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“It’s so hard to not want to have every single step planned”

Dr. Anne Peled is a breast cancer & plastic surgeon in the Bay Area and is also a breast cancer survivor. She joins us during Breast Cancer Awareness Month to discuss moving from awareness to action from both the doctor and patient perspectives. She is simply remarkable, I am truly touched by our conversation.

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Sponsor: Elevate your expertise with Creighton University’s Healthcare Executive Educational programming. Learn more about Creighton’s Executive MBA and Executive Fellowship programs at www.creighton.edu/CHEE.

Key Learnings

1. Emotions triggered by the words “breast cancer awareness month

2. Converting awareness to action around the calendar

3. Acknowledging racial and ethnic disparaties in care and screening as critical items requiring action

4. Action items from the patient perspective

5. How the spouse of a person with breast cancer can think about ways to be supportive

6. Wishing that back pain could just be back pain

7. Reinventing “one step at a time” & the importance of context

8. The value of getting out of your head

9. Acknowledging the experience of men with breast cancer

Links

Twitter @annepeledmd  Instagram @drannepeled

Dr. Peled’s website

Breast cancer resources from The American Cancer Society

About Breast Cancer from The Komen Foundation

Facing Our Risk

The Breasties

Transcript for this episode

Mark Shapiro (00:01):

Welcome back to Explore The Space podcast. I’m your host Mark Shapiro. Before we get to today’s episode, a word of thanks to our sponsor, Laurie Baedke and Creighton University. Creighton university believes in equipping physicians for success in the exam room, the operating room, and in the boardroom. If you want to increase your business acumen, deepen your leadership knowledge and earn your seat at the table. Creighton’s health care executive education is for you. Specifically tailored to busy physicians, our hybrid programs blend the richness of on-campus residencies with the flexibility of online learning. Earn a Creighton university executive MBA degree in 18 months, or complete the non-degree executive fellowship in six months, visit www.creighton.edu/CHEE to learn more. My guest in this episode of Explore The Space Podcast is Dr. Anne Peled. Dr. Peled is a breast cancer and plastic surgeon in the Bay Area, and she is also a breast cancer survivor.

Mark Shapiro (00:57):

This being Breast Cancer Awareness Month, she joins us to discuss a really interesting perspective of how we move this idea of awareness of breast cancer, to action, to actionable things, to tangible steps we can take to make progress around reducing morbidity, mortality, and disparities in breast cancer, diagnosis and treatment. And she brings some really brilliant insights from the perspective of both a surgeon who treats people with breast cancer and a patient who has survived breast cancer. It’s a really wonderful way to approach a difficult and charged and sad and sometimes inspiring topic. And it’s obviously one that has been a focal point of my life and certainly on Explore The Space Podcast we’ve shared on this show in the past, the episode that I did with my wife, Jessica, who is the voice of Explore The Space, she was also a breast cancer survivor.

Mark Shapiro (01:51):

And so we really try to make a point of focusing on this topic each October. And I’m delighted that Dr. Peled was able to join me to help us in that process. Before we get to our conversation, just want to invite everyone to please check out Explore The Space’s full archive is at www.exploretheshow.com. You can email me at mark@explorethespaceshow. You can find me on Twitter @ETSshow, definitely subscribed to Explore The Space wherever you download your shows, Apple podcast, Stitcher Spotify definitely leave us a rating and review as well. That really helps us out. We are adding a full transcript of each episode to the show notes. So you can look in the show notes and find a full transcript. And if there are episodes in the archive that you would like a transcript for, please email [email protected] as well.

Mark Shapiro (02:41):

Finally, just a reminder to everyone to check your registration status, to vote, get registered, make your voting plan. If you’re able to vote early, make sure you do so. There is a tremendous amount going on in the world that goes without saying, and it is also important too, that we pay attention to things that are happening on that recurrent basis, breast cancer awareness month being one of them. I’m delighted that Dr. Peled could come and join us to share some insight and some opportunities for learning and growth around a subject that affects so many people in the United States and around the world. So without further ado, Dr. Anne Peled.

