Anu Gaba, MD - Sanford Health News

The wellness benefits of running

Host (Simon Floss): Hello, and thanks for listening to this special podcast, brought to you by the experts at Sanford Health. I am your host Simon Floss with Sanford Health News, and today we are talking all about exercise, but not just any exercise. Depending on who you ask, it’s either the best, or the worst, form of exercise. Of course, we’re talking about running.

We have a ton of topics to cover from the overall health benefits of running, getting started in your running and health wellness journey, to even training for some races and the involvement Sanford Health has.

So, as I mentioned, we’ve got a lot of topics to get to, but first we have got to meet our experts. Joining me today is Dr. Anu Gaba and Jenny Dalland. Thank you both for joining me today.

Let’s first get to know each of you a little bit. Tell me about your running history and also what both of you do at Sanford. Dr. Gaba, we’ll start with you.

Dr. Anu Gaba: Yeah, so I’m Anu Gaba. I’m a medical oncologist at the Roger Maris Cancer Center in Fargo. And other than that, I have enjoyed running. And I would say that the running journey started after I moved to Fargo. So, in 2004 we initially started with just running the 5k’s and then gradually 5k’s and 10k’s, and then the longer distances.

Host: As far as a longer distance you know, that’s different for everybody, but what qualifies as a longer distance for you?

Dr. Anu Gaba: Yes. So, they’ll half marathons and the full marathons. I first ran about four or five half marathons and when I would run them, I had promised myself that I would never do a full because of the fear of injuries, but I just decided to take the leap. And then in the 10th year of the Fargo marathon, which was in 2014 I ran my first full marathon. And then after that, I’ve run seven more. So, I’ve run about eight full marathons and a lot of half-marathons. So yes, I would consider the full marathon as a longer distance and a long distance.

Host: And you mentioned running all the races in Fargo, we’ve got some in Sioux Falls, and that’s a topic that we’re going to get to, but thanks again for being here. Now, let’s move and talk with Jenny.

Jenny Dalland: Hi. Like you said, my name’s Jenny, I’m an athletic trainer here at the Sanford Field House, and I work pretty much with all the runners that come in the door here. So Josie Stockland the physical therapist and I work with our, our runners doing 3D running analysis on both injured and healthy runners. Our goal is always to get runners back doing what they love and that’s to run.

For me personally, I was also a late start to running. I was a swimmer initially, and didn’t really get into the sport of running until after I had kids, I couldn’t to the gym anymore or taking the time to go to the pool was just not going to happen and running all you need is shoes. So, go out for a run and come home. So, for me being, having my swimming background, I’ve gotten more into triathlons. So, I specifically like the sprint tri’s, the little bit shorter distance and breaking it up with the running biking and swimming. And I’ll stick to the mid-distance races, which are your 5k, 10k’s. But definitely for me, my passion is always with the runners and the running community and getting the runners back, doing what they love.

Host: You mentioned triathlons, just curious, have you ever done the Okoboji triathlon?

Jenny Dalland: I have not, but I’ve heard a lot of good things.

Host: It is such a fun time. I grew up in Okoboji and so I’ve of course done that. The only thing is swimming in that open water with like hundreds of people next to you. Nice and terrifying, you know, and it’s like right away in the morning, you’re like, Ooh, okay, this is a lot. But speaking of a lot, again, we got a lot of things to get to. The first thing I want to talk about today is just the overall benefits of running. So, Dr. Gaba, we’ll start with you, but Jenny you’ll have a chance to answer all of these questions too. Why is running beneficial and how can running benefit your overall health?

Dr. Anu Gaba: Yeah, that’s so very good question. I think the running form of exercise is one of the easiest and one of the most beneficial. First of all, it helps me spend some time with my husband, my friends and my family. Even when we go on family trips to any city or a national park, we try to take time out to run together. And I think when you are discovering a city, you can get around so much faster. If you can run from one spot to another than if you try to walk, of course, if it’s a very long distance, we would take a car, but intermediate distances, it’s really fun to run around a new city and it’s a good way to explore. And then I think when our, we have two daughters who are now 20 and 25, but when they were younger, it was a great way to get them out of the house and to join us in running 5k’s, and 10k’s, and they enjoyed it too. It became a really a family event on Saturdays and Sundays when we would find out what are the 5k’s and 10k’s in the Fargo area around it.

