WEBVTT NOTE duration: "01:06:58.858" NOTE Confidence: 0.99902344 00:00:00.719 --> 00:00:01.939 Welcome to our, NOTE Confidence: 0.70564777 00:00:02.720 --> 00:00:03.220 SmiloShares NOTE Confidence: 0.99853516 00:00:03.600 --> 00:00:05.140 event for this evening. NOTE Confidence: 0.9817766 00:00:06.000 --> 00:00:07.460 My name is Veda Geary, NOTE Confidence: 0.9817766 00:00:07.520 --> 00:00:08.880 and, I will be the NOTE Confidence: 0.9817766 00:00:08.880 --> 00:00:10.740 moderator for the SmiloShares NOTE Confidence: 0.9996745 00:00:11.119 --> 00:00:12.315 event for today. NOTE Confidence: 0.99638313 00:00:13.275 --> 00:00:14.155 This is the first in NOTE Confidence: 0.99638313 00:00:14.155 --> 00:00:15.295 a series of SmiloShares NOTE Confidence: 0.92903644 00:00:15.674 --> 00:00:18.095 from the Yale Cancer Center's NOTE Confidence: 0.92903644 00:00:18.235 --> 00:00:19.855 early onset cancer program. NOTE Confidence: 0.99909127 00:00:20.555 --> 00:00:22.075 And, we wanted this to NOTE Confidence: 0.99909127 00:00:22.075 --> 00:00:23.914 focus on a very important NOTE Confidence: 0.99909127 00:00:23.914 --> 00:00:25.890 topic that has been coming NOTE Confidence: 0.99909127 00:00:25.890 --> 00:00:27.590 forward to recognition, NOTE Confidence: 0.98738605 00:00:28.930 --> 00:00:30.850 particularly in the public and NOTE Confidence: 0.98738605 00:00:30.850 --> 00:00:31.350 by, NOTE Confidence: 0.9724121 00:00:32.050 --> 00:00:32.550 doctors, NOTE Confidence: 0.9955833 00:00:33.409 --> 00:00:35.250 to really think about cancers NOTE Confidence: 0.9955833 00:00:35.250 --> 00:00:36.530 that are happening in younger NOTE Confidence: 0.9955833 00:00:36.530 --> 00:00:37.030 individuals. NOTE Confidence: 0.9748792 00:00:37.995 --> 00:00:39.595 And a question that we NOTE Confidence: 0.9748792 00:00:39.595 --> 00:00:41.115 are asked a lot is NOTE Confidence: 0.9748792 00:00:41.115 --> 00:00:42.475 what can we do for NOTE Confidence: 0.9748792 00:00:42.475 --> 00:00:44.015 screening for these cancers, NOTE Confidence: 0.9917864 00:00:44.955 --> 00:00:46.555 particularly for cancers that are NOTE Confidence: 0.9917864 00:00:46.555 --> 00:00:47.515 some of the most common NOTE Confidence: 0.9917864 00:00:47.515 --> 00:00:48.815 cancers that we're noticing, NOTE Confidence: 0.9313965 00:00:49.354 --> 00:00:50.255 in the population? NOTE Confidence: 0.9852024 00:00:51.050 --> 00:00:52.490 So we decided to focus NOTE Confidence: 0.9852024 00:00:52.490 --> 00:00:54.090 on screening for early onset NOTE Confidence: 0.9852024 00:00:54.090 --> 00:00:56.330 breast, cancers focused on breast NOTE Confidence: 0.9852024 00:00:56.330 --> 00:00:57.870 cancer and gastrointestinal NOTE Confidence: 0.9658203 00:00:58.490 --> 00:00:58.990 cancers. NOTE Confidence: 0.99836075 00:01:00.170 --> 00:01:01.210 And so we have an NOTE Confidence: 0.99836075 00:01:01.210 --> 00:01:02.890 expert panel today who will NOTE Confidence: 0.99836075 00:01:02.890 --> 00:01:04.350 be speaking to you NOTE Confidence: 0.9375 00:01:05.814 --> 00:01:06.174 regarding, NOTE Confidence: 1 00:01:06.655 --> 00:01:08.034 factors to think about NOTE Confidence: 0.9909668 00:01:08.414 --> 00:01:09.235 and strategies NOTE Confidence: 0.9984375 00:01:09.615 --> 00:01:11.555 for early onset cancer screening. NOTE Confidence: 0.9933675 00:01:12.094 --> 00:01:13.715 So I am very pleased NOTE Confidence: 0.9933675 00:01:13.774 --> 00:01:14.274 to, NOTE Confidence: 0.9724528 00:01:15.454 --> 00:01:17.475 reintroduce to you our panelists NOTE Confidence: 0.9724528 00:01:17.694 --> 00:01:18.194 today. NOTE Confidence: 0.9497884 00:01:19.590 --> 00:01:21.450 Our experts are Amy Wiegand, NOTE Confidence: 0.9497884 00:01:21.509 --> 00:01:22.969 who is a genetic counselor NOTE Confidence: 0.9497884 00:01:23.110 --> 00:01:23.590 from the, NOTE Confidence: 0.91039026 00:01:24.709 --> 00:01:26.549 Yale and Smilow Cancer Genetics NOTE Confidence: 0.91039026 00:01:26.549 --> 00:01:27.689 and Prevention Program, NOTE Confidence: 0.79423827 00:01:28.390 --> 00:01:29.530 doctor Eli Prasaloglu, NOTE Confidence: 0.98123604 00:01:29.909 --> 00:01:31.189 who is a breast surgeon NOTE Confidence: 0.98123604 00:01:31.189 --> 00:01:31.929 here at, NOTE Confidence: 0.97159827 00:01:32.375 --> 00:01:33.655 Yale Cancer Center and Smilow NOTE Confidence: 0.97159827 00:01:33.655 --> 00:01:34.475 Cancer Hospital, NOTE Confidence: 0.9021759 00:01:34.855 --> 00:01:36.555 and doctor Tejal Shreekumar, NOTE Confidence: 0.99450684 00:01:37.095 --> 00:01:38.635 who is a gastrointestinal NOTE Confidence: 0.95732725 00:01:39.095 --> 00:01:41.515 or GI medical oncologist also NOTE Confidence: 0.95732725 00:01:41.735 --> 00:01:43.495 at Yale and Smilow Cancer NOTE Confidence: 0.95732725 00:01:43.495 --> 00:01:43.995 Hospital. NOTE Confidence: 0.995894 00:01:44.470 --> 00:01:46.229 So please send any questions NOTE Confidence: 0.995894 00:01:46.229 --> 00:01:47.350 that you have through the NOTE Confidence: 0.995894 00:01:47.350 --> 00:01:47.830 chat, NOTE Confidence: 0.99912107 00:01:48.150 --> 00:01:49.930 as the presenters are speaking. NOTE Confidence: 1 00:01:50.310 --> 00:01:51.190 What we will do is NOTE Confidence: 1 00:01:51.190 --> 00:01:52.250 have each presenter NOTE Confidence: 0.985208 00:01:52.550 --> 00:01:53.990 talk for about ten minutes NOTE Confidence: 0.985208 00:01:53.990 --> 00:01:55.830 or so, and then, we'll NOTE Confidence: 0.985208 00:01:55.830 --> 00:01:57.134 have about five minutes in NOTE Confidence: 0.985208 00:01:57.134 --> 00:01:57.795 between presentations NOTE Confidence: 0.9934166 00:01:58.895 --> 00:02:00.174 so that, we can try NOTE Confidence: 0.9934166 00:02:00.174 --> 00:02:01.054 to field some of the NOTE Confidence: 0.9934166 00:02:01.054 --> 00:02:02.575 questions. And we'll also have NOTE Confidence: 0.9934166 00:02:02.575 --> 00:02:03.795 some time at the end NOTE Confidence: 0.9934166 00:02:03.935 --> 00:02:05.695 for, any final thoughts or NOTE Confidence: 0.9934166 00:02:05.695 --> 00:02:07.075 questions as well. So NOTE Confidence: 0.9733073 00:02:07.454 --> 00:02:08.275 at this point, NOTE Confidence: 0.954834 00:02:08.974 --> 00:02:09.694 I would, NOTE Confidence: 0.8518982 00:02:10.415 --> 00:02:12.680 invite, Amy Weekand to, NOTE Confidence: 0.99243164 00:02:13.299 --> 00:02:14.980 start her presentation. I'll stop NOTE Confidence: 0.99243164 00:02:14.980 --> 00:02:16.200 sharing. And in the meantime, NOTE Confidence: 0.99243164 00:02:16.260 --> 00:02:16.919 I will NOTE Confidence: 0.98168945 00:02:17.620 --> 00:02:18.120 introduce, NOTE Confidence: 1 00:02:18.900 --> 00:02:19.400 Amy. NOTE Confidence: 0.99443614 00:02:20.099 --> 00:02:21.780 So Amy Wiegand is a NOTE Confidence: 0.99443614 00:02:21.780 --> 00:02:23.620 licensed and board certified genetic NOTE Confidence: 0.99443614 00:02:23.620 --> 00:02:25.459 counselor who graduated from the NOTE Confidence: 0.99443614 00:02:25.459 --> 00:02:27.079 Icahn School of Medicine NOTE Confidence: 0.943278 00:02:27.495 --> 00:02:28.715 at Mount Sinai, NOTE Confidence: 0.9300537 00:02:30.215 --> 00:02:32.055 in, twenty seventeen and has NOTE Confidence: 0.9300537 00:02:32.055 --> 00:02:32.855 been a part of the NOTE Confidence: 0.9300537 00:02:32.855 --> 00:02:34.875 Smilow Cancer Genetics and Prevention NOTE Confidence: 0.9300537 00:02:34.935 --> 00:02:36.794 Program for almost nine years. NOTE Confidence: 0.97835284 00:02:37.815 --> 00:02:39.415 She has seen over two NOTE Confidence: 0.97835284 00:02:39.415 --> 00:02:41.415 thousand five hundred patients with NOTE Confidence: 0.97835284 00:02:41.415 --> 00:02:42.919 a personal and or family NOTE Confidence: 0.97835284 00:02:42.919 --> 00:02:44.680 history of cancer for genetic NOTE Confidence: 0.97835284 00:02:44.680 --> 00:02:45.180 counseling, NOTE Confidence: 0.99960935 00:02:45.720 --> 00:02:47.160 and she is passionate about NOTE Confidence: 0.99960935 00:02:47.160 --> 00:02:49.180 cancer prevention and early detection NOTE Confidence: 0.92716473 00:02:49.560 --> 00:02:51.160 empowered by results of genetic NOTE Confidence: 0.92716473 00:02:51.160 --> 00:02:51.660 testing. NOTE Confidence: 0.9388428 00:02:52.040 --> 00:02:53.660 Her research interests include NOTE Confidence: 0.9953613 00:02:54.040 --> 00:02:56.585 alternative delivery care models and NOTE Confidence: 0.9953613 00:02:56.585 --> 00:02:58.505 high risk pancreatic screening as NOTE Confidence: 0.9953613 00:02:58.505 --> 00:03:00.345 well. And Amy is going NOTE Confidence: 0.9953613 00:03:00.345 --> 00:03:01.485 to be talking about NOTE Confidence: 0.98746747 00:03:01.785 --> 00:03:04.185 factors such as family cancer NOTE Confidence: 0.98746747 00:03:04.185 --> 00:03:04.685 history NOTE Confidence: 0.9928589 00:03:05.065 --> 00:03:06.905 and genetic testing, which can NOTE Confidence: 0.9928589 00:03:06.905 --> 00:03:08.764 be very important when thinking NOTE Confidence: 0.9928589 00:03:08.825 --> 00:03:10.044 about ways NOTE Confidence: 0.9989421 00:03:10.470 --> 00:03:12.150 to have those, pieces of NOTE Confidence: 0.9989421 00:03:12.150 --> 00:03:12.650 information NOTE Confidence: 0.9989624 00:03:13.030 --> 00:03:14.950 inform who should potentially consider NOTE Confidence: 0.9989624 00:03:14.950 --> 00:03:16.090 early cancer screening. NOTE Confidence: 0.9870981 00:03:16.470 --> 00:03:17.830 So, Amy, thank you so NOTE Confidence: 0.9870981 00:03:17.830 --> 00:03:19.590 much again for participating and NOTE Confidence: 0.9870981 00:03:19.590 --> 00:03:20.489 for your presentation. NOTE Confidence: 0.94748944 00:03:21.349 --> 00:03:22.310 Great. Thank you so much, NOTE Confidence: 0.94748944 00:03:22.310 --> 00:03:23.269 doctor Deary. Thank you for NOTE Confidence: 0.94748944 00:03:23.269 --> 00:03:23.865 the introduction. NOTE Confidence: 0.9962935 00:03:24.425 --> 00:03:26.105 Good evening, everyone. I'm very NOTE Confidence: 0.9962935 00:03:26.105 --> 00:03:27.625 happy to be giving this NOTE Confidence: 0.9962935 00:03:27.625 --> 00:03:28.125 presentation, NOTE Confidence: 0.9826563 00:03:28.505 --> 00:03:29.865 and I will be setting NOTE Confidence: 0.9826563 00:03:29.865 --> 00:03:31.885 the stage for doctor Prasaloglu's NOTE Confidence: 0.93200684 00:03:32.264 --> 00:03:33.325 and doctor Sreekumar's NOTE Confidence: 0.9827418 00:03:33.705 --> 00:03:35.545 talks. So, essentially, what I'll NOTE Confidence: 0.9827418 00:03:35.545 --> 00:03:36.505 be talking about today, we're NOTE Confidence: 0.9827418 00:03:36.505 --> 00:03:37.785 gonna be talking about family NOTE Confidence: 0.9827418 00:03:37.785 --> 00:03:40.260 history and genetic testing, focusing NOTE Confidence: 0.9827418 00:03:40.260 --> 00:03:41.860 on key information that can NOTE Confidence: 0.9827418 00:03:41.860 --> 00:03:43.480 guide early cancer screening. NOTE Confidence: 0.9616699 00:03:44.900 --> 00:03:46.180 So just for the agenda, NOTE Confidence: 0.9616699 00:03:46.180 --> 00:03:47.700 some questions I wanna answer NOTE Confidence: 0.9616699 00:03:47.700 --> 00:03:49.060 are why do some families NOTE Confidence: 0.9616699 00:03:49.060 --> 00:03:50.440 have more cancer than others? NOTE Confidence: 0.9819336 00:03:50.935 --> 00:03:52.534 What is a hereditary cancer NOTE Confidence: 0.9819336 00:03:52.534 --> 00:03:53.814 syndrome, and how are they NOTE Confidence: 0.9819336 00:03:53.814 --> 00:03:54.314 identified, NOTE Confidence: 0.9874573 00:03:55.174 --> 00:03:56.795 and how does family history NOTE Confidence: 0.9874573 00:03:56.935 --> 00:03:58.875 impact risk assessment and recommendations NOTE Confidence: 0.9874573 00:03:59.095 --> 00:04:01.174 for cancer screening at younger NOTE Confidence: 0.9874573 00:04:01.174 --> 00:04:01.674 ages. NOTE Confidence: 0.99523926 00:04:03.570 --> 00:04:05.190 So what causes cancer? NOTE Confidence: 0.9769423 00:04:05.490 --> 00:04:06.850 Just as some background, the NOTE Confidence: 0.9769423 00:04:06.850 --> 00:04:09.090 majority of cancer, almost seventy NOTE Confidence: 0.9769423 00:04:09.090 --> 00:04:10.610 percent of cancer, is what NOTE Confidence: 0.9769423 00:04:10.610 --> 00:04:11.510 we call sporadic. NOTE Confidence: 0.9817592 00:04:12.290 --> 00:04:14.450 That occurs by either complete NOTE Confidence: 0.9817592 00:04:14.450 --> 00:04:16.310 random chance or a combination NOTE Confidence: 0.9817592 00:04:16.370 --> 00:04:18.150 of other factors, including NOTE Confidence: 0.96835166 00:04:18.914 --> 00:04:20.995 environmental risk factors, like, for NOTE Confidence: 0.96835166 00:04:20.995 --> 00:04:22.514 example, having a lot of NOTE Confidence: 0.96835166 00:04:22.514 --> 00:04:23.875 sun exposure being a risk NOTE Confidence: 0.96835166 00:04:23.875 --> 00:04:25.175 factor for skin cancer, NOTE Confidence: 0.9589844 00:04:25.634 --> 00:04:28.275 lifestyle factors, such as tobacco NOTE Confidence: 0.9589844 00:04:28.275 --> 00:04:30.294 use or excessive alcohol use, NOTE Confidence: 0.9712402 00:04:30.675 --> 00:04:32.220 also the natural aging process. NOTE Confidence: 0.9231939 00:04:32.620 --> 00:04:34.060 Aging is something that we NOTE Confidence: 0.9231939 00:04:34.060 --> 00:04:35.740 can't change. So this is NOTE Confidence: 0.9231939 00:04:35.740 --> 00:04:37.580 a natural process of aging NOTE Confidence: 0.9231939 00:04:37.580 --> 00:04:38.700 or getting older can be NOTE Confidence: 0.9231939 00:04:38.700 --> 00:04:40.000 a risk factor for cancer. NOTE Confidence: 0.9231939 00:04:40.300 --> 00:04:41.180 And there may be other NOTE Confidence: 0.9231939 00:04:41.180 --> 00:04:42.779 factors that are unknown, and, NOTE Confidence: 0.9231939 00:04:42.779 --> 00:04:44.620 again, random chance can sometimes NOTE Confidence: 0.9231939 00:04:44.620 --> 00:04:46.060 play a role in cancer NOTE Confidence: 0.9231939 00:04:46.060 --> 00:04:46.560 development. NOTE Confidence: 0.98813474 00:04:48.034 --> 00:04:49.395 Now twenty percent of cancer NOTE Confidence: 0.98813474 00:04:49.395 --> 00:04:50.694 is what we call familial. NOTE Confidence: 0.9961751 00:04:51.235 --> 00:04:52.275 That means you might see NOTE Confidence: 0.9961751 00:04:52.275 --> 00:04:52.775 clusterings NOTE Confidence: 0.99740833 00:04:53.154 --> 00:04:54.435 of the same cancer in NOTE Confidence: 0.99740833 00:04:54.435 --> 00:04:56.115 one family, but we don't NOTE Confidence: 0.99740833 00:04:56.115 --> 00:04:57.574 find one single NOTE Confidence: 0.97865516 00:04:57.875 --> 00:04:59.555 either genetic cause or one NOTE Confidence: 0.97865516 00:04:59.555 --> 00:05:00.455 single explanation. NOTE Confidence: 0.9861328 00:05:01.159 --> 00:05:02.279 So we think that this NOTE Confidence: 0.9861328 00:05:02.279 --> 00:05:03.879 could occur due to factors NOTE Confidence: 0.9861328 00:05:03.879 --> 00:05:05.879 that families share. Families often NOTE Confidence: 0.9861328 00:05:05.879 --> 00:05:07.099 live in the same locations, NOTE Confidence: 0.9861328 00:05:07.240 --> 00:05:09.500 have similar environments, similar diets, NOTE Confidence: 0.9903739 00:05:09.879 --> 00:05:11.319 and then in combination with NOTE Confidence: 0.9903739 00:05:11.319 --> 00:05:13.800 maybe smaller genetic factors that NOTE Confidence: 0.9903739 00:05:13.800 --> 00:05:15.259 result in this clustering NOTE Confidence: 0.9950823 00:05:15.560 --> 00:05:16.794 or seeing the same type NOTE Confidence: 0.9950823 00:05:16.794 --> 00:05:17.495 of cancer, NOTE Confidence: 0.99690753 00:05:18.035 --> 00:05:19.154 in multiple people in the NOTE Confidence: 0.99690753 00:05:19.154 --> 00:05:19.654 family. NOTE Confidence: 0.93357337 00:05:21.635 --> 00:05:23.235 And finally, there's the smallest, NOTE Confidence: 0.93357337 00:05:23.475 --> 00:05:25.415 portion, which is hereditary cancer NOTE Confidence: 0.93357337 00:05:25.555 --> 00:05:27.875 that's, is caused by associated NOTE Confidence: 0.93357337 00:05:27.875 --> 00:05:28.915 with five to ten percent NOTE Confidence: 0.93357337 00:05:28.915 --> 00:05:30.839 of all cancer. And hereditary NOTE Confidence: 0.93357337 00:05:30.900 --> 00:05:32.339 cancer is due to having NOTE Confidence: 0.93357337 00:05:32.339 --> 00:05:33.080 an inherited NOTE Confidence: 0.9389836 00:05:33.620 --> 00:05:35.620 harmful genetic change, which we NOTE Confidence: 0.9389836 00:05:35.620 --> 00:05:37.400 call either a pathogenic variant NOTE Confidence: 0.9389836 00:05:37.620 --> 00:05:38.760 or gene mutation. NOTE Confidence: 0.9985962 00:05:41.380 --> 00:05:42.660 So why is collecting a NOTE Confidence: 0.9985962 00:05:42.660 --> 00:05:43.880 family history important? NOTE Confidence: 0.99221194 00:05:44.254 --> 00:05:45.854 Family history is a really NOTE Confidence: 0.99221194 00:05:45.854 --> 00:05:48.034 important cancer risk assessment tool, NOTE Confidence: 0.99221194 00:05:48.175 --> 00:05:49.055 and it can help with NOTE Confidence: 0.99221194 00:05:49.055 --> 00:05:50.495 a few things. It can NOTE Confidence: 0.99221194 00:05:50.495 --> 00:05:52.815 determine whether genetic testing for NOTE Confidence: 0.99221194 00:05:52.815 --> 00:05:55.315 inherited cancer risk is indicated. NOTE Confidence: 0.9744466 00:05:55.694 --> 00:05:57.455 It can also determine someone's NOTE Confidence: 0.9744466 00:05:57.455 --> 00:05:59.134 personal cancer risks based on NOTE Confidence: 0.9744466 00:05:59.134 --> 00:06:00.034 family history, NOTE Confidence: 0.9890779 00:06:00.470 --> 00:06:01.669 and it also can determine NOTE Confidence: 0.9890779 00:06:01.669 --> 00:06:03.029 the age to begin cancer NOTE Confidence: 0.9890779 00:06:03.029 --> 00:06:04.389 screening as well as the NOTE Confidence: 0.9890779 00:06:04.389 --> 00:06:06.009 strategy for cancer screening. NOTE Confidence: 0.9645359 00:06:07.029 --> 00:06:08.070 Just to start, I'm gonna NOTE Confidence: 0.9645359 00:06:08.070 --> 00:06:09.350 be focusing on number one NOTE Confidence: 0.9645359 00:06:09.350 --> 00:06:11.589 to determine essentially determine whether NOTE Confidence: 0.9645359 00:06:11.589 --> 00:06:13.509 genetic testing for inherited cancer NOTE Confidence: 0.9645359 00:06:13.509 --> 00:06:14.570 risk is indicated. NOTE Confidence: 0.96539307 00:06:16.625 --> 00:06:18.145 As I mentioned, most cancer NOTE Confidence: 0.96539307 00:06:18.145 --> 00:06:19.205 is not hereditary, NOTE Confidence: 0.9972331 00:06:19.585 --> 00:06:20.625 but there can be risk NOTE Confidence: 0.9972331 00:06:20.625 --> 00:06:22.404 factors or red flags NOTE Confidence: 0.9977295 00:06:22.785 --> 00:06:23.585 that could be in a NOTE Confidence: 0.9977295 00:06:23.585 --> 00:06:25.525 person's personal or family history NOTE Confidence: 0.9977295 00:06:25.745 --> 00:06:27.505 that could increase suspicion that NOTE Confidence: 0.9977295 00:06:27.505 --> 00:06:29.444 the cancers could be hereditary. NOTE Confidence: 0.99565196 00:06:30.950 --> 00:06:32.070 One thing that we see NOTE Confidence: 0.99565196 00:06:32.070 --> 00:06:33.270 is that if we see NOTE Confidence: 0.99565196 00:06:33.270 --> 00:06:35.430 cancer diagnosed at younger than NOTE Confidence: 0.99565196 00:06:35.430 --> 00:06:37.190 expected ages for that cancer NOTE Confidence: 0.99565196 00:06:37.190 --> 00:06:37.690 type, NOTE Confidence: 0.97894967 00:06:38.070 --> 00:06:39.350 that could be suspicious that NOTE Confidence: 0.97894967 00:06:39.350 --> 00:06:40.490 the cancer is hereditary. NOTE Confidence: 0.9852973 00:06:41.510 --> 00:06:42.970 Just as some some examples NOTE Confidence: 0.9852973 00:06:43.030 --> 00:06:44.805 would include colon cancer or NOTE Confidence: 0.9852973 00:06:44.805 --> 00:06:46.645 breast cancer diagnosed under the NOTE Confidence: 0.9852973 00:06:46.645 --> 00:06:47.464 age of fifty. NOTE Confidence: 0.9800212 00:06:48.805 --> 00:06:50.725 We might also see several NOTE Confidence: 0.9800212 00:06:50.725 --> 00:06:52.165 family members on the same NOTE Confidence: 0.9800212 00:06:52.165 --> 00:06:53.205 side of the family with NOTE Confidence: 0.9800212 00:06:53.205 --> 00:06:54.505 the same type of cancer, NOTE Confidence: 0.9800212 00:06:54.725 --> 00:06:56.325 such as multiple people in NOTE Confidence: 0.9800212 00:06:56.325 --> 00:06:57.785 one family with breast cancer. NOTE Confidence: 0.97817385 00:06:58.710 --> 00:07:00.410 Also, when cancer is hereditary, NOTE Confidence: 0.9802806 00:07:01.110 --> 00:07:02.470 certain cancers can be seen NOTE Confidence: 0.9802806 00:07:02.470 --> 00:07:04.730 together through one single gene. NOTE Confidence: 0.9802806 00:07:04.790 --> 00:07:06.150 So sometimes we can see, NOTE Confidence: 0.9802806 00:07:06.150 --> 00:07:07.670 even though the cancers aren't NOTE Confidence: 0.9802806 00:07:07.670 --> 00:07:08.890 the same type of cancer, NOTE Confidence: 0.9802806 00:07:09.110 --> 00:07:10.470 if we see cancers like NOTE Confidence: 0.9802806 00:07:10.470 --> 00:07:12.150 breast and ovarian cancer or NOTE Confidence: 0.9802806 00:07:12.150 --> 00:07:14.125 colon or uterine cancer, that NOTE Confidence: 0.9802806 00:07:14.125 --> 00:07:15.405 pattern could be suspicious of NOTE Confidence: 0.9802806 00:07:15.405 --> 00:07:16.865 hereditary cancer risk. NOTE Confidence: 0.94938153 00:07:17.885 --> 00:07:19.505 Ashkenazi Jewish ancestry, NOTE Confidence: 0.9973958 00:07:20.125 --> 00:07:21.105 people who are Ashkenazi NOTE Confidence: 0.9675248 00:07:21.485 --> 00:07:23.005 Jewish, about one in forty NOTE Confidence: 0.9675248 00:07:23.005 --> 00:07:24.445 people who are Ashkenazi Jewish NOTE Confidence: 0.9675248 00:07:24.445 --> 00:07:25.965 will have hereditary breast and NOTE Confidence: 0.9675248 00:07:25.965 --> 00:07:27.505 ovarian cancer syndrome NOTE Confidence: 0.9963074 00:07:27.970 --> 00:07:29.090 compared to about one in NOTE Confidence: 0.9963074 00:07:29.090 --> 00:07:31.090 four hundred individuals who are NOTE Confidence: 0.9963074 00:07:31.090 --> 00:07:31.910 not Ashkenazi. NOTE Confidence: 0.91715497 00:07:32.290 --> 00:07:34.290 So sometimes seeing Ashkenazi Jewish NOTE Confidence: 0.91715497 00:07:34.290 --> 00:07:34.790 ancestry NOTE Confidence: 0.984375 00:07:35.169 --> 00:07:36.389 in combination with NOTE Confidence: 0.9830877 00:07:36.690 --> 00:07:37.970 breast or ovarian cancer in NOTE Confidence: 0.9830877 00:07:37.970 --> 00:07:39.250 the family can also be NOTE Confidence: 0.9830877 00:07:39.250 --> 00:07:39.750 suspicious. NOTE Confidence: 0.9746094 00:07:41.425 --> 00:07:42.785 Rare cancers also might be NOTE Confidence: 0.9746094 00:07:42.785 --> 00:07:44.165 more likely to be hereditary, NOTE Confidence: 0.98398435 00:07:44.545 --> 00:07:46.065 such as seeing breast cancer NOTE Confidence: 0.98398435 00:07:46.065 --> 00:07:48.245 in men or pancreatic cancer. NOTE Confidence: 0.95251465 00:07:49.745 --> 00:07:51.505 Also, seeing one person with NOTE Confidence: 0.95251465 00:07:51.505 --> 00:07:52.965 multiple cancer diagnoses, NOTE Confidence: 0.9511632 00:07:54.020 --> 00:07:55.220 in in that one person. NOTE Confidence: 0.9511632 00:07:55.220 --> 00:07:56.580 So for example, someone who NOTE Confidence: 0.9511632 00:07:56.580 --> 00:07:58.259 is diagnosed with stomach cancer NOTE Confidence: 0.9511632 00:07:58.259 --> 00:08:00.020 at age fifty and then NOTE Confidence: 0.9511632 00:08:00.020 --> 00:08:01.880 colon cancer, a separate cancer NOTE Confidence: 0.9511632 00:08:02.099 --> 00:08:03.160 at age sixty. NOTE Confidence: 0.97694904 00:08:04.740 --> 00:08:05.940 Cancer on both sides of NOTE Confidence: 0.97694904 00:08:05.940 --> 00:08:06.979 the body, so that could NOTE Confidence: 0.97694904 00:08:06.979 --> 00:08:07.800 be bilateral NOTE Confidence: 0.9592692 00:08:08.180 --> 00:08:09.755 kidney cancer or kidney cancer NOTE Confidence: 0.9592692 00:08:09.755 --> 00:08:11.695 in both kidneys or bilateral NOTE Confidence: 0.9592692 00:08:11.835 --> 00:08:12.655 breast cancer. NOTE Confidence: 0.9404785 00:08:13.995 --> 00:08:15.595 Sometimes advanced cancer might be NOTE Confidence: 0.9404785 00:08:15.595 --> 00:08:16.895 more likely to be hereditary, NOTE Confidence: 0.93078613 00:08:17.195 --> 00:08:18.014 so specifically, NOTE Confidence: 0.99108887 00:08:18.395 --> 00:08:20.395 stage four or metastatic prostate NOTE Confidence: 0.99108887 00:08:20.395 --> 00:08:20.895 cancer. NOTE Confidence: 0.9899597 00:08:21.780 --> 00:08:22.980 And finally, of course, if NOTE Confidence: 0.9899597 00:08:22.980 --> 00:08:24.580 someone has a relative that NOTE Confidence: 0.9899597 00:08:24.580 --> 00:08:26.420 has a known hereditary cancer NOTE Confidence: 0.9899597 00:08:26.420 --> 00:08:26.920 syndrome, NOTE Confidence: 0.999721 00:08:27.540 --> 00:08:28.420 that would also be a NOTE Confidence: 0.999721 00:08:28.420 --> 00:08:29.700 risk factor for that person NOTE Confidence: 0.999721 00:08:29.700 --> 00:08:31.640 having hereditary cancer risk. NOTE Confidence: 0.96008724 00:08:33.875 --> 00:08:35.075 So those are the risk NOTE Confidence: 0.96008724 00:08:35.075 --> 00:08:36.115 factors that can make us NOTE Confidence: 0.96008724 00:08:36.115 --> 00:08:37.315 suspicious that cancer could be NOTE Confidence: 0.96008724 00:08:37.315 --> 00:08:39.154 hereditary, but how does genetic NOTE Confidence: 0.96008724 00:08:39.154 --> 00:08:40.755 testing actually work? How does NOTE Confidence: 0.96008724 00:08:40.755 --> 00:08:42.695 identify hereditary cancer risk? NOTE Confidence: 