🎗️ Surviving Breast Cancer: My Story with Dr. Pamela Hayes 🎗️ 🎉 #GetYourBoobsSqueezed 🎉

📢I talk🎙️with Dr Pamela Hayes, M.D. Medical Oncologist at Texas Oncology in Dallas, TX. She specializes in Hematology and Medical Oncology! 👏🍷 🎇 🎉 ✨ 👏 🥂  😁

💬 "It's your journey. Don't compare it to anyone else." - Dr. Pamela Hayes

This summer, I was diagnosed with stage zero breast cancer (DCIS)—a mild case, but still life-changing. I sat down with my oncologist, Dr. Pamela Hayes, to share my experience and spread awareness about early detection, treatment, and recovery. Here are some key takeaways from our conversation:

Watch on YouTube! https://youtu.be/R9HIy93UP-0

🔬 Early Detection & Diagnosis

✔️ Mammograms matter! Many cases are caught early through routine screening.
✔️ Dense breast tissue = more screening (I had it & was called back for more tests).
✔️ DCIS is "stage zero" cancer, meaning the cells are abnormal but haven't spread.

💬 "Think of it like a tiger in a cage. Given enough time, it can break out." - Dr. Hayes on DCIS

🏥 Treatment Journey

📌 Biopsy & Lumpectomy: Surgery removed abnormal cells, but margins were close—so I had a second procedure.
📌 Radiation: Based on my risk score, radiation was recommended to prevent recurrence. I had 21 treatments. And I Rang the Bell!
📌 Hormone Therapy: I’m on low-dose tamoxifen for 5 years to reduce future risk.

💬 "Our goal is to make sure this NEVER comes back." - Dr. Hayes

🧬 What Increases Breast Cancer Risk?

🔸 Family history & genetics (BRCA gene mutations)
🔸 Early puberty or late menopause
🔸 Dense breast tissue (like mine!)
🔸 Obesity & lack of exercise
🔸 Alcohol consumption (moderation is key!)

💬 "Alcohol isn't the biggest risk factor, but excess can increase estrogen levels, which fuel some breast cancers." - Dr. Hayes

💪 Life After Treatment

🌿 Exercise helps! I’m walking 2-3 miles/day & doing weight training.
🍎 Balanced diet > extreme diets. No need to cut out everything!
🩺 Regular screenings & check-ups are a must.

💬 "Tiny changes make a big impact." - Dr. Hayes

💖 Final Thoughts
Breast cancer is emotionally and physically overwhelming, but having a strong support system, great doctors, and the right mindset makes all the difference. If you're going through this or know someone who is, you're not alone.

💬 "Your body is constantly working to protect you—trust it, take care of it, and stay proactive."

🎉 #GetYourBoobsSqueezed 🎉

👀 PSA, ladies! It’s time for your annual mammogram—because early detection saves lives!

💖 Mammos after 40 = Self-care & peace of mind!
💖 Takes just 20 minutes! (Faster than your Starbucks run ☕)
💖 Smash those boobs, not your chances!

👉 No excuses—schedule your mammogram to

NOW ON YOUTUBE!!! Thank you for Listening! Join us on Facebook, Instagram or Twitter!

Host Jessie Ott's Profile on LinkedIn

Chapters

• 0:28 Introduction to Dr. Pamela Hayes
• 3:19 Dr. Hayes' Journey to Oncology
• 6:31 Understanding Oncology and Hematology
• 9:25 The Role of Community in Breast Cancer Awareness
• 12:33 Breast Cancer Statistics and Screening
• 15:16 The Importance of Early Detection
• 18:39 Dr. Hayes' Educational Background and Texas Oncology
• 21:29 Patient Experiences at Texas Oncology
• 24:25 Navigating the Emotional Toll of Cancer Diagnosis
• 27:31 The Diagnostic Process for Breast Cancer
• 35:38 Understanding Sentinel Lymph Node Evaluation
• 39:15 Ductal Carcinoma In Situ (DCIS) Explained
• 46:54 Breast Cancer Types and Treatment Options
• 59:21 The Role of Hormones in Breast Cancer
• 1:01:15 Alcohol and Cancer Risk Discussion
• 1:15:49 Healthy Living and Cancer Prevention Strategies
• 1:16:57 Produced by Fedora J Productions

Transcript

Jessie Ott (00:01.08)
Hello everybody and welcome to Thursday Thursdays. I am Jessi and I have a special occasion here special segment with Dr. Pamela Hayes, medical oncologist. Welcome Dr. Hayes.

Dr. Pamela Hayes (00:15.61)
Excited to be here.

Jessie Ott (00:17.25)
Well, I'm glad you are. we will get into Dr. Hayes' story here, but just to give a little intro, obviously she's my doctor and I met her, this summer. I had a, a mild case I would call of breast cancer, stage zero. the results were kind of a bummer, but we'll get it all into that. And, so Dr. Hayes, where are you calling from?

Dr. Pamela Hayes (00:44.73)
So I'm calling from Dallas, Texas.

Jessie Ott (00:48.066)
Dallas, okay, yes, that's where home front is for us, but we're spending the winter here in supposedly sunny Florida, which is nice.

Dr. Pamela Hayes (00:58.548)
lucky we've been having a touch of snow over here, which is unusual.

Jessie Ott (01:05.09)
Yeah, I don't really miss that.

Dr. Pamela Hayes (01:07.353)
Hahaha!

Jessie Ott (01:09.71)
So where are you originally from?

Dr. Pamela Hayes (01:13.146)
I mean, I've been in Texas since I was five. I'm originally from California, the Bay Area, but kind of a bit of an army brat. So we moved around a lot and then ended up in kind of the Dallas area. And I was kind of raised from there.

Jessie Ott (01:31.854)
Okay, alright, so you're kind of born and raised, went to high school and all those things in Dallas.

Dr. Pamela Hayes (01:36.886)
Mm-hmm in the Plano area to be exact if anybody knows anything about the Dallas area. It's it's a huge metroplex

Jessie Ott (01:45.154)
Yeah, mean, gosh, how many high schools do they have now? Three?

Dr. Pamela Hayes (01:49.114)
I believe there's three of them there and there's, think my graduating class was well over a thousand people.

Jessie Ott (01:56.984)
Yeah. Plano is well south after, I would say in the metro area.

Dr. Pamela Hayes (02:05.57)
Yes, it was a fine place to grow up. ain't going to complain.

Jessie Ott (02:08.686)
Yeah, nice city. Really close to Dallas. But also now they have the Rough Riders up there. The Starplex is up that area. don't know. Is it technically Plano or is it Frisco? The Starplex.