And now when I’ve gotten older and my girls have gotten older and they have different interests and they are not in Fargo anymore. Me and my husband, we have a close group of friends with whom we run regularly. So, it is a lot of camaraderie with them. Running is a long-distance sport and we spend a lot of time doing it. We talk a lot about our families, our interests, our hobbies and even our day-to-day life. And, I find that so relaxing, I don’t have to worry about the upcoming day what’s going to happen. Or, what the other things that I have to do that day or on the weekend. So, those are all the   benefits from running.

Now, running is definitely important for physical and mental health. I think the biggest benefit of running is the cardiovascular benefit. It gets the heart pump pumping stronger every time you run. And as we know cardiac disease is the number one killer in America. So, if we can maintain our cardiovascular health by running, I think that’s a good benefit. It’s good for the bones. Especially once men grow older and women attain menopause, our bones tend to get weaker and running, being an exercise where you’re putting pressure on the bones. It makes the bone stronger. It’s good for our muscles. We are exercising various parts of our body. It’s good for maintaining a healthy weight. And if we can maintain a healthy weight that has so many benefits in many different types of diseases, including cancer there have been many studies and different types of cancer, which have shown that if we can maintain a healthy weight, it decreases the risk of the cancer coming back.

So, I really think that running adds, it not only adds life to our years, but it definitely adds years to life. I think the other benefit of running is that it helps us maintain our balance. We don’t realize it, but as we grow older our ability to balance gets affected in subtle ways. But, by keeping up with your running, you are maintaining your balance every time you run. And that definitely will help us in old age. There are mental benefits, people who run because they have exhausted themselves to some extent during the day, they are able to sleep better. And like I said, running gives you a time to be with yourself or with your friends, and you can reduce your anxiety. It can reduce depression. And, we all know that after a good duration of exercise you get the nice hormones secreted in your body, which helps you feel better. You feel that you’ve done something worthwhile. So yes, so running has a lot of mental and physical benefits and a lot of corollary benefits that I talked about earlier.

Host: And Jenny as you mentioned the only thing that you need to do any running is just a pair of shoes. Anybody can do these in anybody can experience these benefits.

Jenny Dalland: Yep, absolutely. I couldn’t agree with Dr. Gaba more, as far as I think she did a really good job covering both the physical and mental benefits of running. And again, it is something that everyone can do. It can be very daunting to a new person getting into exercise. Running is definitely something that people think where you’re going to go run, and they’re going to just run as hard and fast as you can. You see kids, they don’t understand jogging. And, I think a lot of people when they first get into the sport, don’t understand the difference between jogging and running. And, I think that’s where it gets really intimidating, but it is definitely beneficial to your overall physical and mental health.

Just to kind of tie into more of the mental health thing, there’s a lot of social running groups locally in the area and running clubs that just that comradery between fellow runners and having this group of people that have the likeness of running has really just helps with just your mental wellbeing and having those friendships as well.

Host: And, there is just nothing better than the feeling of right when you get done with a run, you have all that dopamine and all those endorphins flooding in. It’s a good time. Are there any risks associated with running?

Jenny Dalland: Yes. I mean, with any form of exercise, there’s always going to be a risk. You know, we see injured runners all the time, so are there risks to running? Absolutely. But I think the benefits outweigh those risks because the cardiovascular effects in itself, and we know how important exercise is, is why it’s still going to be a benefit to do some form of physical exercise.

I will say there’s always a misconception out there. I hear it all the time is that if, if you run, you’re going to wear out your knees or you’re going to have to have your knees replaced. And I think that’s something that’s a misconception because the people that fall into that category are your very high-level elite runners who are running very high volume, high intensity for years and years and years and years. The majority of the population is going to fall in that range of your moderate exercise, where that risk is very, very low.

Host: And Dr. Gaba now say that there is someone listening, who’s thought about running, but they really don’t have any idea where to get started. What would you say to them to get them started on the right path?