0.98477936 00:08:43.235 --> 00:08:44.515 So just as some background NOTE Confidence: 0.98477936 00:08:44.515 --> 00:08:45.955 briefly, genes can be thought NOTE Confidence: 0.98477936 00:08:45.955 --> 00:08:47.495 of as the instruction manuals NOTE Confidence: 0.98477936 00:08:47.554 --> 00:08:49.019 for our body. We have NOTE Confidence: 0.98477936 00:08:49.019 --> 00:08:50.620 about twenty thousand genes in NOTE Confidence: 0.98477936 00:08:50.620 --> 00:08:51.899 our body. They all do NOTE Confidence: 0.98477936 00:08:51.899 --> 00:08:52.720 different jobs. NOTE Confidence: 0.9881487 00:08:53.259 --> 00:08:54.779 Some genes, they actually determine NOTE Confidence: 0.9881487 00:08:54.779 --> 00:08:55.899 our eye color and other NOTE Confidence: 0.9881487 00:08:55.899 --> 00:08:57.500 factors, but then there's other NOTE Confidence: 0.9881487 00:08:57.500 --> 00:08:58.699 genes that actually are known NOTE Confidence: 0.9881487 00:08:58.699 --> 00:09:00.399 to prevent cancer from developing, NOTE Confidence: 0.9881487 00:09:00.699 --> 00:09:01.500 and these can be thought NOTE Confidence: 0.9881487 00:09:01.500 --> 00:09:03.279 of as cancer prevention genes. NOTE Confidence: 0.9912191 00:09:03.660 --> 00:09:04.514 So you see here on NOTE Confidence: 0.9912191 00:09:04.514 --> 00:09:05.315 the right, this is just NOTE Confidence: 0.9912191 00:09:05.315 --> 00:09:06.675 an example of a cancer NOTE Confidence: 0.9912191 00:09:06.675 --> 00:09:08.774 prevention gene. All the letters NOTE Confidence: 0.9912191 00:09:08.915 --> 00:09:10.995 are DNA, the code that NOTE Confidence: 0.9912191 00:09:10.995 --> 00:09:12.695 actually makes up the gene. NOTE Confidence: 0.9955037 00:09:13.714 --> 00:09:14.755 And we have two copies NOTE Confidence: 0.9955037 00:09:14.755 --> 00:09:15.795 of every single gene in NOTE Confidence: 0.9955037 00:09:15.795 --> 00:09:16.675 our body because you get NOTE Confidence: 0.9955037 00:09:16.675 --> 00:09:17.875 one from your mother and NOTE Confidence: 0.9955037 00:09:17.875 --> 00:09:19.014 one from your father. NOTE Confidence: 0.9672607 00:09:20.510 --> 00:09:21.630 So if someone has a NOTE Confidence: 0.9672607 00:09:21.630 --> 00:09:23.490 mutation or a pathogenic variant, NOTE Confidence: 0.9672607 00:09:23.550 --> 00:09:24.590 one way of thinking about NOTE Confidence: 0.9672607 00:09:24.590 --> 00:09:25.470 is that that it's a NOTE Confidence: 0.9672607 00:09:25.470 --> 00:09:27.550 spelling error, meaning that there's NOTE Confidence: 0.9672607 00:09:27.550 --> 00:09:28.830 a change in the DNA NOTE Confidence: 0.9672607 00:09:28.830 --> 00:09:30.270 code that does not allow NOTE Confidence: 0.9672607 00:09:30.270 --> 00:09:31.570 that gene to work correctly. NOTE Confidence: 0.97630006 00:09:32.445 --> 00:09:33.085 So if that gene is NOTE Confidence: 0.97630006 00:09:33.085 --> 00:09:34.925 a cancer prevention gene and NOTE Confidence: 0.97630006 00:09:34.925 --> 00:09:36.445 there's a mutation that causes NOTE Confidence: 0.97630006 00:09:36.445 --> 00:09:38.145 it to not work correctly, NOTE Confidence: 0.97630006 00:09:38.205 --> 00:09:39.245 so it can't do its NOTE Confidence: 0.97630006 00:09:39.245 --> 00:09:41.085 job of preventing cancer, that NOTE Confidence: 0.97630006 00:09:41.085 --> 00:09:42.525 person essentially is born with NOTE Confidence: 0.97630006 00:09:42.525 --> 00:09:43.905 a higher risk of developing NOTE Confidence: 0.99890137 00:09:44.285 --> 00:09:45.585 certain types of cancers. NOTE Confidence: 0.98257446 00:09:47.790 --> 00:09:49.230 And so genetic testing or NOTE Confidence: 0.98257446 00:09:49.230 --> 00:09:50.610 germline genetic testing, NOTE Confidence: 0.9946675 00:09:51.230 --> 00:09:53.650 looks for inherited gene mutations NOTE Confidence: 0.9946675 00:09:53.950 --> 00:09:55.070 that would be present in NOTE Confidence: 0.9946675 00:09:55.070 --> 00:09:56.429 this in every single cell NOTE Confidence: 0.9946675 00:09:56.429 --> 00:09:57.890 of a person's body. NOTE Confidence: 0.99990237 00:09:58.590 --> 00:09:59.710 And if someone has a NOTE Confidence: 0.99990237 00:09:59.710 --> 00:10:01.890 pathogenic or inherited gene mutation NOTE Confidence: 0.99450684 00:10:02.434 --> 00:10:03.255 that's identified, NOTE Confidence: 0.97830635 00:10:03.875 --> 00:10:05.635 those gene mutations can be NOTE Confidence: 0.97830635 00:10:05.635 --> 00:10:06.595 passed on to a purse NOTE Confidence: 0.97830635 00:10:06.675 --> 00:10:07.894 to a person's children. NOTE Confidence: 0.97068685 00:10:08.995 --> 00:10:09.954 And so this can be NOTE Confidence: 0.97068685 00:10:09.954 --> 00:10:11.235 really helpful because if we NOTE Confidence: 0.97068685 00:10:11.235 --> 00:10:12.934 know someone has an inherited NOTE Confidence: 0.97068685 00:10:13.154 --> 00:10:15.240 hereditary cancer risk, that can NOTE Confidence: 0.97068685 00:10:15.240 --> 00:10:17.080 help clarify that person's own NOTE Confidence: 0.97068685 00:10:17.080 --> 00:10:18.940 specific lifetime risk of cancer. NOTE Confidence: 0.99159074 00:10:19.880 --> 00:10:21.800 And especially with hereditary cancer NOTE Confidence: 0.99159074 00:10:21.800 --> 00:10:23.320 risk, we're much more likely NOTE Confidence: 0.99159074 00:10:23.320 --> 00:10:24.920 to see cancers diagnosed at NOTE Confidence: 0.99159074 00:10:24.920 --> 00:10:27.900 younger ages. So identifying hereditary NOTE Confidence: 0.99159074 00:10:28.040 --> 00:10:29.505 risk of cancer can actually NOTE Confidence: 0.99159074 00:10:29.505 --> 00:10:30.565 guide screening NOTE Confidence: 0.96051896 00:10:30.865 --> 00:10:32.485 and then make management recommendations NOTE Confidence: 0.96051896 00:10:32.785 --> 00:10:34.645 actually starting at younger ages NOTE Confidence: 0.96051896 00:10:34.785 --> 00:10:36.005 than the general population. NOTE Confidence: 0.9826118 00:10:38.465 --> 00:10:39.505 So how does it help? NOTE Confidence: 0.9826118 00:10:39.505 --> 00:10:40.225 I alluded to it a NOTE Confidence: 0.9826118 00:10:40.225 --> 00:10:41.040 little bit, but I wanna NOTE Confidence: 0.9826118 00:10:41.120 --> 00:10:42.720 talk about some examples of NOTE Confidence: 0.9826118 00:10:42.720 --> 00:10:44.720 hereditary cancer syndromes just to NOTE Confidence: 0.9826118 00:10:44.720 --> 00:10:46.899 show exactly what screening entails NOTE Confidence: 0.9913976 00:10:47.360 --> 00:10:48.559 and also to show that NOTE Confidence: 0.9913976 00:10:48.559 --> 00:10:50.160 earlier screening can be really NOTE Confidence: 0.9913976 00:10:50.160 --> 00:10:51.699 helpful for people with hereditary NOTE Confidence: 0.9913976 00:10:51.759 --> 00:10:52.660 cancer syndromes. NOTE Confidence: 0.9905369 00:10:53.554 --> 00:10:55.074 Hereditary breast and ovarian cancer NOTE Confidence: 0.9905369 00:10:55.074 --> 00:10:56.035 syndrome is one of the NOTE Confidence: 0.9905369 00:10:56.035 --> 00:10:57.315 most common ones that that NOTE Confidence: 0.9905369 00:10:57.315 --> 00:10:58.834 we talk about. Some people NOTE Confidence: 0.9905369 00:10:58.834 --> 00:11:00.274 have heard about these genes NOTE Confidence: 0.9905369 00:11:00.274 --> 00:11:02.054 called BRCA one and BRCA NOTE Confidence: 0.9905369 00:11:02.274 --> 00:11:03.954 two, also sometimes referred to NOTE Confidence: 0.9905369 00:11:03.954 --> 00:11:05.255 as the BRCA genes. NOTE Confidence: 0.9928152 00:11:05.880 --> 00:11:07.420 If someone has an inherited NOTE Confidence: 0.9928152 00:11:07.559 --> 00:11:09.240 mutation in either BRCA one NOTE Confidence: 0.9928152 00:11:09.240 --> 00:11:11.000 or BRCA two, there's an NOTE Confidence: 0.9928152 00:11:11.000 --> 00:11:13.179 associated risk of breast, ovarian, NOTE Confidence: 0.9928152 00:11:13.400 --> 00:11:13.900 pancreatic, NOTE Confidence: 0.99731445 00:11:14.280 --> 00:11:15.420 and prostate cancer. NOTE Confidence: 0.9838867 00:11:16.520 --> 00:11:18.300 And there's multiple different recommendations NOTE Confidence: 0.9838867 00:11:18.440 --> 00:11:20.360 for increased cancer surveillance, and NOTE Confidence: 0.9838867 00:11:20.360 --> 00:11:21.855 the important thing is that NOTE Confidence: 0.9640706 00:11:22.415 --> 00:11:23.615 lot of these surveillance and NOTE Confidence: 0.9640706 00:11:23.615 --> 00:11:25.214 prevention measures start at much NOTE Confidence: 0.9640706 00:11:25.214 --> 00:11:26.115 younger ages. NOTE Confidence: 0.9222005 00:11:26.574 --> 00:11:27.554 So, for example, NOTE Confidence: 0.99869794 00:11:27.934 --> 00:11:29.315 women who are BRCA NOTE Confidence: 0.98619246 00:11:29.695 --> 00:11:31.135 positive, meaning they have a NOTE Confidence: 0.98619246 00:11:31.135 --> 00:11:31.635 BRCA NOTE Confidence: 0.986084 00:11:32.095 --> 00:11:32.915 gene mutation, NOTE Confidence: 0.96754736 00:11:33.295 --> 00:11:34.495 they are recommended to start NOTE Confidence: 0.96754736 00:11:34.495 --> 00:11:36.175 breast imaging with annual breast NOTE Confidence: 0.96754736 00:11:36.175 --> 00:11:37.880 MRI starting at age twenty NOTE Confidence: 0.96754736 00:11:37.880 --> 00:11:39.559 five as well as annual NOTE Confidence: 0.96754736 00:11:39.559 --> 00:11:40.920 mammogram that then start at NOTE Confidence: 0.96754736 00:11:40.920 --> 00:11:41.660 age thirty. NOTE Confidence: 0.9967748 00:11:42.120 --> 00:11:43.320 Just for some context, the NOTE Confidence: 0.9967748 00:11:43.320 --> 00:11:45.000 average for general population for NOTE Confidence: 0.9967748 00:11:45.000 --> 00:11:46.920 women, mammograms are recommended to NOTE Confidence: 0.9967748 00:11:46.920 --> 00:11:48.300 start around age forty. NOTE Confidence: 0.97372276 00:11:49.080 --> 00:11:50.679 Additionally, because of the associated NOTE Confidence: 0.97372276 00:11:50.679 --> 00:11:52.395 risk of ovarian cancer, there NOTE Confidence: 0.97372276 00:11:52.395 --> 00:11:54.075 is a recommendation for risk NOTE Confidence: 0.97372276 00:11:54.075 --> 00:11:56.495 reducing bilateral salpingo oophorectomy, NOTE Confidence: 0.96211594 00:11:56.875 --> 00:11:57.835 which is removal of the NOTE Confidence: 0.96211594 00:11:57.835 --> 00:11:59.535 ovaries and the fallopian tubes NOTE Confidence: 0.96211594 00:11:59.595 --> 00:12:01.115 at around age forty. So NOTE Confidence: 0.96211594 00:12:01.115 --> 00:12:02.875 again, another example of cancer NOTE Confidence: 0.96211594 00:12:02.875 --> 00:12:04.875 prevention strategy at a younger NOTE Confidence: 0.96211594 00:12:04.875 --> 00:12:05.375 age. NOTE Confidence: 0.96274275 00:12:05.940 --> 00:12:07.220 Men are also recommended who NOTE Confidence: 0.96274275 00:12:07.220 --> 00:12:08.660 are BRCA positive to start NOTE Confidence: 0.96274275 00:12:08.660 --> 00:12:09.160 prostate NOTE Confidence: 0.9291504 00:12:09.540 --> 00:12:11.220 cancer screening at a younger NOTE Confidence: 0.9291504 00:12:11.220 --> 00:12:12.840 age, so at age forty. NOTE Confidence: 0.99609375 00:12:13.300 --> 00:12:14.679 And other cancer screening NOTE Confidence: 0.9373779 00:12:15.059 --> 00:12:16.100 could be considered would be NOTE Confidence: 0.9373779 00:12:16.100 --> 00:12:17.640 pancreatic cancer screening. NOTE Confidence: 0.9908244 00:12:19.804 --> 00:12:21.404 Another another example of a NOTE Confidence: 0.9908244 00:12:21.404 --> 00:12:23.324 common hereditary cancer syndrome is NOTE Confidence: 0.9908244 00:12:23.324 --> 00:12:25.165 Lynch syndrome. So it's caused NOTE Confidence: 0.9908244 00:12:25.165 --> 00:12:27.165 by inherited mutations in one NOTE Confidence: 0.9908244 00:12:27.165 --> 00:12:28.464 of five different genes. NOTE Confidence: 0.9710286 00:12:29.004 --> 00:12:30.605 Lynch syndrome is associated with NOTE Confidence: 0.9710286 00:12:30.605 --> 00:12:32.524 increased risk of colon, uterine, NOTE Confidence: 0.9710286 00:12:32.524 --> 00:12:33.665 ovarian, pancreatic, NOTE Confidence: 0.98078614 00:12:33.970 --> 00:12:35.570 prostate, urinary tract, as well NOTE Confidence: 0.98078614 00:12:35.570 --> 00:12:37.429 as other different cancer types. NOTE Confidence: 0.9878906 00:12:38.370 --> 00:12:39.330 And just to review a NOTE Confidence: 0.9878906 00:12:39.330 --> 00:12:40.290 little bit some of the NOTE Confidence: 0.9878906 00:12:40.290 --> 00:12:42.550 recommendations for increased cancer surveillance, NOTE Confidence: 0.97669816 00:12:43.809 --> 00:12:45.170 people with Lynch syndrome are NOTE Confidence: 0.97669816 00:12:45.170 --> 00:12:46.550 recommended to start colonoscopies NOTE Confidence: 0.9892578 00:12:47.330 --> 00:12:48.550 in in their twenties NOTE Confidence: 0.9893799 00:12:49.134 --> 00:12:49.954 or thirties. NOTE Confidence: 0.9354461 00:12:50.255 --> 00:12:51.214 Just to get us for NOTE Confidence: 0.9354461 00:12:51.214 --> 00:12:52.975 some context, for the general NOTE Confidence: 0.9354461 00:12:52.975 --> 00:12:55.394 population, colonoscopy screening is recommended NOTE Confidence: 0.9354461 00:12:55.454 --> 00:12:56.894 to start around age forty NOTE Confidence: 0.9354461 00:12:56.894 --> 00:12:57.394 five. NOTE Confidence: 0.9850464 00:12:58.175 --> 00:12:59.535 Also, we would recommend upper NOTE Confidence: 0.9850464 00:12:59.535 --> 00:13:01.375 endoscopy screening starting at age NOTE Confidence: 0.9850464 00:13:01.375 --> 00:13:02.194 thirty five. NOTE Confidence: 0.9349546 00:13:03.020 --> 00:13:04.620 With this also recommendation for NOTE Confidence: 0.9349546 00:13:04.620 --> 00:13:06.700 risk reducing total hysterectomy, so NOTE Confidence: 0.9349546 00:13:06.700 --> 00:13:08.059 removal of the uterus, ovaries, NOTE Confidence: 0.9349546 00:13:08.059 --> 00:13:09.820 and the fallopian tubes between NOTE Confidence: 0.9349546 00:13:09.820 --> 00:13:10.860 the ages of forty five NOTE Confidence: 0.9349546 00:13:10.860 --> 00:13:11.600 and fifty. NOTE Confidence: 0.95367074 00:13:11.980 --> 00:13:13.580 And consideration of screening for NOTE Confidence: 0.95367074 00:13:13.580 --> 00:13:15.179 other types of cancers such NOTE Confidence: 0.95367074 00:13:15.179 --> 00:13:16.700 as urinary tract cancers and NOTE Confidence: 0.95367074 00:13:16.700 --> 00:13:17.600 prostate cancers. NOTE Confidence: 0.9728597 00:13:18.975 --> 00:13:20.335 So just to recap, genetic NOTE Confidence: 0.9728597 00:13:20.335 --> 00:13:22.175 testing, if hereditary cancer risk NOTE Confidence: 0.9728597 00:13:22.175 --> 00:13:22.995 is identified, NOTE Confidence: 0.99088544 00:13:23.375 --> 00:13:24.655 that could be really helpful NOTE Confidence: 0.99088544 00:13:24.655 --> 00:13:26.655 in determining someone's lifetime risk NOTE Confidence: 0.99088544 00:13:26.655 --> 00:13:27.235 of cancers NOTE Confidence: 0.975708 00:13:27.695 --> 00:13:29.375 and also determining what screening NOTE Confidence: 0.975708 00:13:29.375 --> 00:13:30.300 can start at NOTE Confidence: 0.92801553 00:13:30.860 --> 00:13:32.620 at which age. And particularly, NOTE Confidence: 0.92801553 00:13:32.620 --> 00:13:33.500 we want we wanna start NOTE Confidence: 0.92801553 00:13:33.500 --> 00:13:34.860 at a younger age because NOTE Confidence: 0.92801553 00:13:34.860 --> 00:13:35.980 the goal of doing genetic NOTE Confidence: 0.92801553 00:13:35.980 --> 00:13:37.899 testing and identifying hereditary cancer NOTE Confidence: 0.92801553 00:13:37.899 --> 00:13:39.740 risk is to cat either NOTE Confidence: 0.92801553 00:13:39.740 --> 00:13:40.959 catch cancer early NOTE Confidence: 0.9975586 00:13:41.339 --> 00:13:42.399 or prevent it. NOTE Confidence: 0.9655762 00:13:44.145 --> 00:13:45.425 Now as I mentioned, genetic NOTE Confidence: 0.9655762 00:13:45.425 --> 00:13:46.865 testing is is a is NOTE Confidence: 0.9655762 00:13:46.865 --> 00:13:48.225 a part of a part NOTE Confidence: 0.9655762 00:13:48.225 --> 00:13:49.585 of, again, why family history NOTE Confidence: 0.9655762 00:13:49.585 --> 00:13:51.605 collection is important, but NOTE Confidence: 0.97508514 00:13:52.065 --> 00:13:53.605 especially when we identify hereditary NOTE Confidence: 0.97508514 00:13:53.665 --> 00:13:54.945 cancer risk. But what if NOTE Confidence: 0.97508514 00:13:54.945 --> 00:13:56.885 someone has negative genetic testing? NOTE Confidence: 0.97508514 00:13:56.910 --> 00:13:57.870 They have a family history NOTE Confidence: 0.97508514 00:13:57.870 --> 00:13:59.389 of cancer. They have negative NOTE Confidence: 0.97508514 00:13:59.389 --> 00:14:00.750 genetic testing, which means that NOTE Confidence: 0.97508514 00:14:00.750 --> 00:14:01.949 they don't have any known NOTE Confidence: 0.97508514 00:14:01.949 --> 00:14:03.410 hereditary risk of cancer. NOTE Confidence: 0.9966471 00:14:03.790 --> 00:14:04.990 If we go back to NOTE Confidence: 0.9966471 00:14:04.990 --> 00:14:06.429 this prior slide of why NOTE Confidence: 0.9966471 00:14:06.429 --> 00:14:08.209 family history collection is important, NOTE Confidence: 0.94992065 00:14:08.589 --> 00:14:10.190 family history collection can be NOTE Confidence: 0.94992065 00:14:10.190 --> 00:14:11.790 really helpful, again, to determine NOTE Confidence: 0.94992065 00:14:11.790 --> 00:14:12.690 cancer risks. NOTE Confidence: 0.96092224 00:14:13.025 --> 00:14:14.625 And also, most importantly, maybe NOTE Confidence: 0.96092224 00:14:14.625 --> 00:14:16.225 determine age to begin cancer NOTE Confidence: 0.96092224 00:14:16.225 --> 00:14:17.985 screening just based on family NOTE Confidence: 0.96092224 00:14:17.985 --> 00:14:18.485 history. NOTE Confidence: 0.90103585 00:14:19.985 --> 00:14:21.185 So how does family history NOTE Confidence: 0.90103585 00:14:21.185 --> 00:14:22.865 can of cancer impact cancer NOTE Confidence: 0.90103585 00:14:22.865 --> 00:14:24.405 risk and screening recommendations? NOTE Confidence: 0.98432076 00:14:25.170 --> 00:14:26.210 So as I mentioned, family NOTE Confidence: 0.98432076 00:14:26.210 --> 00:14:27.490 history of cancer might be NOTE Confidence: 0.98432076 00:14:27.490 --> 00:14:29.010 associated with increased risk to NOTE Confidence: 0.98432076 00:14:29.010 --> 00:14:31.410 develop that cancer type even NOTE Confidence: 0.98432076 00:14:31.410 --> 00:14:32.770 with negative genetic testing in NOTE Confidence: 0.98432076 00:14:32.770 --> 00:14:33.350 the family. NOTE Confidence: 0.97505265 00:14:34.050 --> 00:14:35.089 What we see is that NOTE Confidence: 0.97505265 00:14:35.089 --> 00:14:36.290 even if someone has negative NOTE Confidence: 0.97505265 00:14:36.290 --> 00:14:38.235 or normal genetic testing, if NOTE Confidence: 0.97505265 00:14:38.235 --> 00:14:40.075 someone's more closely related to NOTE Confidence: 0.97505265 00:14:40.075 --> 00:14:41.755 a relative with cancer, that NOTE Confidence: 0.97505265 00:14:41.755 --> 00:14:42.635 might have more of an NOTE Confidence: 0.97505265 00:14:42.635 --> 00:14:44.415 impact on that person's estimated NOTE Confidence: 0.97505265 00:14:44.475 --> 00:14:45.375 risk of cancer. NOTE Confidence: 0.90581805 00:14:45.755 --> 00:14:47.195 So for example, if someone's NOTE Confidence: 0.90581805 00:14:47.195 --> 00:14:48.555 mother is that has history NOTE Confidence: 0.90581805 00:14:48.555 --> 00:14:49.375 of breast cancer, NOTE Confidence: 0.9767524 00:14:49.755 --> 00:14:50.875 that person's own risk of NOTE Confidence: 0.9767524 00:14:50.875 --> 00:14:52.415 breast cancer might be higher NOTE Confidence: 0.9767524 00:14:52.710 --> 00:14:53.910 because they're more closely related NOTE Confidence: 0.9767524 00:14:53.910 --> 00:14:54.810 to their mother NOTE Confidence: 0.9838104 00:14:55.110 --> 00:14:56.230 as compared to if they NOTE Confidence: 0.9838104 00:14:56.230 --> 00:14:57.990 had a first cousin with NOTE Confidence: 0.9838104 00:14:57.990 --> 00:14:59.510 breast cancer, so more distantly NOTE Confidence: 0.9838104 00:14:59.510 --> 00:15:00.010 related. NOTE Confidence: 0.9393605 00:15:01.110 --> 00:15:02.970 Also, younger age to diagnosis NOTE Confidence: 0.9393605 00:15:03.030 --> 00:15:04.310 in a family may also NOTE Confidence: 0.9393605 00:15:04.310 --> 00:15:05.830 have a greater impact on NOTE Confidence: 0.9393605 00:15:05.830 --> 00:15:07.430 a person's estimated risk of NOTE Confidence: 0.9393605 00:15:07.430 --> 00:15:09.535 cancer compared to cancers diagnosed NOTE Confidence: 0.9393605 00:15:09.535 --> 00:15:10.595 at a later age. NOTE Confidence: 0.96706605 00:15:11.135 --> 00:15:12.415 So for example, having a NOTE Confidence: 0.96706605 00:15:12.415 --> 00:15:14.095 relative diagnosed with breast cancer NOTE Confidence: 0.96706605 00:15:14.095 --> 00:15:15.075 in their thirties NOTE Confidence: 0.98899335 00:15:15.615 --> 00:15:16.895 might be related to a NOTE Confidence: 0.98899335 00:15:16.895 --> 00:15:18.495 higher estimated risk of cancer NOTE Confidence: 0.98899335 00:15:18.495 --> 00:15:20.095 for that person as compared NOTE Confidence: 0.98899335 00:15:20.095 --> 00:15:21.215 to if that relative is NOTE Confidence: 0.98899335 00:15:21.215 --> 00:15:22.835 diagnosed in their seventies. NOTE Confidence: 0.98243713 00:15:24.300 --> 00:15:25.340 And so even with a NOTE Confidence: 0.98243713 00:15:25.340 --> 00:15:27.100 negative genetic test result, increased NOTE Confidence: 0.98243713 00:15:27.100 --> 00:15:28.460 cancer screening may still be NOTE Confidence: 0.98243713 00:15:28.460 --> 00:15:28.960 recommended NOTE Confidence: 0.9813843 00:15:29.340 --> 00:15:30.540 just based on that family NOTE Confidence: 0.9813843 00:15:30.540 --> 00:15:31.600 history of cancer. NOTE Confidence: 0.9946733 00:15:32.380 --> 00:15:34.140 And the important thing is NOTE Confidence: 0.9946733 00:15:34.140 --> 00:15:35.580 that this cancer screening may NOTE Confidence: 0.9946733 00:15:35.580 --> 00:15:36.780 be recommended to begin at NOTE Confidence: 0.9946733 00:15:36.780 --> 00:15:37.820 a younger age in the NOTE Confidence: 0.9946733 00:15:37.820 --> 00:15:38.720 general population NOTE Confidence: 0.92023927 00:15:39.275 --> 00:15:40.555 if there's younger than average NOTE Confidence: 0.92023927 00:15:40.555 --> 00:15:42.335 cancer diagnosis in the family. NOTE Confidence: 0.9315482 00:15:42.875 --> 00:15:44.235 So for breast cancer and NOTE Confidence: 0.9315482 00:15:44.235 --> 00:15:46.495 doctor Rasaloglu and doctor Sreekumar NOTE Confidence: 0.9315482 00:15:46.715 --> 00:15:47.755 will discuss this in more NOTE Confidence: 0.9315482 00:15:47.755 --> 00:15:48.955 detail, but just as a NOTE Confidence: 0.9315482 00:15:48.955 --> 00:15:49.855 brief overview, NOTE Confidence: 0.9761963 00:15:50.155 --> 00:15:51.275 if someone has a first NOTE Confidence: 0.9761963 00:15:51.275 --> 00:15:53.115 degree relative with breast cancer, NOTE Confidence: 0.91923255 00:15:54.480 --> 00:15:56.240 or, like, mother, sister, daughter, NOTE Confidence: 0.91923255 00:15:56.240 --> 00:15:57.360 or having a a second NOTE Confidence: 0.91923255 00:15:57.360 --> 00:15:59.440 degree relative, aunt, grandmother, or NOTE Confidence: 0.91923255 00:15:59.440 --> 00:16:00.260 half sister, NOTE Confidence: 0.9847412 00:16:00.640 --> 00:16:02.160 that may be associated with NOTE Confidence: 0.9847412 00:16:02.160 --> 00:16:03.120 a higher risk of breast NOTE Confidence: 0.9847412 00:16:03.120 --> 00:16:04.500 cancer for that individual. NOTE Confidence: 0.8249512 00:16:05.200 --> 00:16:05.940 And particularly, NOTE Confidence: 0.94152117 00:16:06.320 --> 00:16:08.075 if there's if if a NOTE Confidence: 0.94152117 00:16:08.075 --> 00:16:09.275 relative is diagnosed with breast NOTE Confidence: 0.94152117 00:16:09.275 --> 00:16:10.635 cancer at a younger than NOTE Confidence: 0.94152117 00:16:10.635 --> 00:16:11.695 expected age, NOTE Confidence: 0.99902344 00:16:12.395 --> 00:16:12.895 starting NOTE Confidence: 0.9949951 00:16:13.275 --> 00:16:15.275 breast MRIs with additional breast NOTE Confidence: 0.9949951 00:16:15.275 --> 00:16:16.495 imaging or mammograms NOTE Confidence: 0.9421875 00:16:16.875 --> 00:16:18.335 might be recommended to begin NOTE Confidence: 0.9421875 00:16:18.475 --> 00:16:20.175 at younger than average ages, NOTE Confidence: 0.8795654 00:16:20.635 --> 00:16:21.755 again, depending on the age NOTE Confidence: 0.8795654 00:16:21.755 --> 00:16:23.295 of the breast cancer diagnosis NOTE Confidence: 0.9998372 00:16:23.889 --> 00:16:24.709 in the family. NOTE Confidence: 0.97038436 00:16:25.810 --> 00:16:27.410 For colon cancer as well, NOTE Confidence: 0.97038436 00:16:27.410 --> 00:16:28.930 having a first degree relative NOTE Confidence: 0.97038436 00:16:28.930 --> 00:16:30.130 such as a parent, sibling, NOTE Confidence: 0.97038436 00:16:30.130 --> 00:16:31.670 or child with colon cancer NOTE Confidence: 0.97038436 00:16:31.889 --> 00:16:33.089 is associated with a higher NOTE Confidence: 0.97038436 00:16:33.089 --> 00:16:34.529 risk to develop colon cancer NOTE Confidence: 0.97038436 00:16:34.529 --> 00:16:35.730 when compared to the general NOTE Confidence: 0.97038436 00:16:35.730 --> 00:16:36.230 population NOTE Confidence: 0.9465332 00:16:36.769 --> 00:16:38.550 even with negative genetic testing. NOTE Confidence: 0.9651341 00:16:39.045 --> 00:16:40.345 And so that's why colonoscopy NOTE Confidence: 0.9651341 00:16:40.565 --> 00:16:42.805 surveillance is recommended starting at NOTE Confidence: 0.9651341 00:16:42.805 --> 00:16:44.404 a younger age if someone NOTE Confidence: 0.9651341 00:16:44.404 --> 00:16:45.285 does have a first year NOTE Confidence: 0.9651341 00:16:45.285 --> 00:16:47.365 