Anne, welcome to Explore The Space. Thank you so much for coming on. Thank you so much for having me. I’m really glad that you’re here. This is a heavy month. October is always kind of a heavy time. This October has been really heavy October of 2020, but for, for many people all around the country, it’s a little bit heavier in general because it’s breast cancer awareness month, and that’s really why you’re here. And I want to start, I always like to start strategically. I like to start really high level. When you hear the term, when you see it on TV, when you get an invitation to come on a podcast and talk about those four words, breast cancer awareness month, I want to start with the emotions that it triggers for you.

Anne Peled (03:57):

Yeah, it’s incredible. It’s been almost three years since I was diagnosed with breast cancer, but it was actually an October of 2017 where I first felt the lump that I was sure it was going to be a cyst because I was a 37 year old vegetarian triathlete with no family history. Like we hear so often, and I feel like this concept of breast cancer awareness. It just to think about everything that it entails from following up on lumps that you feel to getting your mammograms, to raising awareness around metastatic breast cancer, which is a big topic, especially with today being metastatic breast cancer awareness day. I feel in many ways, transported back very quickly. And it does amaze me. It’s been this way every year since my diagnosis. And so many different emotions come up, but I also love the feeling of action that I get as well. And I’ve been really excited to see this breast cancer awareness month at so many groups are really focusing on actions and not just awareness. And for me, that feels like as you could imagine, a much better place to be, and it makes me feel like I can really channel what I’m feeling to help others really do more than just awareness, but actually have action behind it as well.

Mark Shapiro (05:16):

That’s a good place to start with this idea of, of it being something that’s actionable because awareness months can become, or at least run that risk of becoming lip service or a platitude, or just sort of going through the motions, but the people for whom breast cancer as part of their reality, it’s not, does that sense of actionability. Does that help bridge that divide so that in February and in July and in December, it’s still awareness month in October, but it’s action around the calendar.

Anne Peled (05:52):

Yeah, I completely agree. I think that idea that how do we take, you know, something that has become in so many ways like commercialized and all of this, it’s more than pink. The ideas behind that are good ones. You know, we want to be getting more funds for breast cancer research. We want women to go get their mammograms. So the awareness part of it is important. But as you said, it’s for the women who are, and men who are actually diagnosed with breast cancer, what does that look like when they find out they’re diagnosed in a different month of the year end? Can they remember what they were told about? You know, for me, I focus a lot on how people can get better treatment options and know their options. And are they going to remember that genetic screening and counseling is a really important part of breast cancer treatment? And so I think you’re right, that it allows it to move past this month, but it also gives people the tools when they’re diagnosed or thinking about prevention and screening the rest of the year, they have these action items, this education to take better care of themselves and to get better options when that comes up

Mark Shapiro (06:53):

Is that level of action in your clinical practice, not from your experience as a patient, but in your clinical practice. Do you feel like the penetration at a population level is improving over time? Is it static or is it getting worse?

Anne Peled (07:10):

That’s such a fascinating question. No, I know, but I love the question to be honest cause there’s so many factors that go into whether or not people can take action on preventing and treating breast cancer. And I think we’re at this amazing place and amazing in a bad and good way where we’re really focusing on what are those barriers for people. And we know that COVID has been a major barrier for people going and getting the healthcare screening they need. And unfortunately, I think we’re going to see the impact of that for years to come. The other thing that there’s a ton of wonderful focus on right now is the racial and ethnic disparities in care and screening. And we know for instance that black women are much more likely to present with more advanced stages of disease, less likely to get the treatment they need and less likely to get the full spectrum just as one example. So I think in my mind that, yes, we’re getting better penetration than some places, but I think we’re really missing getting better care than others. And so again, super excited to see action around these kinds of issues so that we’re not just doing better for some, but we’re doing better for all, as we move forward.

Mark Shapiro (08:21):

That concept of doing better for all has come up more and more certainly on this podcast as well. So if you were to look in your toolbox and see things that are not there, that you would like to be there to bridge that divide, what would be kind of number one, two and three on the, on, on, on your wishlist?

