Cancer Treatment Surgery

>> cancer awareness, next, "on call with the prairie doc." >> good evening and welcome to "on call with the prairie doc." dr. holm is off tonight. i am lindsey meyers, former host of this program. it's great to be back with you for an evening. in the united states, breast cancer is the second most common cancer in women after skin cancer. each year, there are about 230,000 new cases in women. with all of the walks, runs and fundraisers that happen around breast cancer, like the avera race which will bring thousands of people together saturday, it's hard not to notice the pink ribbons around us signifying the survivors. but beyond all of the events are the personal stories of people who are touched by breast cancer. the uncertainty of a diagnosis

or the joy of being cancer-free are experienced not only by the patients but by their friends and families as well. breast cancer touches almost all of us in some way. before we introduce our guests tonight, let's take a look at this week's prairie doc quiz question. it is a multiple choice this week. among women who have health insurance, 72% have had a mammogram in the last two years. among those who do not have insurance, the rate is: a - 22% b - 39% c - 44% d - 53% viewers who call in the correct answer will be entered into a drawing to win a signed copy of our book, "the picture of health." each of dr. holm's essays, originally written for this show, comes with a wonderful accompanying photograph by dr. judith peterson.

we will announce the answer and the winner at the end of the show. remember, you only have 10 minutes to get your answer in! we answer your medical questions about breast cancer as they are called in or sent to us via facebook or email. call in questions to 1-888-376-6225 or send us an email to the address on the screen. to begin our program tonight, we have dr. julie reiland with avera medical group comprehensive breast care. and julie's sister, jill machi, who is a breast cancer survivor. thank you both for being here tonight. >> thanks for having us. >> we're excited to have you with us, jill, and we understand you're a survivor and your sister works in this field, so tell me about when you were diagnosed and what happened.

>> sure. interestingly enough, five years ago this week, i was diagnosed with invasive rodular carcinoma. i was 48, had no family history of it. my first phone call was to her because i didn't want to call my husband unless i knew what was going on so we chatted and within three weeks, i was scheduled for bilateral mastectomy, dissection, followed by chemotherapy, radiation, reconstruction, physical therapy and the whole shebang. >> dr. reiland, what was that phone call like for you working in the field? >> well, you know, i think there's something where you feel like if i'm a breast surgeon, then somehow the rest of my family will be protected from this. by doing this and taking care of other people, i can protect my own family so that was kind

of a tough call. but, you know, at the same time, it was i know how to do this so i was -- i'll call you back. i know people. she lives in milwaukee and i knew someone who lived in milwaukee who was actually connected and i started making phone calls and i got her lined up with the people that i thought were going to be the best for her. >> wow. and you really do have to be an advocate when you're going through a cancer journey, wouldn't you agree, jill? >> absolutely. for me the road was pretty well-paved. she called me back within four hours and said here's your surgeon, an option for a plastic surgeon and i was like, julie, what am i going to look like after a mastectomy? i didn't know.

i don't know that a lot of women really do know. and she said give me four hours, i'll send you a powerpoint and she did. she sent me a powerpoint of all her patients who had double mastectomies and i was like, okay, that's what i'm going to look like. all right. let's giddy up and go. >> wow, you have a great attitude going through this. >> it is all about attitude, it is. i mean, i finished treatment and two months later i was training for a triathalon just to show my body who was in charge, so it's just really all about, you know, taking care of yourself and sticking with it and persevering through it. >> so five years, i mean, that's wonderful news. >> it is wonderful. >> so is it frightening when

you go in for your checkups or do you use feel empowered you've made the right choices -- >> i feel i made the right choices. i definitely would not change anything i did. i didn't have a lot of options, i'll a small-breasted woman so it was pretty mandatory that i have a double mastectomy. i didn't have a lot of choices for my health. when you go in, there's always that ahhh, are they going to find anything? the first two years, you know, if my knuckle hurt, i'm like, my god, i have cancer in my knuckle. my oncologist was you're good, jill, you're good. i'm healthy, have a healthy lifestyle and i feel really positive about my long-term outcome and survival rate. >> dr. reiland, your sister had a great champion in you to help her pick a great surgeon.

what do you recommend to patients when they're looking for a care team when they do have a diagnosis like she did? >> i think word of mouth is really important. i think if a woman -- usually, in my experience that once you get breast cancer diagnosis, other women with breast cancer call you immediately and people you never knew had breast cancer will call and say, i had it, this is what you need to do. be careful because some of those women are -- this is what i did, therefore this is what you need to do. everybody's different and everybody has to have a different treatment, but i think if there's something that you feel uncomfortable about or if you're like, yeah, i think i want to get a second opinion, it's always good to say, i need a second opinion. i always tell my patients, if someone tells you that that's

not a good idea, you run from their office because we should all be okay with somebody -- any of our patients needing to have reassurance from someone else, besides us, and it's not about us, it's about them and being comfortable. so if you see someone, you're like i think i better go check something, listen to your inner tuition because that's -- that's actually very, very accurate. so many of my patients had that great in tuition, inner tuition, that great intuition that made them do the things that they did and they made good choices. so listen to that. >> so, you too have had a cooking class last night together so is prevention part of your story, then? >> absolutely. >> being able to change diet and exercise as much as you can? >> absolutely.