Dr. Pamela Hayes (02:24.122)
I think they're doing a lot of stuff up in the Frisco area. Yeah, they're building up like a new theme park up there, I think, too. I mean, the whole area is expanding like crazy. I don't know where they're going to put more people here. The traffic's already crazy enough.

Jessie Ott (02:28.248)
Frisco.

Jessie Ott (02:34.638)
You

Jessie Ott (02:41.61)
It really is. Yeah, that's true. I forgot. There's also a surf place. You can go surfing. There's a surf bar.

Dr. Pamela Hayes (02:48.026)
I don't know about that, but that sounds awesome.

Jessie Ott (02:50.976)
Yeah, there's a complex that's up there. There's indoor mini golf and there's, we played that once. Yeah, it's kind of fun up there. I don't remember what it's called, but it's fairly new, I think, in the last year or two.

Yeah. Yeah, definitely. The kids dig the miniature golf indoor so you could go now in the winter time. Yeah, it's kind of cool. So, so when did you know that you wanted to be a doctor? I mean, I would assume it was pretty general at first.

Dr. Pamela Hayes (03:18.01)
it.

Dr. Pamela Hayes (03:31.854)
Well, funnily enough, my mother has told me that since the age of three, I knew I wanted to be a doctor. And at least I always joked with people that as soon as I was old enough to realize that I couldn't be a unicorn when I grew up, that doctor was, I guess, the next best choice. So I've known for a long, time that this is kind of what I wanted to do and all through

Jessie Ott (03:54.446)
Yeah.

Dr. Pamela Hayes (04:02.252)
middle school, high school, college that I was very focused on that. Which is nice because usually if you get into medicine you have to kind of be very focused the whole way through. Not always, but in general, yeah, exactly. So I was kind of fortunate at least that I sort of had a plan and a goal in kind of doing everything. As far as my journey to oncology, that was a little bit...

Jessie Ott (04:14.412)
You really do. You gotta get those grades.

Dr. Pamela Hayes (04:33.693)
more circuitous because I wasn't quite sure. There's a pretty big mental component to oncology. There are a lot of victories, but there's a lot of sadness and grieving that you do as you get really close to your patients. And I was a bit concerned that that might be kind of hard.

Jessie Ott (04:53.87)
Yeah.

Dr. Pamela Hayes (05:00.09)
on me, but once I did my rotation, one of my large parts of my training in oncology was in breast oncology before I actually committed to doing my fellowship in oncology. And I just loved it. I loved the patients. I loved the interactions that you get.

It's a good blend of kind of long-term care as well as kind of acute care. And I knew it was something that I couldn't not continue to be a part of. And my mentor at the time also felt that I was a good match for it. And he encouraged me to move forward.

My husband wasn't really excited about taking in another additional three years of training before starting my career, but he was he was very supportive.

Jessie Ott (06:02.956)
Yeah, well, that's a big commitment. And when you say... Sorry?

Dr. Pamela Hayes (06:05.946)
It's a lot of time. I said it's yes. Overall, all the training all combined is a lot.

Jessie Ott (06:15.16)
So what were the extra three years that had to do with being a breast oncologist?

Dr. Pamela Hayes (06:20.854)
It's not specifically in breast itself, it's for oncology in general, so that's just anything. But there's two different ways that you can go about it. In general, the fellowship for oncology is two years. And then you can take an additional year for three years total.

Jessie Ott (06:26.155)
In general, okay.

Dr. Pamela Hayes (06:44.312)
to get boarded both in oncology and hematology, because there's a lot of crossover between those two. And so that's what I did. So I'm board certified both in oncology as well as hematology.

Jessie Ott (06:57.175)
And what's the difference?

Dr. Pamela Hayes (06:59.518)
hematology is the study of blood disorders in general, so that could be anything from benign issues such as iron deficiency, to cancers of a kind of hematopoietic system. So, you know, your chronic leukemias, acute leukemias are usually taken care of by our transplant team, but certain types of lymphomas and leukemias are also

Jessie Ott (07:19.074)
Yeah.

Dr. Pamela Hayes (07:28.57)
a part of the group of patients that I will take care of.

Jessie Ott (07:32.558)
Okay, so my dad would have been in that group because he was in the jungle, the 9th Infantry in Vietnam, so he was deep down in there, got sprayed and ended up with Agent Orange, but they called it a type of leukemia.

Dr. Pamela Hayes (07:47.13)
Okay, Agent Orange definitely had a lot of nasty side effects that we're seeing.

Jessie Ott (07:58.092)
Yeah, yeah, it's interesting because his group got together two or three years ago and it was great. There was four of them and two of the four all of a sudden, well, my dad passed because he got COVID, but another, another, you know, another gentleman that came to visit from Illinois didn't know that he had it.

Dr. Pamela Hayes (08:14.638)
Mm.

Jessie Ott (08:25.93)
And then all of a sudden just passed away and that's what he, they ended up doing an autopsy and they, they, they, said it was due to a type of Agent Orange that he didn't know about.

Yeah, I don't know. I'm not saying it right. But anyway, know, those those effects, you know, they really they have they have their effects on people, obviously.

Dr. Pamela Hayes (08:42.19)
Yeah, I don't know.

Jessie Ott (08:52.718)
So anyway, back to you. Sorry. Okay, so you're now then a doctor of oncology and you cover all cancers then and you cover both the hemoglobin and what's the other one?

Dr. Pamela Hayes (08:56.428)
No, no, no, let's be tangential. It's

Dr. Pamela Hayes (09:12.152)
Just yeah, any kind of blood disorders, take care of blood disorders as well as most types of solid organ cancers as well. So you'll definitely see there's,

Jessie Ott (09:15.64)
Yeah.

Jessie Ott (09:22.574)
cancer.

Dr. Pamela Hayes (09:27.826)
different practices are very different on the type of patients that they see. So you definitely can find oncologists that subspecialize where you have only patients that are only seeing breast cancers or only seeing melanomas or only seeing prostate cancers. So it just sort of depends on the area, the practice, the type of

you know, patient population that you want to see. But in general, in my practice at Medical City, we kind of see a range of patients. But I will say that a large majority of my patients are breast cancer patients.

Jessie Ott (10:17.998)
Okay, like 70 % maybe.

Dr. Pamela Hayes (10:21.53)
That that might be a little bit on the high side maybe in the realm of 40 to 50 percent There's a lot of different types of cancers out there

Jessie Ott (10:30.382)
Okay. Yeah, there are and it's growing.

the different types too, I'm sure. Okay, so that's quite a few then. mean, at least half or around half is a lot.