Anne Peled (08:42):

I think one of the things that we see in medicine and in other industries is it’s difficult. If you’re a person thinking about whether it’s getting care, whether it’s advancing in your field, whether it’s taking the next steps to move, it’s really hard to do those things. If you don’t have people who look like you and feel like you, they understand your experiences. And so for me, when I think about it, I wish that we had more funding, more resources to get people into communities where they don’t feel like they’re being, well-represented where they’re not seeing people who look like them in advertisements, if you will, or social media or other educational pieces around getting screening, for instance, for mammograms. And I think if we did a better job, both representing different types of people, engaging in screening behavior, but then also really getting people out into communities to encourage that.

Anne Peled (09:31):

I think that would be a huge step. It takes a lot of funding. It takes resources, it takes commitment. When I was in DC, I worked with my dad, who’s a medical oncologist at Georgetown and we helped work on a program for Latina women on breast and cervical cancer screening. And honestly it was much better to have people from that community going and encouraging them then to have me and my dad in there. And so I think we see what that looks like. So for me, that would be a first huge step in terms of moving forward for getting better access to care. I think the next thing that we see has to do, and again, we see this across the spectrum in medicine, but it’s thinking about better representation in clinical trials. And there’s so much wonderfully, there’s so much research on breast cancer and on breast cancer treatments, but we do a very poor job with making sure that people are well-represented and that we have diversity in our clinical trials. So I think those would be two big areas that we could focus on both for screening and prevention and then as well as treatment for breast cancer

Mark Shapiro (10:30):

Context is always critically important in these interviews. And so as we’re sitting here, it’s 21 days before election day in 2020. And what you’ve just articulated is a very clear vision for a better future. Would you ever take that into the political space? Would you ever run for office?

Anne Peled (10:46):

I would say seeing that the, what it would look like to be an office right now, that is a very hard no, but I do that so we can use, and I know your platform is important to you. I mean, I think honestly, as, as physicians, as healthcare providers, I think we’re often, we often feel like we can’t be political. I don’t know if you’ve, you have felt this previously. I know you don’t feel this now, but I’ve often felt over the years, like we’re not supposed to take a stand on political issues and we focus on our healthcare and what we can do. And I think the world we’re in now, we can’t do that anymore. As healthcare providers, we have to use our voices and encouraged people getting out and voting and explain to people what that really means, and that the link between voting and picking people elected in office and what your healthcare and what others health care is going to look like is very real. So I love seeing, again, I know that’s a big priority for you and everything you’ve done. And I think healthcare providers are really changing the way they think about being active in that way.

Mark Shapiro (11:44):

You’re right. It is a big part of what I do now. And you’re also right that for the bulk of my career preceding, it was not. And those were because of implicit and explicit messages that were conveyed during my training, that it was not the physician’s place to participate. And that disconnect is something that I do not recognize as being valid anymore and had been pretty outspoken about that on the show and on social media and in my personal life as well. So I’m glad that you also see it because we all have to walk that road and we don’t have to agree on what the policy should look like necessarily, but we have to agree that we’re participating and that we’re going to join the conversations and support others in doing that as well. And then once we’re doing that, then we can argue like crazy about what’s the right way to go forward.

Anne Peled (12:23):

Exactly, exactly. But no, as you said, I mean, I think it really is. It’s, it’s realizing that. And I think unfortunately with COVID we know more than ever how much politics impacts healthcare and what we as healthcare providers can do and have a voice. And so I’m, I’m so glad again, to see that that’s really becoming a part of all of our, our narrative as healthcare providers.

Mark Shapiro (12:47):

I agree with you. So then I do want to pivot, you’ve laid out that really clear vision of how we could make things better from the perspective of a breast cancer surgeon or breast cancer researcher or a breast cancer advocate. Now we pivot to that other place. You’re a breast cancer survivor and the road may or may not look different. And that’s what I’m really curious. I love, I love juxtaposition. And so having you kind of walking both of those roads literally and figuratively at the same time is really powerful. If you just kind of close your eyes, took a deep breath, and then I asked you that exists, those exact same questions. Would your vision for a different looking future around morbidity and mortality reduction in breast cancer in the United States, would it be any different?