i have always been very healthy, always been pretty active because i wanted to. now i am because i need to. i try to do mostly plant-based diet, really try to avoid sugar. i challenge myself a lot with my physical activity. last year i biked 1,000 miles, this year i'm going to bike 1500. now i've said it on tv, i have to do it, right? [ laughter ] but i just -- it's -- to me it's mandatory. i have to eat healthy, i have to maintain a weight, have to keep the fat off, have to keep the sugars out. it's not -- it's mandatory for me, not a choice. >> dr. reiland, has this changed how you approach your patients, going through this journey with your sister? >> absolutely.

she told me things about her recovery and her journey that my patients are probably too shy to tell me so then i was able to open up to my patients and say, you know, how is nipple sensation for you because she shared -- >> don't ever them anymore so how is it? [ laughter ] >> so i was like, oh, my gosh, jill, i've always wondered but i never knew -- because for some women it's really important, for other women, not so important. she helped me by telling me how it worked for her, so i thought i have to start asking my patients this because she needed to have that conversation. there were so many things that she went through that i went, i just didn't think about it as a provider, but now i have my sister who doesn't have any problems tell me anything. [ laughter ]

>> you two are an amazing duo, we're so excited to have you and congratulations on that important anniversary you're celebrating. thanks for being here. we'll have more with you, dr. reiland in a minute. we'll be back after this. >> my cousin veronica was diagnosed with breast cancer when she was 38 and she's just a year older than i am. and my family, there are a total of six women who have been diagnosed with breast cancer. four of those women were under the age of 50 when they were diagnosed. the first person diagnosed was my aunt martha. she was 39 years old and i was 19 years old. then, when another aunt became diagnosed and then another one, it started becoming way too real. i had the conversation about breast cancer before my son was born, but once my kids were

born, everything just amplified, i guess you could say. all of a sudden, now i have children to think of, i have children i want to be there for. now that veronica had cancer and us both having young children, it also made me very aware of how i could possibly be the next person in my family. i started talking to my doctor about it when they were asking me about family history and they found out how many aunts i have with breast cancer. knowing my family history of breast cancer helps me manage my own risk. it can be hard to start this conversation with your family, particularly if they're private. if you have a family member who has a gift about talking to others, maybe you can use them to help relay the information to you. my family history with breast cancer doesn't predict my

future but it does help me make more informed decisions about my future. >> joining julie and me in the studio now to help answer your questions tonight is dr. amy krie with avera medical group oncology and hematology in sioux falls. thank you for being here with us also. >> thanks. >> so, dr. krie, tell me about the prevalence of breast cancer. seems like it's almost everywhere with the races and pink ribbon, but is it more prevalent in south dakota or what do you see as far as rates go? >> we see -- the problems in south dakota is really no different than any other state in the midwest. breast cancer is the most common invasive cancer diagnosed in women in south dakota and, on average per year, we expect somewhere between six and 700 women to be diagnosed with breast cancer in our state.

>> it's such a scary diagnosis that we hear of so often but survivability is very good, is it not? >> right. we tell women for early stage breast cancers, the majority of women are going to have 90 to 95% survivals now, so for most women coming through our clinics, see julie and i, their outcomes are going to be very, very good. there are patients who present with more aggressive cancers and more advanced cancers, and that's when we really like to get our research teams involved because we know there is a chance that those women could have recurrences and we want to do everything we can do for them upfront. >> dr. reiland, is it mostly those more invasive cancers that you see as a surgeon, then? >> well, a lot of times i'm the gatekeeper so once a woman is diagnosed with a lump, she

comes to see us, or she's had a biopsy and then we talk about her options but today, there are so many options that they can have for their initial treatment. it's not always going to be surgery and it's my job to really look at that woman and say, your tumor is the type that you would actually benefit from chemotherapy first. i need to send you to dr. krie. but this is also after we've had our multi-disciplinary conference and talked about that woman as a group so then when i meet her, i've had 15 other docs and we've all had a wonderful discussion about that individual, and then i can say, okay, this is what we think is your best path. and then we get you to the right people. so today it's not surgery first and then do chemo and radiation, it's actually what