relative with colon cancer, usually NOTE Confidence: 0.9651341 00:16:47.365 --> 00:16:49.045 by age forty compared to NOTE Confidence: 0.9651341 00:16:49.045 --> 00:16:50.165 age forty five for the NOTE Confidence: 0.9651341 00:16:50.165 --> 00:16:51.145 general population NOTE Confidence: 0.8807373 00:16:51.765 --> 00:16:53.225 or ten years prior NOTE Confidence: 0.9946777 00:16:53.580 --> 00:16:55.360 and then also having colonoscopies NOTE Confidence: 0.98154294 00:16:56.220 --> 00:16:57.500 more frequently, so even as NOTE Confidence: 0.98154294 00:16:57.500 --> 00:16:59.440 frequently as every five years. NOTE Confidence: 0.99609375 00:17:01.100 --> 00:17:02.620 So just as a recap NOTE Confidence: 0.99609375 00:17:02.620 --> 00:17:03.760 in terms of reviewing NOTE Confidence: 0.9936899 00:17:04.140 --> 00:17:05.580 the family history of cancer, NOTE Confidence: 0.9936899 00:17:05.580 --> 00:17:06.780 what things to really think NOTE Confidence: 0.9936899 00:17:06.780 --> 00:17:08.080 about is that NOTE Confidence: 0.9728665 00:17:08.984 --> 00:17:09.825 is of course, it can NOTE Confidence: 0.9728665 00:17:09.825 --> 00:17:10.945 be hard to collect sometimes NOTE Confidence: 0.9728665 00:17:10.945 --> 00:17:12.785 really detailed information about family NOTE Confidence: 0.9728665 00:17:12.785 --> 00:17:14.385 history. But the more information NOTE Confidence: 0.9728665 00:17:14.385 --> 00:17:15.345 you have about your family NOTE Confidence: 0.9728665 00:17:15.345 --> 00:17:16.945 history of cancer, the better NOTE Confidence: 0.9728665 00:17:16.945 --> 00:17:18.145 risk assessment that can be NOTE Confidence: 0.9728665 00:17:18.145 --> 00:17:18.645 performed. NOTE Confidence: 0.9448353 00:17:19.105 --> 00:17:19.905 I would say the most NOTE Confidence: 0.9448353 00:17:19.905 --> 00:17:21.505 important thing is knowing what NOTE Confidence: 0.9448353 00:17:21.505 --> 00:17:23.170 the cancer type was, if NOTE Confidence: 0.9448353 00:17:23.170 --> 00:17:24.609 it's if possible diagnosed in NOTE Confidence: 0.9448353 00:17:24.609 --> 00:17:25.270 a relative, NOTE Confidence: 0.9734497 00:17:25.730 --> 00:17:26.950 and their age diagnosis. NOTE Confidence: 0.9586792 00:17:27.330 --> 00:17:29.910 Because, again, age diagnosis, especially NOTE Confidence: 0.9586792 00:17:29.970 --> 00:17:31.109 young age diagnosis, NOTE Confidence: 0.9998372 00:17:31.650 --> 00:17:33.730 that can impact recommendations for NOTE Confidence: 0.9998372 00:17:33.730 --> 00:17:34.230 earlier NOTE Confidence: 0.9916992 00:17:34.609 --> 00:17:35.510 cancer screening. NOTE Confidence: 0.9844037 00:17:36.705 --> 00:17:38.304 Especially if anyone's had cancer NOTE Confidence: 0.9844037 00:17:38.304 --> 00:17:39.665 twice in the family, maybe NOTE Confidence: 0.9844037 00:17:39.665 --> 00:17:40.785 try to figure out if NOTE Confidence: 0.9844037 00:17:40.785 --> 00:17:41.445 it was NOTE Confidence: 0.9458618 00:17:41.905 --> 00:17:43.505 a new cancer, so not NOTE Confidence: 0.9458618 00:17:43.505 --> 00:17:45.424 on, prior cancer that came NOTE Confidence: 0.9458618 00:17:45.424 --> 00:17:46.705 back or maybe it was NOTE Confidence: 0.9458618 00:17:46.705 --> 00:17:48.145 in a different part different NOTE Confidence: 0.9458618 00:17:48.145 --> 00:17:49.045 part of the body. NOTE Confidence: 0.9507107 00:17:49.919 --> 00:17:50.799 And it can be hard NOTE Confidence: 0.9507107 00:17:50.799 --> 00:17:52.320 especially thinking about family, NOTE Confidence: 0.9615184 00:17:52.720 --> 00:17:54.320 family members, but you don't NOTE Confidence: 0.9615184 00:17:54.320 --> 00:17:55.200 have to go, you know, NOTE Confidence: 0.9615184 00:17:55.200 --> 00:17:56.720 extremely far back to great NOTE Confidence: 0.9615184 00:17:56.720 --> 00:17:58.639 great great grandparents, but focus NOTE Confidence: 0.9615184 00:17:58.639 --> 00:18:00.159 on the close relatives first, NOTE Confidence: 0.9615184 00:18:00.159 --> 00:18:01.379 so first degree relatives, NOTE Confidence: 0.97539693 00:18:01.840 --> 00:18:03.359 then second degree, and then NOTE Confidence: 0.97539693 00:18:03.359 --> 00:18:04.835 third degree. And And as NOTE Confidence: 0.97539693 00:18:04.835 --> 00:18:05.795 I said, do the best NOTE Confidence: 0.97539693 00:18:05.795 --> 00:18:07.715 that you can. Oftentimes, family NOTE Confidence: 0.97539693 00:18:07.715 --> 00:18:09.075 history may not be complete. NOTE Confidence: 0.97539693 00:18:09.075 --> 00:18:10.355 Some people may not disclose NOTE Confidence: 0.97539693 00:18:10.355 --> 00:18:10.855 diagnoses, NOTE Confidence: 0.9920279 00:18:11.234 --> 00:18:12.035 but all you can do NOTE Confidence: 0.9920279 00:18:12.035 --> 00:18:13.475 is really collect the information NOTE Confidence: 0.9920279 00:18:13.475 --> 00:18:14.915 that you can and really NOTE Confidence: 0.9920279 00:18:14.915 --> 00:18:16.994 focusing on cancer type in NOTE Confidence: 0.9920279 00:18:16.994 --> 00:18:18.915 the family and approximate age NOTE Confidence: 0.9920279 00:18:18.915 --> 00:18:19.415 diagnosis. NOTE Confidence: 0.9838867 00:18:21.290 --> 00:18:22.750 So just as a summary, NOTE Confidence: 0.9947754 00:18:23.450 --> 00:18:24.730 specific risk factors in a NOTE Confidence: 0.9947754 00:18:24.730 --> 00:18:26.410 family of cancer can increase NOTE Confidence: 0.9947754 00:18:26.410 --> 00:18:28.750 suspicion of hereditary cancer syndromes. NOTE Confidence: 0.9797257 00:18:29.530 --> 00:18:31.210 Genetic testing can determine if NOTE Confidence: 0.9797257 00:18:31.210 --> 00:18:33.225 someone has hereditary cancer risk, NOTE Confidence: 0.9797257 00:18:33.385 --> 00:18:34.825 which then can inform their NOTE Confidence: 0.9797257 00:18:34.825 --> 00:18:36.345 lifetime risk of cancer and NOTE Confidence: 0.9797257 00:18:36.345 --> 00:18:37.645 cancer screening recommendations, NOTE Confidence: 0.99365234 00:18:38.184 --> 00:18:38.684 oftentimes NOTE Confidence: 0.9267578 00:18:39.225 --> 00:18:40.984 cancer screening starting at younger NOTE Confidence: 0.9267578 00:18:40.984 --> 00:18:41.484 ages. NOTE Confidence: 0.9361128 00:18:42.184 --> 00:18:43.544 In family history of cancer NOTE Confidence: 0.9361128 00:18:43.544 --> 00:18:45.225 alone, even with negative genetic NOTE Confidence: 0.9361128 00:18:45.225 --> 00:18:46.664 testing, may still impact the NOTE Confidence: 0.9361128 00:18:46.664 --> 00:18:48.780 person's cancer risk estimates and NOTE Confidence: 0.9361128 00:18:48.780 --> 00:18:49.760 screening recommendations, NOTE Confidence: 0.9172363 00:18:50.300 --> 00:18:51.820 even possibly starting at younger NOTE Confidence: 0.9172363 00:18:51.820 --> 00:18:52.320 ages. NOTE Confidence: 0.97749025 00:18:52.860 --> 00:18:54.300 And collecting a detailed family NOTE Confidence: 0.97749025 00:18:54.300 --> 00:18:55.500 history of cancer can be NOTE Confidence: 0.97749025 00:18:55.500 --> 00:18:57.280 key in forming a personalized NOTE Confidence: 0.97749025 00:18:57.420 --> 00:18:59.280 cancer screening and prevention plan. NOTE Confidence: 0.92198443 00:19:00.734 --> 00:19:01.615 I'll just take a moment NOTE Confidence: 0.92198443 00:19:01.615 --> 00:19:03.135 to highlight our team here. NOTE Confidence: 0.92198443 00:19:03.135 --> 00:19:04.014 Doctor Geary is gonna talk NOTE Confidence: 0.92198443 00:19:04.014 --> 00:19:04.815 a little bit more about NOTE Confidence: 0.92198443 00:19:04.815 --> 00:19:06.335 it, but I have the NOTE Confidence: 0.92198443 00:19:06.335 --> 00:19:07.635 privilege of working with, NOTE Confidence: 0.80419225 00:19:08.174 --> 00:19:09.775 some very excellent providers including NOTE Confidence: 0.80419225 00:19:09.775 --> 00:19:10.515 doctor Prasaloglu, NOTE Confidence: 0.9667236 00:19:11.054 --> 00:19:12.095 as well as other high NOTE Confidence: 0.9667236 00:19:12.095 --> 00:19:13.859 risk providers who see patients, NOTE Confidence: 0.9667236 00:19:13.859 --> 00:19:14.900 a great team of genetic NOTE Confidence: 0.9667236 00:19:14.900 --> 00:19:17.320 counselors, clinical, genetic clinical coordinators, NOTE Confidence: 0.9753418 00:19:17.700 --> 00:19:19.460 and genetic counseling assistants, and NOTE Confidence: 0.9753418 00:19:19.460 --> 00:19:20.580 we're able to see patients NOTE Confidence: 0.9753418 00:19:20.580 --> 00:19:21.960 all across the state. NOTE Confidence: 0.96358097 00:19:23.619 --> 00:19:24.980 And I now will have NOTE Confidence: 0.96358097 00:19:24.980 --> 00:19:26.179 some time for questions, and, NOTE Confidence: 0.96358097 00:19:26.179 --> 00:19:26.900 of course, I will be NOTE Confidence: 0.96358097 00:19:26.900 --> 00:19:27.780 available at the end if NOTE Confidence: 0.96358097 00:19:27.780 --> 00:19:28.820 people have any any other NOTE Confidence: 0.96358097 00:19:28.820 --> 00:19:30.035 questions at that time. NOTE Confidence: 1 00:19:31.455 --> 00:19:31.955 Wonderful. NOTE Confidence: 0.99243164 00:19:32.415 --> 00:19:34.035 Thank you so much, Amy, NOTE Confidence: 0.99243164 00:19:34.095 --> 00:19:35.795 for that really insightful presentation. NOTE Confidence: 0.9960716 00:19:36.655 --> 00:19:38.015 And, it really does set NOTE Confidence: 0.9960716 00:19:38.015 --> 00:19:39.935 the stage for thinking about NOTE Confidence: 0.9960716 00:19:39.935 --> 00:19:40.435 factors, NOTE Confidence: 0.9859483 00:19:41.295 --> 00:19:43.100 relevant to not only breast NOTE Confidence: 0.9859483 00:19:43.100 --> 00:19:44.399 cancer and the gastrointestinal, NOTE Confidence: 0.96818036 00:19:45.179 --> 00:19:47.259 cancers like colon cancer, but NOTE Confidence: 0.96818036 00:19:47.259 --> 00:19:48.779 but also beyond. So when NOTE Confidence: 0.96818036 00:19:48.779 --> 00:19:50.220 we think about cancers across NOTE Confidence: 0.96818036 00:19:50.220 --> 00:19:51.200 the board. So, NOTE Confidence: 0.99397784 00:19:52.619 --> 00:19:54.059 I don't actually see any NOTE Confidence: 0.99397784 00:19:54.059 --> 00:19:56.059 questions right now, that have NOTE Confidence: 0.99397784 00:19:56.059 --> 00:19:56.799 come through. NOTE Confidence: 0.9946289 00:19:57.325 --> 00:19:57.805 So, NOTE Confidence: 0.97457886 00:19:58.205 --> 00:19:59.325 we can go forward. And NOTE Confidence: 0.97457886 00:19:59.325 --> 00:20:00.765 if anyone has any questions, NOTE Confidence: 0.97457886 00:20:00.765 --> 00:20:02.445 even for presentations that have NOTE Confidence: 0.97457886 00:20:02.445 --> 00:20:02.945 been, NOTE Confidence: 0.9911914 00:20:03.805 --> 00:20:05.325 completed, please go ahead and NOTE Confidence: 0.9911914 00:20:05.325 --> 00:20:06.365 put them in the QA NOTE Confidence: 0.9911914 00:20:06.365 --> 00:20:08.125 or the chat, and, I NOTE Confidence: 0.9911914 00:20:08.125 --> 00:20:09.565 will definitely bring them forward NOTE Confidence: 0.9911914 00:20:09.565 --> 00:20:11.025 as we move along. So, NOTE Confidence: 0.99969953 00:20:11.885 --> 00:20:13.480 thank you so much. We NOTE Confidence: 0.99969953 00:20:13.480 --> 00:20:15.159 will now move along to NOTE Confidence: 0.99969953 00:20:15.159 --> 00:20:16.380 our next presenter NOTE Confidence: 0.83410645 00:20:17.240 --> 00:20:17.960 who is, NOTE Confidence: 0.7581787 00:20:18.359 --> 00:20:19.659 doctor Eli Persologlu. NOTE Confidence: 0.99748886 00:20:20.039 --> 00:20:21.240 And while we pull the NOTE Confidence: 0.99748886 00:20:21.240 --> 00:20:22.059 slides up, NOTE Confidence: 0.99472046 00:20:22.520 --> 00:20:24.279 I will, give an introduction NOTE Confidence: 0.99472046 00:20:24.279 --> 00:20:25.260 for doctor Persologlu. NOTE Confidence: 0.98121995 00:20:26.455 --> 00:20:28.294 Doctor Prasaloglu is an assistant NOTE Confidence: 0.98121995 00:20:28.294 --> 00:20:30.394 professor of breast surgical oncology NOTE Confidence: 0.98121995 00:20:30.455 --> 00:20:31.595 at Yale University, NOTE Confidence: 0.91502106 00:20:32.695 --> 00:20:34.294 and, school of medicine and NOTE Confidence: 0.91502106 00:20:34.294 --> 00:20:35.755 the Smilow Cancer Hospital. NOTE Confidence: 0.97853 00:20:36.294 --> 00:20:37.654 She's also the physician leader NOTE Confidence: 0.97853 00:20:37.654 --> 00:20:39.195 for high risk breast care NOTE Confidence: 0.97853 00:20:39.255 --> 00:20:40.534 in the cancer genetics and NOTE Confidence: 0.97853 00:20:40.534 --> 00:20:41.514 prevention program. NOTE Confidence: 0.97254133 00:20:41.869 --> 00:20:43.170 She is a board certified NOTE Confidence: 0.97254133 00:20:43.230 --> 00:20:45.070 OB GYN who graduated from NOTE Confidence: 0.97254133 00:20:45.070 --> 00:20:46.750 the University of Chicago School NOTE Confidence: 0.97254133 00:20:46.750 --> 00:20:47.410 of Medicine NOTE Confidence: 0.9845581 00:20:47.710 --> 00:20:49.010 and completed her residency, NOTE Confidence: 0.99853516 00:20:49.550 --> 00:20:51.070 training in OB GYN at NOTE Confidence: 0.99853516 00:20:51.070 --> 00:20:51.890 Brown University NOTE Confidence: 0.9644531 00:20:52.350 --> 00:20:53.550 and then her fellowship in NOTE Confidence: 0.9644531 00:20:53.550 --> 00:20:55.410 breast surgery at Yale University. NOTE Confidence: 0.9328613 00:20:56.265 --> 00:20:57.085 Doctor Prasaloglu's NOTE Confidence: 0.9940863 00:20:57.465 --> 00:20:58.825 joint training in breast and NOTE Confidence: 0.9940863 00:20:58.825 --> 00:20:59.325 gynecologic NOTE Confidence: 0.9992676 00:20:59.705 --> 00:21:01.645 surgery allows for comprehensive NOTE Confidence: 0.96669924 00:21:01.945 --> 00:21:03.965 counseling on breast cancer care, NOTE Confidence: 0.9913411 00:21:04.265 --> 00:21:05.645 focusing on oncofertility, NOTE Confidence: 0.9871419 00:21:06.905 --> 00:21:07.405 menopausal, NOTE Confidence: 0.99523926 00:21:08.185 --> 00:21:10.240 care, and sexual effects of NOTE Confidence: 0.99523926 00:21:10.240 --> 00:21:10.740 treatment. NOTE Confidence: 0.9836914 00:21:11.200 --> 00:21:12.400 She is also a health NOTE Confidence: 0.9836914 00:21:12.400 --> 00:21:14.820 services researcher studying decision making NOTE Confidence: 0.9943673 00:21:15.200 --> 00:21:16.980 among high risk gene carriers, NOTE Confidence: 0.9943673 00:21:17.200 --> 00:21:19.520 pregnancy associated cancer, quality of NOTE Confidence: 0.9943673 00:21:19.520 --> 00:21:21.220 life, and financial toxicity. NOTE Confidence: 0.9865007 00:21:21.685 --> 00:21:23.045 So doctor Prasaloglu will be NOTE Confidence: 0.9865007 00:21:23.045 --> 00:21:24.725 talking about risk based breast NOTE Confidence: 0.9865007 00:21:24.725 --> 00:21:26.565 cancer screening approach approaches and NOTE Confidence: 0.9865007 00:21:26.565 --> 00:21:28.244 how this impacts screening for NOTE Confidence: 0.9865007 00:21:28.244 --> 00:21:29.845 early onset breast cancer. Thank NOTE Confidence: 0.9865007 00:21:29.845 --> 00:21:31.225 you very much, doctor Prasaloglu. NOTE Confidence: 0.9732428 00:21:32.165 --> 00:21:33.605 Thanks so much, doctor Geary, NOTE Confidence: 0.9732428 00:21:33.605 --> 00:21:35.060 and thanks to everyone who's NOTE Confidence: 0.9732428 00:21:35.060 --> 00:21:36.340 listening in live as well NOTE Confidence: 0.9732428 00:21:36.340 --> 00:21:37.220 as those who listen to NOTE Confidence: 0.9732428 00:21:37.220 --> 00:21:38.840 our webinar recorded later. NOTE Confidence: 0.9970215 00:21:39.380 --> 00:21:40.260 Amy, that was such a NOTE Confidence: 0.9970215 00:21:40.260 --> 00:21:42.020 wonderful presentation and nicely teed NOTE Confidence: 0.9970215 00:21:42.020 --> 00:21:42.820 me up for a lot NOTE Confidence: 0.9970215 00:21:42.820 --> 00:21:44.119 of the things we'll discuss. NOTE Confidence: 0.97583896 00:21:44.900 --> 00:21:46.580 So, when we think about NOTE Confidence: 0.97583896 00:21:46.580 --> 00:21:48.225 breast cancer, we know that NOTE Confidence: 0.97583896 00:21:48.225 --> 00:21:49.744 early onset breast cancer is NOTE Confidence: 0.97583896 00:21:49.744 --> 00:21:50.785 on the rise. Here are NOTE Confidence: 0.97583896 00:21:50.785 --> 00:21:52.305 just a couple of news NOTE Confidence: 0.97583896 00:21:52.305 --> 00:21:53.825 postings from the past year, NOTE Confidence: 0.97583896 00:21:53.825 --> 00:21:55.025 year and a half talking NOTE Confidence: 0.97583896 00:21:55.025 --> 00:21:56.705 about both celebrities as well NOTE Confidence: 0.97583896 00:21:56.705 --> 00:21:58.545 as, you know, regular people NOTE Confidence: 0.97583896 00:21:58.545 --> 00:22:00.465 who are being diagnosed earlier NOTE Confidence: 0.97583896 00:22:00.465 --> 00:22:01.830 and earlier with breast cancer. NOTE Confidence: 0.98381835 00:22:02.390 --> 00:22:04.010 So, when given the opportunity NOTE Confidence: 0.98381835 00:22:04.070 --> 00:22:05.269 to think about this problem NOTE Confidence: 0.98381835 00:22:05.269 --> 00:22:06.230 and talk to you all NOTE Confidence: 0.98381835 00:22:06.230 --> 00:22:07.429 today, I wanted to dive NOTE Confidence: 0.98381835 00:22:07.429 --> 00:22:08.809 into a couple of things. NOTE Confidence: 0.9816284 00:22:09.830 --> 00:22:11.049 The first is to review NOTE Confidence: 0.9816284 00:22:11.109 --> 00:22:12.470 a little bit about what NOTE Confidence: 0.9816284 00:22:12.470 --> 00:22:14.230 the current breast cancer screening NOTE Confidence: 0.9816284 00:22:14.230 --> 00:22:15.750 recommendations are and how that NOTE Confidence: 0.9816284 00:22:15.750 --> 00:22:17.075 has shifted over time, NOTE Confidence: 0.9926351 00:22:17.775 --> 00:22:18.734 to talk a little bit NOTE Confidence: 0.9926351 00:22:18.734 --> 00:22:20.494 about the subset of patients NOTE Confidence: 0.9926351 00:22:20.494 --> 00:22:22.095 that are considered high risk, NOTE Confidence: 0.9926351 00:22:22.095 --> 00:22:22.855 as well as to give NOTE Confidence: 0.9926351 00:22:22.855 --> 00:22:24.034 a few case examples. NOTE Confidence: 0.9164429 00:22:26.815 --> 00:22:28.355 So, the United States, NOTE Confidence: 0.96669227 00:22:29.340 --> 00:22:31.260 Protective Services Task Force used NOTE Confidence: 0.96669227 00:22:31.260 --> 00:22:32.940 to recommend screening for breast NOTE Confidence: 0.96669227 00:22:32.940 --> 00:22:34.619 cancer in average risk women NOTE Confidence: 0.96669227 00:22:34.619 --> 00:22:35.660 starting at the age of NOTE Confidence: 0.96669227 00:22:35.660 --> 00:22:36.160 fifty. NOTE Confidence: 0.9903906 00:22:36.619 --> 00:22:38.140 But just last year, they NOTE Confidence: 0.9903906 00:22:38.140 --> 00:22:39.820 actually updated this to recommend NOTE Confidence: 0.9903906 00:22:39.820 --> 00:22:41.340 screening beginning at the age NOTE Confidence: 0.9903906 00:22:41.340 --> 00:22:43.115 of forty, thinking about doing NOTE Confidence: 0.9903906 00:22:43.115 --> 00:22:45.054 that likely every two years. NOTE Confidence: 0.99780273 00:22:46.075 --> 00:22:48.075 This brought their recommendations closer NOTE Confidence: 0.99780273 00:22:48.075 --> 00:22:49.054 to other organizations NOTE Confidence: 0.9496528 00:22:49.514 --> 00:22:50.715 and I will highlight here NOTE Confidence: 0.9496528 00:22:50.715 --> 00:22:52.014 that this big organization NOTE Confidence: 0.74560547 00:22:52.475 --> 00:22:52.975 which, NOTE Confidence: 0.95825195 00:22:53.835 --> 00:22:55.355 takes the lead or sort NOTE Confidence: 0.95825195 00:22:55.355 --> 00:22:57.375 of drives many insurance companies NOTE Confidence: 0.95825195 00:22:57.434 --> 00:22:58.820 and their coverage decisions, NOTE Confidence: 0.9558327 00:22:59.359 --> 00:23:00.320 does say we should be NOTE Confidence: 0.9558327 00:23:00.320 --> 00:23:02.799 assessing patients with individualized risk NOTE Confidence: 0.9558327 00:23:02.799 --> 00:23:03.299 assessments NOTE Confidence: 0.94657177 00:23:03.760 --> 00:23:04.720 and then refer to our NOTE Confidence: 0.94657177 00:23:04.720 --> 00:23:06.240 counselors such as Amy and NOTE Confidence: 0.94657177 00:23:06.240 --> 00:23:08.000 her colleagues for genetic counseling NOTE Confidence: 0.94657177 00:23:08.000 --> 00:23:09.380 and testing if warranted. NOTE Confidence: 0.92996216 00:23:11.525 --> 00:23:13.465 Other major organizations agree. NOTE Confidence: 0.9469141 00:23:13.845 --> 00:23:15.684 Early onset screening is very NOTE Confidence: 0.9469141 00:23:15.684 --> 00:23:17.445 important and for years the NOTE Confidence: 0.9469141 00:23:17.445 --> 00:23:19.205 American Society of Breast Surgeons NOTE Confidence: 0.9469141 00:23:19.205 --> 00:23:20.164 as well as the American NOTE Confidence: 0.9469141 00:23:20.164 --> 00:23:22.025 College of Obstetricians and Gynecologists NOTE Confidence: 0.9875837 00:23:22.725 --> 00:23:24.965 has recommended starting screening for NOTE Confidence: 0.9875837 00:23:24.965 --> 00:23:26.645 average risk women as young NOTE Confidence: 0.9875837 00:23:26.645 --> 00:23:28.859 as forty and continuing that NOTE Confidence: 0.9875837 00:23:28.859 --> 00:23:30.460 at least until age seventy NOTE Confidence: 0.9875837 00:23:30.460 --> 00:23:30.960 five. NOTE Confidence: 0.98082316 00:23:31.500 --> 00:23:32.859 Now, of course, our focus NOTE Confidence: 0.98082316 00:23:32.859 --> 00:23:34.220 today is thinking about early NOTE Confidence: 0.98082316 00:23:34.220 --> 00:23:36.220 onset cancers, which in the NOTE Confidence: 0.98082316 00:23:36.220 --> 00:23:37.659 breast world is generally thought NOTE Confidence: 0.98082316 00:23:37.659 --> 00:23:39.119 about as less than fifty, NOTE Confidence: 0.98082316 00:23:39.340 --> 00:23:40.220 but I think it's an NOTE Confidence: 0.98082316 00:23:40.220 --> 00:23:40.720 important, NOTE Confidence: 0.9480957 00:23:41.705 --> 00:23:43.305 point here to take a NOTE Confidence: 0.9480957 00:23:43.305 --> 00:23:44.685 take a step and remember NOTE Confidence: 0.9804164 00:23:45.225 --> 00:23:46.744 that patients, regardless of their NOTE Confidence: 0.9804164 00:23:46.744 --> 00:23:48.285 age, we should be making NOTE Confidence: 0.9804164 00:23:48.505 --> 00:23:50.205 thoughtful decisions about screening NOTE Confidence: 0.9733887 00:23:50.505 --> 00:23:51.385 even if you're on the NOTE Confidence: 0.9733887 00:23:51.385 --> 00:23:52.765 older end of that spectrum. NOTE Confidence: 0.9754761 00:23:53.225 --> 00:23:54.744 In fact, the American Society NOTE Confidence: 0.9754761 00:23:54.744 --> 00:23:56.609 of Breast Surgeons recommends continuing NOTE Confidence: 0.9754761 00:23:56.609 --> 00:23:58.530 screening until life expectancy is NOTE Confidence: 0.9754761 00:23:58.530 --> 00:24:00.130 less than ten years. And NOTE Confidence: 0.9754761 00:24:00.130 --> 00:24:01.330 in my practice, I tell NOTE Confidence: 0.9754761 00:24:01.330 --> 00:24:03.250 patients, especially family members of NOTE Confidence: 0.9754761 00:24:03.250 --> 00:24:04.930 those diagnosed with early onset NOTE Confidence: 0.9754761 00:24:04.930 --> 00:24:06.530 breast cancer, but as long NOTE Confidence: 0.9754761 00:24:06.530 --> 00:24:07.490 as you're healthy enough that NOTE Confidence: 0.9754761 00:24:07.490 --> 00:24:08.450 you would do something with NOTE Confidence: 0.9754761 00:24:08.450 --> 00:24:10.050 the information you receive from NOTE Confidence: 0.9754761 00:24:10.050 --> 00:24:11.910 a mammogram, screening is very NOTE Confidence: 0.98408777 00:24:13.645 --> 00:24:15.244 appropriate. So what does it NOTE Confidence: 0.98408777 00:24:15.244 --> 00:24:16.765 mean to do risk based NOTE Confidence: 0.98408777 00:24:16.765 --> 00:24:18.625 screening or to do formalized NOTE Confidence: 0.98408777 00:24:18.685 --> 00:24:19.425 risk assessments? NOTE Confidence: 0.93706596 00:24:19.965 --> 00:24:21.725 We know that a wide NOTE Confidence: 0.93706596 00:24:21.725 --> 00:24:23.505 host of organizations, including NOTE Confidence: 0.9792132 00:24:24.125 --> 00:24:25.505 the American College of Radiologists, NOTE Confidence: 0.9792132 00:24:25.725 --> 00:24:27.244 the American College of Surgeons, NOTE Confidence: 0.9792132 00:24:27.244 --> 00:24:28.859 and other groups listed there NOTE Confidence: 0.9792132 00:24:29.159 --> 00:24:30.859 recommend doing a risk assessment NOTE Confidence: 0.9792132 00:24:31.080 --> 00:24:33.080 no older, no later than NOTE Confidence: 0.9792132 00:24:33.080 --> 00:24:34.220 age twenty five. NOTE Confidence: 0.9630263 00:24:34.600 --> 00:24:36.119 And that is because by NOTE Confidence: 0.9630263 00:24:36.119 --> 00:24:37.799 screening at forty, while we NOTE Confidence: 0.9630263 00:24:37.799 --> 00:24:39.159 capture a large percentage of NOTE Confidence: 0.9630263 00:24:39.159 --> 00:24:41.159 patients, we're missing patients that NOTE Confidence: 0.9630263 00:24:41.159 --> 00:24:43.635 have personal or familial risks NOTE Confidence: 0.9630263 00:24:43.775 --> 00:24:44.515 that significantly NOTE Confidence: 0.9958684 00:24:44.815 --> 00:24:46.255 increase the chance of getting NOTE Confidence: 0.9958684 00:24:46.255 --> 00:24:48.015 a breast cancer diagnosis less NOTE Confidence: 0.9958684 00:24:48.015 --> 00:24:48.994 than age forty. NOTE Confidence: 0.9948382 00:24:50.975 --> 00:24:52.415 Our goal here is to NOTE Confidence: 0.9948382 00:24:52.415 --> 00:24:53.234 think critically NOTE Confidence: 0.9519348 00:24:53.535 --> 00:24:55.555 and do risk tailored individualized NOTE Confidence: 0.9519348 00:24:55.855 --> 00:24:57.380 care for patients. So to NOTE Confidence: 0.9519348 00:24:57.380 --> 00:24:59.220 say, not just on broad NOTE Confidence: 0.9519348 00:24:59.220 --> 00:24:59.720 strokes, NOTE Confidence: 0.9878472 00:25:00.419 --> 00:25:01.700 everyone should get screening at