Anne Peled (13:29):

I think for me, having gone through breast cancer, myself and being in a family of, I mentioned my father’s a medical oncologist who treats breast cancer. My sister and my mother are both breast cancer, radiation oncologist. And I think for me having gone through it personally in that context of my family and the real concerns they had, understandably at each step of the way of what the, the data we would find out, you know, everything from what was my, my longterm risk to what treatment I was going to pick and what the impact that would have on my personal wellbeing. Not to mention the fact that I’m a mom of young kids and I’m married to a surgeon who knows enough about breast cancer to worry as well. I think for me, that the way that I pivoted in some ways is really understanding the longterm impact of the treatments that we do and the impact on quality of life.

Anne Peled (14:28):

That many of the treatments that we do in breast cancer can have on people and their sense of self and their ability to move past their breast cancer. So on the one hand, there’s that part of it, where I, I love to focus on getting better education, getting better information about outcomes and quality of life. But on the other hand, when it comes down to it, I’m still a person that had cancer. And once you have had cancer, you sort of always have, cause it could come back at any time. And so thinking about the reality of metastatic breast cancer and what those numbers look like, that never goes away. So for me, again, I, I think better care for all and not just better care for some, but we all know that we can do better for stage four breast cancer, both from a funding standpoint, from a research standpoint, from an awareness, but awareness to action standpoint. So I think I would answer your question saying yes, some of it is the same, but a lot of it is just much more real and much more personal having been through it myself.

Mark Shapiro (15:24):

Can I add one as the spouse of a breast cancer survivor? And if you’d rather that I don’t like, I, I still don’t fully understand the role of the breast cancer survivor spouse as advocate. If it’s better to not have that voice or to be super loud or somewhere in the middle, I am still trying to figure that out and it’s been years. And so I’ll sort of ask you that question before I put my thought about what maybe could also be better into the mix.

Anne Peled (15:52):

No, I’m so glad that you brought that up. Cause I actually wanted to ask you about that as part of this, because I do think that that is, like you said, it’s a uniquely challenging place to be in and I don’t want to speak for you, but having seen my husband go through it, I think it’s a uniquely challenging place to be in as a spouse in medicine where again, you know, enough, but you don’t know quite everything. And I would say, I think sort of seeing his going through it. I think my husband did a remarkably good job letting me come to my decisions myself about what was going to be the right treatment plan for me. And I realized as a dual breast surgeon and breast reconstruction surgeon, I am in a lucky position if you will, to figure that out. But I have to say I’ve been so incredibly grateful for every step of the way.

Anne Peled (16:39):

You know, he’s there, he supports my, what I need in my choices, but he just really listens. And I I’ve seen how he talks to his patients. And I know that he’s so much more active and involved with them, but with me, he’s just, he’s been there and he supports, and I think for me, that was the right, that was the right path. But again, everyone’s different. So I’m really, really curious and excited to hear sort of about your experience and how things went through and what your thoughts are about that. Cause I think everyone’s different in terms of what that, that support can be like.

Mark Shapiro (17:06):

Yeah. It’s so thank you for that space. You know, your, your husband can call me anytime and he, and I can debrief together too. You know, I, I, the thing that I would say is an opportunity for improvement. You mentioned at the beginning of this interview, that idea of being transported back and you know, being transported back to that moment in time where you were informed. And, you know, thankfully I was with my wife when she was informed that her mammogram looked at normal and we, we kinda knew we were embarking on a journey together and I’m comfortable sharing that now because she shared it very transparently on the podcast before the, the, the, the construct that’s set up for a woman who’s being diagnosed with breast cancer or a man who’s been diagnosed with breast cancer and their partner, if they’re available at the time, or whoever’s there as support the construct around how that’s communicated should just never be underestimated because those people will be transported back to that moment over and over and over.