Dr. Pamela Hayes (10:44.056)
Mm-hmm. yeah, I mean breast cancers is outside of skin cancer is going to be the most common cancer that's going to be affecting women and so just Playing the numbers game. We're gonna see a lot more of those types of cancers

Jessie Ott (11:00.556)
Yeah. And given that you're from Plano and I've lived in Dallas for, I don't know, 20 years, something like that now. And having the Susan B. Komen organization local, do you feel that that has its effects on kind of the whole community in itself? Just the camaraderie and how different groups kind of combine together or women and breast cancer survivors?

Is there any kind of influence do you feel like from a community standpoint that that has?

Dr. Pamela Hayes (11:37.088)
sure if that in itself is kind of a huge player in this area. think in general when it comes to breast cancer it's a very, it tends to come with a really strong support group somewhat wherever. I think the good thing about being in Dallas is it's such a large area that it's easy to find those types of support groups and not only

groups for breast cancer in general, maybe even support groups that, you know, fit your age demographic or, you know, even the area that you're in so you don't have to travel that far. So I think just in general, a lot of survivors are very motivated to get out there, spread the word, not only on

breast cancer surveillance, but also to be that support if they've gone through chemotherapy, radiation surgery, what have you, to kind of share their story to kind of help other women that are going through kind of the same thing.

Jessie Ott (12:42.734)
Yeah. Yeah, I think so. Well, it's pretty common. I read a book in Dr. DiPasquale's office and for the audience that was my breast surgeon, but one in eight women get breast cancer. And I was really shocked by that. And, you know, it's one of those things I've heard is that as a woman, you're going to get it at some point.

Like men get prostate cancer. there any truth to that?

Dr. Pamela Hayes (13:13.806)
Right.

There is a little bit of a, I mean, no, not every single woman just, you know, if they live to be 102 is going to get it. But there is this kind of thought that the, you know, the more time that you have with your breast tissue, the, you know, the higher and higher risk that you are to get some abnormal tissue going on in there. And I think we've been doing a really good job of

getting information out there to say, let's get our mammograms done. And so I think we're screening a higher number of people. And when you're screening a higher number of people, you're going to be finding more of these cases and hopefully in earlier stages than you would have otherwise, just because again, the internet people that are

wanting to speak out more about it, having good family care and general practitioners that are out there encouraging their patients to have this done, I think has been very helpful in finding cases.

Jessie Ott (14:31.694)
So in other words, there's an uptick in cases, but it's also your screening earlier and finding cases that are earlier stages versus waiting. Am I saying that kind of, is that kind what you're saying?

Dr. Pamela Hayes (14:47.844)
Well, I just think again, as people are getting more informed, whether that's, you know, listening to podcasts that are talking about it or reading things on the internet, I think we are generally becoming more educated about our health. and so I think there's a lot more of a push that women are wanting to kind of be proactive with their health. But also I do think that our, our

Screening modalities are getting better. They're getting more sensitive. We're seeing abnormalities a little bit easier as the imaging is getting better. There is some concern that we are seeing earlier cases of cancers in younger individuals. And there's probably several factors that play into that.

Jessie Ott (15:26.531)
Yeah.

Dr. Pamela Hayes (15:42.724)
But one of which I think is that we're doing a better job of getting the word out to have our women start their annual mammograms at the age of 40. Now, of course, if there's a strong family history or other type of concern for genetic disorders, that may even be earlier than that that we recommend starting screening. But I think there's a multitude of factors that go into

why we're seeing a slight uptick in cancers in younger populations.

Jessie Ott (16:17.784)
So 40 is the age where women should start getting their mammograms and it's kind of standard. Because I feel like that's been that way for a while, no? 40?

Dr. Pamela Hayes (16:24.322)
Mm-hmm. That's.

Dr. Pamela Hayes (16:31.322)
For it's, think early on that it was always like start at 50 at least. I think the age between 40 and 50 has been a little bit of a gray zone. Cause when you, if you start screening earlier, you have this increased risk of finding more benign issues where.

Jessie Ott (16:37.154)
Okay.

Dr. Pamela Hayes (16:56.184)
you they might see an abnormality and you may need to have a biopsy. You have a kind of a higher risk that that may be a benign finding and that can cause, you know, pain from the biopsy, the anxiety of waiting to hear back from your pathology. But, but again, as our screenings are getting a little bit clearer, think that we're hopefully seeing less of those cases, but you know, the younger that you start them, the more likely that you'll get these.

false positives on there, but I think the benefit of starting at that age outweighs the risk of kind of having these abnormalities that may not be something that needs to be acted on at least.

Jessie Ott (17:40.366)
Yeah. My mom had breast cancer and so I started at 35. They wanted to get a baseline for me. And so yeah, I've been in this world for a long time. Yeah, for sure. Okay. So did you end up going to school? Where did you go to school? And then where did you, did you end up working with Texas Oncology there at Medical City before a full-time job or what's your, what?

Dr. Pamela Hayes (17:44.932)
Mm-hmm.

Jessie Ott (18:10.702)
Can you talk about that?

Dr. Pamela Hayes (18:10.948)
So my whole kind of, I did my medical school training down at UTMB in Galveston. And after that, I knew I wanted to be back in the Dallas area so I could be around family. So I did my internship residency as well as my fellowship at, it's now Baylor Scott and White down in Dallas. And so I did.

Jessie Ott (18:37.783)
Okay.

Dr. Pamela Hayes (18:40.58)
did the rest of my training there. And then when I graduated from the program, I took a job with Texas Oncology at Medical City Dallas.

Jessie Ott (18:52.962)
Yeah, can you talk a little bit about Texas Oncology? I think it's a pretty great organization, at least from my experience as a patient. And I'm very jealous of all your t-shirts. I really want a Texas Oncology t-shirt. I can't help it. I even had things like, let's raise money. I just want a t-shirt. Silly.

Dr. Pamela Hayes (19:08.132)
Hahaha!

Dr. Pamela Hayes (19:17.434)
I will try and see if I can find you one. I'm sure I can get you one.

Jessie Ott (19:20.59)
Because I'm like every Texas oncology patient should be wearing that with pride.

