you know what we do on the dr joy show before we get started we take it down with three deep breaths are you ready inhale exhale inhale last one inhales exhale how do you feel i know i feel great i want to welcome dr jana andrews to the d here i'm going to read a little bit about her dr jana and andrews is the founder creator of a nonprofit called kick that in heels for breast cancer survivors which has a focus on young women and women of color the impact and significance of kick that in heels experiences continued growth as the mission of kick that in heels is to further the end of health care disparities in breast cancer did i summarize that where she specialized in radiation oncology now you are on the staff of north well health as an assistant clinical professor of radiation oncology specializing in breast delivering those beautiful babies at four in the morning was great just was not for me right and so a friend of mine had mentioned that given my history in inclination towards research i should look at radiation oncol because it was a nice marriage between patient care and actually being able to conduct research toward cancer so when i did the rotation i really enjoyed connecting with the patients and learning about their their families their lives what have you kind of becoming green into their families but also having the vehicle to be able to do research which i felt was so important for cancer and pushing the field forward so you too you merge two good worlds to make one best world  absolutely that is wonderful so some facts about according to the american cancer society and this is specifically for african american women breast cancer is the most commonly diagnosed cancer for african american women wow and only about fifty one percent of breast cancers were diagnosed at the local stage when you say local stage how is that what is how is that determined the local stage will be early stage stay age one so stage zero stage one zero stays zero there's a stays there on the stage zero which would be pretty invasive breast cancer is something called d c i ass ok wow and then the survival rates are less of african american women then of other races correct so there are about three million breast cancer survivors so i just want to put that out there because that's a very compelling number and where i am making strides we are saving  lives but when you look at breast cancer and you look at it across the races the incidence is about the same for black women and white women it used to be less for black women the question that we have is if the incidence is the same wire more black women dying right from breast cancer compared to their white peers so if you have one hundred women twenty seven black women are expected to die of breast cancer compared to eighteen that information was put out by the c d c a few years ago so overall black women have a forty one percent higher mortality rate of dying from breast cancer and why is that and that is what we are trying to figure out  again the incidence is the same so the question is are black women if they are going for their screening and they're getting their mammograms at the same rate as white women is there a delay in the diagnosis is there a delay in the biopsy if there's a delay in the or there isn't a delay in the biopsy is there a delay in actually having the surgery is there a delay in meeting the medical oncologists is there a delay in reading meeting the radiation oncologist we're not really quite sure where these disparities lie but we know that they do exist so let's talk about some of the risk factors so tell me some of the risk factor was so some of the risk factors for breast cancer one would be a family history ok so know your family history i would say especially for communities of color we don't necessarily talk about cancer in our families and most of us think that we don't necessarily have cancer in our family i certainly didn't think that i had in cancer in my family and i can say that four  onse passed away from multiple myeloma but nobody discussed it just was not a topic that was ever brought up and i know i don't know i imagine that cultural nuances ok right in terms of knowing your body in terms of other risk factors know your breast right the american cancer society doesn't really recommend that you do self breast exams or clinical exams anymore only because research has not shown that that has been more effective in discover new breast cancer that being said you should still know your body and so if you notice a lot or if you notice a lump under your arm or in your bras if you notice that your breasts are swelling any sort of pain in the bras these are reasons to go and see your physician and have a work up or have a mammogram depending on your age and what have you so those are the warning signs pain lumps swelling and just basically know your body know your body oftentimes i will say that the lump is not painful right most of the time breast cancer is not painful but that being said it doesn't mean it can present that way so what about breast cancer in patients that have implants so the woman was healthy she decided that she wanted thought mentation and get implants is it harder to diagnose that's a good question certainly even if you have implants and there's nothing wrong with breast augmentation you should still undergo screening but you just may have to have more images taken in the woman that doesn't have implants because you really want to be able to get behind the implant to make sure that you're seeing all the breast tissue but it's not necessarily harder to detect it just requires a little bit more work and so those warning signs that you had alluded to before that you stated before those would be the same for women with implant sure absolutely although women with implants probably have to also keep in mind that they could be experiencing ruptures or or other issues with their implants but either way it's reason enough if they notice any change in their bras to go actually and see their  clinician so discuss recommendations for screening what are the recommended steps so the american cancer society came out with new recommendations for screening where they recommend that women with average risk so no family history what have you average risk start getting mammograms between the ages of forty and forty four as a baseline and then as of as of the age of forty five having memory arms annually forty five to fifty four and then from fifty four on until there's at least ten year life expectancy so fifty five to eighty five ninety depending on how you healthy you are so it's good to know but if you have any sort of family history or above average risk that would make you more inclined if you have very dense breasts what have you perhaps you should be getting screened in your early as opposed to every and perhaps you should start earlier than did or what exactly oh well ok so is the screening the mammogram the best way to detect is that the earliest that's the best way to detect it at the earliest age for women with average arrest yes for women with average risk of breast cancer mammography is probably the best tool that you you have ok if you have dense breasts you want to make sure that your pairing mammography plus ultrasound just so that