Mark Shapiro (18:03):

And it never, I’m like, I’m about to cry. It never gets easier. It’s, it’s, it’s so uncomfortable. You relive it. I don’t relive it in such a way of like, what would I have done differently as you know, obviously I wish you’d never been in that place, but it’s just, you relive that space and you’re feeling your heart rate shoot up and knowing that life is different and the word choices from the physicians and providers in those moments, they are a hammer and the hammer can fall heavily, or it can fall with a little bit more of a gentle touch. And that art is a place where I think we can get better.

Anne Peled (18:37):

Yeah, no, I, I think you’re so spot on on that. And I got, I really felt like before my diagnosis, I was thinking about, and I was thinking through it, but you’re right. The words matter so much. And then the timing of things, like, I think about the waiting over the weekend, right? Especially the waiting over a long weekend for test results. And sometimes it gets 8:00 PM on a Friday, and I see pathology results that came back that I hadn’t seen. And yes, they would have loved to have been doing that before, but I didn’t really know what it’s like to wait until you’re there. And you realize all that, all the data that you’re waiting for is agony. And so I will say, I think you’re right. I think that we could, we could do better in that space. I also think a lot about the level of information that comes out in those first visits is just, there’s so much of it.

Anne Peled (19:28):

And I struggle with how can we do better so that it’s more digestible, so people can make choices. So more of it can stick. And I love, and I’m so happy for your wife that you were able to be there because a lot of people, when they get that initial information, they don’t have someone there with them. You know, they’re not expecting it, that even the diagnosis, they may not be expecting it. And it is so much to process next step survival, longterm short term and having a person there and making it more digestible, I think would be hugely helpful.

Mark Shapiro (20:01):

It’s hard. It’s just, you know, you just want as a practicing physician, right? I always want my communication skills to be as optimal as possible. And I am sure there is a long gray line of people who would say, you know, dr. Shapiro in that moment, you could have also chosen words differently and chosen your affect differently. And we just, we carry that. And I, and I don’t bring that topic up to say, like, we’re not doing a good job of it. You’re not going to also hit a hundred percent and you’re not going to nail it. It’s a brutal thing to hear. And so when, I guess when I’m calling it out, it’s, I’m not calling out our physicians and providers on it. I think it’s just, it’s, it’s just that opportunity to just get more sophisticated in and more gentle and hopefully have a construct of care delivery where you have more time and you can choose the environments. And like you say, Friday at eight 30, that it’s still the right space and time to make those phone calls. It’s just, it’s that opportunity, right? It’s not, it’s not a criticism, it’s just acknowledging an opportunity. So that when you, as someone who has a clear vision of what good policy could look like, whether or not you choose to run on that someday, and I’m going to maybe push you again a little bit down the road,

Anne Peled (21:14):

It will be addressed later, maybe.

Mark Shapiro (21:17):

Right, right, right. I guess that, it’s just that it’s, it’s seeing it as that opportunity. And so when we’re sitting in a, a month of awareness, it’s being awareness of opportunities for improvement.

Anne Peled (21:27):

Yeah. I love that. And you think it’s also though that it’s the trying like we do as physicians to try to see where people are coming from and where they are, and to read that right. You know, which is really hard. And I remember for me, I kept it together so well, like traveled for my surgery because I needed to have the exact people and it was fine. And I was teaching the next week and everything went so smoothly. And then I drove in for my first day of radiation and I had to park in the patient parking space and it just did me in, I literally like, I, my radiation oncologist blocked in and I just lost it. And it was truly that act of parking in the patient parking space. That’s all, that’s what it was. And that is what it came down to. And so I think as you were saying with breast cancer awareness month, it’s that idea as we engage with our community about all of this understanding how triggering, like we started this conversation and how triggering things can be and seeing where people are before we start, you know, unleashing the, the montage of pink things and breast cancer awareness. And how can we, how can we find out where people are starting to try to minimize, triggering and try to make it a safer space for people?

