Advancements in Breast Cancer Care with Abi Siva, MD

More women are surviving breast cancer than ever before, yet, the statistic remains that breast cancer is the second leading cause of cancer death in women. In this episode, Dr. Abi Siva, a MUSC Health breast oncologist, explains the latest offerings in treatment and early detection from MUSC Hollings Cancer Center, that are helping more women live longer, healthier lives after a breast cancer diagnosis.

“The breast cancer field is evolving. Every year, there's so much research happening, and so many new drugs are being approved. Because of that, our patients are living longer and longer. And we are all very proud to say that the field is advancing in the right direction.”
-Abi Siva, MD, Director of Medical Oncology at the MUSC Hollings Cancer Center

Topics Covered in this Show:

• Breast cancer most commonly occurs in patients who are in their 60s or older. However, the risk of breast cancer varies with age and genetic factors. One in eight women in the United States may face a breast cancer diagnosis in their lifetime. Regular screenings through mammograms are recommended to increase the chances of successful management and cure.
• For younger women, breast self-exams are recommended, as well as maintaining vigilance and self-awareness for any changes that may occur. Guidelines from the American Cancer Society suggest annual mammograms starting at age 40.
• Guidelines are evolving for breast cancer screenings. Dr. Siva emphasizes the need for individualized decisions, considering factors such as health, life expectancy and comorbidities.
• Lifestyle factors can influence the risk of breast cancer. Dr. Siva recommends weekly exercise, limiting alcohol intake and avoiding smoking to reduce this risk.
• Every December, Dr. Siva attends the San Antonio Breast Cancer Symposium, one of the largest gatherings of breast cancer professionals in the world. Researchers and doctors share medical breakthroughs, new drugs and new treatment strategies, contributing to advancements in breast oncology. Cutting-edge findings are brought back to MUSC Health and MUSC Hollings Cancer Center and are often implemented into practice following this conference.
• Those receiving care at MUSC Health will have access to a wide variety of specialists and cutting-edge treatments. Dr. Siva emphasizes a multidisciplinary approach is critical in breast cancer care. The collaborative efforts of the breast cancer team of specialists at MUSC Hollings Cancer Center provide first-class treatment with convenience, bringing peace of mind to patients.
• Dr. Siva advises patients recently diagnosed with breast cancer to call the center with any questions they may have. Navigators are available as the first point of contact for patients, making sure all patient questions are answered.
• She says as the field of breast cancer treatment advances and new drugs and approaches are approved, she is hopeful that the life expectancy of patients will increase, too.

Read the Transcript:

[00:00:00] Erin Spain, MS: Welcome to Advance with MUSC Health. I'm your host, Erin Spain. This show's mission is to help you find ways to preserve and optimize your health and get the care you need to live well. More women are surviving breast cancer than ever before yet the statistic remains that breast cancer is the second leading cause of cancer death. At MUSC Hollings Cancer Center, breast oncologist Dr. Abi Siva is committed to keeping up with the advancements in her field to help her patients receive leading-edge breast cancer care and early detection. She is the director of medical oncology at MUSC Hollings Cancer Center and joins me today to talk about her approach to improve the diagnosis and treatment of breast cancer. Welcome to the show.

[00:00:54] Abi Siva, MD: Thank you so much for having me here.

[00:00:56] Erin Spain, MS: We want to talk about breast cancer today. This is your area of specialty. Breast cancer is a significant concern for many, especially women who are at high risk of the disease. Can you share some insight with the listeners about breast cancer risk? What's the average risk? What's a high risk? And how important is it to know your risk level?

[00:01:16] Abi Siva, MD: If you look at the cancer statistics, one in eight women unfortunately will encounter the diagnosis of breast cancer in the United States. So that's the general statistics. But the risk actually varies by somebody's age and other biological and genetic factors. The most common age the incidence is more frequent in the sixties to seventies. Unfortunately, we do see way younger patients sometimes coming to us with the breast cancer diagnosis. Sometimes it could be related to certain high-risk genes in their family, such as BRCA1 or BRCA2 or CHEK2 mutation that you may have heard of. Sometimes it's independent of these genetic changes. On average, the incidence actually peaks in their 60s.

[00:01:56] Erin Spain, MS: Why is this information so important for women to know?