NOTE Confidence: 0.9878472 00:25:01.700 --> 00:25:03.000 age forty, but rather, NOTE Confidence: 0.97580296 00:25:03.380 --> 00:25:04.500 you know, you with your NOTE Confidence: 0.97580296 00:25:04.500 --> 00:25:06.039 personal and family history. NOTE Confidence: 0.9978693 00:25:06.340 --> 00:25:07.460 How do we think about NOTE Confidence: 0.9978693 00:25:07.460 --> 00:25:09.940 whether additional screening modalities beyond NOTE Confidence: 0.9978693 00:25:09.940 --> 00:25:10.440 mammogram NOTE Confidence: 0.99593097 00:25:10.740 --> 00:25:12.225 or earlier screening would be NOTE Confidence: 0.99593097 00:25:12.225 --> 00:25:12.725 relevant. NOTE Confidence: 0.9857178 00:25:13.825 --> 00:25:15.025 And so, you know, this NOTE Confidence: 0.9857178 00:25:15.025 --> 00:25:16.005 begs the question, NOTE Confidence: 0.99504393 00:25:16.625 --> 00:25:18.065 who is high risk? When NOTE Confidence: 0.99504393 00:25:18.065 --> 00:25:19.505 we think about breast cancer, NOTE Confidence: 0.99504393 00:25:19.505 --> 00:25:20.385 what does it mean to NOTE Confidence: 0.99504393 00:25:20.385 --> 00:25:21.685 be in this high risk, NOTE Confidence: 0.9916992 00:25:22.305 --> 00:25:23.205 breast category? NOTE Confidence: 0.9706421 00:25:24.070 --> 00:25:25.690 And really, it it boils NOTE Confidence: 0.9706421 00:25:25.750 --> 00:25:27.270 down to having a lifetime NOTE Confidence: 0.9706421 00:25:27.270 --> 00:25:28.790 risk greater than about twenty NOTE Confidence: 0.9706421 00:25:28.790 --> 00:25:29.290 percent. NOTE Confidence: 0.94625854 00:25:30.150 --> 00:25:32.230 In contrast, the average woman's NOTE Confidence: 0.94625854 00:25:32.230 --> 00:25:33.109 risk, and and I should NOTE Confidence: 0.94625854 00:25:33.109 --> 00:25:34.070 have said as a caveat NOTE Confidence: 0.94625854 00:25:34.070 --> 00:25:34.570 upfront, NOTE Confidence: 0.9841684 00:25:35.270 --> 00:25:36.550 men and women can both NOTE Confidence: 0.9841684 00:25:36.550 --> 00:25:38.230 get breast cancer. Certainly, we NOTE Confidence: 0.9841684 00:25:38.230 --> 00:25:39.525 should also be thinking about NOTE Confidence: 0.9841684 00:25:39.525 --> 00:25:41.045 gender diversity. And so when NOTE Confidence: 0.9841684 00:25:41.045 --> 00:25:42.165 I say women, what I NOTE Confidence: 0.9841684 00:25:42.165 --> 00:25:43.765 really mean is assigned female NOTE Confidence: 0.9841684 00:25:43.765 --> 00:25:45.445 at birth, so people born NOTE Confidence: 0.9841684 00:25:45.445 --> 00:25:47.145 with female reproductive organs. NOTE Confidence: 0.9952567 00:25:48.085 --> 00:25:49.285 But the average, you know, NOTE Confidence: 0.9952567 00:25:49.285 --> 00:25:50.885 person who's assigned female at NOTE Confidence: 0.9952567 00:25:50.885 --> 00:25:52.244 birth, their lifetime risk is NOTE Confidence: 0.9952567 00:25:52.244 --> 00:25:53.925 about twelve to thirteen percent. NOTE Confidence: 0.9952567 00:25:53.925 --> 00:25:54.425 So NOTE Confidence: 0.9674225 00:25:54.919 --> 00:25:56.760 our high risk cutoff is NOTE Confidence: 0.9674225 00:25:56.760 --> 00:25:58.119 about double, a little bit NOTE Confidence: 0.9674225 00:25:58.119 --> 00:25:59.240 less than that compared to NOTE Confidence: 0.9674225 00:25:59.240 --> 00:25:59.559 other, NOTE Confidence: 0.99690753 00:26:00.359 --> 00:26:01.419 average risk people. NOTE Confidence: 0.9616699 00:26:01.880 --> 00:26:03.400 And so as Amy nicely NOTE Confidence: 0.9616699 00:26:03.400 --> 00:26:03.900 highlighted, NOTE Confidence: 0.99662274 00:26:04.520 --> 00:26:06.200 this does include people that NOTE Confidence: 0.99662274 00:26:06.200 --> 00:26:07.400 have a family history of NOTE Confidence: 0.99662274 00:26:07.400 --> 00:26:08.220 breast cancer. NOTE Confidence: 0.951052 00:26:09.675 --> 00:26:11.275 It includes individuals who have NOTE Confidence: 0.951052 00:26:11.275 --> 00:26:13.115 a specific genetic risk of NOTE Confidence: 0.951052 00:26:13.115 --> 00:26:14.235 breast cancer, such as the NOTE Confidence: 0.951052 00:26:14.235 --> 00:26:15.855 BRCA syndrome she mentioned. NOTE Confidence: 0.9366777 00:26:18.075 --> 00:26:19.935 Patients who have had personal NOTE Confidence: 0.9366777 00:26:20.075 --> 00:26:21.595 chest wall radiation. So this NOTE Confidence: 0.9366777 00:26:21.595 --> 00:26:22.820 is not your usual chest NOTE Confidence: 0.9366777 00:26:22.820 --> 00:26:24.180 x-ray, but actually if you've NOTE Confidence: 0.9366777 00:26:24.180 --> 00:26:25.560 had a Hodgkin's lymphoma NOTE Confidence: 0.97201 00:26:26.020 --> 00:26:27.380 and had what's called mantle NOTE Confidence: 0.97201 00:26:27.380 --> 00:26:28.660 radiation to the chest, you're NOTE Confidence: 0.97201 00:26:28.660 --> 00:26:29.700 at much higher risk of NOTE Confidence: 0.97201 00:26:29.700 --> 00:26:30.600 cancer development NOTE Confidence: 0.9603446 00:26:31.060 --> 00:26:32.100 even in the absence of NOTE Confidence: 0.9603446 00:26:32.100 --> 00:26:33.000 family history. NOTE Confidence: 0.99633104 00:26:34.755 --> 00:26:36.295 Patients who have had personal NOTE Confidence: 0.99633104 00:26:36.595 --> 00:26:38.994 abnormal or atypical biopsies in NOTE Confidence: 0.99633104 00:26:38.994 --> 00:26:39.575 the past, NOTE Confidence: 0.9993164 00:26:41.395 --> 00:26:42.435 as well as a whole NOTE Confidence: 0.9993164 00:26:42.435 --> 00:26:44.535 host of other environmental factors. NOTE Confidence: 0.98880005 00:26:44.994 --> 00:26:45.955 And so, you know, I NOTE Confidence: 0.98880005 00:26:45.955 --> 00:26:46.920 really like this, NOTE Confidence: 0.9904929 00:26:47.480 --> 00:26:49.480 infographic because it helps divide NOTE Confidence: 0.9904929 00:26:49.480 --> 00:26:50.520 out the things that we NOTE Confidence: 0.9904929 00:26:50.520 --> 00:26:51.720 have control over and the NOTE Confidence: 0.9904929 00:26:51.720 --> 00:26:52.940 things that we do not. NOTE Confidence: 0.9904929 00:26:53.080 --> 00:26:54.280 So many patients that I NOTE Confidence: 0.9904929 00:26:54.280 --> 00:26:55.240 see in my high risk NOTE Confidence: 0.9904929 00:26:55.240 --> 00:26:57.100 clinic before cancer development NOTE Confidence: 0.9566275 00:26:57.560 --> 00:26:59.400 and, also those that I NOTE Confidence: 0.9566275 00:26:59.400 --> 00:27:00.840 see, you know, after cancer NOTE Confidence: 0.9566275 00:27:00.840 --> 00:27:02.265 has been diagnosed say, well, NOTE Confidence: 0.9566275 00:27:02.425 --> 00:27:03.545 you know, what caused this? NOTE Confidence: 0.9566275 00:27:03.545 --> 00:27:04.744 What could I do? And NOTE Confidence: 0.9566275 00:27:04.744 --> 00:27:05.244 unfortunately, NOTE Confidence: 0.99772763 00:27:06.265 --> 00:27:07.625 the three main risk factors NOTE Confidence: 0.99772763 00:27:07.625 --> 00:27:09.085 for developing a breast cancer NOTE Confidence: 0.99772763 00:27:09.145 --> 00:27:10.105 are being born, NOTE Confidence: 0.9980469 00:27:10.744 --> 00:27:11.965 biologically female, NOTE Confidence: 0.97558594 00:27:12.345 --> 00:27:13.705 getting older, and your family NOTE Confidence: 0.97558594 00:27:13.705 --> 00:27:14.905 history, none of which you NOTE Confidence: 0.97558594 00:27:14.905 --> 00:27:16.205 have any control over. NOTE Confidence: 0.9789768 00:27:17.250 --> 00:27:19.090 Additional things listed there include NOTE Confidence: 0.9789768 00:27:19.090 --> 00:27:21.090 reproductive history, such as not NOTE Confidence: 0.9789768 00:27:21.090 --> 00:27:22.290 having had children or not NOTE Confidence: 0.9789768 00:27:22.290 --> 00:27:23.590 having breastfed children, NOTE Confidence: 0.9882929 00:27:24.530 --> 00:27:26.290 your menstrual history, so lifetime NOTE Confidence: 0.9882929 00:27:26.290 --> 00:27:27.970 exposure to estrogen, and the NOTE Confidence: 0.9882929 00:27:27.970 --> 00:27:29.250 density of your breast tissue, NOTE Confidence: 0.9882929 00:27:29.250 --> 00:27:30.369 which you have no control NOTE Confidence: 0.9882929 00:27:30.369 --> 00:27:30.869 over. NOTE Confidence: 0.98289657 00:27:31.385 --> 00:27:32.985 There are some modifiable risk NOTE Confidence: 0.98289657 00:27:32.985 --> 00:27:34.025 factors that we speak to NOTE Confidence: 0.98289657 00:27:34.025 --> 00:27:35.885 patients about such as supplemental NOTE Confidence: 0.98289657 00:27:36.105 --> 00:27:37.325 estrogen and progesterone. NOTE Confidence: 0.9887207 00:27:37.785 --> 00:27:39.645 There's some debate and and NOTE Confidence: 0.9887207 00:27:39.785 --> 00:27:41.705 nuance to whether all forms NOTE Confidence: 0.9887207 00:27:41.705 --> 00:27:42.744 increase the risk of breast NOTE Confidence: 0.9887207 00:27:42.744 --> 00:27:43.865 cancer, so I encourage you NOTE Confidence: 0.9887207 00:27:43.865 --> 00:27:44.905 to speak to your doctor NOTE Confidence: 0.9887207 00:27:44.905 --> 00:27:45.785 as it's not a one NOTE Confidence: 0.9887207 00:27:45.785 --> 00:27:47.410 size fits all. But we NOTE Confidence: 0.9887207 00:27:47.410 --> 00:27:48.790 do know that some supplemental NOTE Confidence: 0.9859009 00:27:49.170 --> 00:27:50.790 hormones do increase risk. NOTE Confidence: 0.96936977 00:27:51.570 --> 00:27:52.609 You know, whether or not NOTE Confidence: 0.96936977 00:27:52.609 --> 00:27:53.730 you breastfeed in the age NOTE Confidence: 0.96936977 00:27:53.730 --> 00:27:55.490 of your first child modulates NOTE Confidence: 0.96936977 00:27:55.490 --> 00:27:56.450 your risk as well as NOTE Confidence: 0.96936977 00:27:56.450 --> 00:27:58.290 things like obesity and alcohol NOTE Confidence: 0.96936977 00:27:58.290 --> 00:27:58.790 consumption. NOTE Confidence: 0.9979894 00:28:01.285 --> 00:28:02.244 You can tell that this NOTE Confidence: 0.9979894 00:28:02.244 --> 00:28:03.765 is a popular graphic. I NOTE Confidence: 0.9979894 00:28:03.765 --> 00:28:04.805 know that Amy had it NOTE Confidence: 0.9979894 00:28:04.805 --> 00:28:05.385 in her, NOTE Confidence: 0.9878845 00:28:06.005 --> 00:28:07.205 in her presentation, so I NOTE Confidence: 0.9878845 00:28:07.205 --> 00:28:08.565 won't belabor this point, but NOTE Confidence: 0.9878845 00:28:08.565 --> 00:28:10.185 just to remind you that NOTE Confidence: 0.9878845 00:28:10.325 --> 00:28:12.085 genetic testing and risk assessment NOTE Confidence: 0.9878845 00:28:12.085 --> 00:28:13.145 is not the same. NOTE Confidence: 0.9664781 00:28:13.519 --> 00:28:14.559 And when we find out NOTE Confidence: 0.9664781 00:28:14.559 --> 00:28:15.840 that someone's high risk for NOTE Confidence: 0.9664781 00:28:15.840 --> 00:28:17.840 whatever reason, we think about NOTE Confidence: 0.9664781 00:28:17.840 --> 00:28:19.119 high risk breast care in NOTE Confidence: 0.9664781 00:28:19.119 --> 00:28:20.960 two arms. We say, we NOTE Confidence: 0.9664781 00:28:20.960 --> 00:28:22.820 wanna focus on early detection, NOTE Confidence: 0.9664781 00:28:22.879 --> 00:28:24.639 high risk screening. So catching NOTE Confidence: 0.9664781 00:28:24.639 --> 00:28:25.139 cancer NOTE Confidence: 0.9939716 00:28:25.785 --> 00:28:27.225 as early as possible with NOTE Confidence: 0.9939716 00:28:27.225 --> 00:28:28.905 regular breast exams and high NOTE Confidence: 0.9939716 00:28:28.905 --> 00:28:30.045 risk breast imaging. NOTE Confidence: 0.93119884 00:28:30.825 --> 00:28:31.865 But we can also think NOTE Confidence: 0.93119884 00:28:31.865 --> 00:28:33.785 about tools for risk reduction NOTE Confidence: 0.93119884 00:28:33.785 --> 00:28:35.385 such as medication that reduce NOTE Confidence: 0.93119884 00:28:35.385 --> 00:28:37.145 risk or even risk reducing NOTE Confidence: 0.93119884 00:28:37.145 --> 00:28:37.645 surgery. NOTE Confidence: 0.9970703 00:28:38.210 --> 00:28:39.810 In that instance, we're hoping NOTE Confidence: 0.9970703 00:28:39.810 --> 00:28:41.590 to prevent cancer from ultimately NOTE Confidence: 0.9970703 00:28:41.650 --> 00:28:42.150 developing. NOTE Confidence: 0.98108333 00:28:43.810 --> 00:28:44.850 And so, you know, our NOTE Confidence: 0.98108333 00:28:44.850 --> 00:28:46.550 focus today is about screening. NOTE Confidence: 0.98108333 00:28:46.610 --> 00:28:48.450 So, both identification of patients NOTE Confidence: 0.98108333 00:28:48.450 --> 00:28:49.570 at high risk as well NOTE Confidence: 0.98108333 00:28:49.570 --> 00:28:50.770 as specifics of what that NOTE Confidence: 0.98108333 00:28:50.770 --> 00:28:52.230 screening would look like. NOTE Confidence: 0.96605283 00:28:52.595 --> 00:28:54.115 And as Amy alluded to, NOTE Confidence: 0.96605283 00:28:54.115 --> 00:28:55.395 many patients that are gene NOTE Confidence: 0.96605283 00:28:55.395 --> 00:28:57.635 positive regardless of family history NOTE Confidence: 0.96605283 00:28:57.635 --> 00:28:59.475 would qualify for early screening. NOTE Confidence: 0.96605283 00:28:59.475 --> 00:28:59.975 So, NOTE Confidence: 0.97562665 00:29:00.355 --> 00:29:01.475 you know, we know that NOTE Confidence: 0.97562665 00:29:01.475 --> 00:29:03.395 many gene related breast cancers NOTE Confidence: 0.97562665 00:29:03.395 --> 00:29:05.315 are diagnosed in one's thirties NOTE Confidence: 0.97562665 00:29:05.315 --> 00:29:06.915 and early forties. And so NOTE Confidence: 0.97562665 00:29:06.915 --> 00:29:08.370 waiting until forty to start NOTE Confidence: 0.97562665 00:29:08.370 --> 00:29:08.870 screening NOTE Confidence: 0.98558134 00:29:09.410 --> 00:29:10.690 doesn't make sense because we NOTE Confidence: 0.98558134 00:29:10.690 --> 00:29:11.970 are likely to catch those NOTE Confidence: 0.98558134 00:29:11.970 --> 00:29:13.490 cancers when they're larger and NOTE Confidence: 0.98558134 00:29:13.490 --> 00:29:14.230 more aggressive. NOTE Confidence: 0.979934 00:29:15.410 --> 00:29:17.010 When we use patient's family NOTE Confidence: 0.979934 00:29:17.010 --> 00:29:19.250 history, we generally recommend starting NOTE Confidence: 0.979934 00:29:19.250 --> 00:29:21.465 screening about ten years younger NOTE Confidence: 0.979934 00:29:21.465 --> 00:29:22.905 than the earliest onset breast NOTE Confidence: 0.979934 00:29:22.905 --> 00:29:23.405 cancer. NOTE Confidence: 0.91064453 00:29:24.025 --> 00:29:25.865 They'll usually no younger than NOTE Confidence: 0.91064453 00:29:25.865 --> 00:29:26.685 twenty five. NOTE Confidence: 0.97824824 00:29:27.145 --> 00:29:28.585 But, obviously, that's a decision, NOTE Confidence: 0.97824824 00:29:28.585 --> 00:29:29.805 you know, to make individually NOTE Confidence: 0.97824824 00:29:29.945 --> 00:29:31.545 with your breast team. But NOTE Confidence: 0.97824824 00:29:31.545 --> 00:29:32.985 you can imagine if you NOTE Confidence: 0.97824824 00:29:32.985 --> 00:29:33.485 have NOTE Confidence: 0.9620443 00:29:34.370 --> 00:29:35.330 a a mother or a NOTE Confidence: 0.9620443 00:29:35.330 --> 00:29:36.610 cousin or a sister who NOTE Confidence: 0.9620443 00:29:36.610 --> 00:29:38.310 was diagnosed with breast cancer NOTE Confidence: 0.9872546 00:29:38.850 --> 00:29:40.210 in her, you know, mid NOTE Confidence: 0.9872546 00:29:40.210 --> 00:29:41.910 thirties, you might start screening NOTE Confidence: 0.9872546 00:29:41.970 --> 00:29:43.490 as early as twenty five NOTE Confidence: 0.9872546 00:29:43.490 --> 00:29:44.610 even if there's no genetic NOTE Confidence: 0.9872546 00:29:44.610 --> 00:29:46.050 cause in your family. So NOTE Confidence: 0.9872546 00:29:46.050 --> 00:29:47.410 that means fifteen years of NOTE Confidence: 0.9872546 00:29:47.410 --> 00:29:48.850 screening beyond what an average NOTE Confidence: 0.9872546 00:29:48.850 --> 00:29:50.150 risk person would get. NOTE Confidence: 0.9620978 00:29:51.625 --> 00:29:52.985 And what is breast cancer NOTE Confidence: 0.9620978 00:29:52.985 --> 00:29:55.225 screening? There's multiple forms. So NOTE Confidence: 0.9620978 00:29:55.225 --> 00:29:56.345 many people have heard about NOTE Confidence: 0.9620978 00:29:56.345 --> 00:29:58.105 mammography, which is in essence NOTE Confidence: 0.9620978 00:29:58.105 --> 00:29:59.385 sort of a breast x-ray NOTE Confidence: 0.9620978 00:29:59.385 --> 00:30:01.065 of sorts that works on NOTE Confidence: 0.9620978 00:30:01.065 --> 00:30:03.005 compression to fight early cancers. NOTE Confidence: 0.950735 00:30:04.070 --> 00:30:05.590 Ultrasound, which is recommended for NOTE Confidence: 0.950735 00:30:05.590 --> 00:30:07.110 women with dense breasts or NOTE Confidence: 0.950735 00:30:07.110 --> 00:30:08.710 a supplemental testing if your NOTE Confidence: 0.950735 00:30:08.710 --> 00:30:10.410 initial mammogram is abnormal, NOTE Confidence: 0.9812012 00:30:11.030 --> 00:30:12.710 and breast MRI, which works NOTE Confidence: 0.9812012 00:30:12.710 --> 00:30:14.230 differently. It works based on NOTE Confidence: 0.9812012 00:30:14.230 --> 00:30:15.910 blood flow images to find NOTE Confidence: 0.9812012 00:30:15.910 --> 00:30:17.510 areas of early changes in NOTE Confidence: 0.9812012 00:30:17.510 --> 00:30:18.170 the breast, NOTE Confidence: 0.97092694 00:30:18.795 --> 00:30:20.395 including breast cancers as well NOTE Confidence: 0.97092694 00:30:20.395 --> 00:30:21.775 as precancerous changes. NOTE Confidence: 0.9891276 00:30:23.355 --> 00:30:24.955 Now, this is a busy NOTE Confidence: 0.9891276 00:30:24.955 --> 00:30:26.155 table, but I show it NOTE Confidence: 0.9891276 00:30:26.155 --> 00:30:27.455 to you just to highlight NOTE Confidence: 0.99785155 00:30:27.995 --> 00:30:30.235 that mammogram and MRI are NOTE Confidence: 0.99785155 00:30:30.235 --> 00:30:32.415 recommended for different genetic carriers NOTE Confidence: 0.95365393 00:30:33.040 --> 00:30:34.640 much earlier than average risk NOTE Confidence: 0.95365393 00:30:34.640 --> 00:30:36.560 people. So, for example, for NOTE Confidence: 0.95365393 00:30:36.560 --> 00:30:37.920 patients with a rare syndrome NOTE Confidence: 0.95365393 00:30:37.920 --> 00:30:39.600 called Li Fraumeni syndrome who NOTE Confidence: 0.95365393 00:30:39.600 --> 00:30:40.960 are known to be TP NOTE Confidence: 0.95365393 00:30:40.960 --> 00:30:42.020 fifty three positive, NOTE Confidence: 0.9971147 00:30:42.560 --> 00:30:44.400 we actually recommend screening with NOTE Confidence: 0.9971147 00:30:44.400 --> 00:30:45.920 MRI as early as age NOTE Confidence: 0.9971147 00:30:45.920 --> 00:30:46.420 twenty. NOTE Confidence: 0.9696378 00:30:47.955 --> 00:30:49.395 So when we think about NOTE Confidence: 0.9696378 00:30:49.395 --> 00:30:51.235 patients, again, I'll I'll I'll NOTE Confidence: 0.9696378 00:30:51.235 --> 00:30:52.515 skim through this because Amy NOTE Confidence: 0.9696378 00:30:52.515 --> 00:30:53.475 went through it, but there NOTE Confidence: 0.9696378 00:30:53.475 --> 00:30:54.755 are families like this one NOTE Confidence: 0.9696378 00:30:54.755 --> 00:30:56.035 where there's lots of early NOTE Confidence: 0.9696378 00:30:56.035 --> 00:30:57.335 onset breast cancer NOTE Confidence: 0.94640005 00:30:57.875 --> 00:30:59.735 and we know that patients NOTE Confidence: 0.94640005 00:30:59.875 --> 00:31:01.815 clearly meet criteria for genetic NOTE Confidence: 0.94640005 00:31:01.875 --> 00:31:02.375 testing. NOTE Confidence: 0.98405707 00:31:03.800 --> 00:31:05.320 In this instance, we see NOTE Confidence: 0.98405707 00:31:05.320 --> 00:31:06.920 breast and ovarian cancers, and NOTE Confidence: 0.98405707 00:31:06.920 --> 00:31:07.960 this is a real patient NOTE Confidence: 0.98405707 00:31:07.960 --> 00:31:09.240 we took care of who NOTE Confidence: 0.98405707 00:31:09.240 --> 00:31:10.440 was found to carry the NOTE Confidence: 0.98405707 00:31:10.440 --> 00:31:12.040 BRCA one gene and started NOTE Confidence: 0.98405707 00:31:12.040 --> 00:31:13.400 high risk screening with me NOTE Confidence: 0.98405707 00:31:13.400 --> 00:31:14.540 at the age of diagnosis NOTE Confidence: 0.98405707 00:31:14.680 --> 00:31:15.740 at twenty nine. NOTE Confidence: 0.98977566 00:31:16.424 --> 00:31:18.345 But even patients with BRCA NOTE Confidence: 0.98977566 00:31:18.345 --> 00:31:19.784 do not always have family NOTE Confidence: 0.98977566 00:31:19.784 --> 00:31:21.544 history. And so Amy alluded NOTE Confidence: 0.98977566 00:31:21.544 --> 00:31:23.705 to aggressive prostate cancers and NOTE Confidence: 0.98977566 00:31:23.705 --> 00:31:24.924 pancreatic cancers. NOTE Confidence: 0.9765625 00:31:25.384 --> 00:31:26.745 And in the same family, NOTE Confidence: 0.9765625 00:31:26.745 --> 00:31:28.365 we see that two pancreatic NOTE Confidence: 0.9765625 00:31:28.505 --> 00:31:29.784 cancers are what led to NOTE Confidence: 0.9765625 00:31:29.784 --> 00:31:30.524 her testing, NOTE Confidence: 0.99877185 00:31:31.159 --> 00:31:32.440 and she was diagnosed as NOTE Confidence: 0.99877185 00:31:32.440 --> 00:31:34.039 a BRCA positive patient as NOTE Confidence: 0.99877185 00:31:34.039 --> 00:31:34.539 well. NOTE Confidence: 0.9932617 00:31:35.960 --> 00:31:37.659 But here's the important contrast. NOTE Confidence: 0.99035645 00:31:37.960 --> 00:31:38.779 This patient, NOTE Confidence: 0.9983259 00:31:39.240 --> 00:31:41.320 early onset breast cancer in NOTE Confidence: 0.9983259 00:31:41.320 --> 00:31:42.140 three relatives NOTE Confidence: 0.95996094 00:31:42.519 --> 00:31:43.340 right here, NOTE Confidence: 0.98503673 00:31:43.799 --> 00:31:45.159 in their early fifties, as NOTE Confidence: 0.98503673 00:31:45.159 --> 00:31:46.700 well as an ovarian cancer. NOTE Confidence: 0.98503673 00:31:46.815 --> 00:31:48.335 She was very high risk. NOTE Confidence: 0.98503673 00:31:48.335 --> 00:31:49.715 She had genetic testing, NOTE Confidence: 0.99558514 00:31:50.575 --> 00:31:52.115 and her test was negative. NOTE Confidence: 0.99558514 00:31:52.174 --> 00:31:52.975 So what do we do NOTE Confidence: 0.99558514 00:31:52.975 --> 00:31:53.634 with that? NOTE Confidence: 0.9733073 00:31:54.254 --> 00:31:55.855 We want to remember that NOTE Confidence: 0.9733073 00:31:55.855 --> 00:31:57.455 we have other tools to NOTE Confidence: 0.9733073 00:31:57.455 --> 00:31:59.534 assess patients' risk by doing NOTE Confidence: 0.9733073 00:31:59.534 --> 00:32:00.434 a risk calculation. NOTE Confidence: 0.97612303 00:32:02.000 --> 00:32:03.360 And, we found that this, NOTE Confidence: 0.97612303 00:32:03.360 --> 00:32:04.720 this young woman, this forty NOTE Confidence: 0.97612303 00:32:04.720 --> 00:32:05.679 two year old, had a NOTE Confidence: 0.97612303 00:32:05.679 --> 00:32:07.600 lifetime risk that was nearing NOTE Confidence: 0.97612303 00:32:07.600 --> 00:32:09.460 those of gene positive patients NOTE Confidence: 0.885437 00:32:09.919 --> 00:32:11.299 greater than forty percent. NOTE Confidence: 0.9702723 00:32:11.679 --> 00:32:13.279 So, knowing her family history NOTE Confidence: 0.9702723 00:32:13.279 --> 00:32:14.799 and doing genetic testing, even NOTE Confidence: 0.9702723 00:32:14.799 --> 00:32:15.679 though we didn't find a NOTE Confidence: 0.9702723 00:32:15.679 --> 00:32:16.500 gene responsible, NOTE Confidence: 0.92856854 00:32:17.325 --> 00:32:19.005 led to initiation of MRI NOTE Confidence: 0.92856854 00:32:19.005 --> 00:32:20.524 screening, and for this patient, NOTE Confidence: 0.92856854 00:32:20.524 --> 00:32:21.585 ultimately surgery NOTE Confidence: 0.99764 00:32:22.044 --> 00:32:23.585 of a precancerous lesion. NOTE Confidence: 0.9768241 00:32:24.125 --> 00:32:25.325 So it's important to know NOTE Confidence: 0.9768241 00:32:25.325 --> 00:32:26.605 your history, as Amy said, NOTE Confidence: 0.9768241 00:32:26.605 --> 00:32:28.304 and important to remember NOTE Confidence: 0.9538269 00:32:28.765 --> 00:32:29.804 that if you are high NOTE Confidence: 0.9538269 00:32:29.804 --> 00:32:31.325 risk, you're at risk for NOTE Confidence: 0.9538269 00:32:31.325 --> 00:32:32.850 an earlier diagnosis of a NOTE Confidence: 0.9538269 00:32:32.929 --> 00:32:33.429 cancer, NOTE Confidence: 0.9458822 00:32:33.730 --> 00:32:36.390 we oftentimes recommend multimodal screening, NOTE Confidence: 0.93258464 00:32:37.169 --> 00:32:38.610 and we can talk to NOTE Confidence: 0.93258464 00:32:38.610 --> 00:32:40.130 you about both about different NOTE Confidence: 0.93258464 00:32:40.130 --> 00:32:42.390 options such as ultrasound, MRI, NOTE Confidence: 0.93364805 00:32:42.770 --> 00:32:43.990 and or mammography, NOTE Confidence: 0.999442 00:32:44.370 --> 00:32:45.490 as well as options for NOTE Confidence: 0.999442 00:32:45.490 --> 00:32:46.230 risk reduction. NOTE Confidence: 0.99544543 00:32:46.924 --> 00:32:48.125 So with that, thank you NOTE Confidence: 0.99544543 00:32:48.125 --> 00:32:49.265 so much for your attention, NOTE Confidence: 0.99544543 00:32:49.325 --> 00:32:50.284 and I will turn it NOTE Confidence: 0.99544543 00:32:50.284 --> 00:32:51.245 back over to the other NOTE Confidence: 0.99544543 00:32:51.245 --> 00:32:52.525 panelists. I'm happy to take NOTE Confidence: 0.99544543 00:32:52.525 --> 00:32:54.065 questions if any come through. NOTE Confidence: 0.9889964 00:32:57.645 --> 00:32:59.245 Thank you so much, doctor NOTE Confidence: 0.9889964 00:32:59.245 --> 00:33:01.230 Prasaloglu. That was just such NOTE Confidence: 0.9889964 00:33:01.230 --> 00:33:02.510 an important talk when we NOTE Confidence: 0.9889964 00:33:02.510 --> 00:33:03.250 think about NOTE Confidence: 0.98964435 00:33:03.550 --> 00:33:05.550 marrying these factors together, in NOTE Confidence: 0.98964435 00:33:05.550 --> 00:33:06.910 terms of risk assessment for NOTE Confidence: 0.98964435 00:33:06.910 --> 00:33:08.430 