Dr. Anu Gaba: Great question. And I hope that people who are listening do get motivated. I agree with Jenny that anybody can start a running program. All you need is a pair of shoes and some time, even if it’s 15 to 20 minutes, I think that’s a good place to start. I would say starting slow is important. The most difficult step is to get your clothes and your running shoes on and get out of the house. I think that’s the most difficult step once you do that, that step itself will cause us such a big upswing in your mood, knowing that you’re going to do the right thing. And I would say, definitely start slow. You can just start jogging instead of running and even shoot for maybe half a mile. If you’ve never run before, if you have done some running, maybe shoot for one and a half miles, it’s important to be consistent.

So, once you’ve done that first step of getting out of the house, try to do it once again, maybe two days or three days later. And, I think if anybody can at least start off with doing it three times a week, one to one and a half miles a day, that is a great start. Continue to do that, and then after three or four months, you’ll probably tell yourself maybe I can do a 5k and then join up to do a 5k.

And, when one takes spot in any race, it’s so inspiring because you’ll see many, many, many people who are taller than you shorter than you, heavier than you lighter than you. People who are disabled, people who are professional athletes, everybody’s taking part in the race. Nobody is going to ridicule you for running slow or you know, not being a professional athlete, you’ll find so many people cheering you on in the run. Whether you’re at the back of the line or in the middle of the group.

Host: That is definitely something that I’ve experienced too, you know, you, you meet some of the kindest, most fun, welcoming people in run groups in whatever city that you’re in. So, to your point there, Dr. Gaba, it’s, it’s just a very welcoming, accepting, and, and fun community to be a part of.

So, switching now to someone who’s more familiar with running, or maybe they’re even training for race season, Jenny, what are some good bits for them to keep in mind?

Jenny Dalland: I would definitely say when I see these runners, especially if we get injured and they’re in the middle of a training period, it definitely can mess with them. How do you overcome? How do I keep my mileage up? How am I going to reach my race goal if I’m injured? And I think the most important thing is you need to be flexible with your training plan. I wouldn’t get focused so much on getting that long run in or getting the certain volume in to make sure that you can achieve your race goal. You need to be able to be flexible, be okay if we get sick, be okay if there’s a minor mire, mild setback, because it’s going to happen. And if you don’t have that flexibility, you’re setting yourself up for disaster.

Host: Not only in running but in life, I think it’s important for a lot of us to remember, when we do have those setbacks look at, look at these things with grace. You know, it might sound crazy, but grace actually helps you recover better in my opinion here.

So, this next topic, I, I definitely want to get both of your viewpoints on. Chronic over-training, that’s a real thing. I’ve personally experienced it myself. Dr. Gaba, we’ll first start with you, how can people avoid this, and how important are rest days after?

Dr. Anu Gaba: I would say that rest days are important for the majority of us. There are some people who have extraordinary capabilities and are able to run every day and run free. But I think for the majority of us rest days are important.

When we run, we use a certain set of muscles and having rest days gives those muscles a rest, and helps to improve your core. So, when you’re running, you’re not really exercising your upper lamps or your core muscles, but they are necessary for you to maintain your balance and to maintain your running form.

So, when we take rest days from running and try to do some different types of exercise, that helps you become a better runner and also helps to prevent injuries. So, the type of rest days that I take part in, and the type of other exercises that I do as I try to do ‘body pump’ at the YMCA maybe twice a week, where I can exercise the different muscle groups in the body, I’ll sometimes swim which is also a good workout because it improves my core. And then occasionally, I might try to do some exercises that are specific for running to improve core muscles again. But I would say even if we are running three to four times a week, it’s important to have rest days where you’re doing other forms of exercise for the other three days.

Host: Jenny, what should rest days look like? I mean, you know, you might feel like being a couch potato after a big, long run, but it’s important to, to have an active rest day. For those listening that don’t really know what an active rest day is. Can you explain that?

Jenny Dalland: Sure. Active rest days really involve where you can still do some form of low impact exercise. Biking is a good option, yoga, if that’s something you interested in, or just active stretching or other good options of active rest. Elliptical is also would be something that would be less load bearing.

And, I think you could even maybe tie strength training into your active rest days for all of our runners that we see here, we think it’s very important to have some form of strength training. I think that goes hand in hand to help ward off injuries and strength training can be built into those rest days as well.

