00:00Hola, le saluda el doctor Bolívar Arboleda Osorio, presidente de la Sociedad Puerto
00:29Riqueña de Cenología. Nos encontramos en el 22º Congreso Mundial de Cáncer de Seno de la Sociedad
00:37Internacional de Cenología, la CIS, y me acompaña el doctor Attila Soran, secretario general de la
00:45Sociedad Internacional de Cenología. How are you, Attila? I'm good. How are you? Oh, we're doing
00:51fine. I was introducing you in Spanish, but the rest of the interview will be in English. We wanted
00:59to know a little bit first about the International Society, SIS. Tell us a little bit about the SIS.
01:06All right. So, first of all, I'm from Pittsburgh, University of Pittsburgh. I'm a professor of
01:11surgery and a general secretary of the Cenology International Society. This society is one of
01:18the biggest societies established in 1974. And in all continents, a lot of countries are our members
01:26and expanding recently more and more. This is the organization trying to not only get together,
01:33not only the meetings, but we also have the other things such as the fellowship program,
01:39such as we have the programs for the accreditation of the centers. We are trying to educate not only the
01:46physicians, also the nurses and then other healthcare professionals for the breast cancer. As you know,
01:53breast cancer is the most common cancer all over the world in women. So it's the time maybe for to be
02:01more active on all of the continents, not only focusing one area to make sure that everybody's
02:07getting the at least standardized therapy and diagnosis. And we are very happy being in Puerto Rico
02:13is a great, I should say, the country and the city, even if it's a United States territory. I think it's
02:21the Puerto Rico has its own culture. I have been in this city and all over the Puerto Rico more than six
02:30times. I love it. Great hospitality, great environment. But additionally, this meeting is a great opportunity for the
02:38Puerto Rican physicians who are dealing with the breast cancer, in general, breast diseases to learn and to
02:45communicate with the expertise all over the world, and also share their experiences with us. It's important
02:52to learn from the local as well, and their diagnostic approach and treatment.
02:57Yeah, I think this is very important in the sense that a meeting of this caliber, a truly international
03:07meeting with speakers of the greatest knowledge in the field, have convened here in Puerto Rico to share
03:17their knowledge with us. And as you say, perhaps take a little bit from us too, because every different
03:23country have their own difficulties in diagnosis, management, treatment. The beauty of an international
03:35society like ours is that we get to know what is going on in each of these countries that have different
03:44different cultures, they have different economic means. And what we learn about ideal treatment in the
03:55United States, Puerto Rico, and other advanced countries in Europe may not be available in a number of
04:01countries. And we have to tailor that approach to see what we have to do with those in those countries.
04:12As it pertains to Puerto Rico, the Sociedad Puerto Riqueña de Cenología was founded in 2013. We have been a
04:21member of the international societies in 2014. And we are honored to have been selected to host this
04:31international meeting. Breast cancer in Puerto Rico, as well as in the United States, as Atila just mentioned,
04:39is the most common cancer in women. So we have a lot of work to do. Early detection is definitely
04:50the most important tool we have for this disease. If we detect breast cancer early, we have an excellent
05:00opportunity to cure our patients, don't we?
05:04Corey, I agree with you. Even if we look at the last 10-20 years, there's a lot of development in
05:12medicine, including the pharmacy, pharmaceutical companies. We have a lot of different therapeutic
05:20tools. But if you diagnose the patient in early stage, you may not need that much
05:25therapies, maybe like in the DCIS, which we call stage zero disease. Most of the times,
05:32you don't need anything else. You just maybe need some small diagnosed, some,
05:39you may need just some like the systemic therapy, we may need just like a short term radiation therapy,
05:46that's it. So there's a hundred percent cure. But if the patient comes like the stage three advanced
05:51or stage four disease, there's a time that you have to do a lot of things, you may change the survival.