figure what that tumor biology is, what makes that tumor aggressive or not aggressive and then make decisions based on that. >> tell me more about that team. you don't hear that very often, that you have 15 doctors that are looking at your cases, is that really the case with patients that come through? >> we actually still present every case of breast cancer at avera and then we have a lot of different outreach sites so we sometimes, if a surgeon has a complicated case in a smaller community, they'll review that case with our team, as well, and sometimes we'll make recommendations and we'll have to come to sioux falls for part of the treatments but we do also open that conference up for people who have other questions. there is a lot -- what will present is sort of the

pathology so our pathologist who do a lot of breast cancer will look at their pathology, give opinions on something we call the -- how aggressive does it look under the microscope. there are certain markers, i'm sure women have heard of estrogen receptor, progesterone receptor, we'll talk about those and present all her breast imaging, her mammograms, if she's had ultrasound or mri. and then the team comes to a consensus as to what is the best approach for that patient, is it surgery upfront, a simple, straightforward breast conservation followed by radiation therapy or is this something that needs to be more involved. >> and you have a multi-disciplinary team of many different perspectives coming together. are there disagreements and how do you work those out sometimes?

>> wonderful disagreements, bus -- well, you know, if you all agree, then everybody gets kind of laid back and they're not -- everybody -- i'm so proud of our group because everyone is so passionate about how they see their job and type the radiologists are very, very passionate about what -- and i'm just as passionate about what i should do so it gets -- never unfriendly but very passionate. [ laughter ] i guess that's a good word. >> i think the best thing about the conference for me that i experience with sort of life through someone else's eyes, so i know what i do and i know what do i very well and i know how to give chemo and pills and i know all about that but looking to see maybe what is dr. reiland thinking when she approaches a patient or what is

the radiologist/oncologist thing before i start the chemo and shrink the tumor that will affect how they later on treat that patient. so probably the best aspect of a comprehensive team like we have is that you also learn what's going to be important for your partners to know so things don't get missed. and that way we're not, you know, julie knows a lot about what i do so by the time that the patient has seen me, julie's sort of gotten all the pieces of the puzzle that i need to do to make decision and i hope vice versa but that perspective is probably one of the best outcomes. >> you have a team that you're working with at avera. when do they get brought into that conversation, then, for patients? >> so dr. leland jones and his team joined us two or three

years ago, i don't know, we're all getting older, but so where genomics comes in, very commonly, is for patients who have stage 4 breast cancer. maybe i should explain what genomics is, first, because that's a buzz worth that i think people maybe don't fully understand. so, genomics is sort of the next level of looking at a cancer. so grade her 2 standard, these are things that are standardly done but what the future holds and what we're doing as part of our genomics research is looking at the genetic changes within a tumor. and so some of those genetic changes will help us to know before we give a treatment that that treatment will or won't work, or at least give us a strong suggestion or some of those genetic changes may tell us that, you know, a certain

treatment or a certain research is going to be better for that patient to enroll on a certain clinical trial because that drug would work for the genetic changes we're seeing in that patient so it's the next dive down in getting very specific about how we treat patients. we've known for a long time that not every chemo works for every patient, that you may have breast cancer that respond to a drug called packsil and you may have a cancer that doesn't. what the genomics are doing is allowing us to predict ahead of time the best combination of treatments and also using a lot more targeted drugs so we can hopefully minimize the side effects that patient is experiencing but keep that tumor under good control. >> wow. would that be standard of care some day with the way that

medicine is moving? >> it really will be, it will be. >> that's exciting. >> what's really exciting is -- i speak about this around the country and when i tell people what we're doing at avera in sioux falls, nobody can believe it. they say, what -- you're doing that in sioux falls? i say, yea, we are. well, we don't think we're going to be able to do that for the next five years, how did you manage this? we just have a great combination of some really talented people that came together and it was the perfect thing. and so we are doing things that no one else in the country is doing right now. >> and dr. reiland, you're travel all over the world to talk about interoperative radiation therapy that you offer. tell me a little bit about that because we'll see more from one

of your patients in a couple minutes >> >> the standard after a patient has breast conservation, let me say, whether you remove your breast and do a mastectomy or have a lumpectomy and radiation, your survival will be the same. i always tell my patients, removing your breast does not guarantee you will live longer, so why not keep the breast? and one of the problems that we have in south dakota is that so many of our women are in the rural areas and getting to radiation which is typically six weeks, five days a week, that's a really long time and a lot of my patients were choosing mastectomy because they wanted to avoid radiation. so interoperative radiation has been around about since 1998 and we now have studies that show for patients who have better behaved or lower grade tumors, that we can give them a

