cancer as part of their long-term treatment, so my activation tip for patients is to ask how long their formal and therapy is recommended and what potential side effects there are of their treatment.


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An Overview of Breast Cancer Subtypes: Tips for Being Proactive

An Overview of Breast Cancer Subtypes: Tips for Being Proactive from Patient Empowerment Network on Vimeo.

Breast cancer has various subtypes, but what do patients need to know about them? Expert Dr. Demetria Smith-Graziani shares an overview of breast cancer subtypes, what is examined in each type, treatments for some subtypes, and advice for patients to be proactive. 

Demetria Smith-Graziani, MD, MPH is an Assistant Professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. Learn more about Dr. Smith-Graziani.

[ACT]IVATION TIP

“.. ask, what subtype of breast cancer do I have, and what kinds of treatment would I expect with the subtype of breast cancer?”

Download Guide  |   Descargar Guía en Español

See More from [ACT]IVATED Breast Cancer

Related Resources:

Eliminating Disparities in Breast Cancer | Tips for Navigating Inequities
 
Is My Breast Cancer Hereditary?
 
Noted Racial, Ethnic, and Socioeconomic Disparities In Breast Cancer Outcomes

Noted Racial, Ethnic, and Socioeconomic Disparities In Breast Cancer Outcomes


Transcript:

Lisa Hatfield:

What are the various subtypes of breast cancer?

Dr. Demetria Smith-Graziani:

So we tend to think of breast cancer as being either hormone receptor-positive and HER2-negative, or hormone receptor-positive and HER2-positive or hormone receptor-negative and HER2-positive, or what we call triple-negative. Now, that’s really confusing. So let me take a step back. When we are looking at the cancer cells under the microscope, we look at specific proteins in these cells, and based on what proteins we see, we designate it as positive or negative for the estrogen receptor, the progesterone receptor, or a protein called HER2. When a cancer expresses the estrogen or progesterone receptor, that means that it feeds off of those hormones that your body makes, and that’s why we refer to it as hormone receptor-positive.

When your breast cancer over expresses a particular protein called HER2 that allows us to target your cancer with certain treatments that target HER2-positive cells. When a breast cancer is triple-negative, that means that it is negative for all three of those proteins, it does not have the estrogen receptor, the progesterone receptor, or the HER2 protein. 

And it’s important that we know what subtype of breast cancer you have, because it affects the type of treatment that you can get. So my activation tip is that patients should ask, “What subtype of breast cancer do I have, and what kinds of treatment would I expect with the subtype of breast cancer?”


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What Is Node-Positive and Node-Negative Breast Cancer?

What is Node-Positive and Node-Negative Breast Cancer? from Patient Empowerment Network on Vimeo.

Node-positive and node-negative breast cancer are two types, but what do patients need to know about them? Expert Dr. Demetria Smith-Graziani explains the difference between the types and recommends questions for patients to ask their doctor.

Demetria Smith-Graziani, MD, MPH is an Assistant Professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. Learn more about Dr. Smith-Graziani.

[ACT]IVATION TIP

“…ask, ‘What stage of breast cancer do I have, where has my breast cancer spread?’”

Download Guide  |   Descargar Guía en Español

See More from [ACT]IVATED Breast Cancer

Related Resources:

The Role of Immunotherapy for Metastatic Breast Cancer or Relapse
 
What is High-Risk Breast Cancer?
 
What Treatments Are Available for HER2-Positive Metastatic Breast Cancer?

What Treatments Are Available for HER2-Positive Metastatic Breast Cancer?


Transcript:

Lisa Hatfield:

What is node-positive and node-negative breast cancer, and how does this impact breast cancer staging?

Dr. Demetria Smith-Graziani:

A Great question. So when breast cancer starts, it starts in the cells of the breast, usually the first place that it spreads to after it leaves the breast, are what we call lymph nodes that are under the arm or sometimes in the chest, and when we say that cancer is node-positive it means that we have found evidence of cancer cells in those lymph nodes.

Node-negative breast cancer is cancer that has just been found in the breast, and you don’t see any evidence of it in the lymph nodes. So my activation tip for patients is you should ask, “What stage of breast cancer do I have, where has my breast cancer spread?”


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Breast Cancer Staging: An Expert Explains

Breast Cancer Staging: An Expert Explains from Patient Empowerment Network on Vimeo.

What do breast cancer patients need to know about staging? Expert Dr. Demetria Smith-Graziani explains breast cancer staging, parts of the body that can be involved, and recommended questions for patients to ask their doctor.