breast cancer and how that NOTE Confidence: 0.98964435 00:33:08.430 --> 00:33:10.590 can impact earlier, breast cancer NOTE Confidence: 0.98964435 00:33:10.590 --> 00:33:12.290 screening for for patients. NOTE Confidence: 0.96523815 00:33:13.550 --> 00:33:14.654 I don't see any questions NOTE Confidence: 0.96523815 00:33:14.654 --> 00:33:15.534 that have come through the NOTE Confidence: 0.96523815 00:33:15.534 --> 00:33:16.575 chat quite the, NOTE Confidence: 0.9914551 00:33:17.054 --> 00:33:17.934 q and a or the NOTE Confidence: 0.9914551 00:33:17.934 --> 00:33:19.294 chat. So, again, we can NOTE Confidence: 0.9914551 00:33:19.294 --> 00:33:21.054 keep going forward and give NOTE Confidence: 0.9914551 00:33:21.054 --> 00:33:22.835 the audience a chance to, NOTE Confidence: 0.9931928 00:33:23.534 --> 00:33:24.815 think about questions. And, again, NOTE Confidence: 0.9931928 00:33:24.815 --> 00:33:25.980 I encourage you to please NOTE Confidence: 0.9931928 00:33:26.140 --> 00:33:27.179 put them in the chat, NOTE Confidence: 0.9931928 00:33:27.179 --> 00:33:27.900 put them in the q NOTE Confidence: 0.9931928 00:33:27.900 --> 00:33:29.580 and a, and, we'll be NOTE Confidence: 0.9931928 00:33:29.580 --> 00:33:30.700 able to ask our our NOTE Confidence: 0.9931928 00:33:30.700 --> 00:33:32.299 panelists about this. And, NOTE Confidence: 0.9843151 00:33:32.780 --> 00:33:33.500 you know, it's just such NOTE Confidence: 0.9843151 00:33:33.500 --> 00:33:34.780 an important topic as we NOTE Confidence: 0.9843151 00:33:34.780 --> 00:33:35.820 think about, you know, this NOTE Confidence: 0.9843151 00:33:35.820 --> 00:33:37.020 field. So thank you again, NOTE Confidence: 0.9843151 00:33:37.020 --> 00:33:37.840 doctor Prasaloglu. NOTE Confidence: 0.97021484 00:33:39.865 --> 00:33:40.665 So our, NOTE Confidence: 0.951572 00:33:41.465 --> 00:33:43.725 final speaker is doctor Dejal NOTE Confidence: 0.951572 00:33:43.785 --> 00:33:44.285 Shreekumar. NOTE Confidence: 0.99494356 00:33:44.985 --> 00:33:46.184 And while the slides are NOTE Confidence: 0.99494356 00:33:46.184 --> 00:33:47.305 coming up there, I'll do NOTE Confidence: 0.99494356 00:33:47.305 --> 00:33:49.005 an introduction here. Doctor Shreekumar NOTE Confidence: 0.99403214 00:33:49.305 --> 00:33:51.065 is an assistant professor of NOTE Confidence: 0.99403214 00:33:51.065 --> 00:33:52.765 medicine in medical oncology NOTE Confidence: 0.99890137 00:33:53.360 --> 00:33:54.740 and cares for patients, NOTE Confidence: 0.95731026 00:33:55.280 --> 00:33:56.240 as part of the Center NOTE Confidence: 0.95731026 00:33:56.240 --> 00:33:56.980 for Gastrointestinal NOTE Confidence: 0.98602074 00:33:57.360 --> 00:33:59.360 Cancers at Smilow Cancer Hospital NOTE Confidence: 0.98602074 00:33:59.360 --> 00:34:00.660 and Yale Cancer Center. NOTE Confidence: 0.9788025 00:34:00.960 --> 00:34:02.720 After obtaining her undergraduate degree NOTE Confidence: 0.9788025 00:34:02.720 --> 00:34:04.560 from Harvard, doctor Shreekumar received NOTE Confidence: 0.9788025 00:34:04.560 --> 00:34:05.760 her medical degree from the NOTE Confidence: 0.9788025 00:34:05.760 --> 00:34:07.220 University of South Florida NOTE Confidence: 0.9954631 00:34:07.774 --> 00:34:09.454 and completed her residency and NOTE Confidence: 0.9954631 00:34:09.454 --> 00:34:10.755 fellowship in oncology NOTE Confidence: 1 00:34:11.055 --> 00:34:11.714 at Yale. NOTE Confidence: 0.9949294 00:34:12.335 --> 00:34:13.935 Her clinical and research efforts NOTE Confidence: 0.9949294 00:34:13.935 --> 00:34:15.535 center around caring for young NOTE Confidence: 0.9949294 00:34:15.535 --> 00:34:16.994 adults with gastrointestinal NOTE Confidence: 0.91589355 00:34:17.454 --> 00:34:17.954 malignancies. NOTE Confidence: 0.9803573 00:34:18.815 --> 00:34:20.494 And doctor Sreekumar is also NOTE Confidence: 0.9803573 00:34:20.494 --> 00:34:22.815 passionate about medical education, serving NOTE Confidence: 0.9803573 00:34:22.815 --> 00:34:24.489 as the assistant program director NOTE Confidence: 0.9803573 00:34:24.710 --> 00:34:26.150 for training of our fellows NOTE Confidence: 0.9803573 00:34:26.150 --> 00:34:27.510 in our fellowship program in NOTE Confidence: 0.9803573 00:34:27.510 --> 00:34:28.410 medical oncology. NOTE Confidence: 0.9765484 00:34:29.349 --> 00:34:30.869 Furthermore, doctor Sreekumar is on NOTE Confidence: 0.9765484 00:34:30.869 --> 00:34:32.070 the leadership team for the NOTE Confidence: 0.9765484 00:34:32.070 --> 00:34:34.170 Yale early onset cancer program NOTE Confidence: 0.9765484 00:34:34.310 --> 00:34:36.070 with long standing passion for NOTE Confidence: 0.9765484 00:34:36.070 --> 00:34:37.210 early onset cancers. NOTE Confidence: 0.96667105 00:34:37.745 --> 00:34:39.265 And today, doctor Sreekumar will NOTE Confidence: 0.96667105 00:34:39.265 --> 00:34:40.805 be talking about risk based NOTE Confidence: 0.96667105 00:34:40.945 --> 00:34:41.445 screening NOTE Confidence: 0.9995117 00:34:41.985 --> 00:34:42.805 for gastrointestinal NOTE Confidence: 0.9692993 00:34:43.344 --> 00:34:44.864 cancers, which are also, NOTE Confidence: 0.998291 00:34:45.425 --> 00:34:46.545 we're hearing more and more NOTE Confidence: 0.998291 00:34:46.545 --> 00:34:47.905 about in the news and, NOTE Confidence: 0.998291 00:34:48.145 --> 00:34:48.885 in the public. NOTE Confidence: 0.9914551 00:34:49.185 --> 00:34:50.725 So thank you, doctor Sreekumar, NOTE Confidence: 0.9914551 00:34:50.945 --> 00:34:52.485 for your presentation today. NOTE Confidence: 0.975708 00:34:53.550 --> 00:34:54.830 Thank you so much, doctor NOTE Confidence: 0.975708 00:34:54.830 --> 00:34:56.830 Giri. I am really honored NOTE Confidence: 0.975708 00:34:56.830 --> 00:34:57.870 to be speaking with you NOTE Confidence: 0.975708 00:34:57.870 --> 00:34:59.170 all today about, NOTE Confidence: 0.98435056 00:35:00.190 --> 00:35:02.270 risk based strategies in GI NOTE Confidence: 0.98435056 00:35:02.270 --> 00:35:04.690 cancers, especially for our younger, NOTE Confidence: 0.9995117 00:35:05.870 --> 00:35:06.370 patients. NOTE Confidence: 0.9975586 00:35:07.175 --> 00:35:07.675 So, NOTE Confidence: 0.98079705 00:35:08.135 --> 00:35:09.494 I'll start with some quick NOTE Confidence: 0.98079705 00:35:09.494 --> 00:35:10.775 background, and then I plan NOTE Confidence: 0.98079705 00:35:10.775 --> 00:35:12.475 to focus my talk primarily NOTE Confidence: 0.98079705 00:35:12.614 --> 00:35:14.875 on colorectal cancer screening since NOTE Confidence: 0.98079705 00:35:15.015 --> 00:35:16.055 this is what we have NOTE Confidence: 0.98079705 00:35:16.055 --> 00:35:17.755 the most evidence in. NOTE Confidence: 0.9963867 00:35:18.295 --> 00:35:19.494 But I will also touch NOTE Confidence: 0.9963867 00:35:19.494 --> 00:35:21.594 on pancreatic screening as well. NOTE Confidence: 0.99838257 00:35:22.670 --> 00:35:23.710 And I just wanna make NOTE Confidence: 0.99838257 00:35:23.710 --> 00:35:24.589 sure that we are all NOTE Confidence: 0.99838257 00:35:24.589 --> 00:35:26.029 starting on the same page. NOTE Confidence: 0.99838257 00:35:26.029 --> 00:35:26.529 So, NOTE Confidence: 0.99902344 00:35:27.549 --> 00:35:29.069 when I refer to a NOTE Confidence: 0.99902344 00:35:29.069 --> 00:35:30.289 GI cancer, NOTE Confidence: 0.94528663 00:35:30.989 --> 00:35:32.910 I'm referring to any cancer NOTE Confidence: 0.94528663 00:35:32.910 --> 00:35:34.509 that affects the digestive system. NOTE Confidence: 0.94528663 00:35:34.509 --> 00:35:35.869 So any of these organs NOTE Confidence: 0.94528663 00:35:35.869 --> 00:35:36.989 that you see here in NOTE Confidence: 0.94528663 00:35:36.989 --> 00:35:38.805 this chart, from the esophagus NOTE Confidence: 0.94528663 00:35:38.805 --> 00:35:40.244 and stomach and pancreas to NOTE Confidence: 0.94528663 00:35:40.244 --> 00:35:41.685 the liver, to the large NOTE Confidence: 0.94528663 00:35:41.685 --> 00:35:43.045 the large bowel, the small NOTE Confidence: 0.94528663 00:35:43.045 --> 00:35:43.545 bowel, NOTE Confidence: 0.9536377 00:35:44.085 --> 00:35:45.625 to the anal canal. So NOTE Confidence: 0.9536377 00:35:45.765 --> 00:35:47.625 really the whole digestive system. NOTE Confidence: 0.99609375 00:35:48.244 --> 00:35:48.645 And, NOTE Confidence: 0.9386719 00:35:49.125 --> 00:35:50.984 as mentioned by doctor Prusalloglu, NOTE Confidence: 0.9816504 00:35:52.109 --> 00:35:53.150 when I'm talking about early NOTE Confidence: 0.9816504 00:35:53.150 --> 00:35:54.670 onset GI cancers for the NOTE Confidence: 0.9816504 00:35:54.670 --> 00:35:55.789 purpose of this talk, I NOTE Confidence: 0.9816504 00:35:55.789 --> 00:35:57.410 mean cancers that are diagnosed NOTE Confidence: 0.9816504 00:35:57.469 --> 00:35:59.009 under the age of fifty. NOTE Confidence: 0.97906494 00:36:00.269 --> 00:36:02.109 As doctor Giri mentioned, we've NOTE Confidence: 0.97906494 00:36:02.109 --> 00:36:03.309 all seen on the news NOTE Confidence: 0.97906494 00:36:03.309 --> 00:36:04.989 that we are seeing a NOTE Confidence: 0.97906494 00:36:04.989 --> 00:36:05.489 dramatic NOTE Confidence: 0.99487305 00:36:05.805 --> 00:36:07.565 rise in GI cancers in NOTE Confidence: 0.99487305 00:36:07.565 --> 00:36:08.944 the early onset population, NOTE Confidence: 0.96859306 00:36:10.204 --> 00:36:11.585 over the last few decades NOTE Confidence: 0.96859306 00:36:11.645 --> 00:36:13.405 of increases of greater than NOTE Confidence: 0.96859306 00:36:13.405 --> 00:36:14.785 fifty or sixty percent. NOTE Confidence: 0.9952726 00:36:15.484 --> 00:36:17.244 And while there is a NOTE Confidence: 0.9952726 00:36:17.244 --> 00:36:19.130 lot of focus that has NOTE Confidence: 0.9952726 00:36:19.130 --> 00:36:19.610 been, NOTE Confidence: 0.99300444 00:36:20.170 --> 00:36:22.410 made on colorectal cancer, which NOTE Confidence: 0.99300444 00:36:22.410 --> 00:36:23.530 you can see here in NOTE Confidence: 0.99300444 00:36:23.530 --> 00:36:24.830 this orange line, NOTE Confidence: 0.98626155 00:36:25.450 --> 00:36:27.230 other GI cancers are increasing NOTE Confidence: 0.98626155 00:36:27.290 --> 00:36:29.310 as well, like pancreatic cancer NOTE Confidence: 0.98626155 00:36:29.450 --> 00:36:29.950 and, NOTE Confidence: 0.989624 00:36:30.730 --> 00:36:31.710 gastric cancer. NOTE Confidence: 0.9972479 00:36:32.465 --> 00:36:33.825 But what's important to note NOTE Confidence: 0.9972479 00:36:33.825 --> 00:36:35.445 is that while we have NOTE Confidence: 0.9972479 00:36:35.585 --> 00:36:36.085 screening, NOTE Confidence: 0.99902344 00:36:36.785 --> 00:36:37.285 recommendations NOTE Confidence: 0.8302409 00:36:38.145 --> 00:36:39.765 from nationally for NOTE Confidence: 0.9946289 00:36:40.385 --> 00:36:42.485 average risk adults for colorectal NOTE Confidence: 0.9946289 00:36:42.545 --> 00:36:43.045 cancer, NOTE Confidence: 1 00:36:43.425 --> 00:36:44.785 we don't have those screening NOTE Confidence: 1 00:36:44.785 --> 00:36:45.844 guidelines available NOTE Confidence: 0.9861043 00:36:46.145 --> 00:36:48.180 for other GI cancers unless NOTE Confidence: 0.9861043 00:36:48.180 --> 00:36:49.460 you're at higher risk, which NOTE Confidence: 0.9861043 00:36:49.460 --> 00:36:50.120 is why, NOTE Confidence: 0.99975586 00:36:50.580 --> 00:36:51.780 knowing your risk is so NOTE Confidence: 0.99975586 00:36:51.780 --> 00:36:52.280 important. NOTE Confidence: 0.97524005 00:36:53.060 --> 00:36:54.020 And I think the big NOTE Confidence: 0.97524005 00:36:54.020 --> 00:36:55.300 question a lot of us NOTE Confidence: 0.97524005 00:36:55.300 --> 00:36:56.580 are asking and trying to NOTE Confidence: 0.97524005 00:36:56.580 --> 00:36:57.860 research and find out is NOTE Confidence: 0.97524005 00:36:57.860 --> 00:36:59.000 why is this happening? NOTE Confidence: 0.9992676 00:36:59.540 --> 00:37:01.454 And it's probably a very NOTE Confidence: 0.9992676 00:37:01.454 --> 00:37:01.954 complicated NOTE Confidence: 0.9663086 00:37:02.494 --> 00:37:02.994 situation. NOTE Confidence: 0.9479283 00:37:03.694 --> 00:37:05.614 It's probably an interaction between NOTE Confidence: 0.9479283 00:37:05.614 --> 00:37:06.434 our genes, NOTE Confidence: 0.926845 00:37:07.214 --> 00:37:08.575 the lifestyle we live, and NOTE Confidence: 0.926845 00:37:08.575 --> 00:37:09.315 our environment, NOTE Confidence: 0.97524005 00:37:09.855 --> 00:37:11.535 leading to younger and younger NOTE Confidence: 0.97524005 00:37:11.535 --> 00:37:13.375 people getting, cancer. But we NOTE Confidence: 0.97524005 00:37:13.375 --> 00:37:14.575 haven't quite figured it out NOTE Confidence: 0.97524005 00:37:14.575 --> 00:37:16.650 yet. And so until we NOTE Confidence: 0.97524005 00:37:16.650 --> 00:37:18.330 do, this becomes even more NOTE Confidence: 0.97524005 00:37:18.330 --> 00:37:20.410 important to understand understand if NOTE Confidence: 0.97524005 00:37:20.410 --> 00:37:21.450 and when you should start NOTE Confidence: 0.97524005 00:37:21.450 --> 00:37:21.950 screening. NOTE Confidence: 0.9955241 00:37:23.369 --> 00:37:24.989 So to focus on colorectal NOTE Confidence: 0.9955241 00:37:25.050 --> 00:37:26.650 cancer screening, I'm gonna, NOTE Confidence: 0.99723935 00:37:28.010 --> 00:37:29.505 specifically call out how your NOTE Confidence: 0.99723935 00:37:29.585 --> 00:37:31.505 personal history, your family history, NOTE Confidence: 0.99723935 00:37:31.505 --> 00:37:32.404 and your genetics NOTE Confidence: 0.9984375 00:37:32.864 --> 00:37:34.644 can alter the screening recommendations. NOTE Confidence: 0.9795464 00:37:36.065 --> 00:37:37.265 Now why do we do NOTE Confidence: 0.9795464 00:37:37.265 --> 00:37:38.805 screening for colorectal cancer? NOTE Confidence: 0.99433595 00:37:39.265 --> 00:37:40.704 Well, it is the second NOTE Confidence: 0.99433595 00:37:40.704 --> 00:37:42.144 leading cause of cancer death NOTE Confidence: 0.99433595 00:37:42.144 --> 00:37:43.684 in in men and women. NOTE Confidence: 0.94873047 00:37:43.984 --> 00:37:44.460 However, NOTE Confidence: 0.9898204 00:37:45.020 --> 00:37:46.460 when it is caught early, NOTE Confidence: 0.9898204 00:37:46.460 --> 00:37:48.140 there is a really high NOTE Confidence: 0.9898204 00:37:48.140 --> 00:37:49.900 survival rate, which is the NOTE Confidence: 0.9898204 00:37:49.900 --> 00:37:51.180 reason why we try to NOTE Confidence: 0.9898204 00:37:51.180 --> 00:37:52.160 be so proactive NOTE Confidence: 0.99943036 00:37:52.460 --> 00:37:53.660 in trying to find these NOTE Confidence: 0.99943036 00:37:53.660 --> 00:37:54.160 cancers. NOTE Confidence: 0.97721726 00:37:55.820 --> 00:37:57.180 In discussing with your primary NOTE Confidence: 0.97721726 00:37:57.180 --> 00:37:58.625 care doctor, you've probably heard NOTE Confidence: 0.97721726 00:37:58.625 --> 00:37:59.744 that there are different kind NOTE Confidence: 0.97721726 00:37:59.984 --> 00:38:01.505 different ways to screen for NOTE Confidence: 0.97721726 00:38:01.505 --> 00:38:02.565 colorectal cancer, NOTE Confidence: 0.99713135 00:38:03.265 --> 00:38:04.805 whether it is endoscopies NOTE Confidence: 0.9715169 00:38:05.825 --> 00:38:07.204 or stool testing, NOTE Confidence: 0.95060223 00:38:08.145 --> 00:38:09.364 even some imaging. NOTE Confidence: 0.9642334 00:38:09.665 --> 00:38:10.885 And lately, NOTE Confidence: 0.9495192 00:38:11.344 --> 00:38:12.700 we heard heard some information NOTE Confidence: 0.9495192 00:38:12.700 --> 00:38:13.739 about how we can use NOTE Confidence: 0.9495192 00:38:13.739 --> 00:38:14.960 blood based tests NOTE Confidence: 0.9996163 00:38:15.340 --> 00:38:17.020 to screen for colorectal cancer NOTE Confidence: 0.9996163 00:38:17.020 --> 00:38:17.680 as well. NOTE Confidence: 0.99645466 00:38:18.219 --> 00:38:20.060 However, it's really important to NOTE Confidence: 0.99645466 00:38:20.060 --> 00:38:21.100 note that if you are NOTE Confidence: 0.99645466 00:38:21.100 --> 00:38:22.140 considered to be at a NOTE Confidence: 0.99645466 00:38:22.140 --> 00:38:24.300 high risk of colon cancer NOTE Confidence: 0.99645466 00:38:24.300 --> 00:38:25.440 or rectal cancer, NOTE Confidence: 0.9655762 00:38:26.075 --> 00:38:27.355 really, you wanna stick with NOTE Confidence: 0.9655762 00:38:27.355 --> 00:38:28.255 getting a colonoscopy NOTE Confidence: 0.96481323 00:38:28.634 --> 00:38:29.994 because this is the best, NOTE Confidence: 0.96481323 00:38:29.994 --> 00:38:31.214 most accurate way, NOTE Confidence: 0.9857003 00:38:31.674 --> 00:38:33.035 for finding whether or not NOTE Confidence: 0.9857003 00:38:33.035 --> 00:38:34.795 you have, a cancer if NOTE Confidence: 0.9857003 00:38:34.795 --> 00:38:36.015 you're at higher risk. NOTE Confidence: 0.9844194 00:38:37.515 --> 00:38:39.275 Now, if you are considered NOTE Confidence: 0.9844194 00:38:39.275 --> 00:38:40.739 to be at an average NOTE Confidence: 0.9844194 00:38:40.739 --> 00:38:41.239 risk, NOTE Confidence: 0.9754883 00:38:41.700 --> 00:38:42.520 the USPSTF, NOTE Confidence: 0.90509033 00:38:43.140 --> 00:38:44.200 which doctor Prusalloglu NOTE Confidence: 0.9946289 00:38:44.500 --> 00:38:45.000 mentioned, NOTE Confidence: 0.9930013 00:38:46.020 --> 00:38:47.800 has now changed their recommendations NOTE Confidence: 0.9930013 00:38:48.020 --> 00:38:49.560 as of twenty twenty one NOTE Confidence: 0.9930013 00:38:49.620 --> 00:38:51.620 to start colorectal cancer screening NOTE Confidence: 0.9930013 00:38:51.620 --> 00:38:52.900 at the age of forty NOTE Confidence: 0.9930013 00:38:52.900 --> 00:38:53.400 five, NOTE Confidence: 0.98853517 00:38:53.885 --> 00:38:54.844 which is lower than the NOTE Confidence: 0.98853517 00:38:54.844 --> 00:38:56.844 prior recommendation of age fifty. NOTE Confidence: 0.98853517 00:38:56.844 --> 00:38:57.964 And this is in part NOTE Confidence: 0.98853517 00:38:57.964 --> 00:38:59.244 because of these trends that NOTE Confidence: 0.98853517 00:38:59.244 --> 00:39:01.105 we're seeing of younger people NOTE Confidence: 0.9995117 00:39:01.484 --> 00:39:03.025 getting colorectal cancer. NOTE Confidence: 1 00:39:03.565 --> 00:39:04.065 However, NOTE Confidence: 0.9892766 00:39:04.684 --> 00:39:05.405 if you are at a NOTE Confidence: 0.9892766 00:39:05.405 --> 00:39:07.165 higher risk, you may actually NOTE Confidence: 0.9892766 00:39:07.165 --> 00:39:07.890 need to start, NOTE Confidence: 0.9980957 00:39:08.369 --> 00:39:10.309 screening at a younger age. NOTE Confidence: 0.999163 00:39:11.089 --> 00:39:12.930 And I wanna be really NOTE Confidence: 0.999163 00:39:12.930 --> 00:39:14.150 clear that, NOTE Confidence: 0.98476046 00:39:15.329 --> 00:39:17.269 if you are having concerning NOTE Confidence: 0.98476046 00:39:17.489 --> 00:39:19.890 signs or symptoms, so things NOTE Confidence: 0.98476046 00:39:19.890 --> 00:39:21.425 like blood in your stool NOTE Confidence: 0.98476046 00:39:21.425 --> 00:39:23.285 or unexpected weight loss. NOTE Confidence: 0.99797714 00:39:23.665 --> 00:39:24.705 We don't really think of NOTE Confidence: 0.99797714 00:39:24.705 --> 00:39:25.525 that as, NOTE Confidence: 0.99904156 00:39:26.305 --> 00:39:28.325 falling into the screening category NOTE Confidence: 0.99904156 00:39:28.385 --> 00:39:29.685 anymore. If you're symptomatic, NOTE Confidence: 0.98713684 00:39:30.305 --> 00:39:31.105 you should talk to your NOTE Confidence: 0.98713684 00:39:31.105 --> 00:39:32.385 doctor about it right away NOTE Confidence: 0.98713684 00:39:32.385 --> 00:39:33.745 and discuss whether or not NOTE Confidence: 0.98713684 00:39:33.745 --> 00:39:34.785 we need to do more NOTE Confidence: 0.98713684 00:39:34.785 --> 00:39:36.350 workup because that could be NOTE Confidence: 0.98713684 00:39:36.350 --> 00:39:38.110 an an early sign of NOTE Confidence: 0.98713684 00:39:38.110 --> 00:39:39.090 cancer development. NOTE Confidence: 0.97021484 00:39:41.550 --> 00:39:42.930 One of our national organizations NOTE Confidence: 0.97021484 00:39:43.070 --> 00:39:45.070 called the National Comprehensive Cancer NOTE Confidence: 0.97021484 00:39:45.070 --> 00:39:45.570 Network NOTE Confidence: 0.9477539 00:39:45.950 --> 00:39:46.450 recommends, NOTE Confidence: 0.97646487 00:39:48.110 --> 00:39:50.295 specific screening depending on your NOTE Confidence: 0.97646487 00:39:50.295 --> 00:39:51.975 risks, as I mentioned, personal NOTE Confidence: 0.97646487 00:39:51.975 --> 00:39:53.975 risk, your family history risk, NOTE Confidence: 0.97646487 00:39:53.975 --> 00:39:56.215 and, related to genetic syndrome. NOTE Confidence: 0.97646487 00:39:56.215 --> 00:39:58.215 So, for example, if you NOTE Confidence: 0.97646487 00:39:58.215 --> 00:39:59.415 have a personal history of NOTE Confidence: 0.97646487 00:39:59.415 --> 00:40:01.675 certain medical conditions, such as NOTE Confidence: 0.99886066 00:40:02.369 --> 00:40:03.910 inflammatory bowel disease, NOTE Confidence: 0.9928385 00:40:04.369 --> 00:40:05.430 cystic fibrosis, NOTE Confidence: 0.9487915 00:40:06.210 --> 00:40:07.170 or if you had, NOTE Confidence: 0.9811626 00:40:07.809 --> 00:40:09.170 cancer when you were young, NOTE Confidence: 0.9811626 00:40:09.170 --> 00:40:10.210 a different cancer when you NOTE Confidence: 0.9811626 00:40:10.210 --> 00:40:11.410 were young that got certain NOTE Confidence: 0.9811626 00:40:11.410 --> 00:40:13.349 chemotherapy or radiation treatments, NOTE Confidence: 0.9959717 00:40:13.809 --> 00:40:15.170 you may be recommended to NOTE Confidence: 0.9959717 00:40:15.170 --> 00:40:16.390 start treatment early. NOTE Confidence: 0.96402717 00:40:16.795 --> 00:40:17.835 I'm not gonna focus on NOTE Confidence: 0.96402717 00:40:17.835 --> 00:40:19.195 this though because if you NOTE Confidence: 0.96402717 00:40:19.195 --> 00:40:20.235 have one of these conditions, NOTE Confidence: 0.96402717 00:40:20.235 --> 00:40:21.675 you probably are already following NOTE Confidence: 0.96402717 00:40:21.675 --> 00:40:23.035 with specialists who can help NOTE Confidence: 0.96402717 00:40:23.035 --> 00:40:24.175 guide you through this. NOTE Confidence: 0.9851825 00:40:25.915 --> 00:40:27.995 As Amy mentioned, family history NOTE Confidence: 0.9851825 00:40:27.995 --> 00:40:29.355 is also really important for NOTE Confidence: 0.9851825 00:40:29.355 --> 00:40:30.815 colorectal cancer screening, NOTE Confidence: 0.9838664 00:40:31.410 --> 00:40:32.770 Particularly, if you have a NOTE Confidence: 0.9838664 00:40:32.770 --> 00:40:34.290 first degree family member with NOTE Confidence: 0.9838664 00:40:34.290 --> 00:40:35.430 colorectal cancer, NOTE Confidence: 0.99870956 00:40:35.890 --> 00:40:37.250 you start screening at age NOTE Confidence: 0.99870956 00:40:37.250 --> 00:40:39.109 forty or ten years before NOTE Confidence: 0.99870956 00:40:39.170 --> 00:40:40.790 the first family member, NOTE Confidence: 0.9904785 00:40:41.250 --> 00:40:42.309 had the diagnosis. NOTE Confidence: 0.9071045 00:40:43.329 --> 00:40:44.150 But, also, NOTE Confidence: 0.99960935 00:40:44.945 --> 00:40:46.225 even if your first degree NOTE Confidence: 0.99960935 00:40:46.225 --> 00:40:48.005 family member had an advanced NOTE Confidence: 0.9872455 00:40:48.305 --> 00:40:50.145 or high risk polyp or NOTE Confidence: 0.9872455 00:40:50.145 --> 00:40:51.265 if they had lots of NOTE Confidence: 0.9872455 00:40:51.265 --> 00:40:51.765 polyps, NOTE Confidence: 0.9980913 00:40:52.145 --> 00:40:53.605 that could be another reason NOTE Confidence: 0.9980913 00:40:53.665 --> 00:40:55.285 why you should start screening NOTE Confidence: 0.9980913 00:40:55.344 --> 00:40:55.844 earlier. NOTE Confidence: 0.9991455 00:40:56.385 --> 00:40:57.960 And so this is all NOTE Confidence: 0.9991455 00:40:57.960 --> 00:40:59.160 the more reason why it's NOTE Confidence: 0.9991455 00:40:59.160 --> 00:41:00.440 so important for you to NOTE Confidence: 0.9991455 00:41:00.440 --> 00:41:02.380 know your family health history. NOTE Confidence: 0.98709106 00:41:04.599 --> 00:41:06.760 As Amy mentioned, genetic testing NOTE Confidence: 0.98709106 00:41:06.760 --> 00:41:08.200 might be recommended depending on NOTE Confidence: 0.98709106 00:41:08.200 --> 00:41:09.880 your family history, and she NOTE Confidence: 0.98709106 00:41:09.880 --> 00:41:10.380 discussed, NOTE Confidence: 0.91345215 00:41:10.760 --> 00:41:11.980 multiple different, NOTE Confidence: 0.9520019 00:41:14.174 --> 00:41:15.775 factors that might weigh into NOTE Confidence: 0.9520019 00:41:15.775 --> 00:41:17.134 this, like having a younger NOTE Confidence: 0.9520019 00:41:17.134 --> 00:41:18.994 age at diagnosis or multiple NOTE Confidence: 0.98535156 00:41:19.295 --> 00:41:19.795 family NOTE Confidence: 0.8739421 00:41:20.734 --> 00:41:21.875 members with cancer. NOTE Confidence: 0.99960935 00:41:22.894 --> 00:41:23.934 And I wanted to give NOTE Confidence: 0.99960935 00:41:23.934 --> 00:41:25.375 a couple of examples of NOTE Confidence: 0.99960935 00:41:25.375 --> 00:41:26.835 what this might look like. NOTE Confidence: 0.9709812 00:41:27.579 --> 00:41:29.579 Amy discussed Lynch syndrome, which NOTE Confidence: 0.9709812 00:41:29.579 --> 00:41:30.780 we consider to be a NOTE Confidence: 0.9709812 00:41:30.780 --> 00:41:31.680 non polyposis NOTE Confidence: 0.9805908 00:41:31.980 --> 00:41:33.819 or a syndrome that does NOTE Confidence: 0.9805908 00:41:33.819 --> 00:41:34.719 not have to NOTE Confidence: 0.99400383 00:41:35.020 --> 00:41:36.460 go through the pathway of NOTE Confidence: 