Mark Shapiro (22:34):

That’s a really smart perspective, because like you said earlier, right. It’s, you know, it’s the pink, and it’s the, you know, football games with the pink gloves and stuff. And it can start to feel performative as opposed to feeling like here are some actual, tangible learning opportunities if you are ever in this place, or if, you know, someone who’s in this place. I mean, I remember for me, it was a couple of days later and I was back to work and I bumped into one of my colleagues whose spouse had been diagnosed with a different type of cancer. And I just said to him, like, what the fuck do I do, man? And he said, and he gave me some really, really good advice. And so it’s like, you know, one day, you know, you, your husband and I would write the book, like, what the fuck do I do now?

Anne Peled (23:11):

Yeah. That’s really helpful.

Mark Shapiro (23:16):

We’re all thinking that. And we’re all kind of wondering, and it’s like, why do we have to keep reinventing the wheel?

Anne Peled (23:21):

Exactly. Or I think about the fact that like, I wish that I could get back pain and it could just be back pain. It’s just not anymore. Right. Like as of December, 2017, like back pain, doesn’t just get to be back pain anymore. And I feel like in those moments, the same thing, like as, as the spouse of this person who has back pain and their mind is going in a million different directions, what do you say in those moments and how do we support someone through that? And honestly, I think that would be so incredibly helpful. There’s never going to be right. It’s just hard, like you said, a few minutes ago, but there, I think there are ways of things to say in that moment that kind of, you know, would bring me back from that edge of that cliff. And you know, what it probably is just back pain. Cause I worked out for like crazy yesterday, but, but I think you need someone right. To kind of kind of reel that back in.

Mark Shapiro (24:11):

These are gratifying conversations. And I think it’s good that we have physicians that are sort of, of the same generation give or take trained in the same way and still have a long career who are going to navigate not just their careers, but life in such a fashion that we can call these sorts of things out and write books with provocative titles like what the fuck do I do now?

Anne Peled (24:30):

You guys are gonna so successful. Think about the politics of you and my husband’s even thinking about the book.

Mark Shapiro (24:38):

There you go. I am glad that you called out the exercise and cause there’s a topic that’s come up on the show, a great deal more actually in the past, but we’ve done a lot of content on Explore The Space around ultra running, endurance sports, and the lessons that can be learned and the toughness that can be gleaned and the, the way that anyone can look at a challenge and take lessons from that, whether they have the physical ability to, or desire to do a run or a walk or anything, there’s still lessons around using the muscle of brain to move through a challenge. And so for you, as someone who has had to navigate tough physical challenges before, were there things in the toolbox that you were glad that you had that can be generalized to other people? Not because they’re going to go run triathlons as part of their treatment for cancer, but that anyone that is going to move into that really, really difficult space of a cancer diagnosis or particularly breast cancer for what we’re talking about now that they can say like these are things that will help your mental toughness in terms of navigating all those challenges.

Anne Peled (25:48):

I love that question so much because there’s no doubt in my mind that having gone into cancer treatment, being an athlete helped across the board. And we have really good data that show that actually exercise decreases the chance of recurrence. So yes, not everyone is going to be calm, let triathlete, but even just the act of getting out and walking regularly that will bring down your recurrence risk. So I think for me, the things that I found that I was able to do one of the first ones is, is when you’re training for races or if you’re in a half marathon or marathon or triathlon, you know, that you can’t be thinking about mile 26 when you’re on mile one and you’re just going to destroy yourself that way. And so, you know, thinking about what is your next accomplishment, what is the next landmark or milestone you’re going to hit?

Anne Peled (26:32):

And you only have to get to there right now. And then you’re at the top of that Hill. And then you have the next tail, but you made the top of that Hill. And so one of the things I tell my patients is trying to things a step at a time, and it is so hard, especially people who like being in control of things like so many of us do, especially as physicians, it’s so hard to not want to have every single step planned, but I think that so clearly people do better when they’re actually able to just see that they’ve gotten through the first step and that’s what they focus on. So for me, I think that was a huge part of, as you said, kind of the mental toughness and preparedness is really taking it a step at a time, celebrating the victory of that step healing from that, and then being in a good place to move on to the next.