Dr. Pamela Hayes (19:27.392)
Yeah, you know, it wasn't until very recently that I got my first because a lot of the nurses will get them and I've always looked at them very jealously myself. So let's see if I can get one for you. Yeah, so Texas, I wish I should have done looking at it. It is. I believe it's the largest grouping of oncologists.

in Texas, I think it's one of the largest groups actually, almost in the US. I wanna say there's like 400 of people that I could technically call my partners. Yeah, yeah, so I mean, in general, in my personal practice at Medical City, there are six physicians. But Texas oncology, again, is huge and it's sort of scattered all throughout Texas.

Jessie Ott (20:09.174)
Okay, that's big.

Dr. Pamela Hayes (20:25.626)
But in general, it's a wonderful, wonderful, I mean, as soon as I knew about Texas Oncology, I knew this was a practice that I wanted to join into, not only because I knew how patient-centered, of course, that they are. think it has a very good, they're very good to their physicians, very good to the staff. People are happy.

And people don't leave, I mean, that's the other thing with any practice, you wanna see that people completely stay in that organization and they do. So it is a decision that I would make time and time again. I've loved my, I've been in this practice almost four years now.

Jessie Ott (21:00.451)
Yeah.

Jessie Ott (21:11.296)
Okay. Yeah, I would say at every level I've had a good experience and I'll give you one kind of awkward one. So it was when I went and I think I had my MRI and I, for some reason I put my headphones in, you know, my iPods and then I had to go and get an EKG. And so my, guess I put my ear pods in the pocket of my coat and my coat

kind of fell off and I lost an earbud. And I finally figured out on my phone that I could find it. And I'm telling the ladies at the desk, they're so nice. They were so nice and helped me. And I walked, I walked everywhere. I put an extra two miles on trying to find this finally, because we asked the tech that was back there. He's like, no, it's not here. It's not here. And finally I said to the ladies, go, can I please go back there because

Dr. Pamela Hayes (21:57.461)
Hahaha!

Jessie Ott (22:07.456)
My phone is showing that my earbud is in this part of the building. And so they walked back there with me, I think just because they were just as interested in finding it as I was at that point. And there it was, it had fallen just right up against the wall. And so he didn't see it when he looked under. And so, you know, just at every level, people were just so nice and friendly.

Dr. Pamela Hayes (22:10.147)
Uh-huh.

Dr. Pamela Hayes (22:25.273)
huh.

Dr. Pamela Hayes (22:31.818)
Good. Yeah, I would expect that everyone kind of wants to go above and beyond for our patients.

Jessie Ott (22:38.134)
Yeah, like even surgery, you know, all the anesthesiologists and like everybody was super, super nice. Like it was a great experience. I had a wonderful experience throughout the whole thing. And obviously your colleague, Dr. D. Pasquale is pretty amazing and she's got a cult following of people. Yeah.

Dr. Pamela Hayes (23:01.466)
Yeah, she's amazing.

Jessie Ott (23:05.566)
It's funny because, you know, obviously with any patient, you're gonna connect with your surgeon because they're saving your life, right? Like it's kind of a big deal. Or it's the first stage, right? It's like that first big piece to it. And then I went to her, Dr. DiBesquale had like a symposium.

Dr. Pamela Hayes (23:16.506)
Mm-hmm.

Dr. Pamela Hayes (23:24.811)
Mm-hmm.

Jessie Ott (23:32.204)
And there was a whole room full of women that felt the same way. It was really cool. And then she had speakers and people that kind of, you know, obviously had a lot harder cases than I did. I would say I'm pretty mild being stage zero.

Dr. Pamela Hayes (23:50.954)
You know, what I always tell patients is, don't compare your journey to anybody else, because this is, it's your journey. And it's incredibly, regardless of whether you're told you have a stage zero, or you have a stage four, and yes, of course, those are very different prognoses, very different kind of expectations for what the future is going to bring. But

Jessie Ott (23:56.173)
Yeah.

Dr. Pamela Hayes (24:17.114)
In the world, there's always going to be people that have it easier than you and there's going to be people that have it harder to you. This is your journey and your experience and it's hard to say that you can't experience the hardships that may be a part of things just because there's someone next to you that might be going through a hard chemo or something like that. So you don't need to...

downplay that it's hard being told, you've got something that's not right in your breast. That's a freaky experience.

Jessie Ott (24:55.468)
Yeah, it's definitely an emotional toll, right? It's certainly, you know, when you get your diagnosis, you know, you're like, okay, well, we're just going to do whatever it takes. But at the same time, you have to literally drop everything you're doing and get in the system. Right? Like I had plans for the summer and those all got derailed because I couldn't

Dr. Pamela Hayes (25:15.854)
Mm-hmm.

Jessie Ott (25:22.722)
There's just, it's not anyone's fault. It's the process of how it works, right? You get diagnosed, you do whatever it takes to get into the next step, the next step, the next step. And so it is sort of handcuffing because we were supposed to be in Florida, which is no big deal. We have a place in Dallas, it worked out fine and everything. It's just, you all of a sudden have no control over what happens next.

Dr. Pamela Hayes (25:27.832)
Right.

Dr. Pamela Hayes (25:49.038)
Mm-hmm.

Jessie Ott (25:51.594)
And that's okay, you just roll with it, right? And that's okay. But I think the emotional component is definitely the toughest piece to overcome. mean, the surgery for me was easy, wasn't difficult. My wife, not to compare, like you said, but my wife did have the double mastectomy and reconstruction. And so that's a completely different recovery time.

Dr. Pamela Hayes (26:17.046)
Yeah, yeah.

Jessie Ott (26:20.682)
That's not to say I still have pain from radiation and I don't understand it. It's three months later and there's still quite a lot of weird pain and it's not de-habilitating or anything but I don't understand it.

Dr. Pamela Hayes (26:28.131)
Mm-hmm.

Dr. Pamela Hayes (26:38.722)
Yeah, and some patients even beyond three months may still have some skin tightness and irritation in that area following radiation, which is normal, but frustrating.

Jessie Ott (26:53.39)
Yeah. You know, when I talked to Dr. O'Connor and in one second, we should probably back up and kind of talk about the flow of things. You know, and I mentioned, you know, the doctors are like, it's a three month recovery from radiation, no matter what. And I'm like, okay, that's cool. I've read where it can be up to a year and they're like, no, it's not a year. And I'm like, I hope not. But I think your tear.

Dr. Pamela Hayes (27:02.959)
Yeah.

Jessie Ott (27:21.806)
point every experience and everybody's different. However your body reacts to that is going to be unique to that person.

Dr. Pamela Hayes (27:24.782)
Mm-hmm.

Dr. Pamela Hayes (27:33.936)
Absolutely.