0.99400383 00:41:36.460 --> 00:41:37.739 developing a lot of colon NOTE Confidence: 0.99400383 00:41:37.739 --> 00:41:39.260 pop polyps, and I'll discuss NOTE Confidence: 0.99400383 00:41:39.260 --> 00:41:40.140 that a little bit in NOTE Confidence: 0.99400383 00:41:40.140 --> 00:41:40.880 more detail. NOTE Confidence: 0.97994834 00:41:41.555 --> 00:41:42.915 And I wanted to discuss NOTE Confidence: 0.97994834 00:41:42.915 --> 00:41:44.195 an example of what we NOTE Confidence: 0.97994834 00:41:44.195 --> 00:41:45.955 call a polyposis syndrome as NOTE Confidence: 0.97994834 00:41:45.955 --> 00:41:48.055 well using familial adenopenus NOTE Confidence: 0.8947449 00:41:48.595 --> 00:41:50.375 polyposis or f a FAP NOTE Confidence: 0.8947449 00:41:50.515 --> 00:41:51.415 as an example. NOTE Confidence: 1 00:41:52.515 --> 00:41:53.015 So NOTE Confidence: 0.9197998 00:41:53.315 --> 00:41:54.855 starting with Lynch syndrome. NOTE Confidence: 0.996521 00:41:56.180 --> 00:41:57.960 Lynch syndrome, as Amy mentioned, NOTE Confidence: 0.996521 00:41:58.099 --> 00:41:59.079 is a mutation NOTE Confidence: 0.9853167 00:41:59.460 --> 00:42:01.079 in one of these mismatch NOTE Confidence: 0.9853167 00:42:01.299 --> 00:42:02.359 repair proteins. NOTE Confidence: 0.99768066 00:42:02.819 --> 00:42:04.279 And Amy really elegantly NOTE Confidence: 0.99572754 00:42:04.579 --> 00:42:06.759 described how genetic information NOTE Confidence: 0.99509394 00:42:07.555 --> 00:42:09.075 in our body is really NOTE Confidence: 0.99509394 00:42:09.075 --> 00:42:11.495 encoded by our DNA, and NOTE Confidence: 0.99509394 00:42:11.635 --> 00:42:12.995 you can have errors or NOTE Confidence: 0.99509394 00:42:12.995 --> 00:42:14.755 mistakes that happen in your NOTE Confidence: 0.99509394 00:42:14.755 --> 00:42:15.255 DNA. NOTE Confidence: 0.9861799 00:42:16.275 --> 00:42:18.035 Proteins like the mismatch repair NOTE Confidence: 0.9861799 00:42:18.035 --> 00:42:19.395 proteins are supposed to come NOTE Confidence: 0.9861799 00:42:19.395 --> 00:42:20.835 in and recognize when there's NOTE Confidence: 0.9861799 00:42:20.835 --> 00:42:22.200 a mistake and fix the NOTE Confidence: 0.9861799 00:42:22.200 --> 00:42:23.480 mistake so that things can NOTE Confidence: 0.9861799 00:42:23.480 --> 00:42:24.460 go about normally. NOTE Confidence: 0.9975586 00:42:25.239 --> 00:42:25.739 However, NOTE Confidence: 0.9723795 00:42:26.040 --> 00:42:28.300 in syndromes like Lynch syndrome, NOTE Confidence: 1 00:42:28.839 --> 00:42:29.980 you might have a mutation NOTE Confidence: 0.9897461 00:42:30.440 --> 00:42:31.180 in that, NOTE Confidence: 0.99975586 00:42:31.800 --> 00:42:33.320 protein that's supposed to repair NOTE Confidence: 0.99975586 00:42:33.320 --> 00:42:33.820 mistakes. NOTE Confidence: 0.9976981 00:42:34.434 --> 00:42:35.635 So if you get an NOTE Confidence: 0.9976981 00:42:35.635 --> 00:42:37.714 accumulation of these mistakes, this NOTE Confidence: 0.9976981 00:42:37.714 --> 00:42:38.674 leads to a lot of NOTE Confidence: 0.9976981 00:42:38.674 --> 00:42:40.594 errors and abnormalities in the NOTE Confidence: 0.9976981 00:42:40.594 --> 00:42:42.515 cells, which eventually can lead NOTE Confidence: 0.9976981 00:42:42.515 --> 00:42:43.575 to cancer development. NOTE Confidence: 0.975323 00:42:45.635 --> 00:42:47.635 So Lynch syndrome can be NOTE Confidence: 0.975323 00:42:47.635 --> 00:42:49.635 associated with many different cancer NOTE Confidence: 0.975323 00:42:49.635 --> 00:42:50.910 types as seen NOTE Confidence: 0.8510742 00:42:51.290 --> 00:42:51.690 here. NOTE Confidence: 0.9666193 00:42:52.250 --> 00:42:54.330 But specifically for colorectal cancer, NOTE Confidence: 0.9666193 00:42:54.330 --> 00:42:55.690 depending on which gene is NOTE Confidence: 0.9666193 00:42:55.690 --> 00:42:56.190 mutated, NOTE Confidence: 0.9765523 00:42:56.489 --> 00:42:57.850 you might have an increased NOTE Confidence: 0.9765523 00:42:57.850 --> 00:42:59.130 risk of up to sixty NOTE Confidence: 0.9765523 00:42:59.130 --> 00:43:01.070 percent chance of getting colorectal NOTE Confidence: 0.9765523 00:43:01.130 --> 00:43:02.410 cancer as opposed to four NOTE Confidence: 0.9765523 00:43:02.410 --> 00:43:03.550 percent in the population. NOTE Confidence: 0.96611327 00:43:04.494 --> 00:43:06.355 And so for this reason, NOTE Confidence: 0.99967444 00:43:06.655 --> 00:43:07.474 the NCCN NOTE Confidence: 0.93530273 00:43:08.015 --> 00:43:09.795 recommends specific screening, NOTE Confidence: 0.98194796 00:43:10.335 --> 00:43:12.515 not only for colorectal cancer, NOTE Confidence: 0.98194796 00:43:12.655 --> 00:43:13.855 but for other cancers as NOTE Confidence: 0.98194796 00:43:13.855 --> 00:43:15.214 well that are associated with NOTE Confidence: 0.98194796 00:43:15.214 --> 00:43:16.035 Lynch syndrome. NOTE Confidence: 0.94954425 00:43:16.734 --> 00:43:17.875 As Amy mentioned, NOTE Confidence: 0.9991455 00:43:18.255 --> 00:43:19.535 depending on which gene is NOTE Confidence: 0.9991455 00:43:19.535 --> 00:43:22.190 mutated, colonoscopy might be recommended NOTE Confidence: 0.9991455 00:43:22.410 --> 00:43:24.010 as early as age twenty NOTE Confidence: 0.9991455 00:43:24.010 --> 00:43:24.510 five NOTE Confidence: 0.98795575 00:43:25.050 --> 00:43:26.090 or a few years before NOTE Confidence: 0.98795575 00:43:26.090 --> 00:43:27.550 your first family diagnosis. NOTE Confidence: 0.96601564 00:43:28.250 --> 00:43:29.469 And upper endoscopies, NOTE Confidence: 0.97767055 00:43:29.850 --> 00:43:30.969 which we don't have a NOTE Confidence: 0.97767055 00:43:30.969 --> 00:43:32.810 general screening guideline for for NOTE Confidence: 0.97767055 00:43:32.810 --> 00:43:34.190 average risk adults, NOTE Confidence: 0.9815877 00:43:34.655 --> 00:43:36.494 would be recommended, depending on NOTE Confidence: 0.9815877 00:43:36.494 --> 00:43:37.775 your mutation, to start at NOTE Confidence: 0.9815877 00:43:37.775 --> 00:43:38.594 age thirty. NOTE Confidence: 0.9995117 00:43:39.135 --> 00:43:40.275 You might be recommended NOTE Confidence: 0.99853516 00:43:40.575 --> 00:43:41.234 to have, NOTE Confidence: 0.9939779 00:43:42.015 --> 00:43:44.114 biopsies or have a conversation NOTE Confidence: 0.9939779 00:43:44.335 --> 00:43:45.614 about whether or not doing NOTE Confidence: 0.9939779 00:43:45.614 --> 00:43:46.114 surgery NOTE Confidence: 0.9759979 00:43:46.830 --> 00:43:48.190 could reduce your risks of NOTE Confidence: 0.9759979 00:43:48.190 --> 00:43:49.550 other types of cancers, such NOTE Confidence: 0.9759979 00:43:49.550 --> 00:43:51.730 as endometrial cancer and ovarian NOTE Confidence: 0.9759979 00:43:51.790 --> 00:43:52.290 cancer. NOTE Confidence: 0.97505456 00:43:54.350 --> 00:43:55.790 Now, in terms of how NOTE Confidence: 0.97505456 00:43:55.790 --> 00:43:56.989 can we reduce the risk NOTE Confidence: 0.97505456 00:43:56.989 --> 00:43:58.030 of cancer if you have NOTE Confidence: 0.97505456 00:43:58.030 --> 00:43:58.850 Lynch syndrome, NOTE Confidence: 0.99986047 00:43:59.775 --> 00:44:01.135 a study has shown that NOTE Confidence: 0.99986047 00:44:01.135 --> 00:44:02.114 taking aspirin NOTE Confidence: 0.98963994 00:44:02.415 --> 00:44:04.015 can actually reduce your risks NOTE Confidence: 0.98963994 00:44:04.015 --> 00:44:06.094 of getting colorectal cancer. And NOTE Confidence: 0.98963994 00:44:06.094 --> 00:44:07.135 so, this is something that NOTE Confidence: 0.98963994 00:44:07.135 --> 00:44:08.255 would be discussed if you NOTE Confidence: 0.98963994 00:44:08.255 --> 00:44:09.234 had this diagnosis. NOTE Confidence: 0.99144423 00:44:10.974 --> 00:44:12.430 On the other hand, an NOTE Confidence: 0.99144423 00:44:12.430 --> 00:44:14.270 example of a polyposis syndrome, NOTE Confidence: 0.99144423 00:44:14.270 --> 00:44:15.890 as I mentioned, is FAP. NOTE Confidence: 0.9975586 00:44:16.910 --> 00:44:19.250 And FAP is an inherited NOTE Confidence: 0.9975586 00:44:19.310 --> 00:44:21.010 cancer syndrome with a mutation NOTE Confidence: 0.9975586 00:44:21.070 --> 00:44:22.770 in the APC gene. NOTE Confidence: 0.9988544 00:44:23.325 --> 00:44:24.285 Just to give you an NOTE Confidence: 0.9988544 00:44:24.285 --> 00:44:26.305 idea of how cancer develops NOTE Confidence: 0.9988544 00:44:26.445 --> 00:44:27.425 in this situation, NOTE Confidence: 0.9998372 00:44:28.605 --> 00:44:29.724 this is a graphic that NOTE Confidence: 0.9998372 00:44:29.724 --> 00:44:30.224 shows NOTE Confidence: 0.9986165 00:44:30.685 --> 00:44:32.464 what happens when your normal NOTE Confidence: 0.9986165 00:44:32.605 --> 00:44:35.085 colon cells become carcinoma or NOTE Confidence: 0.9986165 00:44:35.085 --> 00:44:36.065 cancer cells. NOTE Confidence: 0.9995117 00:44:36.560 --> 00:44:37.619 So there are mutations NOTE Confidence: 0.99703544 00:44:38.000 --> 00:44:39.600 in these red boxes that NOTE Confidence: 0.99703544 00:44:39.600 --> 00:44:41.040 happen along the way that NOTE Confidence: 0.99703544 00:44:41.040 --> 00:44:42.660 turn normal colon cells NOTE Confidence: 0.8826381 00:44:42.960 --> 00:44:44.820 to colon polyps and eventually NOTE Confidence: 0.8826381 00:44:44.880 --> 00:44:45.540 to cancer. NOTE Confidence: 0.9794108 00:44:46.239 --> 00:44:47.520 And as you can see NOTE Confidence: 0.9794108 00:44:47.520 --> 00:44:48.020 here, NOTE Confidence: 0.99934894 00:44:48.400 --> 00:44:49.815 the first stop NOTE Confidence: 0.9408831 00:44:50.114 --> 00:44:51.795 in that pathway is the NOTE Confidence: 0.9408831 00:44:51.795 --> 00:44:52.855 APC gene. NOTE Confidence: 0.99960935 00:44:53.155 --> 00:44:54.614 So if you have mutations NOTE Confidence: 0.99924046 00:44:54.915 --> 00:44:56.295 in your APC, NOTE Confidence: 0.99591935 00:44:57.075 --> 00:44:58.275 then that might mean that NOTE Confidence: 0.99591935 00:44:58.275 --> 00:44:59.315 you're at a much higher NOTE Confidence: 0.99591935 00:44:59.315 --> 00:45:00.935 risk for getting cancer. NOTE Confidence: 0.99694824 00:45:02.589 --> 00:45:03.790 This is an example of NOTE Confidence: 0.99694824 00:45:03.790 --> 00:45:04.530 a colonoscopy, NOTE Confidence: 0.9819824 00:45:05.310 --> 00:45:06.349 from somebody who might have, NOTE Confidence: 0.7591959 00:45:07.790 --> 00:45:08.369 a FAP. NOTE Confidence: 0.99869055 00:45:08.910 --> 00:45:10.190 And you can see that NOTE Confidence: 0.99869055 00:45:10.190 --> 00:45:11.790 there are all of these NOTE Confidence: 0.99869055 00:45:11.790 --> 00:45:12.290 spots, NOTE Confidence: 0.97436523 00:45:12.750 --> 00:45:14.450 all of these nodules, polyps NOTE Confidence: 0.97436523 00:45:14.510 --> 00:45:15.330 in the colon. NOTE Confidence: 0.99083114 00:45:15.864 --> 00:45:17.145 People who have a diagnosis NOTE Confidence: 0.99083114 00:45:17.145 --> 00:45:18.665 of FAP can have hundreds NOTE Confidence: 0.99083114 00:45:18.665 --> 00:45:19.325 of polyps. NOTE Confidence: 1 00:45:19.864 --> 00:45:20.364 And NOTE Confidence: 0.99768066 00:45:20.745 --> 00:45:21.965 because of that reason, NOTE Confidence: 0.99842834 00:45:22.425 --> 00:45:23.545 there is almost a one NOTE Confidence: 0.99842834 00:45:23.545 --> 00:45:25.225 hundred percent chance of developing NOTE Confidence: 0.99842834 00:45:25.225 --> 00:45:27.225 colorectal cancer if you have NOTE Confidence: 0.99842834 00:45:27.225 --> 00:45:27.725 FAP. NOTE Confidence: 1 00:45:28.610 --> 00:45:29.590 For that reason, NOTE Confidence: 0.98935544 00:45:30.690 --> 00:45:32.050 if you are diagnosed with NOTE Confidence: 0.98935544 00:45:32.050 --> 00:45:33.510 this, there is a recommendation NOTE Confidence: 1 00:45:34.130 --> 00:45:36.770 to surgically remove the colon NOTE Confidence: 1 00:45:36.770 --> 00:45:37.430 and rectum NOTE Confidence: 0.9205322 00:45:37.890 --> 00:45:39.670 usually after age eighteen. NOTE Confidence: 0.9720348 00:45:40.434 --> 00:45:41.154 There are a couple of NOTE Confidence: 0.9720348 00:45:41.154 --> 00:45:42.194 different ways that this can NOTE Confidence: 0.9720348 00:45:42.194 --> 00:45:42.694 happen. NOTE Confidence: 0.98844403 00:45:43.875 --> 00:45:44.855 You can either, NOTE Confidence: 0.9939575 00:45:45.714 --> 00:45:47.474 have your small bowel, NOTE Confidence: 0.99641925 00:45:47.795 --> 00:45:49.315 connected to your rectum and NOTE Confidence: 0.99641925 00:45:49.315 --> 00:45:50.694 just remove the colon. NOTE Confidence: 0.97835284 00:45:51.714 --> 00:45:52.694 You might have, NOTE Confidence: 0.9316406 00:45:53.270 --> 00:45:54.550 your small bowel collect NOTE Confidence: 0.9605713 00:45:55.190 --> 00:45:56.869 connected directly to your anal NOTE Confidence: 0.9605713 00:45:56.869 --> 00:45:57.369 canal, NOTE Confidence: 0.9981864 00:45:58.469 --> 00:46:00.330 or you might have your NOTE Confidence: 0.9981864 00:46:00.390 --> 00:46:01.989 small bowel come into what NOTE Confidence: 0.9981864 00:46:01.989 --> 00:46:03.130 is called an ostomy NOTE Confidence: 0.92982703 00:46:03.589 --> 00:46:05.109 depending on the specifics of NOTE Confidence: 0.92982703 00:46:05.109 --> 00:46:05.770 your condition NOTE Confidence: 0.989209 00:46:06.150 --> 00:46:07.755 and the risks and what NOTE Confidence: 0.989209 00:46:07.755 --> 00:46:09.775 is available at your hospital. NOTE Confidence: 0.9590039 00:46:11.434 --> 00:46:13.835 FAP is also associated with NOTE Confidence: 0.9590039 00:46:13.835 --> 00:46:15.515 other cancer risks as well, NOTE Confidence: 0.9590039 00:46:15.515 --> 00:46:17.434 particularly cancers in the other NOTE Confidence: 0.9590039 00:46:17.434 --> 00:46:18.954 parts of the GI tract, NOTE Confidence: 0.9590039 00:46:18.954 --> 00:46:20.974 and thyroid, and adrenal cancer. NOTE Confidence: 0.9937744 00:46:21.674 --> 00:46:22.494 And similarly, NOTE Confidence: 0.9998373 00:46:23.070 --> 00:46:23.969 the NCCN NOTE Confidence: 0.9807129 00:46:24.989 --> 00:46:25.489 recommends, NOTE Confidence: 0.9777832 00:46:26.190 --> 00:46:27.870 screening, according to this as NOTE Confidence: 0.9777832 00:46:27.870 --> 00:46:28.989 well to try to catch NOTE Confidence: 0.9777832 00:46:28.989 --> 00:46:30.510 these cancers early and to NOTE Confidence: 0.9777832 00:46:30.510 --> 00:46:31.890 help mitigate the risk. NOTE Confidence: 0.9947335 00:46:32.270 --> 00:46:34.110 So for colorectal cancer, as NOTE Confidence: 0.9947335 00:46:34.110 --> 00:46:34.770 I mentioned, NOTE Confidence: 0.94453126 00:46:35.230 --> 00:46:36.610 there is a strong recommendation NOTE Confidence: 0.99658203 00:46:36.989 --> 00:46:38.344 to have a removal, NOTE Confidence: 0.97146267 00:46:38.885 --> 00:46:39.844 of the colon and the NOTE Confidence: 0.97146267 00:46:39.844 --> 00:46:40.344 rectum. NOTE Confidence: 0.9987488 00:46:40.805 --> 00:46:42.244 And even in whatever part NOTE Confidence: 0.9987488 00:46:42.244 --> 00:46:43.765 is left behind, there's a NOTE Confidence: 0.9987488 00:46:43.765 --> 00:46:45.844 recommendation to still screen those NOTE Confidence: 0.9987488 00:46:45.844 --> 00:46:46.344 areas NOTE Confidence: 0.9973755 00:46:46.725 --> 00:46:47.925 to see if there's more NOTE Confidence: 0.9973755 00:46:47.925 --> 00:46:49.065 cancer that develops. NOTE Confidence: 1 00:46:50.010 --> 00:46:50.510 Furthermore, NOTE Confidence: 0.9926409 00:46:51.370 --> 00:46:53.530 for, stomach cancers and upper NOTE Confidence: 0.9926409 00:46:53.530 --> 00:46:54.430 GI cancers, NOTE Confidence: 0.95616317 00:46:54.890 --> 00:46:56.010 a recommendation is made to NOTE Confidence: 0.95616317 00:46:56.010 --> 00:46:57.230 get an upper endoscopy NOTE Confidence: 0.9809299 00:46:57.610 --> 00:46:58.890 starting as early as age NOTE Confidence: 0.9809299 00:46:58.890 --> 00:47:00.270 twenty to twenty five, NOTE Confidence: 0.9994575 00:47:00.650 --> 00:47:01.950 and you might be recommended NOTE Confidence: 0.9994575 00:47:02.010 --> 00:47:03.310 to have more surgeries NOTE Confidence: 0.91955566 00:47:03.924 --> 00:47:04.505 to remove, NOTE Confidence: 0.98967636 00:47:05.045 --> 00:47:06.565 different areas depending on what NOTE Confidence: 0.98967636 00:47:06.565 --> 00:47:07.305 they find. NOTE Confidence: 0.9394299 00:47:08.645 --> 00:47:10.085 For f for patients with NOTE Confidence: 0.9394299 00:47:10.085 --> 00:47:11.145 a FAP, NOTE Confidence: 0.9878906 00:47:11.684 --> 00:47:13.444 screening for thyroid cancer might NOTE Confidence: 0.9878906 00:47:13.444 --> 00:47:15.125 begin as as late as NOTE Confidence: 0.9878906 00:47:15.125 --> 00:47:16.724 in your teenage years. So NOTE Confidence: 0.9878906 00:47:16.724 --> 00:47:18.359 it's really important to know, NOTE Confidence: 0.9864638 00:47:18.760 --> 00:47:20.280 whether or not someone in NOTE Confidence: 0.9864638 00:47:20.280 --> 00:47:21.500 your family has this. NOTE Confidence: 0.99545896 00:47:22.040 --> 00:47:23.500 And a condition called hepatoblastoma NOTE Confidence: 0.97094727 00:47:24.280 --> 00:47:25.260 is actually found, NOTE Confidence: 0.9342256 00:47:26.520 --> 00:47:27.799 in childhood, so in the NOTE Confidence: 0.9342256 00:47:27.799 --> 00:47:29.480 first five years of life. NOTE Confidence: 0.9342256 00:47:29.480 --> 00:47:30.440 So it makes it even NOTE Confidence: 0.9342256 00:47:30.440 --> 00:47:31.180 more important. NOTE Confidence: 0.98412275 00:47:32.945 --> 00:47:34.385 In terms of reducing your NOTE Confidence: 0.98412275 00:47:34.385 --> 00:47:36.805 risk of, cancer with FAP, NOTE Confidence: 0.9439253 00:47:37.665 --> 00:47:38.945 there is a medication called NOTE Confidence: 0.9439253 00:47:38.945 --> 00:47:40.785 Solendac, which is an anti NOTE Confidence: 0.9439253 00:47:40.785 --> 00:47:41.285 inflammatory NOTE Confidence: 0.974149 00:47:41.905 --> 00:47:43.425 drug, which helps to decrease NOTE Confidence: 0.974149 00:47:43.425 --> 00:47:45.210 the polyp risk, but still NOTE Confidence: 0.974149 00:47:45.210 --> 00:47:46.890 your cancer risk is extremely NOTE Confidence: 0.974149 00:47:46.890 --> 00:47:48.810 high, if you have FAP NOTE Confidence: 0.974149 00:47:48.810 --> 00:47:49.530 and if you don't have NOTE Confidence: 0.974149 00:47:49.530 --> 00:47:50.489 surgery. So that is the NOTE Confidence: 0.974149 00:47:50.489 --> 00:47:51.950 reason why it's still recommendation NOTE Confidence: 0.9506836 00:47:52.250 --> 00:47:52.750 recommended. NOTE Confidence: 0.99438477 00:47:54.250 --> 00:47:56.330 And just to briefly touch NOTE Confidence: 0.99438477 00:47:56.330 --> 00:47:58.430 on pancreatic cancer screening, NOTE Confidence: 0.9546086 00:47:59.495 --> 00:48:00.775 we have a lot fewer NOTE Confidence: 0.9546086 00:48:00.775 --> 00:48:01.975 guidelines about what to do NOTE Confidence: 0.9546086 00:48:01.975 --> 00:48:03.195 with pancreas cancer. NOTE Confidence: 0.9664714 00:48:04.055 --> 00:48:05.594 But, this is, NOTE Confidence: 1 00:48:05.975 --> 00:48:07.035 a really important NOTE Confidence: 0.9337158 00:48:07.495 --> 00:48:09.035 topic to discuss because NOTE Confidence: 0.9935506 00:48:09.575 --> 00:48:12.235 while pancreatic cancer only represents NOTE Confidence: 0.9935506 00:48:12.295 --> 00:48:14.200 about three percent of cancer NOTE Confidence: 0.9935506 00:48:14.200 --> 00:48:15.800 cases in the US, it NOTE Confidence: 0.9935506 00:48:15.800 --> 00:48:17.239 represents over eight percent of NOTE Confidence: 0.9935506 00:48:17.239 --> 00:48:18.780 the cancer related death NOTE Confidence: 0.9711304 00:48:19.640 --> 00:48:21.000 cancer related deaths, and that's NOTE Confidence: 0.9711304 00:48:21.000 --> 00:48:22.200 because there is a poor NOTE Confidence: 0.9711304 00:48:22.200 --> 00:48:24.220 survival of of pancreatic cancer. NOTE Confidence: 0.9711304 00:48:24.520 --> 00:48:26.655 It's often found quite late. NOTE Confidence: 0.99902344 00:48:27.535 --> 00:48:28.975 And there is no national NOTE Confidence: 0.99902344 00:48:28.975 --> 00:48:29.475 recommendations NOTE Confidence: 1 00:48:29.935 --> 00:48:30.435 for NOTE Confidence: 0.9975586 00:48:30.815 --> 00:48:32.594 overall global screening, NOTE Confidence: 0.9536133 00:48:33.135 --> 00:48:34.594 for pancreatic cancers, NOTE Confidence: 0.9265137 00:48:35.215 --> 00:48:36.355 at least yet. NOTE Confidence: 0.98410374 00:48:36.895 --> 00:48:39.075 But it is recommended in NOTE Confidence: 0.98410374 00:48:39.135 --> 00:48:40.435 some high risk individuals, NOTE Confidence: 0.948877 00:48:41.430 --> 00:48:43.030 specifically if there are genetic NOTE Confidence: 0.948877 00:48:43.030 --> 00:48:45.290 mutations, a strong family history, NOTE Confidence: 0.99975586 00:48:45.989 --> 00:48:47.210 if you have a hereditary NOTE Confidence: 0.99975586 00:48:47.430 --> 00:48:48.650 condition with pancreatitis NOTE Confidence: 0.9433594 00:48:48.950 --> 00:48:49.770 or cysts. NOTE Confidence: 0.98903584 00:48:50.390 --> 00:48:51.849 But I will focus briefly NOTE Confidence: 0.98903584 00:48:51.910 --> 00:48:53.829 on how genetic mutations can NOTE Confidence: 0.98903584 00:48:53.829 --> 00:48:54.329 increase, NOTE Confidence: 0.9988607 00:48:54.835 --> 00:48:56.435 your risk of pancreas cancer NOTE Confidence: 0.9988607 00:48:56.435 --> 00:48:57.335 and the screening. NOTE Confidence: 0.9968262 00:48:58.675 --> 00:48:59.715 If you have a first NOTE Confidence: 0.9968262 00:48:59.715 --> 00:49:01.315 degree family member with a NOTE Confidence: 0.9968262 00:49:01.315 --> 00:49:02.535 pancreatic cancer, NOTE Confidence: 0.9591878 00:49:03.155 --> 00:49:04.675 that does mean that, actually, NOTE Confidence: 0.9591878 00:49:04.675 --> 00:49:06.195 you should consider getting genetic NOTE Confidence: 0.9591878 00:49:06.195 --> 00:49:07.175 testing because NOTE Confidence: 0.982945 00:49:07.500 --> 00:49:08.780 ten to fifty percent ten NOTE Confidence: 0.982945 00:49:08.780 --> 00:49:09.980 to fifteen percent of people NOTE Confidence: 0.982945 00:49:09.980 --> 00:49:11.440 who have pancreatic cancers NOTE Confidence: 0.9902344 00:49:12.060 --> 00:49:13.920 do have a mutation identified. NOTE Confidence: 0.9980469 00:49:15.500 --> 00:49:16.000 Now, NOTE Confidence: 0.9803467 00:49:16.620 --> 00:49:18.800 pancreatic cancer screening can happen NOTE Confidence: 0.9803467 00:49:18.860 --> 00:49:20.000 through an endoscopy NOTE Confidence: 0.90649414 00:49:27.224 --> 00:49:27.724 pancreas. NOTE Confidence: 0.9404297 00:49:28.744 --> 00:49:29.244 And NOTE Confidence: 0.8941797 00:49:29.785 --> 00:49:31.025 here is a brief table NOTE Confidence: 0.8941797 00:49:31.025 --> 00:49:32.265 just to show you that NOTE Confidence: 0.8941797 00:49:32.265 --> 00:49:34.265 depending on which gene you NOTE Confidence: 0.8941797 00:49:34.265 --> 00:49:34.364 might have as a mutation, NOTE Confidence: 0.8941797 00:49:34.364 --> 00:49:35.164 if you do have an NOTE Confidence: 0.9953003 00:49:35.619 --> 00:49:36.500 if you do have an NOTE Confidence: 0.9953003 00:49:36.500 --> 00:49:37.800 inherited cancer syndrome, NOTE Confidence: 0.9703311 00:49:38.660 --> 00:49:40.760 pancreas screening may be recommended NOTE Confidence: 0.9703311 00:49:40.820 --> 00:49:42.580 to begin begin as early NOTE Confidence: 0.9703311 00:49:42.580 --> 00:49:44.420 as age thirty or as NOTE Confidence: 0.9703311 00:49:44.420 --> 00:49:46.359 late as age fifty depending NOTE Confidence: 0.9703311 00:49:46.500 --> 00:49:47.000 on NOTE Confidence: 0.9935303 00:49:47.300 --> 00:49:48.020 what is, NOTE Confidence: 0.9998372 00:49:48.420 --> 00:49:49.480 what is found. NOTE Confidence: 0.99790734 00:49:50.785 --> 00:49:52.145 There are more studies going NOTE Confidence: 0.99790734 00:49:52.145 --> 00:49:53.425 on to find out whether NOTE Confidence: 0.99790734 00:49:53.425 --> 00:49:54.965 or not people can, NOTE Confidence: 0.97094727 00:49:55.825 --> 00:49:56.325 find, NOTE Confidence: 0.9699707 00:49:57.105 --> 00:49:59.364 pancreatic cancer screening helpful. NOTE Confidence: 0.9784614 00:49:59.665 --> 00:50:00.864 For example, if you don't NOTE Confidence: 0.9784614 00:50:00.864 --> 00:50:02.085 have a genetic condition, NOTE Confidence: 0.9915114 00:50:02.430 --> 00:50:03.950 but you do have family NOTE Confidence: 0.9915114 00:50:03.950 --> 00:50:05.950 history of pancreatic cancer and NOTE Confidence: 0.9915114 00:50:05.950 --> 00:50:06.690 a lot of NOTE Confidence: 0.96829045 00:50:06.989 --> 00:50:08.750 history. And there's actually a NOTE Confidence: 0.96829045 00:50:08.750 --> 00:50:10.190 study called the CAPS five NOTE Confidence: 0.96829045 00:50:10.190 --> 00:50:11.630 study, which is open here NOTE Confidence: 0.96829045 00:50:11.630 --> 00:50:12.369 at Yale NOTE Confidence: 0.8745117 00:50:12.750 --> 00:50:13.650 to help identify, NOTE Confidence: 0.92122394 00:50:14.510 --> 00:50:15.885 individuals who might, NOTE Confidence: 0.9877264 00:50:16.364 --> 00:50:18.364 benefit from increased screening. So NOTE Confidence: 0.9877264 00:50:18.364 --> 00:50:19.405 please reach out if you're NOTE Confidence: 0.9877264 00:50:19.405 --> 00:50:19.905 interested NOTE Confidence: 0.9952148 00:50:20.285 --> 00:50:21.745 in learning more about that. NOTE Confidence: 0.9085286 00:50:22.765 --> 00:50:23.905 So in conclusion, NOTE Confidence: 0.9778687 00:50:24.605 --> 00:50:26.125 early onset GI cancers are NOTE Confidence: 0.9778687 00:50:26.125 --> 00:50:27.005 on the rise, and young NOTE Confidence: 0.9778687 00:50:27.005 --> 00:50:29.185 adults may need, early screening NOTE Confidence: 0.9778687 00:50:29.245 --> 00:50:30.625 