Mark Shapiro (27:15):

But, but again, context is critically important with that one because one step at a time can also be one of the things that I really don’t like, which is a platitude. Once one step at a time can sound really dismissive. And I know that when you say it, you don’t mean it that way, and I’m sure that you’re able to frame it in such a way that your patients and their families are like, yes, I get the message. But if, if we take on as the right approach to tell people, Hey, one step at a time that that really has that risk of someone saying, you’re not hearing me. You’re just telling me what you’ve heard over many, many years and in movies and stuff, one step at a time like that, that, that can feel like a platitude.

Anne Peled (27:50):

I think you were so spot on on that. And it’s completely right, as you said, it’s about the context. And I think it’s about describing the picture, feeling like have options laid out for someone and they feel like you are a part of their team and you’re on this journey together. And then once you have that rapport built, then you’re right. Then you get to the, then you get to celebrate those victories with people. So I think you’re spot on about that from a context standpoint. So I think that’s one of the big ones. I think the other one is the appreciation for space that is just yours, where you get out of your head. And I think it’s incredibly challenging. And now more so than ever to really have space where your mind isn’t going in a million different directions. And as a, as a cancer patient inactive treatment, you have only bad places to go.

Anne Peled (28:39):

Quite honestly, in your mind, you know, you’re not thinking about good things most of the time when you get into, when you get in that head space. So for me, I found that the ability to, to have that space when I was exercising I wore my running clothes to radiation every day. And I loved that. I was going to get done with my radiation. I was going to have time. That was just mine. I didn’t have patients to take care of. I wasn’t going to take care of my kids. I was just going to have that space to clear my head and it was hugely helpful. And not every exercise isn’t going to be that space for everyone. You know, there are so many other places people may find that, but that appreciation for that space, the knowledge that that space exists somewhere and that you can find it was incredibly helpful for me also.

Mark Shapiro (29:17):

Those are really good and useful tools. And in retrospect, they’re things that I think in part of chapter three and four of what the fuck do I do now, those will be really good ones to like help create that space, helped create that mentality. You know, just say you’re, you’re off duty for whatever. Just critically, critically important.

Anne Peled (29:38):

I love that because you’re right. I think and I think it’s, I do want to say, cause I think it’s so key that I think men with breast cancer that get lost a lot in this process. And I do try as much as I can to make sure that we’re being inclusive.

Mark Shapiro (29:51):

The first patient with breast cancer I ever took care of was a man. When I was a medical student at the Houston VA, they had a, a breast cancer clinic and it was the vast majority were men from all over the Southern United States because they would come to the Houston VA for treatment.

Anne Peled (30:04):

I mean, it’s amazing that you had that experience because I have to say in a, both having male breast cancer patients of mine and also seeing what the community is like, it’s a whole different set of challenges, right? Speaking of being in a space where you don’t feel like you’re necessarily being heard, you’re not getting full options. So I, I actually on my list of things that, you know, thinking about getting better access to care, it’s not just racial and ethnic disparities. Right. I think it’s also thinking about gender disparities as well. So I think that thinking about that as incredibly important, but I think getting back to your point given that the vast majority of people who get diagnosed with breast cancer are women and especially women who are used to, you know, taking care of families or their roles at work.

Anne Peled (30:43):

I think it’s very hard to actively make space where you don’t feel like you have to take care of others, even in the midst of active treatment. You know, I see so many of my patients who are going through very hard treatment and are still really focused on everyone else around them. And so I think your idea of as a, as a supporting person, as a partner of someone going through breast cancer, giving someone that space is it is a real gift that is very hard to make yourself. So I love that for chapters three and four. That’s great.

Mark Shapiro (31:13):

Yeah, exactly. So you’ve obviously given us a tremendous amount of insight and expertise and it’s all appreciated and I’m sure you’re asked this a lot, but acknowledging that it is breast cancer awareness month and unbalanced, this is a good thing that we’re doing when people do ask me, like, where should I go to learn more when, when the voltage drop hits into November and December and the next July and so on. And so where do I go? What, how do I learn more? Where do you like to refer people? What resources are your go tos for people who want to learn more about these various topics surrounding breast cancer?