Jessie Ott (27:38.894)
So do you wanna back up and just talk about the process of how someone kinda goes through getting diagnosed? So my experience was, I have been getting called back for my mammograms for the last few years because I have dense breast tissue. And so I got called back last November and we were getting ready to go to Florida and I said, it, cause I knew this breast dense,

Dr. Pamela Hayes (27:46.158)
Yeah, absolutely.

Jessie Ott (28:08.876)
You know, dense breast tissue was an issue. Can I wait until spring? So I did. Waited till we almost went back to Florida, which is a problem. And then of course I got diagnosed with, with the cancer you go in for a second round. And I think right then and there, they're like, yeah, we can kind of see, which I can't see it. They're like, yeah, it's right there. I'm like, okay, I trust you. Right.

And then you get scheduled for your biopsy, for me was the worst. I think it was the worst part of it. And then they send that in and then they, they confirm whether or not it's, it's cancer. And then you kind of, your, your, my GP actually got me in touch with Dr. DiPasquale's group. So I ended up going to see her and then in my first meeting with her,

she gave me your information and Dr. O'Connor's information, who's the radiologist department. And so at that point that I met with her that day, and if you do have your first appointment, I do recommend someone going with you because it's pretty overwhelming and doctors tend to talk fast. But what also they did, which I think is cool, and I don't know if this is a normal thing,

Dr. Pamela Hayes (29:22.868)
Hahaha!

Jessie Ott (29:31.797)
Is they have the,

What are the ladies that are there to help with the process?

Dr. Pamela Hayes (29:43.094)
you're talking about the care managers.

Jessie Ott (29:47.117)
Yeah.

I have it right here.

Jessie Ott (29:54.038)
Nurse navigator. Yeah. Yeah. So you sit down with the nurse navigator. Thank goodness. She was so sweet and so nice throughout the whole process and texted me and, and, and all the things like I don't, I can't imagine what I, what it would be like without a nurse navigator looking back on it, you know? So then not knowing anything about the cancer, just that we scheduled the surgery is that I'm going in and I'm talking to you, Dr. Hayes. And I'm talking to Dr. O'Connor without really knowing.

Dr. Pamela Hayes (29:54.778)
huh, yeah.

Jessie Ott (30:22.612)
anything? Is that normal for patients to come and meet you before there's a diagnosis?

Dr. Pamela Hayes (30:27.066)
Mm-hmm.

Yeah, so if it's alright with you, kind of wanted to circle back and go kind of back over what you had said and let you know that that's a very normal type of process in where it comes to our women kind of across the board. So in general with our first diagnosis, first diagnoses, they're going to be either something that just has come up on a routine mammogram,

Jessie Ott (30:47.937)
Okay.

Dr. Pamela Hayes (31:00.366)
or a woman that has felt an abnormality in her breast or a general practitioner doing a breast exam and finding an abnormality and that prompts going over to the mammograms. So very commonly it's actually quite unusual where I will see a patient that I'm concerned about having a breast cancer before they've been seen by a breast surgeon.

Every once in a while in a blue moon, you know, I'll catch something on other types of imaging where I'm looking elsewhere and I see it beforehand. But that's the usual kind of flow of things where it's usually they see something abnormal will do a biopsy that biopsies concerning for either a high risk lesion or either a high risk lesion or an invasive cancer and then is sent over to the breast surgeon.

Typically the breast surgeon will then send people out to radiation oncology and a medical oncologist. So the difference between all three of those specialties, of course a breast surgeon, their main job is going to be the surgical removal of not only any invasive component, but also any sort of high risk lesions. And those are going to include things like

DCIS or ductal carcinoma in situ or you know kind of other lesions that are just more proliferative those are going to be like your flat epithelial atypia or atypical ductal hyperplasia radial scars these are just things that just show the breast tissue is just getting a little bit more activated doesn't mean that there's a cancer in there but a lot of times if we find those lesions

We can find kind of cancers in and around those areas. So women that have those things on their biopsies, usually we will recommend that they have that area excised just to make sure that there's not kind of a cancer that's sort of hidden in that area. But usually again, anytime that a woman gets told, hey, you have cancer, there's not a lot of women that want to wait before they...

Jessie Ott (33:24.355)
Yeah.

Dr. Pamela Hayes (33:25.092)
they kind of meet their whole team. So even if I, as a medical oncologist, don't have 100 % of the information that I need to be able to say, is everything that we're gonna need to do as far as whether it's endocrine therapy or chemotherapy or just observation, a lot of times just to have the patient know who their team is, is really important.

So again, myself as a medical oncologist, my role is to assist with any medications or chemotherapy agents that are needed. And so that could of course include anything like cytotoxic chemotherapies, which is kind of what most people think about when it comes to oncology versus targeted therapies, which are usually pills that you take or endocrine therapy.

such as hormone blockers and things to prevent the growth of cancer. And then radiation oncologists, their job is to treat usually the area of the breast and or the lymph nodes that are under the arm or in the chest that could have spread to those areas. And so what their role is, is for what we call local control, trying to prevent cancer from coming back.

within the breast tissue or in the lymph nodes under the arm.

Jessie Ott (34:59.266)
Yeah, I did have one of those removed. My wife did too.

Dr. Pamela Hayes (35:02.528)
Mm-hmm, and that's very common. know, previously we used to do quite extensive removal of lymph nodes under the arm to get a huge number of those out for evaluation. And we've found that that's actually not all that helpful. It can cause a lot of problems with what we call lymphedema in the arm where the arm gets very swollen. It can be painful and quite debilitating.

And so by doing something called a sentinel lymph node evaluation, where they're able to see where is the lymphatic flow from the tumor and remove just the kind of highest risk lymph nodes for being positive. And if that, that will give us a pretty good idea of whether or not there's lymph nodes that are going to be involved. And if there is, let's say there is a positive lymph node with that,

Again, usually with a combination of possible chemotherapy and radiation that can kind of help control any spread to those lymph nodes, treat those areas without the surgeon having to go in, remove a lot more lymph nodes and cause more issues with possible lymphedema.

Jessie Ott (36:17.698)
Yeah, my wife ended up getting a lymphedema suit because with her process during COVID, she didn't get as much occupational therapy. She's fine now. It's been five years, but yeah, she had some of that. I haven't had any, but I will say, and I don't know what kind of truth is in this, but I feel that the removal of my lymph nodes has really changed.

Dr. Pamela Hayes (36:26.594)
Mm-hmm.

Jessie Ott (36:47.202)
the flow of things and I feel like I smell bad. I feel like I smell different. Is that possible? Or am I just imagining it?