there's another tool that you can use to make sure that you're not overlooking anything now would you would could a woman select ultrasound versus the mammography now because that's a painful sometimes the mammography on just go say it now so if you have dense breasts you should always have a mammography plus or a mammogram plus ultrasound doesn't mean that the mammogram demonstrated anything it's just another tool in the arsenal to make sure that you're not overlooking anything ok so i want to move on now to the next step a person has been diagnosed woman has been diagnosed with breast cancer what are the stages and we talked briefly about patient navigation and can you explain sure so i think patient avocation is a great topic and it's been around for several years in terms of different medical communities really trying to bring it to lie in the young college and field we feel that patient avocation is imperative and basically what it is is if a patient has been diagnosed with cancer they will have a it is not necessarily a clinician or somebody that's in the clinical nurse necessarily but somebody that understands the process that the patient has to go through so they are there to guide the patient to all their different appointments so if it's a newly diagnosed breast cancer patient they need to meet with the surgeon potentially they also need to meet with the medical oncologists as well as the radiation oncologists they have to have their procedures so the navigator will set up their different procedures for them and make sure that none of these appointments are falling through the cracks so this is what you would say human contact one human contact per patient right so they project manage the process after the healing process yeah is it a healing process or is it yeah well because they have been diagnosed i mean answering my own question but i'm going to ask it is it is it what is it called is it a healing process or i was saying getting them through their treatment but you bring up a good point because because it is a human contact there's potentially less intimidation w asking the patient navigator different questions than what patients may be reluctant to ask their different physicians so there is there is a human aspect or a healing aspect to it because the patients become very comfortable right what the navigators and so depending on their health literacy level they may be too embarrassed to ascertain questions but they will ask their navigator so everyone this diagnosed gets a navigator we would like  that certainly in my health care system we do our best to make sure that certain fields have navigators so i have a brusk nurse navigator i have a gastrointestinal nurse navigate and and i feel like it makes all the difference in terms of making sure my patien get from point a to point b it's really something that we have invested in not every place has the resources but i certainly think it's well worth the investment so it could a patient that's recently diagnosed ask that it's good information for them to know because even the most educated patient does not necessarily have a high level of health literacy right right there's no correlation between your education level and what understand about this new diagnosis which is essentially a different language for you and so i do think if you can have a navigator push you through that process it's much more seamless oh that's c learn something new every day right so what is the goal of radiation treatment will it eliminate the cancer it's a good question because i think most people don't actually know what what we do for a living as a radiation oncol so basically radiation at least in the field of breast cancer you should think of it as actually added insurance right so the surgeon has done this amazing surgery they remove the cancer and for all intensive purposes that patient is now cancer free so they have to do the surgery first before they get the radiation exactly ok and is that the same thing with the chemo as well memory for ok i know it's different depending on the stage but if this is an early stage breast cancer in the patient wants to keep their breasts breast conservation or a lumpectomy we know that from different trials surgery plus radiation is gives you the similar local control as mustek to me oh so that's why we do it right the surgeon has removed the cancer but there's always the risk that there's microscopic cells left behind right and that what we're addressing is radiation oncologists so we are going in and treating the breast and all of our side effects are just local to that breasts and we're trying to minimize the risk of the disease ever coming back oh wow that's that's outstanding so let's talk about now the patient has gone through they've gotten the diagnosis  be really became an issue for me when i was a breast cancer specialist indiana university that was the first time that i had specialized solian in women's health and what i found was that i could get any of my patients through their care or they could get themselves through their hair when they were coming back for a follow up some of the patients seemed depressed they didn't feel beautiful they didn't feel like sexual beings there were certain issues that were being brought up that i didn't necessarily feel equipped to discuss i didn't feel like i had any background on how to have a meaningful conversation about these topics fast forward to five years ago when i moved back to new york to be closer to family i went back into the general radiation oncology practice i wasn't just seeing my breast cancer patients i was seeing all patients but i really missed my breast cancer patients and so i decided to start a nonprofit that focused on survivorship focusing on women of color and young women and we focused on those two nish nice groups we are inclusive but we focused on those two nice groups because we felt like those were two groups that really didn't necessarily feel that cancer applied to them for whatever reason either through marketing or research or what have you those are two groups that didn't necessarily have the same funding knowledge about breast cancer and we wanted to focus on survivorship so we wanted to do these different projects or programs that focused on wellness fitness beauty body image we actually have a tight she workshop coming up that's great and so that's why we started kicked it in heels so you mission is to guide women in the most effective way through the healing process for breast cancer is breast cancer specific specific to breast cancer really to just try to bring you know full circle to acknowledge that just because you're finished with your treatment doesn't fit in mean that you're you're completely healed or you're completely recovered because there's so many aspects of wellness that absolutely pull them you pull them all in together absolutely if you're still going through something even though you're done with your treatment and you're still able to function and keep your family together but you might not be one hundred percent right you might not feel sexual or beautiful but we also use it as a research vehicle so we use it as a research vehicle to look at health care disparities and what have you found this far so last year we did a