[00:02:00] Abi Siva, MD: I think it's very important for women to know about the risk of breast cancer so we can create awareness, and also we can increase the rate of screening measures such as mammograms because this is a disease that if it's caught early on, it can be well managed and very high chance of cure. So if somebody is going for annual mammograms as they should be and getting screening done, and you can detect breast cancer, that cancer could be stage one or sometimes stage two. The chances of taking care of this cancer and curing this cancer is very, very high. Whereas if we wait for symptoms to appear and then they seek attention, which could be stage three, stage four, more advanced disease, then the chance of cure may be lower. And stage four setting, if it's metastatic and spread to other parts of the body, then we can't even talk about curing the cancer. So, therefore, I think creating awareness about breast cancer and the need for mammograms is very, very important.

[00:02:56] Erin Spain, MS: Would you say that for younger women listening, they can start at home doing breast self-exams and then as they age, they can begin doing the mammograms and MRIs if necessary? Kind of walk me through the age and the different types of exams or screenings that you should be aware of as you age.

[00:03:15] Abi Siva, MD: Very good question, a lot of our patients and their family members ask us this all the time. When it comes to self breast exams, there is some controversy there about what age you should start and how reliable is it, because in a younger woman, in their twenties, thirties, there's always these cyclical changes happening in the breast tissue. Sometimes it's very hard for them to tease out what's normal and what's not. But again, self awareness is, I think, important. So I always tell patients just to know what's your norm. And when you see something abnormal happening, this is not your norm, this is not how things were before, and there's a new change happening, then you are the first one to detect and bring it to your provider's attention. So always be vigilant about any changes that's happening in your body, and anything that's concerning. Just bring it up to your provider.

But our American Cancer Society recommends mammogram as the main tool for screening. Usually, we start recommending screening even at the age of 40. So 40 to 45, it's sort of an option that women could choose to start screening every year. But 45 are recommended to get annual mammograms. Some guidelines do say maybe beyond the age of 55, every other year is okay, but at the end of the day, you know, it's good to keep up with the mammograms on an annual basis to detect any new changes.

When it comes to guidelines also, there are multiple different guidelines we have on recommending different things. So American Cancer Society recommendations are the ones that I just mentioned, but the U. S. Preventative Task Force may have a different recommendation. So talk to your doctor, talk to your gynecologist, your primary doctor about what is the age that they are recommending you to start screening and then follow their guidelines, you know, every year. And in some women, if they have a significant family history or a genetic predisposition, they may have to start early on, or they may need an MRI or an ultrasound to go with it. So therefore, again, talk to your providers and be aware of the necessary steps that you need to go through to detect things early on.

[00:05:16] Erin Spain, MS: And women, men, we're all living longer than ever before. Do you continue getting these yearly or every two-year screenings for the rest of your life?

[00:05:26] Abi Siva, MD: That question is a hard one to answer, because the field is evolving. Some guidelines do say that you could stop screening at a certain age, but in our practice, I think age is sort of a... it's a hard number to go by because not every 75-year-old woman is going to be the same way or just have the same life expectancy, you know. There are other factors that we have to look into. So if somebody's very healthy and active and they have a pretty long life expectancy, then we would suggest them to continue the screening because even a stage one diagnosis can be pretty morbid in their seventies to eighties. So that's a sort of an individualized question based on the patient characteristics and comorbidities. And again, that's why you continue to follow with your primary doctors, who can sort of guide you through the necessary steps.

[00:06:13] Erin Spain, MS: While screening is essential to early detection, there are things that people can do to reduce their risk of developing breast cancer. There are some lifestyle things that we can do. Can you go over some of those with me?

[00:06:26] Abi Siva, MD: That is where I think most of our focus should be. So in the general population, what are the things that we can do and we can educate our general population to follow so we can reduce the risk of breast cancer. So exercise, it's been well-studied that routine exercise will decrease the chance of developing breast cancer. So when we say exercise, it's hard to quantify, but the American Cancer Society is recommending that in a week, about 150 to 300 minutes of moderate intense workout. Or about 75 to 150 of vigorous activity, like going to a gym and running on a treadmill, something really vigorous to increase your heart rate and your sweating. Something like that is what's necessary in a week for you to sort of meet that expectation. That's what studies have shown in terms of reducing the chance of breast cancer.