Dr. Pamela Hayes (36:58.614)
I, I, I can't, well, I, you know, I'm, I may even say that of, of the things that you're on, I would say that the hormone blockers that you're on may have more of an effect on anything like that as compared to the removal of your lymph node. But I don't, you would be the first one that, that has made a comment about the change in, in smell with it.

Jessie Ott (37:23.95)
That's par for the course. I feel like it was before I started taking the meds, but it could just, it's just probably in my head, but I, you know, I'm an ot and we, our noses are a thing. And so I'm kind of sensitive to that COVID kind of change some of that. I'm not quite as acute as I used to be.

Dr. Pamela Hayes (37:33.645)
Okay.

Jessie Ott (37:53.198)
But, but yeah, okay. So it's in my head.

Dr. Pamela Hayes (37:59.194)
will never tell anyone that it's in their head but but I don't know you might be an exception to that

Jessie Ott (38:01.416)
hahahaha

Yeah, I don't even know how you test for that.

Dr. Pamela Hayes (38:09.018)
wouldn't, I.

Jessie Ott (38:09.952)
Yeah, well, you can't go back and smell you before.

Dr. Pamela Hayes (38:14.522)
I've got a terrible sense of smell so I wouldn't be able to say one way the other.

Jessie Ott (38:19.165)
Yeah, you know, because of course I had it in the summertime and then in August what they did is they got me ready for radiation and we'll get into all that in a minute. But I got all marked up and, you know, had the tattoos put on and everything and they're like, OK, don't sweat. No, not really. I mean, you can sweat and you can shower and everything. But, you know, it's just kind of funny in August, the hottest month of the year.

Dr. Pamela Hayes (38:46.254)
Mm-hmm.

Jessie Ott (38:47.47)
I missed the whole season of swimming, which is fine, whatever. But you know, it's okay. It happens. It's not the worst thing in the world. Yes, many, many more. Let's hope.

Dr. Pamela Hayes (38:54.65)
There will be more summers.

Dr. Pamela Hayes (39:03.021)
for you, there's, yes. I'm not concerned about you.

Jessie Ott (39:04.611)
Yeah.

Okay, so then I meet with the both of you and so the next process is, okay, I go and get my surgery removed, my spot removed. And so do you want to talk a little bit about the DISC and DCIS? I'm sorry.

Dr. Pamela Hayes (39:22.308)
Yeah, GCIS. Yes, yeah, no worries. So it's Ductal Carcinoma in Situ (DCIS) And so yes, this could be considered a stage zero breast cancer. And what that means is when they looked at your pathology, you had atypical malignant cells, but they were inside the ducts of the breast. So.

the ducts are kind of the passage in which when, of course, you're producing milk, that kind of helps to drain from the kind milk producing cells, take them down out through the nipple. And so that's kind of the area where a lot of cancers arise from, the cells that kind of line those ducts. And so with DCIS, we see the cancer that is within those ducts.

but it's not invading into the tissue. So I tell people it's kind of like having a tiger, but the tiger is carefully locked in a cage. Now you give that tiger enough time, maybe months, it may even be years for some women, but you give that enough time that can develop into an invasive cancer where it can get out into the breast tissue and cause more problems.

So in patients with DCIS, we still will treat that like a true breast cancer where we have to have that area completely removed and make sure that all margins are completely negative, meaning we don't see any evidence of any of those concerning cells at the edge of the sample that gets taken out.

Jessie Ott (41:09.922)
Right. Which is what happened with me and you know, to Dr. DiPasquale's point, it's when it's stage zero, you can't feel and you can't see it. So when they're going in and removing it, they can't tell if they've got the margins. And what she said is that they changed the margin needs and where it is right now, she missed slightly, just a little on one side or something. So three weeks later, I went back in and we did...

another surgery, just a quick one to come and scoop out whatever she needed to at the time.

Dr. Pamela Hayes (41:42.542)
Mm-hmm.

Dr. Pamela Hayes (41:46.648)
Right, of course we try to do everything possible to avoid having to go back in and do any type of surgery. things like breast MRIs that are done before surgery sometimes can kind of help the surgeon to kind of see the full extent of the area of concern. But this is kind of the nature of these can be very sneaky. They can kind of trail through the breast tissue a little bit where it can be really as

your point, there's not really anything that you can see or feel in the breast tissue to really let them know, you know, there's, there's something here or not. And again, these could be the only way to really see these is to look at it under the microscope and be able to say whether or not there's any cells, individual cells that are at those margins. And again, we're trying to do everything in our power to make sure that this never comes back, that it's never going to be a problem for you in the future. So we want to make sure that

Every single cell that we can get out gets out.

Jessie Ott (42:49.4)
gets out. And I know that I don't, I'm not sure the exact timing of the technology, but at Dr. DiPasquale's symposium, there was a booth there of a technology that she uses and it's a little magnet that she puts in during the biopsy. And so she was able to use another machine when she goes in to do the surgery to find the exact spot because she can't exactly see it or feel it. And so

I was really excited to be a part of a team that was using that kind of a technology. I've been told other times they stick a thing and you have a little metal piece, isn't it, outside the breast. And so this is sort of new technology, at least probably the last five years, maybe, if I'm guessing right. But I was really excited that she was really proud and excited to be using the latest technology within

Dr. Pamela Hayes (43:27.47)
Mm-hmm. Yeah.

Jessie Ott (43:46.23)
within what she, her scope of what she could do. And the other piece to that was when I first talked to her about my diagnosis, there was a suggestion that it could have breached the wall.

Dr. Pamela Hayes (44:04.066)
Right, so anytime that you...

come in with a new diagnosis. Again, when the radiologist that does the biopsy, they're going to look at your imaging, they're going to say, this is the area that I have the most concern of, and they, they of course go in with a needle. Sometimes they'll get just one core, sometimes it's a few cores, but in general, they're saying these are kind of the areas that we have the most concern about.

And, but again, we're dealing with, you know, it may be an area of a few centimeters that they're looking at and they're going with a very small needle. And so they're only able to get a small sample of these areas. And so typically again, when we, we see this, say, okay, this all we see is this, is this, you know, low grade lesions stage zero. But again, since we know that these can develop into a cancer,

we always have to kind of say, I doubt we'll find anything, but we may see an invasive component here. Now it's unusual that I tell someone, hey, this looks like a stage zero, going from that to, you have a really large breast cancer, you went from like a stage zero to a stage two or three.

is unusual unless it's something that's crazy and just really, really hiding in the mammogram. So in general, I always have to say, hey, I think this is what our plan is going to be as far as endocrine therapy or observation or whatnot. But I always have to have the caveat of we could find something more and that may change our plan.