Host: I’ve seen and listened to plenty of interviews of ultra-marathoners, people who have been running for years. People like Courtney Dauwalter, who say that their diet consists of nachos, beer, and candy. Then, there’s others like David Goggins who follow a very, very strict clean food diet. How does diet play a role in running? And, what advice would you give to runners when it comes to their diet? Jenny, we’ll start with you.

Jenny Dalland: I think diet plays a huge role. I think we all know how we feel. I know I couldn’t go eat a bag of potato chips and then go run. That’s just, that’s not for me. That’s my own preference, but everyone’s different. I think nutrition is huge. I’m not a dietician, but I do also know that a well-balanced diet is key.

And, especially for those runners who are running their long runs, preparing for marathons and half marathons, it’s going to be important to think of on the run nutrition because we are using all of those carbohydrate stores while we’re running. It’s important to keep our energy up and think about that on the run nutrition. And, the other thing I would tie into this as hydration, most of us are under-hydrated. And in fact, if you have less, more than 2% of a hydrate or water loss that can actually decrease performance. So, I think hydration along with nutrition are really important.

Host: Dr. Gaba, anything that you would want to add to that?

Dr. Anu Gaba: I would also say to maintain a healthy weight and so that you can improve your running. It’s also important to take you know, at least three to four servings of fruits and vegetables every day, it’s important to get your protein intake. It doesn’t have to be meat-based. You can get a good amount of protein from vegetarian diets too.

And then, I wouldn’t say that you have to cut down sweets completely. You can give yourself the pleasure of eating you know, occasional sweets here and there, one dessert a day. I mean, that would be perfectly fine. And, usually I know that on the days of the run, the actual race, you know, whether it’s a half marathon or a full marathon, that’s the day that runners will splurge after the Irish runs. And then you can eat whatever you want, whether it’s beer or nachos or candy, I think all that’s allowable.

Host: We’ll switch gears now and talk about Sanford’s specific involvement with running. Sanford sponsors races across all of our communities, Dr. Gaba, why is this something that we feel so passionate about?

Dr. Anu Gaba: Sanford is a health care organization and we all know that prevention is always better than cure. So, if we can encourage the community around us to be involved in healthy activities, we improve the health of the cities and the towns where we live.

So, I think this is such a great goal to get our communities moving and be healthy and be outdoors. And, what better way can a health care organization do that than by sponsoring activities, which involve the whole community and encourages them to be involved in something like a running event.

Host: And Jenny, Sanford cares so much about not only runners, but all athletes. I mean, Sanford POWER has worked with some of the best athletes in the world from Carson Wentz to Chad Greenway and Zach Zenner just to name a few names. I had the chance to see this 3D running set up that we have yesterday and I was totally blown away. Talk about the running resources that you have here at Sanford POWER.

Jenny Dalland: We definitely have pretty much everything you can imagine at the field house when it to running health. So, like we said, Josie (Stockland) the physical therapist and myself work with all the runners that come through the store. We offer 3D running analysis for both injured and non-injured athletes. So, going off of what Dr. Gaba said, we want to keep them healthy. So, why not try to prevent it before an injury does arise?

We also have all of our strength and conditioning staff out here where we have specialized groups working with runners specifically. And we also have now outsourced a running coach. Kendall out of Fargo is now building programs, running programs for athletes as well. And, along with that, we offer soft tissue and recovery services as well for running. How can people, all athletes and not just runners.

Host: How can people get linked up with this?

Jenny Dalland: So, everything’s on the Sanford POWER website. Every service that we have is available they can always call our front desk to get more information.

Host: Awesome. Any final words or tidbits that either of you two would like to add?

Dr. Anu Gaba: I would say that for those of us listening, if you have never run before, then the most important thing is to start slow. Walking is fine. Try to find like-minded people like you and consistency is important.

Jenny Dalland: Yeah, I completely agree. I think don’t jump in the deep end when it comes to starting any exercise program. Take it easy, take it slow, and don’t be afraid of walking. It’s important that you build your cardio endurance as you start to build miles. As well too, there’s so many running communities out there that have such a strong involvement, encouragement, and build each other up where you can find the pieces that fit you, even if you’re a 12 minute mile or your seven minute mile, there’s a group out there for you that would welcome you with open arms.