single doze of radiation in the operating room and they don't need any other radiation. so we've eliminated that six weeks. and we are one of ten places in the united states that offer this. most of it is being done in europe, so we are early adopters of another new technology. genomics, interoperative radiation, a lot of really novel and advanced things. >> we're going to talk about all these things at the conference tomorrow, too. >> what conference is that? >> so there is a conference tomorrow for survivors at avera, i don't know if it's too late to register or not. >> no, it's not. >> but all day, actually, different breast cancer topics and geared not towards physicians but actually geared towards patients, so i'll be the 4:00 presentation. we're going to go over a lot of

these new things that we're doing at avera so that will be exciting, but just one other point i wanted to make on your study was that that's one of the reasons i think it's still important to find cancers early. so there's been a lot of debate about mammograms, do you need lot of debate out there and i think right now, the guidelines are left to, you know, a woman needs to discuss things with her physician but one thing that i worry about is that if cancers are detected at later stages when they're larger, you know, even though that might not necessarily change a patient's survival, it is probably going to change the options they have in terms of treatment with you, particularly. >> right, very true. >> because interoperative radiation therapy, there is a size limit, so we really do

like to catch these cancers when they're smaller, when a woman's options are going to be, you know, more. she's going to have more choices. >> wow, there's so much to be hopeful for right now with these new treatment options and we'll have more with you in just a minute. in the past, women from rural areas would sometimes opt for a total mastectomy rather than drive for radiation treatment, due to the amount of travel involved. now, a treatment called intraoperative radiation therapy is allowing women, like terry pearman, to get a dose of radiation during surgery, shortening the amount of radiation treatments needed. here's terry's story. >> it was routine mammogram, actually not quite routine. my doctor in butte had been bugging me every time i would

go in for labs to get medication refilled to get my mammogram and stuff done. and so finally about the second or third time, i said, okay, the make you be quiet, i will go ever it done. so then i scheduled it, got in. that was probably in early february. >> terry was diagnosed with a very well-behaved breast cancer. it was small and it certainly was small enough that we were not very concerned about it having spread. so she's an excellent candidate for -- she has a great prognosis, very high chance that she will never be bothered with breast cancer again once her treatments are completed. i do believe that interoperative radiation with electrons is going to be the best treatment that we have for women for breast cancer. so 40 to 60 is where we're

going to want to give those woman a boost of radiation in the operating room and then also give them additional radiation to the whole breast after their surgery. especially for those women who have stage 1 and stage 2 disease. so those are smaller actual tumors and women in their 60s, they're perfect for this. we're going to single doze, so they'll get one doze of radiation in the operating room, make a breast lift, make them look nice and they're done and all they have to do is talk to the medical oncologist, do they need a pill or chemo but their surgery and radiation will be completed in one day. but that day that they told me i had a choice between rapid city, bismarck, north dakota, sioux falls and rare cases mayo clinic in minneapolis, and we're kind of pushing the --

you have to give an answer take day and i couldn't do it. the most information i found was in the sioux falls website. i downloaded a bunch of that that was able to describe everything i was possibly going through, that i was feeling, i knew it was okay to be feeling all of that but it was also enough information that i could pass it on to my husband and my son. so they knew when i was going through and they were knowing what to expect. >> and for her, she actually is very clever woman. she really researched us. she found us online, there were about seven facilities that she looked into and felt that we had the most to offer for her, so she came here. so we definitely, what we'll do when she comes to see us is get her mammograms and -- on the same day.

she'll also see her medical oncologist so every time they come, we do everything in that day. sometimes it's a day or two and they just have to spend the night but to them, it's worth it because now they're done and now they go home for six months. >> i have absolutely no regrets. if i could have everybody know that it's battling breast cancer, come here. it would be -- it would be so much better, i believe. >> the best part about my job is my patients when they come back and six months down the road, they're done with their treatments, they feel good, their breasts look nice, they say, boy, you can't even tell that i had surgery because they look so good. to me, that's the most rewarding part. [music]

>> this is your show and your questions are key to our discussion. call in your questions about breast cancer to 1-888-376-6225, or send us an email to ask@prairiedoc.org. well, that was a really interesting segment and we got to come into surgery with you for that. so -- but you also do a procedure called oncoplasty. tell me what that is? >> oncoplastic surgery is where we remove the cancer, number one. we have to remove the cancer and do that very well and the second part is we use -- we take out the cancer through plastic surgery incisions, the same ones that a woman would have if she wanted to have a breast lift or a breast reduction. and so since i have to go in and take out the breast cancer anyway, why don't i do it

through these sorts of incisions and then after i remove the cancer, i can reshape the breast, close up the breast again and now you have a breast that is more firm and somewhat uplifted and has a much better appearance than perhaps even before your surgery. >> i've talked to some of your patients who have said it's better afterwards which was surprising to me, you don't always hear that, especially when women have gone through a breast cancer journey like that. >> oncoplastic surgery is having a hard time getting a foothold. there are very few surgeons in the country who actually do this. most surgeons when you have a breast cancer, they make an incision right over the tumor and go down into the tissue and take it out and then they close the skin.