based on the risk factors. NOTE Confidence: 0.8776042 00:50:31.085 --> 00:50:31.739 And it's important NOTE Confidence: 0.74194336 00:50:38.860 --> 00:50:40.719 genetic condition that increases NOTE Confidence: 0.88635254 00:50:41.020 --> 00:50:41.920 your risk of GI NOTE Confidence: 0.96777344 00:50:42.460 --> 00:50:42.960 cancers, NOTE Confidence: 0.9454753 00:50:43.420 --> 00:50:44.540 there may be certain medical NOTE Confidence: 0.9454753 00:50:44.540 --> 00:50:46.300 or surgical options to reduce NOTE Confidence: 0.9454753 00:50:46.300 --> 00:50:47.040 your risk. NOTE Confidence: 0.9817139 00:50:48.035 --> 00:50:48.995 Thank you so much for NOTE Confidence: 0.9817139 00:50:48.995 --> 00:50:50.535 your time and attention, and, NOTE Confidence: 0.960319 00:50:50.915 --> 00:50:51.955 I believe doctor Giry is NOTE Confidence: 0.960319 00:50:51.955 --> 00:50:53.395 gonna be briefly talking about NOTE Confidence: 0.960319 00:50:53.395 --> 00:50:54.835 the early onset cancer program, NOTE Confidence: 0.960319 00:50:54.835 --> 00:50:55.955 and here's a QR code NOTE Confidence: 0.960319 00:50:55.955 --> 00:50:57.075 if you're interested in learning NOTE Confidence: 0.960319 00:50:57.075 --> 00:50:58.375 more about that as well. NOTE Confidence: 0.937389 00:51:00.170 --> 00:51:01.530 Thank you very much, doctor NOTE Confidence: 0.937389 00:51:01.530 --> 00:51:02.969 Sri Kumar, for that very NOTE Confidence: 0.937389 00:51:02.969 --> 00:51:03.469 insightful NOTE Confidence: 0.9116211 00:51:03.770 --> 00:51:04.270 presentation. NOTE Confidence: 0.88964844 00:51:06.170 --> 00:51:06.489 And, NOTE Confidence: 0.979187 00:51:07.770 --> 00:51:08.810 we have a few minutes NOTE Confidence: 0.979187 00:51:08.810 --> 00:51:10.110 left for questions, NOTE Confidence: 0.9755615 00:51:10.410 --> 00:51:11.690 and we actually had a NOTE Confidence: 0.9755615 00:51:11.690 --> 00:51:13.469 question that came through from, NOTE Confidence: 0.9966634 00:51:13.875 --> 00:51:15.094 an audience member, NOTE Confidence: 0.998291 00:51:15.635 --> 00:51:16.675 that I thought would be NOTE Confidence: 0.998291 00:51:16.675 --> 00:51:19.015 relevant for comment from both, NOTE Confidence: 0.9471214 00:51:19.715 --> 00:51:21.155 Amy Wiegand from the genetic NOTE Confidence: 0.9471214 00:51:21.155 --> 00:51:23.235 counseling experience and also doctor NOTE Confidence: 0.9471214 00:51:23.235 --> 00:51:23.735 Shreekumar, NOTE Confidence: 0.97857666 00:51:24.195 --> 00:51:25.655 because it's related to, NOTE Confidence: 0.91435546 00:51:26.114 --> 00:51:27.960 an MLH one gene question, NOTE Confidence: 0.9812622 00:51:28.599 --> 00:51:29.640 which is, you know, related NOTE Confidence: 0.9812622 00:51:29.640 --> 00:51:30.619 to Lynch syndrome. NOTE Confidence: 0.9645996 00:51:30.920 --> 00:51:32.119 And the question said, NOTE Confidence: 0.9831543 00:51:32.520 --> 00:51:33.260 was asking, NOTE Confidence: 0.97405136 00:51:33.640 --> 00:51:35.239 does a personal history of NOTE Confidence: 0.97405136 00:51:35.239 --> 00:51:36.060 early onset, NOTE Confidence: 0.99869794 00:51:38.440 --> 00:51:38.940 gynecologic NOTE Confidence: 1 00:51:39.239 --> 00:51:39.739 cancer NOTE Confidence: 0.9347534 00:51:40.244 --> 00:51:41.204 that has an m l NOTE Confidence: 0.9347534 00:51:41.204 --> 00:51:42.424 h one deficiency NOTE Confidence: 0.99934894 00:51:42.724 --> 00:51:43.704 due to methylation NOTE Confidence: 0.9709961 00:51:44.884 --> 00:51:46.244 and the genetic testing is NOTE Confidence: 0.9709961 00:51:46.244 --> 00:51:47.924 negative, does that increase the NOTE Confidence: 0.9709961 00:51:47.924 --> 00:51:49.864 risk of a GI cancer? NOTE Confidence: 0.99318624 00:51:50.484 --> 00:51:52.265 So thinking about, you know, NOTE Confidence: 0.99318624 00:51:52.404 --> 00:51:53.444 is this type of, you NOTE Confidence: 0.99318624 00:51:53.444 --> 00:51:53.944 know, NOTE Confidence: 0.89819336 00:51:54.350 --> 00:51:55.250 testing result NOTE Confidence: 1 00:51:55.710 --> 00:51:56.210 informative NOTE Confidence: 1 00:51:56.670 --> 00:51:57.170 for NOTE Confidence: 0.97593063 00:51:57.469 --> 00:51:59.469 a hereditary cancer risk? I'll, NOTE Confidence: 0.97593063 00:51:59.710 --> 00:52:00.750 turn it over to Amy NOTE Confidence: 0.97593063 00:52:00.750 --> 00:52:02.270 first just talking about, you NOTE Confidence: 0.97593063 00:52:02.270 --> 00:52:03.310 know, the different types of NOTE Confidence: 0.97593063 00:52:03.310 --> 00:52:04.510 genetic tests and and what NOTE Confidence: 0.97593063 00:52:04.510 --> 00:52:05.469 they can kind of tell NOTE Confidence: 0.97593063 00:52:05.469 --> 00:52:06.530 us in different ways. NOTE Confidence: 0.9815499 00:52:07.605 --> 00:52:08.805 Yeah. That's that's a great NOTE Confidence: 0.9815499 00:52:08.805 --> 00:52:09.605 question. So, NOTE Confidence: 0.9995117 00:52:10.325 --> 00:52:11.385 just methylation NOTE Confidence: 0.9768102 00:52:12.085 --> 00:52:13.465 the the MLH one methylation, NOTE Confidence: 0.9768102 00:52:13.685 --> 00:52:15.225 that is considered to be NOTE Confidence: 0.9768102 00:52:15.525 --> 00:52:17.125 a somatic change in the NOTE Confidence: 0.9768102 00:52:17.125 --> 00:52:19.285 tumor itself. So if someone NOTE Confidence: 0.9768102 00:52:19.285 --> 00:52:20.585 has Lynch syndrome, NOTE Confidence: 0.999056 00:52:21.320 --> 00:52:22.940 if someone has Lynch syndrome, NOTE Confidence: 0.999056 00:52:23.000 --> 00:52:24.760 we might see them if NOTE Confidence: 0.999056 00:52:24.760 --> 00:52:26.700 they have an inherited mutation, NOTE Confidence: 0.9571262 00:52:27.160 --> 00:52:28.200 one that they're born with, NOTE Confidence: 0.9571262 00:52:28.200 --> 00:52:29.739 and the MLH one gene, NOTE Confidence: 0.9571262 00:52:29.880 --> 00:52:30.680 if they were to go NOTE Confidence: 0.9571262 00:52:30.680 --> 00:52:31.480 on to develop, NOTE Confidence: 0.9967448 00:52:31.880 --> 00:52:32.380 gynecological NOTE Confidence: 0.9970703 00:52:32.760 --> 00:52:33.260 cancer, NOTE Confidence: 0.93961585 00:52:33.864 --> 00:52:34.445 that gynecological NOTE Confidence: 0.97402346 00:52:34.745 --> 00:52:36.425 cancer might be more likely NOTE Confidence: 0.97402346 00:52:36.425 --> 00:52:37.965 to be MLH one deficient. NOTE Confidence: 0.9979607 00:52:38.425 --> 00:52:40.505 However, methylation of MLH one NOTE Confidence: 0.9979607 00:52:40.505 --> 00:52:41.785 is something that just occurs NOTE Confidence: 0.9979607 00:52:41.785 --> 00:52:43.225 in the cancer itself. It's NOTE Confidence: 0.9979607 00:52:43.225 --> 00:52:44.045 not due NOTE Confidence: 0.9947917 00:52:44.825 --> 00:52:45.725 to an inherited NOTE Confidence: 0.95296633 00:52:46.469 --> 00:52:48.230 gene mutation, and particularly if NOTE Confidence: 0.95296633 00:52:48.230 --> 00:52:50.230 that person had negative genetic NOTE Confidence: 0.95296633 00:52:50.230 --> 00:52:52.330 testing, negative germline genetic testing. NOTE Confidence: 0.95296633 00:52:52.550 --> 00:52:54.010 Most likely what that represents NOTE Confidence: 0.95296633 00:52:54.070 --> 00:52:55.109 is that there this was NOTE Confidence: 0.95296633 00:52:55.109 --> 00:52:57.190 a sporadic cancer, something that NOTE Confidence: 0.95296633 00:52:57.190 --> 00:52:58.310 occurred to, again, due to NOTE Confidence: 0.95296633 00:52:58.310 --> 00:52:59.770 a combination of other factors. NOTE Confidence: 0.95060223 00:53:00.094 --> 00:53:01.535 And having that MLH one NOTE Confidence: 0.95060223 00:53:01.535 --> 00:53:02.035 deficient NOTE Confidence: 0.9995117 00:53:02.494 --> 00:53:03.474 cancer alone NOTE Confidence: 0.9844835 00:53:03.775 --> 00:53:05.855 with negative Lynch syndrome testing NOTE Confidence: 0.9844835 00:53:05.855 --> 00:53:06.894 is not known to be NOTE Confidence: 0.9844835 00:53:06.894 --> 00:53:08.594 related with to increased risk NOTE Confidence: 0.9844835 00:53:08.654 --> 00:53:09.795 of GI cancers. NOTE Confidence: 0.977211 00:53:10.815 --> 00:53:12.030 Thank you very much, Amy. NOTE Confidence: 0.977211 00:53:12.270 --> 00:53:13.390 Doctor Sreekumar, would you like NOTE Confidence: 0.977211 00:53:13.390 --> 00:53:14.830 to add anything about the NOTE Confidence: 0.977211 00:53:14.830 --> 00:53:16.910 potential connection between cancers if NOTE Confidence: 0.977211 00:53:16.910 --> 00:53:18.210 it's a germline mutation? NOTE Confidence: 0.9995117 00:53:18.989 --> 00:53:20.450 Yeah. Thank you so much, NOTE Confidence: 1 00:53:20.910 --> 00:53:21.410 Amy. NOTE Confidence: 0.99609375 00:53:21.870 --> 00:53:22.350 So, NOTE Confidence: 0.974714 00:53:23.230 --> 00:53:24.989 I totally agree. So if NOTE Confidence: 0.974714 00:53:24.989 --> 00:53:25.730 you have, NOTE Confidence: 0.9252581 00:53:27.065 --> 00:53:28.984 a methylation of the MLH NOTE Confidence: 0.9252581 00:53:28.984 --> 00:53:29.644 one gene, NOTE Confidence: 0.99937856 00:53:30.105 --> 00:53:30.984 the other way that I NOTE Confidence: 0.99937856 00:53:30.984 --> 00:53:32.184 like to think about this NOTE Confidence: 0.99937856 00:53:32.184 --> 00:53:32.684 is NOTE Confidence: 0.9908203 00:53:33.704 --> 00:53:36.204 you have almost a signal NOTE Confidence: 0.9995117 00:53:36.744 --> 00:53:37.484 that is NOTE Confidence: 0.99902344 00:53:37.785 --> 00:53:38.285 acquired NOTE Confidence: 0.96540177 00:53:38.744 --> 00:53:40.505 over time that develops usually NOTE Confidence: 0.96540177 00:53:40.505 --> 00:53:41.244 with age NOTE Confidence: 0.918396 00:53:41.545 --> 00:53:43.430 that is turning off your NOTE Confidence: 0.918396 00:53:43.430 --> 00:53:44.969 MLH one gene NOTE Confidence: 0.9114746 00:53:45.270 --> 00:53:47.450 usually in a local area. NOTE Confidence: 0.98420155 00:53:47.829 --> 00:53:49.430 And so it's not in NOTE Confidence: 0.98420155 00:53:49.430 --> 00:53:50.950 every cancer every cell in NOTE Confidence: 0.98420155 00:53:50.950 --> 00:53:51.910 the body the way that NOTE Confidence: 0.98420155 00:53:51.910 --> 00:53:54.170 Amy had described inherited mutations NOTE Confidence: 0.98420155 00:53:54.309 --> 00:53:55.910 are. It's acquired at a NOTE Confidence: 0.98420155 00:53:55.910 --> 00:53:57.614 later age. So if you NOTE Confidence: 0.98420155 00:53:57.614 --> 00:53:59.935 have a germline genetic testing NOTE Confidence: 0.98420155 00:53:59.935 --> 00:54:00.995 that is negative, NOTE Confidence: 0.9995117 00:54:01.455 --> 00:54:03.075 then it is unlikely NOTE Confidence: 0.9935303 00:54:03.535 --> 00:54:04.495 to be, NOTE Confidence: 0.9977214 00:54:05.055 --> 00:54:06.735 associated with an increased risk NOTE Confidence: 0.9977214 00:54:06.735 --> 00:54:08.094 of a GI cancer. Of NOTE Confidence: 0.9977214 00:54:08.094 --> 00:54:09.375 course, it's always important to NOTE Confidence: 0.9977214 00:54:09.375 --> 00:54:10.815 know your full family history NOTE Confidence: 0.9977214 00:54:10.815 --> 00:54:12.250 and other personal history as NOTE Confidence: 0.9977214 00:54:12.250 --> 00:54:13.210 well to see whether or NOTE Confidence: 0.9977214 00:54:13.210 --> 00:54:14.090 not there may be other NOTE Confidence: 0.9977214 00:54:14.090 --> 00:54:14.590 reasons, NOTE Confidence: 0.972229 00:54:15.370 --> 00:54:16.590 to have an increased, NOTE Confidence: 0.9660034 00:54:16.890 --> 00:54:18.270 risk for GI cancer, NOTE Confidence: 0.9953369 00:54:18.730 --> 00:54:20.330 but, this one in itself, NOTE Confidence: 0.9953369 00:54:20.650 --> 00:54:22.110 may not increase the risk. NOTE Confidence: 0.9992676 00:54:22.650 --> 00:54:23.770 Yes. Thank you for that NOTE Confidence: 0.9992676 00:54:23.770 --> 00:54:24.270 question. NOTE Confidence: 0.98488766 00:54:24.935 --> 00:54:26.695 And, doctor Prasaloglu, a question NOTE Confidence: 0.98488766 00:54:26.695 --> 00:54:27.494 that we get asked a NOTE Confidence: 0.98488766 00:54:27.494 --> 00:54:28.234 lot is, NOTE Confidence: 0.93688023 00:54:28.695 --> 00:54:30.215 what kind of discussions do NOTE Confidence: 0.93688023 00:54:30.215 --> 00:54:31.815 you have in a breast NOTE Confidence: 0.93688023 00:54:31.815 --> 00:54:33.035 cancer risk assessment, NOTE Confidence: 0.9743042 00:54:33.655 --> 00:54:35.195 visit, with a patient? NOTE Confidence: 0.9902344 00:54:35.815 --> 00:54:37.350 For example, what are the NOTE Confidence: 0.9902344 00:54:37.350 --> 00:54:38.630 pros and cons of having NOTE Confidence: 0.9902344 00:54:38.630 --> 00:54:40.390 a mammogram done for a NOTE Confidence: 0.9902344 00:54:40.390 --> 00:54:40.890 young, NOTE Confidence: 1 00:54:41.270 --> 00:54:41.770 individual NOTE Confidence: 0.97083807 00:54:42.310 --> 00:54:43.590 versus some of the other NOTE Confidence: 0.97083807 00:54:43.590 --> 00:54:45.030 imaging tests like a breast NOTE Confidence: 0.97083807 00:54:45.030 --> 00:54:46.630 MRI, let's say? What are NOTE Confidence: 0.97083807 00:54:46.630 --> 00:54:48.150 some of the key, topics NOTE Confidence: 0.97083807 00:54:48.150 --> 00:54:49.270 or key pearls that you NOTE Confidence: 0.97083807 00:54:49.270 --> 00:54:50.310 discuss in in a breast NOTE Confidence: 0.97083807 00:54:50.310 --> 00:54:51.590 risk assessment visit when you're NOTE Confidence: 0.97083807 00:54:51.590 --> 00:54:52.650 having these discussions? NOTE Confidence: 0.9526652 00:54:53.315 --> 00:54:54.275 Yeah. That's a it's a NOTE Confidence: 0.9526652 00:54:54.275 --> 00:54:56.055 great question, doctor Geary. So, NOTE Confidence: 0.9940143 00:54:56.515 --> 00:54:57.954 you know, broadly, when I NOTE Confidence: 0.9940143 00:54:57.954 --> 00:54:58.994 meet someone for the first NOTE Confidence: 0.9940143 00:54:58.994 --> 00:55:00.114 time, we spend a lot NOTE Confidence: 0.9940143 00:55:00.114 --> 00:55:01.474 of time talking about their NOTE Confidence: 0.9940143 00:55:01.474 --> 00:55:03.394 personal and family history to NOTE Confidence: 0.9940143 00:55:03.394 --> 00:55:04.535 try to figure out NOTE Confidence: 0.98184204 00:55:05.330 --> 00:55:07.090 which element is driving their NOTE Confidence: 0.98184204 00:55:07.090 --> 00:55:08.610 risk the most. For example, NOTE Confidence: 0.98184204 00:55:08.610 --> 00:55:09.810 if they're a known gene NOTE Confidence: 0.98184204 00:55:09.810 --> 00:55:10.930 carrier, we spend a lot NOTE Confidence: 0.98184204 00:55:10.930 --> 00:55:12.230 of time talking about NOTE Confidence: 0.9982422 00:55:12.770 --> 00:55:14.469 the breast cancer risk associated NOTE Confidence: 0.97965497 00:55:14.850 --> 00:55:15.969 with that gene as well NOTE Confidence: 0.97965497 00:55:15.969 --> 00:55:17.270 as any other associated NOTE Confidence: 0.99975586 00:55:17.810 --> 00:55:19.270 risks with other cancers. NOTE Confidence: 0.9986328 00:55:20.005 --> 00:55:21.305 When it comes to imaging, NOTE Confidence: 0.9877695 00:55:21.685 --> 00:55:23.364 you know, our general guidance NOTE Confidence: 0.9877695 00:55:23.364 --> 00:55:24.645 is that if your exam NOTE Confidence: 0.9877695 00:55:24.645 --> 00:55:26.805 is normal, mammogram less than NOTE Confidence: 0.9877695 00:55:26.805 --> 00:55:28.085 age thirty is really not NOTE Confidence: 0.9877695 00:55:28.085 --> 00:55:29.605 beneficial. And people ask all NOTE Confidence: 0.9877695 00:55:29.605 --> 00:55:30.984 the time why that is. NOTE Confidence: 0.9877695 00:55:31.125 --> 00:55:32.825 And it's because young people NOTE Confidence: 0.9877695 00:55:32.965 --> 00:55:34.325 tend to have very dense NOTE Confidence: 0.9877695 00:55:34.325 --> 00:55:36.880 breast tissue where minor changes NOTE Confidence: 0.9877695 00:55:36.940 --> 00:55:38.300 in the breast tissue that NOTE Confidence: 0.9877695 00:55:38.300 --> 00:55:39.120 might indicate NOTE Confidence: 0.9302368 00:55:39.580 --> 00:55:40.960 a cancer or precancer NOTE Confidence: 0.99851704 00:55:41.580 --> 00:55:42.620 are really not able to NOTE Confidence: 0.99851704 00:55:42.620 --> 00:55:43.760 be seen on mammogram. NOTE Confidence: 0.99383545 00:55:44.140 --> 00:55:45.360 Now there's an important NOTE Confidence: 0.97429013 00:55:45.660 --> 00:55:47.100 caveat here, right, which is NOTE Confidence: 0.97429013 00:55:47.100 --> 00:55:48.860 that is assuming that someone's NOTE Confidence: 0.97429013 00:55:48.860 --> 00:55:49.920 exam is normal. NOTE Confidence: 0.9626116 00:55:50.415 --> 00:55:51.715 If you have a symptom, NOTE Confidence: 0.9626116 00:55:51.935 --> 00:55:53.614 for example, you have bloody NOTE Confidence: 0.9626116 00:55:53.614 --> 00:55:55.455 nipple discharge or your doctor NOTE Confidence: 0.9626116 00:55:55.455 --> 00:55:56.815 feels a mass during your NOTE Confidence: 0.9626116 00:55:56.815 --> 00:55:57.315 exam, NOTE Confidence: 0.97998047 00:55:57.695 --> 00:55:59.215 regardless of your age, even NOTE Confidence: 0.97998047 00:55:59.215 --> 00:56:00.335 though we might start with NOTE Confidence: 0.97998047 00:56:00.335 --> 00:56:01.855 an ultrasound, and I'll circle NOTE Confidence: 0.97998047 00:56:01.855 --> 00:56:03.614 back to ultrasound MRI in NOTE Confidence: 0.97998047 00:56:03.614 --> 00:56:04.275 a minute, NOTE Confidence: 0.99258703 00:56:05.070 --> 00:56:07.010 diagnostic mammogram is really important NOTE Confidence: 0.99258703 00:56:07.150 --> 00:56:08.510 because it's very good at NOTE Confidence: 0.99258703 00:56:08.510 --> 00:56:09.010 catching, NOTE Confidence: 0.99627686 00:56:09.630 --> 00:56:10.770 what are called calcifications NOTE Confidence: 0.9683838 00:56:11.150 --> 00:56:12.610 or little sort of, NOTE Confidence: 0.94649833 00:56:13.790 --> 00:56:15.390 you know, calcium deposits that NOTE Confidence: 0.94649833 00:56:15.390 --> 00:56:16.830 can indicate cancer. And that's NOTE Confidence: 0.94649833 00:56:16.830 --> 00:56:18.190 really mammogram is really the NOTE Confidence: 0.94649833 00:56:18.190 --> 00:56:19.150 only way we can see NOTE Confidence: 0.94649833 00:56:19.150 --> 00:56:19.650 those. NOTE Confidence: 0.9953801 00:56:20.085 --> 00:56:21.125 But if we did that NOTE Confidence: 0.9953801 00:56:21.125 --> 00:56:22.565 routinely on all women in NOTE Confidence: 0.9953801 00:56:22.565 --> 00:56:23.625 their mid twenties, NOTE Confidence: 0.9982422 00:56:23.925 --> 00:56:25.464 we wouldn't find almost anything. NOTE Confidence: 0.9057617 00:56:26.165 --> 00:56:27.385 Now MRI NOTE Confidence: 0.9872943 00:56:27.844 --> 00:56:29.605 is our most detail oriented NOTE Confidence: 0.9872943 00:56:29.605 --> 00:56:30.805 test. So for our high NOTE Confidence: 0.9872943 00:56:30.805 --> 00:56:32.484 risk patients, it's the test NOTE Confidence: 0.9872943 00:56:32.484 --> 00:56:33.525 that gives us the most NOTE Confidence: 0.9872943 00:56:33.525 --> 00:56:35.219 information. But if you were NOTE Confidence: 0.9872943 00:56:35.219 --> 00:56:36.100 sitting in front of me NOTE Confidence: 0.9872943 00:56:36.100 --> 00:56:37.300 as a new patient, I NOTE Confidence: 0.9872943 00:56:37.300 --> 00:56:38.340 would tell you, you know, NOTE Confidence: 0.9872943 00:56:38.340 --> 00:56:39.860 it's very detail oriented. It's NOTE Confidence: 0.9872943 00:56:39.860 --> 00:56:40.600 very sensitive. NOTE Confidence: 0.9918339 00:56:41.140 --> 00:56:42.500 But it's not very specific, NOTE Confidence: 0.9918339 00:56:42.500 --> 00:56:43.460 which means it's not the NOTE Confidence: 0.9918339 00:56:43.460 --> 00:56:44.980 smartest test. When we do NOTE Confidence: 0.9918339 00:56:44.980 --> 00:56:46.260 an MRI for the first NOTE Confidence: 0.9918339 00:56:46.260 --> 00:56:47.685 time of the breast, we NOTE Confidence: 0.9918339 00:56:47.685 --> 00:56:49.305 will see any abnormality, NOTE Confidence: 0.95277625 00:56:49.685 --> 00:56:50.885 which can be a cancer NOTE Confidence: 0.95277625 00:56:50.885 --> 00:56:51.625 or precancer, NOTE Confidence: 0.9563802 00:56:51.925 --> 00:56:53.125 but in young women, it's NOTE Confidence: 0.9563802 00:56:53.125 --> 00:56:54.425 more likely to be NOTE Confidence: 0.99380773 00:56:55.125 --> 00:56:57.445 lactational changes, hormonal changes, or NOTE Confidence: 0.99380773 00:56:57.445 --> 00:56:59.125 benign masses. And so that's NOTE Confidence: 0.99380773 00:56:59.125 --> 00:57:00.405 why, you know, with each NOTE Confidence: 0.99380773 00:57:00.405 --> 00:57:01.685 patient, we really try to NOTE Confidence: 0.99380773 00:57:01.685 --> 00:57:02.505 think about NOTE Confidence: 0.980072 00:57:02.820 --> 00:57:04.680 what is your specific indication NOTE Confidence: 0.980072 00:57:04.900 --> 00:57:06.040 for early screening. NOTE Confidence: 0.9913025 00:57:07.140 --> 00:57:08.840 And, you know, the MRI NOTE Confidence: 0.9913025 00:57:09.060 --> 00:57:10.760 is really good in supplement NOTE Confidence: 0.9913025 00:57:10.900 --> 00:57:12.580 to the mammogram beyond age NOTE Confidence: 0.9913025 00:57:12.580 --> 00:57:13.080 thirty. NOTE Confidence: 0.9906656 00:57:13.460 --> 00:57:14.835 But for our highest risk NOTE Confidence: 0.9906656 00:57:14.994 --> 00:57:16.835 patients, even without that baseline NOTE Confidence: 0.9906656 00:57:16.835 --> 00:57:18.775 mammogram, an MRI is useful NOTE Confidence: 0.9906656 00:57:18.835 --> 00:57:20.375 since we can see cancers NOTE Confidence: 0.9988281 00:57:20.835 --> 00:57:22.195 so very early in some NOTE Confidence: 0.9988281 00:57:22.195 --> 00:57:23.815 of those gene positive patients. NOTE Confidence: 0.98634493 00:57:24.515 --> 00:57:25.474 And then at a in NOTE Confidence: 0.98634493 00:57:25.474 --> 00:57:26.515 a visit, we'll have, you NOTE Confidence: 0.98634493 00:57:26.515 --> 00:57:28.275 know, thoughtful shared decision making NOTE Confidence: 0.98634493 00:57:28.275 --> 00:57:29.315 about whether or not we NOTE Confidence: 0.98634493 00:57:29.315 --> 00:57:30.450 should also be adding an NOTE Confidence: 0.98634493 00:57:30.530 --> 00:57:31.750 ultrasound in for screening, NOTE Confidence: 0.99780273 00:57:32.210 --> 00:57:33.670 which is usually not necessary NOTE Confidence: 0.99780273 00:57:33.730 --> 00:57:34.530 when you do both the NOTE Confidence: 0.99780273 00:57:34.530 --> 00:57:35.589 MRI and the mammogram, NOTE Confidence: 0.95405275 00:57:36.050 --> 00:57:37.410 but something obviously to talk NOTE Confidence: 0.95405275 00:57:37.410 --> 00:57:39.030 about with your individual doctor. NOTE Confidence: 0.99975586 00:57:40.210 --> 00:57:41.490 Thank you so much. Very NOTE Confidence: 0.99975586 00:57:41.490 --> 00:57:41.990 helpful. NOTE Confidence: 0.9909017 00:57:42.945 --> 00:57:44.225 Another question that we are NOTE Confidence: 0.9909017 00:57:44.225 --> 00:57:45.905 asked quite a bit is, NOTE Confidence: 0.9909017 00:57:46.225 --> 00:57:48.405 regarding the family history information. NOTE Confidence: 0.9641113 00:57:48.785 --> 00:57:49.285 And, NOTE Confidence: 0.98172 00:57:50.465 --> 00:57:51.985 sometimes that information can be NOTE Confidence: 0.98172 00:57:51.985 --> 00:57:53.505 challenging to know or is NOTE Confidence: 0.98172 00:57:53.505 --> 00:57:55.285 just unknown in a family NOTE Confidence: 0.98172 00:57:55.345 --> 00:57:55.845 or NOTE Confidence: 0.9422966 00:57:56.260 --> 00:57:57.220 in one side of the NOTE Confidence: 0.9422966 00:57:57.220 --> 00:57:58.660 family or versus another side NOTE Confidence: 0.9422966 00:57:58.660 --> 00:58:00.260 of the family or say NOTE Confidence: 0.9422966 00:58:00.260 --> 00:58:00.920 in relatives. NOTE Confidence: 0.9706543 00:58:01.380 --> 00:58:03.320 So, Amy, how do you, NOTE Confidence: 0.9802246 00:58:03.620 --> 00:58:05.060 what is your recommendation in NOTE Confidence: 0.9802246 00:58:05.060 --> 00:58:05.960 terms of, NOTE Confidence: 0.97426534 00:58:07.380 --> 00:58:08.980 limited knowledge of family history? NOTE Confidence: 0.97426534 00:58:08.980 --> 00:58:10.020 And can it still be NOTE Confidence: 0.97426534 00:58:10.020 --> 00:58:10.520 beneficial NOTE Confidence: 0.99675435 00:58:11.205 --> 00:58:12.665 for a person to bring NOTE Confidence: 0.99675435 00:58:12.805 --> 00:58:14.805 some information to their doctors NOTE Confidence: 0.99675435 00:58:14.805 --> 00:58:15.845 or potentially meet with a NOTE Confidence: 0.99675435 00:58:15.845 --> 00:58:16.745 genetic counselor? NOTE Confidence: 0.9952916 00:58:17.925 --> 00:58:19.205 Yeah. That's a great question. NOTE Confidence: 0.9952916 00:58:19.205 --> 00:58:19.865 I think, NOTE Confidence: 0.9926092 00:58:20.965 --> 00:58:21.845 as I said, I think NOTE Confidence: 0.9926092 00:58:21.845 --> 00:58:23.205 in terms of collecting family NOTE Confidence: 0.9926092 00:58:23.205 --> 00:58:24.565 history, I think all you NOTE Confidence: 0.9926092 00:58:24.565 --> 00:58:25.925 can do is the the NOTE Confidence: 0.9926092 00:58:25.925 --> 00:58:27.339 best that you can. I NOTE Confidence: 0.9926092 00:58:27.339 --> 00:58:27.980 I think we all know NOTE Confidence: 0.9926092 00:58:27.980 --> 00:58:29.260 there can be family dynamics NOTE Confidence: 0.9926092 00:58:29.260 --> 00:58:30.300 that can make it really NOTE Confidence: 0.9926092 00:58:30.300 --> 00:58:31.599 challenging to get information. NOTE Confidence: 0.9971517 00:58:31.900 --> 00:58:33.099 And the farther back you NOTE Confidence: 0.9971517 00:58:33.099 --> 00:58:33.599 go, NOTE Confidence: 0.9834527 00:58:33.980 --> 00:58:34.859 you may not have that NOTE Confidence: 0.9834527 00:58:34.859 --> 00:58:36.880 information, especially if someone NOTE Confidence: 0.9814453 00:58:37.339 --> 00:58:39.260 especially generations ago where cancer NOTE Confidence: 