Another big factor that we worry about is alcohol intake. From one of the studies showed that about 12 percent of new breast cancers are actually linked to alcohol. So we can certainly work on that. You know, if you ask me, I would say no alcohol whatsoever, but of course, people have to have their life too. So the recommendation is at least under, you know, one drink or less. In a week, you know, six to seven drinks a week is the most that they would recommend for the general population. Anything more than that could increase cancer risk, including breast cancer. And smoking, as we all know, can increase multiple different cancers, including breast cancer. So we always counsel our patients about that.

[00:07:57] Erin Spain, MS: You recently attended the largest breast cancer meeting in the world, the San Antonio Breast Cancer Symposium. Explain to our listeners what happens at meetings like this and why you attend.

[00:08:08] Abi Siva, MD: Oh, this is one of the best meetings that we have in our breast oncology world. So every year in December, we go to San Antonio to attend this huge breast cancer meeting. It's the largest internationally, I would say. And researchers, scientists, doctors from all over the world attend this meeting to present their research work, to talk about new drugs, new way of treating cancers. Scientists bring their new ideas to the table and many doctors do follow these experts and learn from them. And then they bring these ideas to their clinic and start implementing , and using their treatment. This year there were multiple new breakthroughs. So I try my best to attend this meeting every year, so I could bring our ideas to the table, but also we could learn so much from others and bring it to our clinics.

[00:08:58] Erin Spain, MS: What are some of the most exciting treatments or prevention strategies on the horizon that have come out of this meeting and others like it?

[00:09:05] Abi Siva, MD: So yeah, I can list a few, you know, studies that were presented at this meeting. We are expecting them to be actually practice changing for us. There was a study called the Inova 120 clinical trial where they talk about a novel medication called Inavolisib, and when they combined it with hormonal treatment in the metastatic breast cancer patients, they found out that they could prevent the recurrence for longer.

Another new drug that they discussed was called the Dato DXd. It has a very long name, but this drug, again, is used for hormone-positive metastatic breast cancer patients. And it was also, again, improving the life of our patients, and we are adding a new option in our armamentarium. They also talked about some previously discussed studies and updated the results, and again, reassuring us that what all these new drugs that we are doing in clinical practice is increasing the life expectancy, or if it's an early stage patients, reducing the risk of reoccurrences in the future. There was another study that looked at omitting radiation in specific selected patients who may have had lymph node-positive disease.

These are a group of studies that look at how can we deescalate some of the treatments because we know sometimes when we do surgery and radiation and certain treatments like that, it can cause side effects like lymphedema or problems with mobility. So we are also doing studies to see in which patients can we omit such morbid treatment and give them a better recovery, and in which patients do we really have to give such treatments because we don't want the breast cancer to come back. Our field is moving towards de-escalating in the right patient, therefore, we don't have to expose the toxicity to many of our patients, and some of these questions were also addressed at the meeting.

[00:10:49] Erin Spain, MS: I know it's important for you to stay up to date on all these new changes, and you're able to bring that back to the Hollings Cancer Center. Explain to our patients why they should consider MUSC Hollings Cancer Center after a breast cancer diagnosis.

[00:11:03] Abi Siva, MD: Our team that's taking care of our breast cancer patient is an excellent team here. First of all, the multidisciplinary approach is very unique and it's very, very important. Breast cancer is not a diagnosis where just one doctor can see the patient and make the treatment plan and go forward. You need multiple different specialties to be involved to come up with the best treatment for the right patient. So a surgeon is mainly involved as the person who is going to remove the cancer and tell the patient, Hey, you are cured. Whereas a medical oncologist like me is important to come into the team and say, what other interventions like hormonal treatment or chemotherapy or targeted therapy may be necessary to reduce the chance of this cancer ever coming back. And then comes a radiation doctor who has his or her role to offer in the treatment of the same patient. Not only that, then there is a social worker, there are supportive physical therapists is important to help them recover from a surgery, your radiation, integrative medicine, psychologist, financial counselor. So, you need a big team of people who are excellent in their own field to bring the expertise to the patient as a team, and also we all see them on the same day when they come as new patients. So we talk to each other, we discuss their case in the morning, so there's a good communication going between all of us. We all help each other, educate each other and come up with this best plan for the patient. So that type of treatment planning is very important, very unique, and that's how the field is going. And patients who come to Hollings Cancer Center will get that first-class approach.