project with mt sinai with an agenda or if dr gender and so we looked at c we did a literacy survey on breast and see a woman of color and that is actually been submitted for publication now out what we found was that a lot of women don't necessarily have a high degree of literacy about  certainly it's a word that's more in the public now they're certainly legislation that has been passed about breast and city and that's why you have mammography plus ultrasound and women are supposed to be informed that they have dense breasts right but what does that mean you know it does you know does that increase your risk of breast cancer or what have you and we found that in our results that a lot of women didn't necessarily know what breast in city meant which gives us more information terms of how do we educate the community  from a non clinical standpoint right before you've even been diagnosed or had to deal with this disease just how do we keep you in the know right of what you should look for this year we're very excited we were doing a project called the beauty shop initiative and basically what we're doing is having stylist our hair stylist ask their clients what they know about breast cancer if they're willing to fill out a survey so instead of the conversation starting with the clinician which again can be very intimidating they can sometimes stop before it even starts we're having stuff you know if hairstylist which you know for especially for women of color or there's probably no closer confidant and have them have the discussion about breast cancer and what do you know and how comfortable about are you getting your your mammograms from there we actually do have a navigation program set up so for any woman that was asked to fill out a survey they are then asked if they need to be navigated to different the centers and depending on what their insurance are we will make sure that they are getting their mammograms now that is in the end that clearly jean is right there because we'll love to get our hair again i mean i was at my salon yesterday we have so how can salons but this a paid in this so we just launched the pilot study so we did a few salons in harlem in east harlem because we also wanted to capture spanish speaking patient right we added a few braiding salons what have you really want to catch or a large demographic of women of color ok so we're completing the pilot study or we're cruising the data on the pilot study once we have accrued all that data what we plan to do is make it expand it and apply for a much larger grant so that we have the money and the resources to do this in multiple areas because i would love to take this back to salon phemie yes to the owner ye know she's watching she watched as much as she does my hair and i bet you they would they would like to participate there in new jersey yes now we would love it we would love it and i have to say that let me know i was at the salon owners and the stylist were so amazing and literally we only had to say one or two things about this is for breast cancer and the automatic response each time was yes what can i do to help what it tells us that the community is engaged in one wants to be involved and so we just have to figure out initiatives where we can get some useful information about what we're asking so then you would put the questions together right you guys would develop the question yes and meet so i would say the the best health strategy it's a good question and it's hard when you have to look at what you what you actually put to practice but i think that having balance is the most important aspect to your your health and mental well being so making sure that you do take the time to exercise i can go back to the american cancer society and say that we are supposed to be getting at least one hundred fifty minutes of moderate exercise a week but if you are true jim enthuse is should be seventy five minutes a very vigorous exercise a week and can't be all on the weekend right so i get more years don't count you know you have easter and i didn't have to be spread out so personally i try to do a lot of yoga yoga is good for me just because it really lets me connects mindfulness with my my body and i really enjoy it it's a form of meditation for me  but that being said you know a little bit of spinning a little bit of lifting i think just keeping it very varied basically right and changing it up but trying to stay active and use and you told me before that shoe golf and sc a snowboard so i am i'm thankful for every day that my body works and that i'm able to do these things i know that me may not allow me to keep snowboarding indefinitely but for as long and then if you dead you're not living we're all athletes which is a different level that's right so do you define that for them i do so i will ask them you know what type of exercise do you do and you know if they're being honest than some of them will say i do absolutely nothing but you actually dig a little bit further and you say but do you do you walk do you do you take walks do you walk your dog well i do you walk around the block on occasion well then you do something you do do something for yourself and you do something for your dog and i just need you do it more right and you do it more often i need you to actually get your heart rate up and that's very tangible right that's something that they can put into practice i without necessarily having to change their their lifestyle or their habits just putting that consciousness in their or their minds for the rest of them whatever you like try something different i had one patient that was actually a very athletic patient and she would list maybe five days a week very heavy weights which we didn't necessarily want her to keep doing that right and i mentioned to her you know would you mind trying yoga for me and i would say for a good year she fought it and then one day she came in for a follow up and said you know i am now  a new yogi and she loved it it's just you know it's just exposure but that being said i don't care what you do i just need you to move need you to move us keep it moving that's right so how can one support kick th so we're always looking for resources to support our program so as i mentioned we have a tight she program coming up last year we did a body image workshop with lord and taylor and they are amazing so we really do try to put on special programs for our survivors so for anybody that wants to we would love any donations that you can give and they can go to our website kicked it in heels dot com and you're on facebook too on facebook also and i just also want to make the distinction we are very grassroots our organization is only five years old my board puts in a ton of work and they are all from different fields one is a v p a google and others an entertainment lawyer and they do this because they truly feel that they need to be of service epic proportions you may not feel bad but i could see it but i didn't see it and i and i know that the patients that you help also a very grateful doctor gianna andrews thank you very much thank you so being a guest on the dr joy show dr joy all right so you heard or keep moving and also make sure that you are screened if you're forty is it forty or forty five forney is ok if you