and after everything heals, you get a dent and then after radiation, that caves in and then you have puckers and it's very disfiguring. so oncoplastic surgery avoids that in a lot of many great ways, and it's just a wonderful opportunity. it's now starting to gain some speed and i teach that to other surgeons around the country, as well, which is really exciting because i can only operate on so many people but if i can teach someone else how to do this, then i have affected a lot more women. >> dr. krie, you see these women right away while they're going through the decision-making time. do you have women who are struggling with what to do and how do you guide them through that? >> sure, sure. so julie and i -- julie

probably more than i partake in this discussion and i think it's a choice, a hard choice, take the hard part or the sort of hard part. there's no good option. when women are faced with a diagnosis of breast cancer, kinds of the first decision they often come to is what surgery to have and i think sometimes out of fear more than anything, women are -- tend to say get it off, it has cancer in it, get it off me. what we know is for mastectomy, there is a little bit higher chance of complications, particularly if a woman needs to get plastic surgery so there are some women who have to have mastectomies. so there are some women who inherit genetic changes so they have strong family histories of cancer. angelina jolie i think is probably the most well known

and those women have a 30% chance of getting another cancer in the next 10 to 15 years, so for those women, mastectomies make sense. for other women, it's a matter of we can't image them very well or maybe their tumor is larger but they have very small breast size so no matter how good julie is, there's no way that we can kind of fix the fact that that breast would be a lot smaller. but that's really kind of the minority of women so the majority of women we see have small not aggressive cancers. they're over the age of 50, they do not have strong family histories and there's really no need, i think, in most circumstances to undergo a mastectomy when a smaller surgery is going to give them equal outcomes, and another thing that people i think

think, you know, that's just cancer in the breast. the real issue is preventing cancer from coming back if the body, so removing both your breasts does not change the chance that breast cancer showing up in your lung or liver. it also doesn't get you out of, you know, if we need to do chemotherapy, we need to do chemotherapy. it doesn't matter whether you do a lumpectomy or mastectomy, that's not going to change my decision on the chemo or the pill treatments. for me, it doesn't matter which breast surgery you do, those are going to be the same because those are based on your cancer's biology and wanting to -- biology and wanting the cancer to spread to other organs. >> so you can do the conservation therapies and still have the same outcome. >> absolutely.

we've shown it for the past 40 years, it hasn't changed. >> you mentioned angelina jolie and that got a lot of press this year. so that seems very radical, for a woman to have mastectomy about that. tell me about that genetic piece. >> so we'll just talk about b-- brca, because this is an hourlong conversation on its own and i talk a lot, obviously. brca, i think of it as the mechanics of your dna or your genetic code. so as we age and our cells divide, that genetic code has to divide, too, and mistakes happen during those divisions. if you have a problem with your brca gene or your brca gene is mutated, like angelina jolie's was, then your mechanic is sort of out to lunch. so you get a lot of genetic changes in your cells very early on.

and that predisposes to very early age onset of aggressive types of breast cancers and ovarian cancer. so if i have the brca gene, and i just found out today if i was brca 1 positive, i would know that my chance of getting breast cancer in my lifetime was probably around 80%. and my chance of getting ovarian cancer is probably, i think the latest statistics are around 60%. >> wow. >> so those are much higher than anyone else in the population. you know, everyone else is down the 11, 12%, so for those women, it's sort of when they're going to get cancer and still, even with the gene, not all of our patients opt to have mastectomies, some choose aggressive screening protocols but that is a step that some women certainly do take and

it's understandable. i think the key that dr. reiland and i always want people to know, though, is that the vast majority of our patients don't have these genetic changes. so the majority of the patients coming into our clinic have no family history at all because one of the things i hate to hear is, well, i didn't get mammograms simply because there's no breast cancer in my family, and for most of our patients, there isn't. so the women who have thighs strong family histories need to be aware, they need to talk to their doctors about seeing dr. reiland or seeing a geneticist, but women who don't have family histories can still get breast cancer and that's a really key message, i think. >> well, when my patients say i didn't think i could get breast

cancer, it's not in my family, i say, welcome to 85%. 85% of women would get breast cancer do not have a family history. only 10 to 15% of women have a genetic mutation that predisposes them to breast cancer, so the majority of women need to have screening and would benefit from that because there's not -- there's not the family that's going on, they're not increased surveillance because of a family history, they're being women and that's why we think it's so important that mammograms are done on a regular basis, for everyone. >> i know women may have -- i know one thing i wanted to talk about tonight was women may have a lot of questions about mammograms because i think there's been a lot of press, right? so one year versus two years versus which one should we do,

and very, very bright people have huge debates about the frequency of doing mammograms and the issues are, when you're younger, you know, mammograms are a little bit harder to read and when you're older, you tend to get, you know, somewhat slower-growing cancers, but those rules don't apply across the board. i think we can debate that. what i actually see is a very large number of patient unfortunately who haven't had a mammogram for five years, six years, so the debate about yearly versus every other year sometimes i think doesn't apply because we still have so much of our population that either have never had one or certainly haven't had one in the last two to five years. >> what age should women get mammograms, because that's very controversial right now.