[00:12:38] Erin Spain, MS: I'm sure that having all the resources in one place means a lot to your patients.

[00:12:42] Abi Siva, MD: It is very, very convenient for our patients, and they appreciate all this attention that's given to them when they come in that day. They are here, they're spending almost the whole day with us to see all these different doctors, and knowing that we all talk to each other and we all agree with each other, gives them such a big peace of mind. And not only to develop the standard treatment plan. Let's say clinical trials, you know, being one of the biggest academic institutions in the whole state we have access to multiple clinical trials with novel drugs, including phase one, which means these are very, very new drugs in development where you don't have any other access to get it. Those are other ways to improve our patients' outcomes. and that's available at Hollings because it's an academic institution.

[00:13:29] Erin Spain, MS: What other advice would you give to someone who's facing a new breast cancer diagnosis or a loved one who is supporting someone through it? Can you share some advice?

[00:13:38] Abi Siva, MD: I'll tell you it is one of the toughest times of their lives. You know, when I see a patient who's recently newly diagnosed with breast cancer, coming with their loved ones to meet our team. You can see that, you can feel that anxiety and the worry in their faces and in their loved one's faces. So, you know, we completely understand what they're going through. And I tell patients the first day when you meet all of us, we're going to tell you about all these steps. It's going to feel like so overwhelming and so complicated, but I tell them take one step at a time. Go through surgery, for example. Then you come back to me. I'll talk about hormonal treatment. Then you go to the radiation doctor, they'll initiate the radiation process. So when we first meet them, we give them the overall plan, and then we sort of walk them through every step of the way. That way, they don't feel like it's so much to process and go through. And they find it, you know, easier when they take one step at a time without worrying about the future, what's going to happen.  We have great breast cancer navigators at our Hollings Cancer Center. They also keep a very close eye with these patients. They talk to them frequently, So the navigators are there as their first line of contact to call and talk to them, ask any questions, and the navigators will then come back to us. We will answer those questions back to the patient. So there's a lot of good communication and support available here. So I say, just don't hesitate, call us. Using our communication system, using our navigators, using us as your resource should help take some of that anxiety away and then taking just one step at a time to get through the complexity would also help.

[00:15:14] Erin Spain, MS: Anything else that you wanted to add that we didn't cover that you think would be interesting or important to our listeners?

[00:15:20] Abi Siva, MD: The breast cancer field is evolving.  Every year, there's so much research happening, and so many new drugs are being approved. Because of that, our patients are living longer and longer.  And we are all very proud to say that the field is advancing in the right direction. Just to give you an example, just in this year, starting from January to December, we have seen multiple new drugs approved by FDA, so we could use them in clinical practice to help these patients. Elacestrant, abemaciclib, sacituzumab. I'm just listing, you know, a few of those drugs that came up, but the field is going towards the right direction and so many new drugs are coming. So I tell patients, I know nobody wants to face this diagnosis. It's very hard to go through this, but the field right now, the direction it's going, our goal is to the quantity of your life and quality of your life. It's not just, we want to cure you and leave you out there with all these side effects. We want to make sure you recover well, you go out as a thriver and get back on with your life without worrying about this ever happening to you. So that's our ideal goal in our mind, and that's where the field is going. So please, anybody with this diagnosis or your loved ones with this diagnosis, don't give up. Don't feel like you don't have anybody, don't have the right resources. You have us here. Come to us; we will get you through the right steps.

[00:16:41] Erin Spain, MS: The last question, and it's a question we ask everyone who comes on this podcast, what do you do to optimize your health and live well?

[00:16:48] Abi Siva, MD: Sometimes as doctors, busy physicians we sometimes forget to take care of our own health. But since I joined MUSC my main goal is to join a gym and make sure I attend at least three sessions a week. So that's my goal. Plus we joined for a family karate class with all my kids and my husband. So It's a black belt program so we are all doing it twice a week. So hopefully with all that, I'll get my health back in shape.

[00:17:15] Erin Spain, MS: Well, thank you so much for coming on the show. This was a great conversation, and I'm sure that this is valuable information for folks who may be experiencing a breast cancer diagnosis or a loved one, or if they need this information in the future. Thank you so much.

[00:17:29] Abi Siva, MD: You're very welcome. And thank you so much for having me here.

[00:17:32] Erin Spain, MS: For more information on this podcast, check out advance.muschealth.org.