Host: Well, again, thank you both for doing this. This has really been a lot of fun.

Dr. Anu Gaba: Yes, thank you and you’re welcome.

Jenny Dalland: Thank you so much.

Host: And, thank you for listening. If you enjoyed this conversation, keep Sanford Health on your radar. We have a ton of podcasts, all covering a wide variety of important topics. He can find us on your favorite podcast apps like apple and Spotify, as well as our website, Sanford Health News. Thanks again for listening. I’m Simon Floss with Sanford Health News.

Learn more about this topic

• Why running is good for you, according to doctors
• Your running shoes: Do they need a medical checkup?
• Proper workout rest and recovery time is rewarding

Get more episodes in this series

What is breast cancer research?

Courtney Collen (Host): Hello and welcome to One in Eight. A new podcast series brought to you by Sanford Health. I’m your host, Courtney Collen with Sanford health News. We’re really eager to kick off this series all about breast cancer awareness because 1 in 8 women will be diagnosed with breast cancer in her lifetime. Today we’re talking with Dr. Anu Gaba at the Roger Maris Cancer Center in Fargo and our topic today is breast cancer research.

Dr. Gaba, thank you so much for being with us.

Dr. Anu Gaba: It’s my pleasure. Thank you.

Courtney Collen (Host): Tell us about your role as a medical oncologist in Fargo.

Dr. Anu Gaba: I started here in 2004 as a medical oncologist. As a medical oncologist, I see patients who come here for the treatment of their cancer. I specialize in breast medical oncology. So I’m a part of a treatment team here we deal with the patient has a whole, we aim to provide wholesome care. So when a patient comes in to get treated for breast cancer, they see the surgeon, they see the radiation oncologist, they see the medical oncologist, they also visit with the nurse navigator. They have to get their scans and imaging done. So our radiologists are involved, our pathologists work closely with them. So we do provide wholesome care and I’m part of a treatment team. What’s humbling is that patients come to us during a vulnerable stage of their life and I think it is an honor for me to be involved during that difficult period of their life.

What I like most about it is that I can be part of a great and wonderful team that is helping the patient in this community. I think being a part of Sanford Health makes me so confident that we can take care of the health of the patient almost entirely in Fargo at the Roger Maris Cancer Center and we constantly tell ourselves that the buck stops here. We have to take the responsibility of doing our best for our patients so that we don’t have to send them out to another place and we can prevent them traveling those extra hours of travel if we have my not sending them out.

Courtney Collen (Host): Yeah. That is so wonderful that you are able to provide that care all in one place up there in Fargo. Let’s move on to this topic of breast cancer research. When we discuss breast cancer research, Dr. Gaba, what exactly are researchers studying?

Dr. Anu Gaba: There are many different types of research. You can do research in the laboratory. You can do research in the clinic and, you know, most people have a sense that research means setting in the lab with test tubes and beakers and then trying to discover things. But clinical research is such an important part of a research in cancer treatments. And at Roger Maris, we do provide a lot of clinical trials for patients to be a part of. So when we talk about breast cancer research, we are trying to determine if we can improve on the current treatment for breast cancer. That is one category of research. So many times these trials are being conducted all over the United States and Roger Maris Cancer Center is an important part of that group. We bring the latest treatment here, but we offer it to our patients in a very controlled setting. The patients are being closely monitored, we watch for side effects, we watch for good results and after the treatment is done, we watch our patients very closely to make sure that they are not developing any complications or if they have a good outcome, we are able to document that. So that’s one aspect of clinical research.

There are phase three trials where patients who go on those trials are actually randomized into two groups where one group gets the current standard of care and the other group gets the current standard of care along with a new treatment, which we think is going to be better than the current standard. We also have phase two trials where it’s all the patients who enroll on that study get the same treatment, but it is a new type of treatment that we are studying for breast cancer.

Courtney Collen (Host): Who is involved in these trials?