>> yeah, i still believe in the age of 40. that's what i did. so i do yearly mammograms since the age of 40, and my reasoning to some degree, because i have no family history but my reasoning is, i think that -- i'm willing to put myself through the risk if i have a false alarm, and i've had false alarms, i've been called back, dr. reiland has to order my follow-up, it very anxiety-provoking and when they're making the screening recommendations, one of the things they look at is, you know, you have a lot of anxiety when you get called back, that your mammogram might not be quite normal and we want to take a second look. i was already planning who's going to raise the kids, i have a list for my husband and all i had was a little bit of an abnormality that needed a

second look. but that's the issue, you know, but what i say is young women do tend to get, on average, those faster-growing cancers, the more aggressive cancers and if i can pick those up as an oncologist early, it's that kind of cancer that's aggressive, i have such better odds of curing that patient and that's why sort of why i do my mammograms more frequently. >> and some women do have difficulty with mammograms, they might have dense breasts and we have a 40-year-old from rapid city who is wondering about mammograms for women with dense breasts. what do you recommend there? >> the 3d mammogram is the new one that's out and that's shown to be much better at looking at dense breast tissue but even though they're really difficult sometimes, so at avera we have

a new thing called a contrast enhanced spectro mammography and i call it a mammogram on steroids. what you do is, it's like an mri, which is a very complex test where you have to lay in a tube with your arms over your head for an hour and they take 4,000 pictures. the enhanced spectro mammography is like an mri, they inject you with dye and then take the mammogram again. cancer cells will take up the dye much faster than normal cells so when we have someone with dense breasts, meaning there's all white in the breast tissue, cancer is white, breasts are whites, you can't see the cancers. but when we do contrast enhanced, only the tissues that have more activity will turn white so everything else is dark. so if we have a woman with dense breasts and do a

mammogram with contrasts, and her breasts are all dark, she doesn't have anything in all those white splotches or all that density. >> wonderful. >> so, yes, that's how -- and it's a wonderful tool for us. >> really important thing, i think, for women to also know is that just because your mammogram's normal, if you feel a lump, that one's not okay. so we hear women come in and they say i had this lump or i had a skin change or a puckering or nipple discharge, i had some sign that i was kind of worried about but when the mammogram was normal, i was reassured so i didn't follow through with it. you know, and then you pick it up another 12 months, 24 months later, so especially for women with dense breast tissue, if that woman notices a breast

change, please pursue that and don't drop that just because your mammogram is read as normal. >> great advice. we'll talk more about self-breast exam when we come back. >> breast cancer is nothing that anyone plans for. a diagnosis is shocking. karin berdick shares her story of diagnosis and how support from her family is helping her through the process of treatment and healing. >> i am a mother of a 10-year-old son and an 8-year-old son. i am also a graduate student at sdsu where i teach. >> my name is guy, a firefighter for the city of sioux falls. i own pioneer patio and spa in brookings and i own a production company where we actually build haunted houses. >> we're very busy, extremely busy. in january of 2015, i rolled over to reach something on my night stand and i think

something itched, i can't remember, but there was a lump. i thought, oh, that doesn't feel like it's supposed to be there and i hadn't noticed it before and i always gave myself self-breast exams. i woke up and called my physician. he did an ultrasound and looked add it, said nothing to worry about. no family history, probably just a fibrous tumor, that's common at your age. come back in six months when you're 40 and we'll do your mammogram and everything else. dr. jana johnson was amazing because she touched that spot, i pointed it out to her, i said, you know, i also have a lump right here. she touched it and goes back, whoo, you need to get this checked. i thought, i have been getting it checked. so the diagnostic mammogram was performed in town here.

dr. judson came and read the mammogram and did the ultrasound and he then ordered a biopsy because it was are not a cyst. i just purchased new bikes for my boys and we were going to go on a bike ride and my phone rang. i had been diagnosed with invasive carcinoma, triple positive breast cancer. >> i knew immediately, just by the look on karin's face that it wasn't good. >> all i thought about was my kids and my husband. [music] >> dr. julie reiland was the surgeon that we met with first. >> she walked in the room and we had no idea what was going on, she said, well, the team got together. i said, what team? as soon as i heard that, i just -- that just blew me away, i thought, wow, karin has a team.