Anne Peled (31:44):

So you get in my mind two separate things when you’re really doing research and some overlap, but you get a lot of actual statistics and data and care being laid out. And I like to send people to that as a first start before getting into the second, which is a community because there is so much misinformation about breast cancer, I’m out in the world and it’s especially true because so many people have breast cancer. So trying to figure out if your story is going to be the same as someone else’s and the different kinds is pretty overwhelming for most people. So personally, I really like to send people to the American cancer society. I think Komen also has really great resources and data, and I think that’s a great place to start just to get a real sense of what is breast cancer, what do I have, what are stages and what might treatment look like?

Anne Peled (32:32):

And I think that’s incredibly important for people who are diagnosed and may not have the support and framework of a nurse navigator or a program behind them. Which is unfortunately true for many people. So a lot of people are so lost right off the bat. And so the basics of breast cancer treatment is incredibly important. I do think though that once you have that, and especially as you start thinking about a treatment plan, I think it’s incredibly important to find a community. Not because everyone is going to be a person who wants to share their story and that is completely fine. And there’s no reason that everyone needs to be thinking about doing that, but it’s more so that you can hear people who have been through treatment similar to yours. You can get information on the types of care you might be getting.

Anne Peled (33:14):

Do you need second opinions, clinical research trials. So for me, a couple of places, I think that are great for that. One of them is Force, which specifically is focused on hereditary cancers. They’ve recently expanded beyond breast and ovarian cancer. But it’s a great resource. They have mentorship programs, they do a great job diving into research. So that’s a great post to start. One of my favorite communities from a breast cancer standpoint is a group called The Breasties. It’s focused on younger women. But really sort of includes all ages. And I have to say the events they host, which will currently virtually, but we’ll go back to being real. And the way that the women in that it is for women, but the way that women support each other and give advice, I have to say, my patients often know more than I ever could have imagined about options and what their recovery might look like and really become very close and have these women supporting them and sending them garments and sending them information on how to go through it. So those are kind of my, my go tos. But I do think we are doing so well with social media now in terms of allowing people to find their communities and get through. I actually think there’s no doubt in my mind that people who are better informed going into treatment recover better on the other side. And I think that seeing the communities on social media now is a huge component of that.

Mark Shapiro (34:33):

And we’ll put links to all of those in our show notes. And then for people who want to find you on social media or your website, where did, where do they find you?

Anne Peled (34:40):

Oh, thanks so much Mark. So on Twitter, it’s @AnnePeledMD and then it’s @DrAnnePeled on Instagram. And then my website is www.annepeledmd.com

Mark Shapiro (34:50):

This was an absolute treat. Thank you so much. It’s, it’s a, it’s an important month. It’s a very fraught and emotional month. I can imagine only what it feels like for you and for your whole family, but thank you so much for coming out and being this transparent and honest and, and really helping to continue to drive us towards a place of progress. So this was very special. Thank you.

Anne Peled (35:10):

Well, thank you, Mark. I have to say, I really appreciate everything you just said. And for me, you know, when I found out I was diagnosed, these kinds of conversations where I feel like we’re, you know, moving things forward, getting better for all and action, make me incredibly happy and make it feel like it was all worth it. So thank you so much. This is a treat for me as well.

Mark Shapiro (35:29):

My thanks once again to Dr. Peled for joining us on this episode of Explore The Space Podcast, definitely check out all of the great resources that she mentioned that are linked in the show notes. Please take advantage of those and share those with anyone who you think may benefit as well. Thank you also to Laurie Baedke and Creighton University for sponsoring this episode, learn more about Creighton’s executive MBA and executive fellowship programs at www.creighton.edu/CHEE. And to all of you, who’ve taken time to listen to this episode and to share it, I really appreciate it, especially on this topic. Thank you so much for your time and your interest and your support. It is inspiring and so appreciated. So as we continue to move forward, remember to wear your masks, maintain physical distancing, wash your hands, get your flu shot. Take good care of yourselves. We will see you soon. Thanks so much. Bye bye.

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