Dr. Pamela Hayes (45:57.956)
So it can be kind of frustrating in that as treating oncologists, if we're very hopeful that it's not going to be complicated and there's not gonna be any invasive disease that can be really challenging to come back and tell the patient like, it's a little bit worse or we have to be a little bit more aggressive or.

If we're thinking that we're not gonna have to do chemotherapy and then later say, no, we're gonna have to do chemo on you, that can be challenging. But I always try and at least mentally prepare some patients, especially if all that we're seeing are these low grade lesions on the pathology that it can get upgraded after final surgery.

Jessie Ott (46:45.976)
So when it comes to getting chemo, does it have to be metastasized in order to receive chemo or in other words, exit the area?

Dr. Pamela Hayes (46:57.396)
No, So breast cancers in general, I'll say, kind of going back a little bit, there's different flavors of breast cancers. The most common of them is going to be your hormone positive breast cancer. So estrogen and progesterone are the normal female hormones and breast cancers, vast majority of them are going to be stimulated by these hormones.

And so the pathologist, after they have your sample, will look and see if you have the receptors on your tumor for estrogen and progesterone, and they'll tell us whether or not that's positive. And so if you're positive for those, we say that you're hormone positive for your breast cancer. Another protein that they look at is something called HER2, H-E-R2.

that if you're positive for HER2, then you can either be a hormone positive HER2 positive, or you can be a hormone negative HER2 positive cancer. And then the third type is you are something called triple negative, which means you are HER2 negative and hormone negative. And the distinction between those is that they're treated very differently.

for our hormone positive cancer patients, sometimes all we have to do is treat with what we call endocrine therapy. So it's a medication that either blocks the receptor or reduces estrogen in a woman's body to prevent the stimulation of cancer cells and as such prevent recurrence of disease. But what typically is done is if we find that there is a

larger breast cancer or one that has maybe one or two lymph nodes, all women will benefit from getting chemotherapy when they're hormone positive. And so a lot of times what I will do is I will send out some additional testing. It is a kind of gene test that looks at kind of different types of

Dr. Pamela Hayes (49:22.36)
mutations that are within the tumor itself. This is very different from just a genetic test that is done to check for things like BRCA1, BRCA2, or PALB2 mutations or other kind of genetic mutations that may be just a part of your DNA in general, but specifically looking for high risk lesion, high risk mutations in the breast cancer itself.

And with that, it's able to give me an estimate of benefit from chemotherapy. And so there's a few different types of these testings, one of which is called mammoprint blueprint, another one is called Oncotype DX, but they will give us either a risk score or just a general kind of risk profile that will let me know is this individual's cancer going to benefit from getting chemotherapy or not.

And so that is something that I will usually run on the tissue that is taken from the biopsy. And that way after the surgery is done and the patient sees me back in consultation after their, either lumpectomy or mastectomy, I have that information back. And so I can tell them on that day, whether or not we're going to need to do chemotherapy or if we just need to do endocrine therapy.

If we're dealing with a HER2 positive breast cancer or a triple negative breast cancer, those types of cancers tend to be more sensitive and to have a lot more benefit to chemotherapy. So typically if it's one of those cancers, anything usually a tumor that's larger than half a centimeter usually benefits from getting chemotherapy. And that can either be done after surgery or

If it's a large tumor or a very aggressive tumor, sometimes we will even treat it what we call neoadjuvantly, meaning before you have your surgery. And that's pretty helpful for a variety of reasons. Not only can we shrink the tumor before your surgery to make it easier for the surgeon, better cosmetic outcomes if we can shrink things down.

Dr. Pamela Hayes (51:43.246)
but it also gives us the information of how sensitive is your cancer to chemotherapy. If we can treat you with chemotherapy and we no longer see the cancer that's there, it's completely gotten rid of it, then we feel a lot better about your overall chances of completely getting cured following all your treatments.

Jessie Ott (52:07.534)
Yeah. Wow. That's interesting. I'm glad you talked about hers too and triple negative because I've seen that and I didn't know how it fit into the category. So I appreciate you taking us through that. Because I have the first one. Oh, that's okay. No, I appreciate you taking us through that because I have the first one, which is the estrogen progesterone, right?

Dr. Pamela Hayes (52:21.24)
Yeah, I'm sorry you broke up a little bit. I'm sorry.

Dr. Pamela Hayes (52:32.166)
huh. Yes.

Jessie Ott (52:32.49)
And then you have the hers too and the triple negatives. And I was wondering about these other two categories because I hadn't learned or seen, I've seen it on TV because they're, really aware of breast cancer now, right? I'm really talking about it a lot. And so now I understand where that it's just, they're just different categories of breast cancer.

Dr. Pamela Hayes (52:40.11)
Mm-hmm.

Dr. Pamela Hayes (52:45.998)
Yes.

Dr. Pamela Hayes (52:51.95)
Yes, yeah, they're, like I said, they're all treated a little bit differently. The chemotherapy is a little bit different within those.

Jessie Ott (53:02.434)
Gotcha. And so what happened was after my first surgery, my sample was taken in and it came back. and they did want to, that's when they did this, right? The, the decision RT.

Dr. Pamela Hayes (53:18.062)
I think that's the decision RT. Yes, yeah. So that's somewhat similar to what I was talking about with the chemotherapy kind of thing where they send it off and they see if there would be a benefit from radiation therapy.

Jessie Ott (53:28.508)
huh.

Jessie Ott (53:34.446)
Yeah. Okay. Yeah, yeah, yeah. And so this score hasn't really anything to do with how you treated me then. Okay.

Dr. Pamela Hayes (53:41.55)
Correct, that is mostly for the radiation oncologist to say whether or not they would need to treat you with radiation after your surgery.

Jessie Ott (53:45.931)
Okay.

Jessie Ott (53:52.91)
Right. And given that I was a 9.2 out of 10, I was told it could come back aggressive and fast. And so that's why I was recommended, right, for radiation. So what's your criteria then? What is the decision factors that went into me being on the meds for five years?

Dr. Pamela Hayes (54:06.17)
Correct.