>> at that appointment, she had said this is your treatment plan which would be six rounds of chemotherapy, and then surgery. people just from everywhere are come out of the woodwork and some of these people are charms and i haven't seen them for 20-plus years. my gratitude for their generosity, love and supports, every single one of these beads have a story about our relationship and it's just empowering. so many good things come from cancer, things that used to be important, they just dribble to the wayside. i mean, it's just -- cancer is... pretty amazing, it really is. >> all the members of sioux falls fire, they're always very compassionate and they always go out of their way to make someone feel a little bit special. but i've always been removed from it.

and i've always been able to show up, take care of the problem, move on. i've always tried to help people above and beyond any way that i can. but now, i look at people differently because i know what they're going through. in the last two month, i can think of probably a dozen people i've been on -- i've stopped and i've spent an extra five, 10 minutes with them just because i know they need to know that there's somebody that cares, that we're there for them. it's made me a better firefighter. >> it's unfortunate you have to go through something that's devastating to realize how blessed you really are and how amazing your life truly is. i just want everybody to make sure that you're staying on top of your health. know what's different. do your breast exams.

pay attention to your whole body. you know when something's wrong. >> so the answer to our prairie doc quiz question tonight: among women who have health insurance, 72% have had a mammogram in the last two years. among those who do not have insurance, the rate is: a - 22% b - 39% c - 44% d - 53% the answer is... b - 39%. it was connecticut-mcmahonon from piedmont who answered the question correctly. thank you, connie, for participating an the book will be in the mail to you soon. so we wanted to talk about self-breast exams a little bits especially after hearing the story we just did. dr. reiland, tell me your advice for women with self-breast exams.

>> i get a lot of women that come to me with a lump, and they say i don't feel my breast because i don't know what i'm feeling for and that's really sill plea because this is your -- that's silly because this is your body. what i tell everyone, there are some great diagrams on what to do but i like to make it easy, really easy because if my patients have to do all of this with their hands, they just go, i can't do that. so let's just really make it easy. when you're lying in bed at night with your arm over your head, can i do this on -- >> absolutely. >> with your land like this not the tips of your fingers because in the tips of your fingers, you'll feel every little lump in your breast, those are normal.

you push down, agent way down to your chest wall. >> like with the pad of your hand. >> with this part, right here, see that? okay. and it should all flatten out. breast tissue is fatty tissue, it squishes out and so it will all flatten. if you have something that's not normal, you'll be able to feel it on your hands, you'll go, wait a minute, that didn't squish out, flatten like it was supposed to. so i carry this in my pocket. can you see it? a little green stone, it is exactly one centimeter. a centimeters is the size of a -- the size that we can feel a cancer so if you had -- and it's really not very big. if you just look at -- i don't know how -- about the size of a pea but the thing is a pea is round.

>> can you hold up that again? >> see that? there we go. a pea is round. this is jagged and irregular. when breast cancer grows, it grows into the tissue and it invades into the tissue. it doesn't grow like a round ball, it grows lie a jagged, irregular -- like a rock. >> like a rock. >> and hard as a rock. so when you put your hand and push your breast down to your skin down to your chest wall that, rock will poke you back. >> so when karin said it was shocking to her when she felt that -- >> it was, it did feel shocking. so when i -- that's what i'm looking for when i do breast exams and do i them on myself and i'm always saying, okay, they're good. it takes five minutes. but it's better than doing nothing, so if you did that

once a month, if you're still having periods, about a week after your period, or if you're not having periods anymore, just do it the first day of every month and you just do that arm up over your head when you're lying down. for some women, when they're in the shower, they say i do it when i'm in the shower. the problem is that under your breast, you can't get to under the breast, especially if we're getting droopy as we get older so you can't feel that as well and that's where some of the cancers can be and you'll miss them. so do it when you're lying down. >> great advice. we have a 62-year-old wondering about the role of diet and exercise in reducing the chance of breast cancer. i know this is something you're both passionate about, so tell me about prevention with diet and exercise.

>> go ahead. >> so we know that for women who are at risk for getting breast cancer, if they can reduce their weight, they can -- and exercise, they can actually reduce their risks by up to 40%. >> wow. >> so we run risk models on people t risk and say you have a 30% chance of developing breast cancer which is 21 greater than 12% of the population. you start dieting and lose that extra pounds that you have and you exercise and the exercise can be 30 minutes of walking, at little as walking five days a week, that's all you have to do, and the studies show that you can reduce those risks from 30% to 18%. so i'm doing the math in my head. so that's remarkable. and when a woman has breast cancer and she's finihed her treatment, we know that when they diet and lose weight, if they're not -- if they're

overweight or keep their weight at their normal bmi, body mass index, and if they exercise regularly, we know those women who diet and exercise actually have a reduced rate of breast cancer recurrence. so after you've had your surgery use, radiation, your chemotherapy, there's actually something that women can do for themselves to reduce their chances of having that breast cancer come back. which is why my sister is such a great food' and -- >> biking 1,000 miles. >> right, because that is the one thing she can do for herself and so for women who feel they're at risk, look in the mirror. if you've got some extra pounds and you want to know what to do about it and how you can reduce your chances of getting breast cancer, lose those pounds. >> diet and exercise.