Dr. Anu Gaba: So it really depends on the trial. If we have a phase three trial that is for treating breast cancer, the patients who go on the trial are patients who have been just diagnosed with breast cancer. They would have completed their surgery, or they may be getting treated before their surgery. These are patients that we would have given them chemotherapy for their breast cancer, but instead we give them the opportunity to take part in the trial. So even when they take part in the trial, they are still going to get chemotherapy. The difference would be that they might be getting a chemotherapy combination that we think is going to be better than the current standard chemotherapy.

Courtney Collen (Host): How important are these trials to continued breast cancer research?

Dr. Anu Gaba: You know, clinical trials in general are important. In fact, very important. And the reason is, it’s only because of the clinical trials that we can change our treatment. If we didn’t have clinical trials, we would still be practicing medicine the same way as we did it 50 years ago. The only reason we can change treatment is if it can be proven in a clinical trial that a new treatment is better than the one we are doing today, there is a very good quote that Sanford research has put out in certain patient areas. It says ‘the gold standard of today was a clinical trial yesterday’. And that is so important for all of us to realize as physicians and as patients, that the treatment that they’re getting today, it’s constant, the standard of care only because there were patients and physicians 10 years ago, who are willing to conduct a trial and patients who are willing to go on that trial, which ended up proving that the current treatment that we’re giving them today is better than what was being given 10 years ago. So, I think the importance of clinical trials cannot be stressed enough. That’s the only way we can make improvements in cancer care and it is the best way to make improvements in cancer care. We can’t just assume that a new treatment that comes out is the one that everybody should go to, unless we’ve proven it in a scientific way that it’s better than the old treatment and a clinical trial is the best method, a scientifically validated method to prove that a new treatment is better than the old treatment.

Courtney Collen (Host): How would you encourage a woman to be a part of one of these clinical trials?

Dr. Anu Gaba: You know, that’s so very good question. I think it really depends on how we put the clinical trial to the patient. We have to be honest with them and explain to them what medications they are getting. What can be the side effects, you know, if it is a treatment trial, and sometimes there are risks involved in a clinical trial. If we are trying out a new drug, there may be some side effects, which they may experience, which patients haven’t experienced before. And we have to be open to that fact, but we assure them that they’re going to be closely monitored by their treating physician. We also have research nurses who are really dedicated to getting the trial completed. They are watching the patients closely. We actually check on our clinical trial patients more often than we do with other patients because we know that they’re trying out something new.

The research nurses are constantly watching them when they come to the infusion center, when they come and see us, we check on their labs more closely. So we give these assurances to the patient and then we also tell them they might be getting the benefit of a new treatment that is going to become the standard of care two to three years from now and this is an opportunity to get that treatment. And then, you know, at the same time we should respect the patient’s wishes. There may be some patients that don’t want to go on the clinical trial and we need to be open to that and very accepting of that. And we also tell patients that even if they don’t agree and they don’t want to go on the clinical trial it’s not going to affect our relationship with the patient. We still want to do the best for them. We are still going to give them the standard of care.

Courtney Collen (Host): I love what you said about clinical trials advancing science and improving that standard of care. Talk about a few of those more significant milestones or medical advancements that researchers have made in the last five, 10, even 25 years.

Dr. Anu Gaba: Yeah. so I like the question since you want to go back even 25 years ago, so that is good. It’s good to reflect back on what advances have been made in breast cancer treatment. So, I would say in the last 25 years the biggest changes I’ve seen is in the extent of surgery. I would save 25 years ago, surgery for breast cancer was radical. It used to be called radical mastectomy. Patients had extensive surgery, a lot of the breast and the muscle underneath was removed. The lymph nodes used to be dissected completely from the axilla and almost all women would have lymphedema and that is swelling of their arm. But as time has gone, gone on surgeons have done such a terrific job of realizing that less is more, that we can get equally good results by doing smaller surgeries. So now we do modified radical mastectomies, or even just lumpectomies. You don’t need to take out the whole breast if you know exactly where the cancer is located. Good imaging has also helped with that. Surgical research has also shown that we don’t need to always take out all the lymph nodes in the axilla. Just taking out a few lymph nodes can give us as good results as taking out all the lymph nodes in the axilla. Then in the last 25 years, I would say that even radiation therapy has advanced significantly. Before, radiation therapy used to be extensive and not focused. So patients who are getting radiated to the breast would also have cardiac complications or lung complications. Radiation therapy has improved so much now and that the beams can be targeted just to the lump where the cancer is. In some cases, they might do the entire breast, but they really minimize the damage to the heart or to the lungs or to the other surrounding structures. In medical treatment, the number of hormonal therapies that are available for treating breast cancer has expanded. And even our chemotherapy it’s gradually become less intense. In some ways we are incorporating more of targeted therapy.