05:59But again, if you do the screening, you can see the calcification, you just start the diagnosis as
06:05early as possible, like any diseases. If you diagnose earlier, there's a lot of opportunity
06:10to cure the patient. The screening is, I heard that, you told me, in the Puerto Rico also,
06:18there's a screening program, which is great. But SIS, some of the countries, unfortunately,
06:23they do not still have any screening programs. So those patients are coming to their physicians in
06:30the very late stage. And unfortunately, some of those countries, they may not have the enough
06:35radiation oncology units. So the tool, the best tool to prevent yourself from the future advanced
06:49cancer is the screening. Definitely. And Atila, I know you are particularly interested in surgery for
06:59advanced breast cancer in some patients. I do remember one of the presentations in ASCO a few
07:09years ago about a study in which you were the PI. Could you tell us a little bit about
07:17when is surgery indicated in patients that have advanced disease? Correct. So the idea came to us
07:25when there is a stage four disease, which means that there is a spread already in some organs,
07:31the idea came to us that if we can remove the breast cancer, can we help those patients to treat
07:38better, even if they have a metastasis? We call these patients de novo stage four breast cancer,
07:44which means that there is already spread to the organs, even if we diagnose the primary tumor
07:50at the same time. So it's like, it depends which country, but it's around six to 10% of women come
07:57to us already as a stage four breast cancer. In the previous decades, we were thinking that they are
08:05done. There's no surgical or radiation therapy benefit for them. So they are going to take only
08:11the systemic therapy, chemotherapy. It may help, it may not help. But we are eating the out of box
08:18differently. So the idea came to us that if we can remove the primary tumor and can it be possible
08:26to fight against the cancer in the metastatic side? I always give this example. So if you think
08:34about you are a general, the commander of the army, there are only one place to fight with the enemy
08:42or you have more than one. So which one is better for a general or which one is better for the commander?
08:48So fight against the one enemy, not more than one. That's the idea, the same thing. So if you remove
08:54the primary tumor, breast cancer, there may be opportunity in some patients that you can,
08:59your medical therapy, your systemic therapy, your chemotherapy, radiation therapy may work better.
09:05So we did the study and show, again, the study was like we started in 2007, but now we have 10 years
09:13follow-up. What we see that if you do the multidisciplinary approach, including surgery,
09:20radiation therapy, and systemic therapy, then 20% of our group of patients in the surgery group,
09:27they are still alive after 10 years. When you compare the control group, no surgery group,
09:32only 4% alive. So yeah, in the five year, actually, when you look at the at five year,
09:39medium five year survival, it is like 58% of the woman who got the primary surgery is still alive
09:46at the five years. So there is a group of patients who are they. So those patients are like the bone
09:52metastasis only, like we call oligometastasis, which means the limited metastasis. So those patients
09:59may have the chance to live longer if you consider multidisciplinary approach. It's not only us,
10:05actually. When you look at the prostate melanoma, when you look at the lung cancer, are all the same,
10:12like kidney cancer, the colorectal cancers. They are all the same approach when they have the ability
10:19to consider the multidisciplinary approach. They live longer, they got better quality of life as well,
10:25because when you remove the breast, there is a 40%. So think about there's a patient with this stage 4,
10:31you don't do the breast surgery, 40%. 40% of patients come back to the surgery for ulcer,
10:40bleeding, infection. So if you remove the tumor, this is like less than 5% may come back to you for
10:48some local problems. For what we call salvage vasectomy.
10:52Exactly. Exactly. So if you are thinking the survival benefit, there is a group of patients
10:58may live longer. But if you think about the local regional control of the breast, which may cause a
11:03problem, so you remove them. So patient quality is much better when you look at who has bleeding or
11:10infection. Correct? Yes. So we have two benefits, but this is not for everybody, of course.
11:17Of course. Well, you know, it's so good to be able to hear experts in each of our different fields in
11:28this conference, Dr. Soran, here with me. And we are so lucky to have this type of meeting here in Puerto
11:39Rico. So I'd like to thank Dr. Soran and all of our international and local speakers that have
11:48contributed to having this meeting here in Puerto Rico. So we are also very thankful a lot for Medicina
11:57y Salud Pública to spread the word and keep informing our medical community, our general community about the
12:10importance of this disease, importance of prevention. And I always mention, every time I have an opportunity,
12:22the mammography saves lives. Las mammografías salvan vidas. So that's something that we have to always
12:31keep in mind. Thank you, Matilda. And it has been a pleasure having you and saludos to all of our
12:40viewing audience. Thank you very much for having us to hear and muchas gracias.
12:45El dolor que causa la endometriosis no es un show, es un dolor extremo durante la menstruación y
12:52durante el sexo. Endometriosis, tómala en serio a ella y a la enfermedad. Habla con tu médico y visita
12:58eldolordeendoeserio.com. En MSP convertimos la ciencia en noticia. Por más de 20 años hemos sido líderes en
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