>> yes. >> so another thing for breast cancer survivors that they should realize it's often a little bit harder after you've gone through your breast cancer treatment to maintain that weight, and so what i always tell patients is look at your weight on the day that you're diagnosed and at least try to maintain that because the average breast cancer survivor is going to gain about 20 pound in the first year, chemotherapy, cash cravings, steroids, not being able to be as active so there are hormonal shifts, becoming post-menopausal, so there are so many different factors but when we write down -- i write down everybody's assignments. i have these famous -- i'm constantly scribbling, we talk about chemo, pills, but number one on my list is you shall exercise 20 to 30 minutes a

day, and one of the key reasons isn't just emotional health and well-being but a lot of women are going on the inhibitor pills, you can get joint stiffness on those and we know that yoga and activity and exercise improves your ability to tolerate your treatments. so that's another really important thing for survivors to know is they have better odds of completing their treatment, too, with the exercise. >> i want to get at least one more question in before we're out of time. we have a 37-year-old woman from brookings who's wondering about early diagnosis, radiation, hysterectomy. she's been doing well on tamoxifen for five years, the doctor says to take it for an additional five years. any thoughts? >> i would have to see her in a consult because it's kind of a complicated question but there

were -- the question is should i do prolonged endocrine therapy. so for a lot of years, five years standard of care. but we know that in hormone-type cancers, half of the recurrences are in the first five years and half in the second five years. so overall, two trials, huge trials showed that ten years of tamoxefin was better than five and that was a benefit of about 3%. so if you have positive nodes and a big tumor, that will be a bigger benefit. if you had a smaller, less aggressive cancer, maybe you don't need the ten years. when my patients get to the five-year mark, we sit down for about 30 minutes and have a discussion because it's an individualized risk versus benefit. >> so come in and see your doctor. >> or talk to the oncologist about what are the pros and cons.

>> thank you both for being here tonight. you've done a great job. we'll be right back. >> my mom was diagnosed with breast cancer at age 38 so she was positive for brca 2, and two years after that, my mom's younger sister was diagnosed with breast cancer. my family history of cancer was my driving factor to pursue my ph.d. and help others and help myself. i tested positive when i was 25. been an emotional journey but a good journey. >> dr. mary helen harris was a college friend. we worked together on student union committees and i grew to appreciate her musical talent, her 4.0 grade average, and her way of supporting others around her. she was accepted into the med school class one year after me, and we had been friends ever since. i took care of her mom and dad living in nearby volga, but

after they were gone, i still touched base with mary helen every once in a while. dr. harris discovered she had spread-to-lymph-node breast cancer maybe 15 years ago, and after a significant struggle through the years, despite all the best care, she passed away this last week, leaving saddened family and friends. the most common cancer in women starts in the breast, and affects about 12% of all women in their lifetime. it's more common in developed countries because of available screening and longevity. the egyptians thought breast cancer occurred as divine punishment for some bad deed and the greeks thought it was a build-up of too much black bile. by the 1700s, people thought breast cancer came from too little or too much sex, too

little or too much breast feeding, breast infections, restrictive clothing, and even from the act of fearing cancer. now, although we know risk factors, we recognize that we don't know why anyone gets breast or any cancer. by the late 1800s, people were living longer. and, since risk increases with age, breast cancer was on the rise. surgeons began to radically excise cancerous breasts along with adjacent muscle and lymph tissue, which raised the survival rate from 10% up to 50%. although more breast cancer patients survived with radical surgery, often they suffered with lymph-swollen painful arms. presently, breast-sparing surgery is done, where just the lump and only a few lymph nodes are removed, resulting in much less arm edema.

and with the advent of safe breast implants, chest deformity is not such a problem. along with these innovations in surgery have come advancements in screening, and better treatments in radiation, hormone, and chemo-therapy, with incredible improvements in survival. now, many more women with breast cancer are alive at five years. and when caught early enough, the lifespan of those with breast cancer are the same as those without. still, cancer can kill despite all the best care anywhere, and i believe my doctor friend mary helen had all that best care. i regret i didn't have the chance to touch base with her one more time. >> a big thank you to our guests... dr. amy krie and dr. julie reiland, both with avera. we sincerely appreciate your

willingness to volunteer to appear on our program. that does it for tonight. have a great evening. >> especially as we get older impacts our lives.