Demetria Smith-Graziani, MD, MPH is an Assistant Professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. Learn more about Dr. Smith-Graziani.

[ACT]IVATION TIP

“…ask what stage your breast cancer is, ask if it is potentially curable and also ask what the risk is of your breast cancer coming back after it’s treated.”

Download Guide  |   Descargar Guía en Español

See More from [ACT]IVATED Breast Cancer

Related Resources:

Is My Breast Cancer Hereditary?
 
Pain Outcomes Among Black Women with Early Stage Breast Cancer After Mastectomy

Pain Outcomes Among Black Women with Early Stage Breast Cancer After Mastectomy


Transcript:

Lisa Hatfield:

Dr. Smith, a cancer diagnosis can be overwhelming, it is overwhelming. Can you speak to staging, and more specifically, what is early breast cancer, or EBC?

Dr. Demetria Smith-Graziani:

Sure. So we assign breast cancer a stage from zero to IV, and that’s based on the size of the cancer itself and whether that cancer has spread to other parts of the body, as well as other factors like how the cells look under the microscope and what proteins we see in the cancer or cells. So we consider early stage breast cancer to be any stage that is lower than stage IV, so to zero through IV, stage zero breast cancer is also called DCIS which stands for ductal carcinoma in situ, and that means that the cancer cells are just in the milk ducts and have not spread beyond those milk ducts.

Stage I, II and III, cancers are spread beyond the milk ducts to the surrounding breast tissue, and they may have also spread to the lymph nodes under the arm or in the chest, and the higher stage breast cancer you have, the higher that number, the higher the risk is of your breast cancer coming back after the treatment is completed.

Now, stage IV breast cancer is cancer that started in the breast but has spread to other distant organs like the lungs or the liver or the bone, we also call this metastatic breast cancer, stage IV breast cancer, unfortunately, can’t be cured, but we can still treat it. So my activation tip for patients is ask what stage your breast cancer is, ask if it is potentially curable and also ask what the risk is of your breast cancer coming back after it’s treated.


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Eliminating Disparities in Breast Cancer | Tips for Navigating Inequities

Eliminating Disparities in Breast Cancer: Tips for Navigating Inequities from Patient Empowerment Network on Vimeo

How can breast cancer patients and healthcare providers advocate for underrepresented  patients? Expert Dr. Demetria Smith-Graziani discusses how some providers are working to reduce care disparities and shares patient advice to help ensure optimal care.

Demetria Smith-Graziani, MD, MPH is an Assistant Professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. Learn more about Dr. Smith-Graziani.

[ACT]IVATION TIP

“…get your list of questions together about your concerns about your diagnosis and your treatment, and if you are feeling like you’re not heard, look for other doctors to talk to to get a second opinion.”

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Related Resources:

Practical Questions About Breast Cancer Treatment Patients Should Ask
 
What is Node-Positive and Node-Negative Breast Cancer?
 
How Advancements in Breast Cancer Are Driven By Clinical Trials
 

Transcript:

Lisa Hatfield:

What are some of the actions being taken to combat or eliminate disparities in breast cancer? How can those in marginalized communities best advocate for themselves?

Dr. Demetria Smith-Graziani:

That’s a great question, and I want to start by saying that the true burden should be on healthcare providers of those within the healthcare system to reduce and eliminate disparities in breast cancer, because patients already have enough to deal with and are receiving discrimination and structural racism from society at large and within the healthcare system. So for providers, it’s important for us to really take a good hard look at our practices with patients, think about the way that we are relating to patients, are we making any assumptions about treatments our patients may or may not want, or may or may not be a candidate for. Are we making those assumptions based on something not related to factual data, like their breast cancer itself or other health problems they have, are we making those assumptions based on their insurance status, based on where they live, based on other social factors like race.

It’s important for us to really reflect on that and think about how we can be more equitable in the way that we deliver our care. It’s also important for us to advocate for our patients to make sure that they are receiving the treatment that they need, and sometimes that means advocating to their insurance company, advocating to our health system, our health care employers advocating to the government to make sure that our patients are all receiving high-quality care no matter where they are, and no matter who they are, now, knowing that we live in this unjust society, what can patients do to navigate these disparities and these inequities.

I think it’s important for patients to be as informed as possible to make sure that they are getting all of their questions answered by their doctor, and if you don’t feel like your questions are getting answered, if you don’t feel like your concerns are being appropriately addressed or acknowledged, please make sure that you get a second or a third opinion and talk to another doctor to see if they can answer your questions.