In the last 10 years, I would say that we are using more of genetics and genomics in the treatment of breast cancer. We do assays and the two more common ones are, one of them is called the Oncotype DX assay. The second is called the Mammoprint and these two tests they are done on the tumor sample after women have had their surgery, rarely they can also be done on their biopsies. They help tell us whether a patient would be benefited from chemotherapy or not. Or in other words, these tests, they look at the genomic makeup of the cancer and they can tell us if we can manage them, but just anti hormonal therapy alone. And if it would be safe to avoid chemotherapy, I think because of these tests, we have probably reducing the need for chemotherapy and almost 60 to 70% of breast cancer patients. We are now able to give chemotherapy only to those patients that actually need it. I think that’s been a big change in the way we practice breast cancer in the last 10 years.

In the last five years you know, for metastatic breast cancer, I think we’ve made a lot of progress. Women with hormonal receptor positive metastatic breast cancer are now living longer than what they did before. And this is because of the availability of a new set of drugs called the CDK 4/6 inhibitors. Patients might know them by the name of palbociclib and ribociclib or abemaciclib. So this is a group of drugs that’s really improved outcomes for metastatic hormonal receptor positive breast cancer. Then patients who have triple negative breast cancer, immunotherapy has helped. And a lot of research is still being done on how we can improve on the use of immunotherapy and determine which other groups of patients that we can use it for. Another development in the last five years is the use of next generation sequencing. We are doing it for women with advanced breast cancers. We take a biopsy and then analyze it for the presence of almost 300 to 500 genetic changes. And on the basis of that, we can determine whether there are targeted treatments that are available, which will benefit these patients.

So to summarize, you know, we do have a lot of advances that are going on and they will help in their own small ways in improving breast cancer care.

Courtney Collen (Host): We talk about the importance of getting a mammogram for breast cancer screening. What have we learned about early detection?

Dr. Anu Gaba: Women need to be aware of their breasts, they need to know what their breasts feel like so that if there is a change, they are alerted to it and then they should be contacting their primary care provider without any delay. We do recommend screening and currently the recommendation is to start at the age of 40 once a year. There is a lot of controversy about breast cancer screening. I think the controversy is in two areas. One is about 3D mammograms versus 2D mammograms is one better than the other. And the other bigger controversy is about the frequency of mammograms. At Sanford, we spent a lot of time discussing about it and we decided that we’re going to continue to recommend annual screening mammograms starting at the age of 40. But I acknowledge that, you know, there are some research analysis that has shown that even every other year mammograms might still be useful. So that’s why I think it’s important for us to take part in trials, which can resolve this issue in the long run. But definitely I would recommend that women continue to do their screening mammograms. And if they have a family history, then they should definitely let their providers know because then we might want to send them for genetic risk assessment and more frequent and more intense screenings. So if there is a strong family history of breast cancer, or we know that they have certain genetic mutations, which are hereditary, then in those women, we recommend not only annual mammograms, but we also recommend annual MRIs for screening purposes.

Courtney Collen (Host): We often hear people say that they want to find a cure for cancer now for breast cancer. What might that look like? Is this something that we would see in our lifetime?