0.9814453 00:58:39.260 --> 00:58:40.780 was either not discussed because NOTE Confidence: 0.9814453 00:58:40.780 --> 00:58:41.599 it was taboo NOTE Confidence: 0.9537598 00:58:41.994 --> 00:58:44.255 or was, possibly not diagnosed. NOTE Confidence: 0.99224854 00:58:45.035 --> 00:58:45.915 So I think if with NOTE Confidence: 0.99224854 00:58:45.915 --> 00:58:47.135 limited family history, NOTE Confidence: 0.97411484 00:58:47.515 --> 00:58:48.955 sometimes even just getting ages NOTE Confidence: 0.97411484 00:58:48.955 --> 00:58:50.335 of death could be helpful NOTE Confidence: 0.97411484 00:58:50.395 --> 00:58:51.835 or, like, anything that maybe NOTE Confidence: 0.97411484 00:58:51.835 --> 00:58:53.275 could be surrounding, like, maybe NOTE Confidence: 0.97411484 00:58:53.275 --> 00:58:54.395 what caused their death that NOTE Confidence: 0.97411484 00:58:54.395 --> 00:58:55.994 maybe could be helpful, maybe NOTE Confidence: 0.97411484 00:58:55.994 --> 00:58:57.900 thinking about if they maybe NOTE Confidence: 0.97411484 00:58:57.900 --> 00:58:59.599 died of, advanced cancer. NOTE Confidence: 0.9373685 00:58:59.980 --> 00:59:00.859 I still think even if NOTE Confidence: 0.9373685 00:59:00.859 --> 00:59:02.619 someone has a a limited NOTE Confidence: 0.9373685 00:59:02.619 --> 00:59:03.920 family history understanding, NOTE Confidence: 0.9323188 00:59:04.299 --> 00:59:05.500 maybe meeting with a genetic NOTE Confidence: 0.9323188 00:59:05.500 --> 00:59:06.640 counselor could be helpful. NOTE Confidence: 0.9394415 00:59:07.099 --> 00:59:08.220 Even though we really focus NOTE Confidence: 0.9394415 00:59:08.220 --> 00:59:09.760 on family history of cancer, NOTE Confidence: 0.9394415 00:59:09.819 --> 00:59:10.859 and as we've talked about, NOTE Confidence: 0.9394415 00:59:11.180 --> 00:59:12.380 everyone's talked about this whole NOTE Confidence: 0.9394415 00:59:12.380 --> 00:59:12.880 presentation, NOTE Confidence: 0.9775216 00:59:13.445 --> 00:59:14.725 family history can be really NOTE Confidence: 0.9775216 00:59:14.725 --> 00:59:16.565 important in risk assessment for NOTE Confidence: 0.9775216 00:59:16.565 --> 00:59:18.105 genetic testing, but also, NOTE Confidence: 0.9103074 00:59:18.645 --> 00:59:20.244 early cancer screening. It still NOTE Confidence: 0.9103074 00:59:20.244 --> 00:59:21.125 will be helpful to me NOTE Confidence: 0.9103074 00:59:21.125 --> 00:59:22.565 with a genetic counselor, I NOTE Confidence: 0.9103074 00:59:22.565 --> 00:59:24.165 think, you know, regardless just NOTE Confidence: 0.9103074 00:59:24.165 --> 00:59:24.665 because NOTE Confidence: 0.9705298 00:59:25.125 --> 00:59:26.380 have as as a genetic NOTE Confidence: 0.9705298 00:59:26.380 --> 00:59:27.340 counselor, what we do is NOTE Confidence: 0.9705298 00:59:27.340 --> 00:59:28.380 we take into account what NOTE Confidence: 0.9705298 00:59:28.380 --> 00:59:29.580 we know about your family NOTE Confidence: 0.9705298 00:59:29.580 --> 00:59:31.180 history. We're able to make NOTE Confidence: 0.9705298 00:59:31.180 --> 00:59:32.540 our assessment and then still NOTE Confidence: 0.9705298 00:59:32.540 --> 00:59:34.620 discuss genetic testing options and NOTE Confidence: 0.9705298 00:59:34.620 --> 00:59:36.380 kinda work walk walk you NOTE Confidence: 0.9705298 00:59:36.380 --> 00:59:37.994 through what genetic testing might NOTE Confidence: 0.9705298 00:59:37.994 --> 00:59:39.615 show, what might be recommended NOTE Confidence: 0.9705298 00:59:39.674 --> 00:59:41.355 depending on the results. So NOTE Confidence: 0.9705298 00:59:41.355 --> 00:59:42.074 I think at the end NOTE Confidence: 0.9705298 00:59:42.074 --> 00:59:42.875 of the day, the best NOTE Confidence: 0.9705298 00:59:42.875 --> 00:59:43.674 that you can do is NOTE Confidence: 0.9705298 00:59:43.674 --> 00:59:44.315 the best that you can NOTE Confidence: 0.9705298 00:59:44.315 --> 00:59:45.775 do with collecting family history. NOTE Confidence: 0.9705298 00:59:45.835 --> 00:59:46.555 And if you do have NOTE Confidence: 0.9705298 00:59:46.555 --> 00:59:48.075 family history of cancer that NOTE Confidence: 0.9705298 00:59:48.075 --> 00:59:49.595 is either you're unsure if NOTE Confidence: 0.9705298 00:59:49.595 --> 00:59:51.454 it's suspicious of hereditary cancer, NOTE Confidence: 0.9671631 00:59:51.869 --> 00:59:52.829 or you don't maybe don't NOTE Confidence: 0.9671631 00:59:52.829 --> 00:59:53.630 know a lot about it, NOTE Confidence: 0.9671631 00:59:53.630 --> 00:59:54.589 I still think meeting with NOTE Confidence: 0.9671631 00:59:54.589 --> 00:59:55.789 a genetic counselor could still NOTE Confidence: 0.9671631 00:59:55.789 --> 00:59:56.450 be helpful. NOTE Confidence: 0.9989258 00:59:57.710 --> 00:59:59.329 Absolutely. Thank you so much. NOTE Confidence: 0.98291016 01:00:00.109 --> 01:00:01.549 And then one final question, NOTE Confidence: 0.8689575 01:00:01.869 --> 01:00:02.769 doctor Shreekumar. NOTE Confidence: 0.92519534 01:00:03.309 --> 01:00:05.329 We received so many questions, NOTE Confidence: 1 01:00:06.295 --> 01:00:06.795 regarding NOTE Confidence: 0.9603027 01:00:07.255 --> 01:00:08.715 what can a person do NOTE Confidence: 0.9603027 01:00:09.015 --> 01:00:10.715 from a a diet standpoint, NOTE Confidence: 0.97528076 01:00:11.975 --> 01:00:13.195 when we think about, NOTE Confidence: 0.904541 01:00:13.815 --> 01:00:15.335 reducing risk for cancers and NOTE Confidence: 0.904541 01:00:15.335 --> 01:00:17.195 in particular, colon cancer. NOTE Confidence: 0.9765625 01:00:18.390 --> 01:00:19.849 Do you have recommendations NOTE Confidence: 0.95996094 01:00:20.390 --> 01:00:20.869 or, NOTE Confidence: 0.9874878 01:00:21.349 --> 01:00:23.270 sources of information that, NOTE Confidence: 0.9680176 01:00:23.670 --> 01:00:25.589 are trusted, reliable sources of NOTE Confidence: 0.9680176 01:00:25.589 --> 01:00:26.730 information online NOTE Confidence: 0.9930284 01:00:27.270 --> 01:00:28.309 that a person can go NOTE Confidence: 0.9930284 01:00:28.309 --> 01:00:29.270 to? What how how do NOTE Confidence: 0.9930284 01:00:29.270 --> 01:00:30.789 you, have these discussions with NOTE Confidence: 0.9930284 01:00:30.789 --> 01:00:31.910 your patients when it comes NOTE Confidence: 0.9930284 01:00:31.910 --> 01:00:33.505 to diet and reducing colon NOTE Confidence: 0.9930284 01:00:33.505 --> 01:00:34.245 cancer risk? NOTE Confidence: 0.96964526 01:00:35.105 --> 01:00:36.385 Yes. Thank you so much, NOTE Confidence: 0.96964526 01:00:36.705 --> 01:00:38.145 doctor Geary, for that question. NOTE Confidence: 0.96964526 01:00:38.145 --> 01:00:38.645 So, NOTE Confidence: 0.99943036 01:00:40.145 --> 01:00:41.665 you know, there have been NOTE Confidence: 0.99943036 01:00:41.665 --> 01:00:43.425 large studies that have been NOTE Confidence: 0.99943036 01:00:43.425 --> 01:00:44.645 done to NOTE Confidence: 1 01:00:45.359 --> 01:00:46.180 look at NOTE Confidence: 0.9718221 01:00:46.720 --> 01:00:48.660 what sort of diets might NOTE Confidence: 0.9718221 01:00:48.880 --> 01:00:50.880 increase your risk of colon NOTE Confidence: 0.9718221 01:00:50.880 --> 01:00:51.779 cancer, or NOTE Confidence: 0.99262154 01:00:52.240 --> 01:00:53.680 I should say, you know, NOTE Confidence: 0.99262154 01:00:53.680 --> 01:00:54.960 patients who are diagnosed with NOTE Confidence: 0.99262154 01:00:54.960 --> 01:00:56.160 colon cancer are found to NOTE Confidence: 0.99262154 01:00:56.160 --> 01:00:57.059 have a higher NOTE Confidence: 0.97595215 01:00:57.440 --> 01:00:59.055 certain subsets of diets, NOTE Confidence: 0.99960935 01:00:59.934 --> 01:01:01.555 and what might be protective NOTE Confidence: 0.9790039 01:01:01.855 --> 01:01:02.355 against, NOTE Confidence: 0.98764646 01:01:02.734 --> 01:01:04.095 diet. What I will say NOTE Confidence: 0.98764646 01:01:04.095 --> 01:01:06.595 is that it's not diet NOTE Confidence: 0.98764646 01:01:06.655 --> 01:01:08.815 alone that will influence whether NOTE Confidence: 0.98764646 01:01:08.815 --> 01:01:09.954 or not you get colorectal NOTE Confidence: 0.98764646 01:01:10.015 --> 01:01:11.395 cancer, and that's really important. NOTE Confidence: 0.609375 01:01:12.630 --> 01:01:13.069 But, NOTE Confidence: 0.957959 01:01:13.510 --> 01:01:14.790 it is maybe what we NOTE Confidence: 0.957959 01:01:14.790 --> 01:01:16.710 consider to be, as as, NOTE Confidence: 0.94861853 01:01:17.109 --> 01:01:19.190 doctor Pasalagu had mentioned, a NOTE Confidence: 0.94861853 01:01:19.190 --> 01:01:20.730 modifiable risk factor. NOTE Confidence: 0.9934082 01:01:21.109 --> 01:01:22.890 So it's important to, NOTE Confidence: 0.97680664 01:01:23.510 --> 01:01:24.010 avoid, NOTE Confidence: 0.94091797 01:01:24.710 --> 01:01:26.010 things such as, NOTE Confidence: 0.9818929 01:01:27.475 --> 01:01:29.315 eating, too much red meat NOTE Confidence: 0.9818929 01:01:29.315 --> 01:01:29.815 or, NOTE Confidence: 0.9445801 01:01:30.675 --> 01:01:31.655 having overconsumption NOTE Confidence: 0.9838867 01:01:31.955 --> 01:01:32.695 of alcohol. NOTE Confidence: 0.9746094 01:01:33.155 --> 01:01:34.135 Those are common, NOTE Confidence: 0.95832825 01:01:35.955 --> 01:01:37.075 things that I will talk NOTE Confidence: 0.95832825 01:01:37.075 --> 01:01:39.075 about with individuals who will NOTE Confidence: 0.95832825 01:01:39.075 --> 01:01:39.875 come see me at my NOTE Confidence: 0.95832825 01:01:39.875 --> 01:01:40.375 clinic. NOTE Confidence: 0.99328613 01:01:41.160 --> 01:01:42.060 Also important, NOTE Confidence: 0.9770952 01:01:42.599 --> 01:01:43.880 if possible, to try to NOTE Confidence: 0.9770952 01:01:43.880 --> 01:01:45.560 minimize the amount of sugar NOTE Confidence: 0.9770952 01:01:45.560 --> 01:01:46.060 sweetened NOTE Confidence: 0.9671224 01:01:46.839 --> 01:01:48.599 beverages that, you're drinking as NOTE Confidence: 0.9671224 01:01:48.599 --> 01:01:49.099 well. NOTE Confidence: 0.997454 01:01:49.560 --> 01:01:51.240 And, what we do see NOTE Confidence: 0.997454 01:01:51.240 --> 01:01:52.760 is that it seems that NOTE Confidence: 0.997454 01:01:52.760 --> 01:01:54.380 having a diet that NOTE Confidence: 0.9899292 01:01:54.775 --> 01:01:56.615 is high high in, you NOTE Confidence: 0.9899292 01:01:56.615 --> 01:01:58.855 know, vegetables and fruits and NOTE Confidence: 0.9899292 01:01:58.855 --> 01:02:00.635 whole grains may be protective NOTE Confidence: 0.9899292 01:02:00.775 --> 01:02:02.315 in this setting as well. NOTE Confidence: 0.99853516 01:02:02.615 --> 01:02:03.095 So, NOTE Confidence: 0.96643066 01:02:03.494 --> 01:02:04.615 what you what you eat NOTE Confidence: 0.96643066 01:02:04.615 --> 01:02:05.755 really does matter. NOTE Confidence: 0.99794006 01:02:06.615 --> 01:02:08.055 We think that what you NOTE Confidence: 0.99794006 01:02:08.055 --> 01:02:10.120 eat can influence the healthy NOTE Confidence: 0.99794006 01:02:10.180 --> 01:02:12.020 bacteria that is in your NOTE Confidence: 0.99794006 01:02:12.020 --> 01:02:12.520 gut, NOTE Confidence: 1 01:02:12.900 --> 01:02:13.400 which NOTE Confidence: 0.9680447 01:02:13.940 --> 01:02:15.780 therefore might be leading to NOTE Confidence: 0.9680447 01:02:15.780 --> 01:02:17.480 more or less inflammation NOTE Confidence: 0.9947917 01:02:17.860 --> 01:02:19.080 and could be, NOTE Confidence: 0.99675643 01:02:19.380 --> 01:02:20.980 you know, influencing your cancer NOTE Confidence: 0.99675643 01:02:20.980 --> 01:02:22.980 risk. So really important thing NOTE Confidence: 0.99675643 01:02:22.980 --> 01:02:24.365 to to think about. NOTE Confidence: 0.9991862 01:02:25.225 --> 01:02:26.665 Thank you so much. Yes. NOTE Confidence: 0.9991862 01:02:26.665 --> 01:02:27.165 Absolutely. NOTE Confidence: 0.98430526 01:02:27.465 --> 01:02:29.085 And the American Cancer Society NOTE Confidence: 0.98430526 01:02:29.225 --> 01:02:30.525 has, guidelines NOTE Confidence: 0.9998372 01:02:30.905 --> 01:02:32.445 for thinking about, NOTE Confidence: 0.9995117 01:02:33.145 --> 01:02:33.805 you know, NOTE Confidence: 0.8991699 01:02:34.585 --> 01:02:35.325 physical activity NOTE Confidence: 0.9456787 01:02:35.625 --> 01:02:36.365 and diet, NOTE Confidence: 0.86954755 01:02:37.200 --> 01:02:38.000 and kind of, NOTE Confidence: 0.99072266 01:02:38.480 --> 01:02:39.599 they break this down in NOTE Confidence: 0.99072266 01:02:39.599 --> 01:02:40.640 in a patient friendly way. NOTE Confidence: 0.99072266 01:02:40.640 --> 01:02:41.840 So that's a resource that NOTE Confidence: 0.99072266 01:02:41.840 --> 01:02:43.119 that, you know, anyone can NOTE Confidence: 0.99072266 01:02:43.119 --> 01:02:44.400 go to online as well. NOTE Confidence: 0.99072266 01:02:44.400 --> 01:02:44.900 So, NOTE Confidence: 0.9374512 01:02:45.840 --> 01:02:46.720 well, I would like to NOTE Confidence: 0.9374512 01:02:46.720 --> 01:02:48.580 wrap up our Smilo shares, NOTE Confidence: 0.9239095 01:02:49.040 --> 01:02:50.180 event for tonight, NOTE Confidence: 0.96118164 01:02:51.265 --> 01:02:53.285 and, wanted to end by NOTE Confidence: 0.96118164 01:02:53.345 --> 01:02:54.165 giving you, NOTE Confidence: 0.9971517 01:02:54.625 --> 01:02:55.845 a little bit of information NOTE Confidence: 0.9971517 01:02:55.984 --> 01:02:57.685 about the, two programs, NOTE Confidence: 0.9539005 01:02:58.145 --> 01:02:59.585 the that you've heard about NOTE Confidence: 0.9539005 01:02:59.585 --> 01:03:01.265 in in, throughout the talks NOTE Confidence: 0.9539005 01:03:01.265 --> 01:03:03.025 tonight, the Yale Early Onset NOTE Confidence: 0.9539005 01:03:03.025 --> 01:03:03.925 Cancer Program, NOTE Confidence: 0.925981 01:03:04.820 --> 01:03:06.340 and the Yale or and NOTE Confidence: 0.925981 01:03:06.340 --> 01:03:08.580 Smilo, cancer genetics and prevention NOTE Confidence: 0.925981 01:03:08.580 --> 01:03:09.080 program. NOTE Confidence: 0.9964844 01:03:09.540 --> 01:03:11.320 The early onset cancer program NOTE Confidence: 0.9874945 01:03:11.620 --> 01:03:13.140 at Yale Cancer Center and NOTE Confidence: 0.9874945 01:03:13.140 --> 01:03:13.640 Smilo, NOTE Confidence: 0.99975586 01:03:14.340 --> 01:03:15.800 is a dedicated team NOTE Confidence: 0.9998915 01:03:16.180 --> 01:03:17.940 that is focused on addressing NOTE Confidence: 0.9998915 01:03:17.940 --> 01:03:19.080 the needs of patients NOTE Confidence: 0.98999023 01:03:19.674 --> 01:03:21.615 who, either have been diagnosed NOTE Confidence: 0.98999023 01:03:21.674 --> 01:03:22.875 with a cancer at a NOTE Confidence: 0.98999023 01:03:22.875 --> 01:03:23.694 young age, NOTE Confidence: 0.99323064 01:03:24.395 --> 01:03:25.755 and also thinking about what NOTE Confidence: 0.99323064 01:03:25.755 --> 01:03:27.115 supports are needed for these NOTE Confidence: 0.99323064 01:03:27.115 --> 01:03:27.615 patients, NOTE Confidence: 0.99609375 01:03:27.994 --> 01:03:29.694 for their families, caregivers, NOTE Confidence: 0.96451086 01:03:30.474 --> 01:03:32.154 and how we can bring NOTE Confidence: 0.96451086 01:03:32.154 --> 01:03:34.720 information such as tonight's Smilo NOTE Confidence: 0.96451086 01:03:34.720 --> 01:03:35.220 shares, NOTE Confidence: 0.9918768 01:03:35.840 --> 01:03:37.200 to the public and to NOTE Confidence: 0.9918768 01:03:37.200 --> 01:03:38.400 our patients and to our NOTE Confidence: 0.9918768 01:03:38.400 --> 01:03:38.900 communities NOTE Confidence: 0.97405136 01:03:39.440 --> 01:03:40.560 to really help bring this NOTE Confidence: 0.97405136 01:03:40.560 --> 01:03:41.300 into awareness NOTE Confidence: 0.9864502 01:03:41.600 --> 01:03:42.720 and really put as much NOTE Confidence: 0.9864502 01:03:42.720 --> 01:03:44.080 information in your hands as NOTE Confidence: 0.9864502 01:03:44.080 --> 01:03:45.780 we possibly can. So, NOTE Confidence: 0.93688965 01:03:46.955 --> 01:03:47.775 I am, NOTE Confidence: 0.9228249 01:03:48.155 --> 01:03:50.315 really, excited to co lead NOTE Confidence: 0.9228249 01:03:50.315 --> 01:03:51.755 this program with doctor Nancy NOTE Confidence: 0.9228249 01:03:51.755 --> 01:03:52.255 Borstelmann. NOTE Confidence: 0.998291 01:03:52.635 --> 01:03:54.095 We have a terrific team, NOTE Confidence: 0.9593506 01:03:54.395 --> 01:03:55.135 that is, NOTE Confidence: 0.9904785 01:03:55.755 --> 01:03:56.875 we all work together to NOTE Confidence: 0.9904785 01:03:56.875 --> 01:03:57.835 think about the needs of NOTE Confidence: 0.9904785 01:03:57.835 --> 01:03:59.295 these patients from a clinical NOTE Confidence: 0.9904785 01:03:59.435 --> 01:03:59.935 standpoint. NOTE Confidence: 0.99131554 01:04:00.470 --> 01:04:01.430 How can we do more NOTE Confidence: 0.99131554 01:04:01.430 --> 01:04:03.130 research to gain more insights NOTE Confidence: 0.99131554 01:04:03.190 --> 01:04:04.569 about early onset cancers? NOTE Confidence: 0.99697876 01:04:05.750 --> 01:04:06.869 How can we support our NOTE Confidence: 0.99697876 01:04:06.869 --> 01:04:08.170 patients and families, NOTE Confidence: 0.96500653 01:04:09.109 --> 01:04:10.010 in a very, NOTE Confidence: 0.9123535 01:04:10.549 --> 01:04:12.470 well rounded holistic way and, NOTE Confidence: 0.9123535 01:04:12.470 --> 01:04:13.769 again, from an educational NOTE Confidence: 0.9803414 01:04:14.595 --> 01:04:16.195 perspective. This is the QR NOTE Confidence: 0.9803414 01:04:16.195 --> 01:04:17.235 code that's here on the NOTE Confidence: 0.9803414 01:04:17.235 --> 01:04:18.994 screen, regarding the early onset NOTE Confidence: 0.9803414 01:04:18.994 --> 01:04:20.195 program if you'd like to NOTE Confidence: 0.9803414 01:04:20.195 --> 01:04:21.015 check it out. NOTE Confidence: 0.98016715 01:04:21.555 --> 01:04:22.835 And there's lots and lots NOTE Confidence: 0.98016715 01:04:22.835 --> 01:04:24.595 of resources online, from our NOTE Confidence: 0.98016715 01:04:24.595 --> 01:04:26.275 program and that we're continuing NOTE Confidence: 0.98016715 01:04:26.275 --> 01:04:27.015 to develop. NOTE Confidence: 0.9795898 01:04:27.470 --> 01:04:28.349 This is our first in NOTE Confidence: 0.9795898 01:04:28.349 --> 01:04:30.049 a series of Smilo shares NOTE Confidence: 0.9931127 01:04:30.349 --> 01:04:31.710 for the early onset program, NOTE Confidence: 0.9931127 01:04:31.710 --> 01:04:32.930 and we will be having NOTE Confidence: 0.9931127 01:04:32.990 --> 01:04:34.589 Smilo shares later this year NOTE Confidence: 0.9931127 01:04:34.589 --> 01:04:36.609 focused on fertility preservation NOTE Confidence: 0.9972479 01:04:36.990 --> 01:04:38.589 for individuals who have had NOTE Confidence: 0.9972479 01:04:38.589 --> 01:04:40.029 a diagnosis of early onset NOTE Confidence: 0.9972479 01:04:40.029 --> 01:04:40.529 cancer NOTE Confidence: 0.9411621 01:04:40.910 --> 01:04:41.390 and, NOTE Confidence: 0.96698 01:04:41.789 --> 01:04:43.089 thinking about, you know, NOTE Confidence: 0.971639 01:04:43.445 --> 01:04:44.905 preserving fertility and childbearing. NOTE Confidence: 0.9565324 01:04:45.845 --> 01:04:47.365 And then another Smilo shares NOTE Confidence: 0.9565324 01:04:47.365 --> 01:04:49.045 focused on what are the NOTE Confidence: 0.9565324 01:04:49.045 --> 01:04:50.565 support services and ways that NOTE Confidence: 0.9565324 01:04:50.565 --> 01:04:51.925 we can help our patients NOTE Confidence: 0.9565324 01:04:51.925 --> 01:04:53.705 and families from that psychosocial NOTE Confidence: 0.9565324 01:04:54.005 --> 01:04:54.905 support standpoint NOTE Confidence: 0.9626465 01:04:55.205 --> 01:04:56.185 as well. So, NOTE Confidence: 0.98986816 01:04:57.119 --> 01:04:57.839 please take a look at NOTE Confidence: 0.98986816 01:04:57.839 --> 01:04:58.880 our website, and, NOTE Confidence: 0.9996338 01:04:59.440 --> 01:05:00.400 we'd love to hear from NOTE Confidence: 0.9996338 01:05:00.400 --> 01:05:01.299 you as well. NOTE Confidence: 0.9647624 01:05:02.400 --> 01:05:03.760 And then, the, NOTE Confidence: 0.94350404 01:05:04.079 --> 01:05:06.180 cancer genetics and prevention program NOTE Confidence: 0.94350404 01:05:06.400 --> 01:05:08.020 at Yale and Smilow NOTE Confidence: 0.78686523 01:05:08.559 --> 01:05:09.059 is, NOTE Confidence: 0.9527588 01:05:10.005 --> 01:05:12.005 just a a very, amazing NOTE Confidence: 0.9527588 01:05:12.005 --> 01:05:13.464 team of experts, NOTE Confidence: 0.9805664 01:05:14.244 --> 01:05:16.644 that includes physicians, that includes, NOTE Confidence: 0.9854492 01:05:16.964 --> 01:05:19.144 genetic counselors and genetics coordinators, NOTE Confidence: 0.9978841 01:05:20.005 --> 01:05:21.385 advanced practice providers. NOTE Confidence: 0.9817418 01:05:21.765 --> 01:05:23.140 We see patients across the NOTE Confidence: 0.9817418 01:05:23.140 --> 01:05:24.820 state of Connecticut at various NOTE Confidence: 0.9817418 01:05:24.820 --> 01:05:26.680 care delivery network sites. NOTE Confidence: 0.99121094 01:05:27.700 --> 01:05:28.200 And NOTE Confidence: 0.970988 01:05:28.500 --> 01:05:30.100 it's it really has been, NOTE Confidence: 0.970988 01:05:30.420 --> 01:05:32.020 important to think about bringing NOTE Confidence: 0.970988 01:05:32.020 --> 01:05:34.100 this aspect of of risk NOTE Confidence: 0.970988 01:05:34.100 --> 01:05:35.080 and risk assessment, NOTE Confidence: 0.9790039 01:05:35.934 --> 01:05:37.714 family history, and genetic testing NOTE Confidence: 0.99332684 01:05:38.015 --> 01:05:39.075 into this conversation NOTE Confidence: 0.97441405 01:05:39.454 --> 01:05:40.895 about who should be screened NOTE Confidence: 0.97441405 01:05:40.895 --> 01:05:42.414 for early onset cancers and NOTE Confidence: 0.97441405 01:05:42.414 --> 01:05:43.615 how do you know that, NOTE Confidence: 0.9995117 01:05:44.414 --> 01:05:45.795 that a particular individual NOTE Confidence: 0.98254395 01:05:46.255 --> 01:05:47.694 really should consider that. And NOTE Confidence: 0.98254395 01:05:47.694 --> 01:05:48.194 so, NOTE Confidence: 0.9864909 01:05:48.890 --> 01:05:50.250 we have the information here NOTE Confidence: 0.9864909 01:05:50.250 --> 01:05:51.850 for the cancer genetics and NOTE Confidence: 0.9864909 01:05:51.850 --> 01:05:53.610 prevention program as well, with NOTE Confidence: 0.9864909 01:05:53.610 --> 01:05:54.670 the QR code, NOTE Confidence: 1 01:05:55.290 --> 01:05:56.270 and the website NOTE Confidence: 0.9331258 01:05:56.570 --> 01:05:57.370 as well as a phone NOTE Confidence: 0.9331258 01:05:57.370 --> 01:05:58.970 number. So anyone that had NOTE Confidence: 0.9331258 01:05:58.970 --> 01:06:00.190 questions about, NOTE Confidence: 0.99031067 01:06:00.995 --> 01:06:02.915 their own personal medical history, NOTE Confidence: 0.99031067 01:06:02.915 --> 01:06:04.115 their family history as you've NOTE Confidence: 0.99031067 01:06:04.115 --> 01:06:05.715 been hearing this information today, NOTE Confidence: 0.99031067 01:06:05.715 --> 01:06:06.675 please do go ahead and NOTE Confidence: 0.99031067 01:06:06.675 --> 01:06:07.555 reach out to us. We'd NOTE Confidence: 0.99031067 01:06:07.555 --> 01:06:08.435 love to hear from you NOTE Confidence: 0.99031067 01:06:08.435 --> 01:06:09.095 as well. NOTE Confidence: 0.93167317 01:06:10.435 --> 01:06:12.135 So this concludes our SmiloShares NOTE Confidence: 0.9421387 01:06:12.435 --> 01:06:14.615 event for this evening, and, NOTE Confidence: 0.86775714 01:06:15.039 --> 01:06:16.160 this, in this, NOTE Confidence: 0.99902344 01:06:16.640 --> 01:06:18.260 recording will actually be available NOTE Confidence: 0.9836426 01:06:18.640 --> 01:06:20.660 online as well. And so NOTE Confidence: 0.9836426 01:06:20.880 --> 01:06:21.619 you can, NOTE Confidence: 0.9775146 01:06:22.319 --> 01:06:24.000 show this to your your NOTE Confidence: 0.9775146 01:06:24.000 --> 01:06:26.019 friends, your families, your networks. NOTE Confidence: 0.999442 01:06:26.720 --> 01:06:28.019 As much as we can NOTE Confidence: 0.999442 01:06:28.155 --> 01:06:29.435 put this information in the NOTE Confidence: 0.999442 01:06:29.435 --> 01:06:30.655 hands of our communities, NOTE Confidence: 0.9927734 01:06:31.355 --> 01:06:32.235 it is really to their NOTE Confidence: 0.9927734 01:06:32.235 --> 01:06:33.915 benefit. And I think some, NOTE Confidence: 0.9550781 01:06:34.475 --> 01:06:36.155 parting words, I would say, NOTE Confidence: 0.9550781 01:06:36.155 --> 01:06:37.135 know your body, NOTE Confidence: 0.98732686 01:06:37.515 --> 01:06:39.275 know your risk, and know NOTE Confidence: 0.98732686 01:06:39.275 --> 01:06:40.575 if you should get screened NOTE Confidence: 0.98732686 01:06:40.635 --> 01:06:41.135 because NOTE Confidence: 0.9689399 01:06:41.550 --> 01:06:43.070 knowledge really is power, and NOTE Confidence: 0.9689399 01:06:43.070 --> 01:06:44.370 we really wanna empower, NOTE Confidence: 0.99076706 01:06:45.470 --> 01:06:47.150 all of us to to NOTE Confidence: 0.99076706 01:06:47.150 --> 01:06:48.510 really think about our health NOTE Confidence: 0.99076706 01:06:48.510 --> 01:06:49.010 and, NOTE Confidence: 0.95302737 01:06:49.710 --> 01:06:50.670 feel that you can that NOTE Confidence: 0.95302737 01:06:50.670 --> 01:06:51.950 you are supported and that NOTE Confidence: 0.95302737 01:06:51.950 --> 01:06:53.650 we advocate for you. So NOTE Confidence: 0.95302737 01:06:53.710 --> 01:06:55.330 thank you again, and everyone NOTE Confidence: 0.95302737 01:06:55.390 --> 01:06:56.770 have a very good evening. NOTE Confidence: 0.9951172 01:06:57.193 --> 01:06:57.693 Thank NOTE Confidence: 0.9802246 01:06:58.026 --> 01:06:58.526 you.