No oncologist is going to be upset with you getting more information from another oncologist about your treatment options, and it’s important for you to pick the doctor that you are comfortable with, that you have a good relationship with and that you feel like you can speak to honestly, and that will give you honest answers, so my activation tip for patients is to get your list of questions together about your concerns about your diagnosis and your treatment, and if you are feeling like you’re not heard, look for other doctors to talk to to get a second opinion. 


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Practical Questions About Breast Cancer Treatment Patients Should Ask

Practical Questions About Breast Cancer Treatment Patients Should Ask from Patient Empowerment Network on Vimeo.

Breast cancer patients and healthcare providers can be partners in care, but what’s important to discuss? Expert Dr. Demetria Smith-Graziani explains information that she presents to patients and shares common questions that patients ask.

Demetria Smith-Graziani, MD, MPH is an Assistant Professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. Learn more about Dr. Smith-Graziani.

[ACT]IVATION TIP

“…ask why a particular treatment is recommended, what the evidence is behind it, ask about the potential side effects and then ask about how the different treatment options compare if you’re given multiple options.”

Download Guide  |   Descargar Guía en Español

See More from [ACT]IVATED Breast Cancer

Related Resources:

Eliminating Disparities in Breast Cancer | Tips for Navigating Inequities
 
How Does Hormone Therapy Impact Breast Cancer Treatment?
 

Transcript:

Lisa Hatfield:

How do you work with your patients to make treatment decisions? With increasing treatment options, what should breast cancer patients consider when deciding on treatments?

Dr. Demetria Smith-Graziani:

So it’s important that patients are really informed about all of their options, so what I tend to do is review the details of diagnosis and staging, and then after we review that  I provide recommendations based on the national guidelines, and then I also provide recommendations for potential clinical trials that are available at our institution that may be a good fit for the patient, and then we discuss the potential risks and benefits of each option as well as how long each treatment will last and how it might affect their daily lives. 

I think that sometimes patients don’t always know what questions to ask, so I tend to suggest questions that I’ve heard in the past from other patients, and I think a lot of what patients want to know in addition to potential side effects are how long is my treatment meaning how long am I going to have to stay in the infusion center if I’m getting an IV medication? Or how many months of treatment do I need to get?

And then how much time do I need to take off of work? Am I going to be able to work while getting my treatment, so it’s those little things which aren’t so little that are important to discuss, so that the patients can get the best overall picture about how each treatment will affect them in the short and the long term, so my activation tip for patients is ask why a particular treatment is recommended, what the evidence is behind it, ask about the potential side effects and then ask about how the different treatment options compare if you’re given multiple options.


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How Is Breast Cancer Explained to Newly Diagnosed Patients?

How Is Breast Cancer Explained to Newly Diagnosed Patients? from Patient Empowerment Network on Vimeo.

What’s important for newly diagnosed breast cancer patients to know? Expert Dr. Demetria Smith-Graziani shares how she explains breast cancer to her patients and advice to patients to help ensure their optimal care.

Demetria Smith-Graziani, MD, MPH is an Assistant Professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. Learn more about Dr. Smith-Graziani.

[ACT]IVATION TIP

“…ask your doctor about what type of breast cancer you have and what cells that your breast cancer came from.”

Download Guide  |   Descargar Guía en Español

See More from [ACT]IVATED Breast Cancer

Related Resources:

What is High-Risk Breast Cancer?
 
An Overview of Breast Cancer Subtypes | Tips for Being Proactive
 
Noted Racial, Ethnic, and Socioeconomic Disparities In Breast Cancer Outcomes

Noted Racial, Ethnic, and Socioeconomic Disparities In Breast Cancer Outcomes


Transcript:

Lisa Hatfield:

Dr. Smith, how do you explain breast cancer to your newly diagnosed patients, knowing that they probably have heard about breast cancer or may even know somebody who has been impacted by breast cancer, this is your newly diagnosed patient, how do you explain that in detail with them?

Dr. Demetria Smith-Graziani:

So breast cancer starts when normal cells in the body or in the breast develop mutations that are changes in their DNA, and those changes caused them to grow and divide out of control. So the most common types of breast cancer come from the cells in the milk ducts, or the cells in the glands that make milk, and when the cancer starts in the cells of the milk ducts, we call it ductal cancer, when the cancer starts in the cells that make the milk, those glands, we call it lobular cancer. So my activation tip is to ask your doctor about what type of breast cancer you have and what cells that your breast cancer came from.


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