Dr. Anu Gaba: That’s a tough question. You know, whether we’ll cure breast cancer in our lifetime I would say cure for breast cancer would be in two fronts. One is in women who have early stage breast cancer, a cure would be if we can treat it such that it never comes back, and we can be assured that it’s not going to come back … that would be one aspect of cure. The other aspect would be for women who have metastatic breast cancer and them, the goal would be to make it a chronic disease like diabetes or hypertension, where women can live a long time with the cancer, knowing that even though we cannot wipe it out completely, we can give, we can give treatments that don’t have many side effects, but can keep the cancer controlled. So I would say that these are the two main categories of treatment that we aim for that can really reduce the chances of women dying from breast cancer. The third aspect would be, you know, if we can find ways and means to prevent breast cancer in the first place. And you know, I think to some extent we can do that by dietary changes, lifestyle modification, but in spite of all our advances, we don’t always have an explanation for why some women get breast cancer and some don’t. Even in the absence of family history, you know, there are women who get breast cancer and many times we don’t have a good explanation for it.

Courtney Collen (Host): About five, 10, 25 years ago, where will research take us in the coming years?

Dr. Anu Gaba: I would say that it is a lot of different things. And you know, when, when developments happen when we realized, ‘wow, this is great, this is, this is going to change breast cancer’. It’s always been retrospective. It’s only after a treatment becomes successful, that we say, ‘well, that was a great milestone’. I think before that happens, we really don’t know where our research will take us. So right now for breast cancer, I would say there are many different avenues that are being looked into. One of them is definitely targeted therapy. I give an example of the CDK 4/6 inhibitors. We talked about next generation sequencing, which gives us the opportunity to try targeted drugs. But I think this is where there is a lot of research going on. We know that there are so many genetic mutations that are involved when a normal cell converts into a breast cancer cell.

Though, we are aware of these genetic mutations. We always don’t have a drug that targets those mutations. I would say we have targeted drugs for less than 10% of all the genetic alterations that occur in a breast tumor. So the research is to find drugs that can target all those various mutations. The second area of research is let’s say a patient’s tumor has 10 different mutations. The research is to find out which is the driver mutation, or which is the main mutation that is driving the cancer and what are the mutations that are just supporting that driver mutation. So that would be another area of research. Then I think immunotherapy has really brought about huge changes in the prognosis for many different types of cancers, especially melanoma, lung cancer, kidney cancer. And it has made inroads into breast cancer, particularly the triple negative breast cancers, but there is still research going on to see how can immunotherapy impact the other different types of breast cancer.

Courtney Collen (Host): October, as you know, is breast cancer awareness month. I’m curious, what impact does that 31-day period of heightened, national awareness actually have on advancing research for breast cancer?

Dr. Anu Gaba: By having a month dedicated to breast cancer awareness, I feel that it gives us an opportunity to talk more about it just like you and I having this putting this podcast together. So this probably in other institutes and other places around the country, so definitely raises awareness of breast cancer at the same time. It allows institutes research organizations to fundraise for breast cancer patients, as well as for breast cancer research and to provide supportive services to breast cancer. This is also a month where we take stock of the research trials that we have and see if we can improve on our research trials and offer more to our patients. We also look at this is the month where we organize our meetings for survivors. You know, so for women who have gone through breast cancer and are now doing well for women who are still dealing with breast cancer and undergoing treatment, we usually have different workshops for them. We have retreats for them where they can meet each other talk to experts, know more about their cancer. So I think having an awareness month definitely raises more focused on breast cancer. And it’s really a great opportunity for patients to learn more about it.

Courtney Collen (Host): Yeah, we know Sanford as a leader when it comes to its research and innovation, how many clinical trials related to breast cancer are available to patients right now?

Dr. Anu Gaba: I would say that overall, we probably have, I’m just going to say from the top of my head, maybe 80 to 120 trials and just in breast cancer, we have about 20 clinical trials. So Sanford and Roger Maris, we definitely want to emphasize clinical trials. And we encourage all patients to take part in them. This is one way of improving cancer care. Now I think patients should know that they are their best advocate and that we work as a team here the physicians, the nurses, the navigators, and that we are here for them, and we have their back.

Courtney Collen (Host): Dr. Gaba. It was great to have you as our guest and just incredibly fascinating to learn more about this continued research when it comes to breast cancer and all that Sanford is doing. And we appreciate all that you do for women in our communities as well.

Dr. Anu Gaba: Well, thank you. It was my pleasure.

Courtney Collen (Host): I’m Courtney Collen. Catch the next episode of One in Eight, our breast cancer podcast series coming soon. Stay well, have a great day.