Dr. Pamela Hayes (54:15.706)
So for you after you know, we had your your surgery and we saw that Hooray, there was no invasive component. So so that's when we say, okay definitively you have stage zero. So for in general when it comes to DCIS, we say your chances now after everything you've been through to have this particular

lesion come back is infinitesimally low. But what we do know is that patients that have these types of lesions, it's just saying like, there's something about your breast tissue that is kind of primed to wanting to have things develop in it. And so we want to make sure that we kind of not only reduce your risk of that lesion coming back, even though that's very low, but also to prevent you from

getting other high-risk lesions or getting a second occurrence of a cancer, just a new one that kind of pops up. And so that's where kind of endocrine therapy comes into play. so Tamoxifen is a selective estrogen receptor blocker and

What that does is it again blocks the receptor for estrogen in your breast tissue. And studies have shown about a 50 % reduction in both invasive and high risk lesions in patients that take that medication. Now recently they've also had studies done that showed benefit of even doing a lower dose of Tamoxifen, which is shown to be

as effective and causes less kind of side effects on the treatment if we use that lower dose. And so I will routinely use what we call low dose Tamoxifen. So instead of the standard 20 milligram daily dose, it is five milligrams daily or 10 milligrams every other day. And patients tend to like that. get less, again, what we call

Dr. Pamela Hayes (56:36.932)
kind of vasomotor symptoms, so kind of the hot flash, mood swings, fatigue that can come with taking estrogen blockers are just greatly reduced with that lower dose.

Jessie Ott (56:52.396)
Okay, so if I'm having fatigue, that's why.

Dr. Pamela Hayes (56:58.328)
Yeah, I'm sorry, I probably did that to you.

Jessie Ott (57:00.79)
Yeah. Well, no, it's interesting because we're doing dry January and I'm just, sleeping like nine hours, which is way more than my normal, you know, six or so. And I don't know if I'm just sort of a zombie, you know, or, you know, if my body is just really needing the rest. I don't know.

Dr. Pamela Hayes (57:24.58)
I mean, I'm sure there's, as we had talked about, everybody can respond very differently to medications, but it's not uncommon that the Tamoxifen, mean, estrogen is so good for so many reasons in the body. And then when you kind of remove some of that, it's going to have effects, even if at a lower dose, you know, I'm...

definitely not surprised that you don't feel quite right.

Jessie Ott (57:57.282)
Okay. Well, we are working out quite a bit too. So I'm sure that takes some toll. I mean, it's good for me, but it does wear the body out. So at least, well, we're trying to lose weight.

Dr. Pamela Hayes (58:10.744)
I mean, well good, good for you. mean, anything that keeps you active and also studies have shown that moderate activity in women, especially with hormone positive breast cancer, that even further reduces risk of recurrent disease. And so anything that you can do to keep yourself healthy in that regards is only going to help. And it doesn't mean that you have to be

you know, turn into a marathon runner or anything like that. But just getting out and walking every day, again, just a little bit of extra activity can hugely improve those risks. So I always encourage my patients, like I said, tiny, tiny changes can make big impact.

Jessie Ott (58:57.58)
Yeah, we walk two to three miles a day, not every day, but many days, probably four to six days a week. And we're trying to incorporate weightlifting twice a week. And then we have a gym membership at Hot Works, which is a hot sauna and it's isometric work. And so we're trying to do that once or twice a week. So we're really, you know, working hard to...

Dr. Pamela Hayes (59:05.358)
That was awesome.

Dr. Pamela Hayes (59:26.042)
I'm jealous, I've got young kids, I hardly have enough time to do anything.

Jessie Ott (59:29.87)
I know, I know you don't, you don't, you have to get up super early to get up to do all that. And, and we're flexible. We work from home. so, you know, that also is a benefit to that, not going into an office and all those things. So it is, it is hard. and I, but we're, we're trying is, is my point. And we're, trying to increase our metabolism, you know? And so we're eating smaller.

Dr. Pamela Hayes (59:52.88)
You're doing great.

Jessie Ott (59:59.31)
portions more often. So we're trying. We'll see. I've got to reduce my cholesterol and blood pressure. So hopefully there'll be some good results there.

Dr. Pamela Hayes (01:00:13.87)
Yeah, well, I always tell everybody just don't try and do too much all at once. Tiny changes. If you try to do big things, it's too hard to keep up with it. So tiny things at a time.

Jessie Ott (01:00:25.58)
Yeah, and I, this is not that abnormal for us, because we work out quite a bit, but the food part is different. It's not really for me because I've been doing it for about a year and a half on and off. And we really mentally prepared ourselves for it. And, but for her to try to get up and eat the first hour, like that's not a problem for me, but for her, it's like so hard. It is, it is hard and the older you get,

Dr. Pamela Hayes (01:00:46.842)
Yeah, I understand.

Jessie Ott (01:00:52.14)
you know, the harder it is to get in that habit, but you got to kick that metabolism. so anyway, that's the hope. I want to switch over to causes for a bit. you know, given that this is how it ties into my industry, which I've been in the beverage industry for over 20 years, and we're getting hit really hard. So the WHO in January of 23 came out and said, no alcohol is good.

So, you know, our government's like two drinks for men, one drink for women is fine, blah, blah, blah. But I will say that through my entire journey working with all three of the doctors with Texas Oncology, not one person asked me or mentioned it or told me to change or told said really anything.

about it. It's all about obviously fixing the situation that we're in and hopefully preventing it in the future. But now the Surgeon General came out and said, the suppliers now have to put Can Cause Cancer on the labels. And so I also feel just in my personal opinion, we're GMA people, Good Morning America on ABC.

Dr. Pamela Hayes (01:02:04.27)
Mm-hmm.

Jessie Ott (01:02:15.05)
And Robin had a very public bout with breast cancer. And so I don't know if they're doing it more than the other channels. I don't know, but they did it a lot. And I feel that our industry got hit hard really bad. I felt like they didn't go through all the things, but they stopped at alcohol, or at least they made sure that they blamed it on alcohol.

Dr. Pamela Hayes (01:02:35.15)
Mm-hmm.

Jessie Ott (01:02:44.654)
And okay, I mean, fine, but that's not the real story. That's not the whole story, right? And so for me, I'd like to just walk through some of the risks that I got here in my pamphlet. And then can we kind of talk about what you feel about alcohol and its effect and, you know.

Dr. Pamela Hayes (01:03:01.357)
Okay, uh-huh.

Dr. Pamela Hayes (01:03:11.523)
Yeah, will be generalities. don't, I, at least when it comes to, okay, that's fine.

Jessie Ott (01:03:14.508)
Yeah, that's it. Yeah, yeah, yeah, yeah. So I got to put my glasses on. Excuse me. So this is from Sarah Cannon, which is part of the, I guess it's part of the Texas Oncology or partner with them. Partner, okay. So this is a risk and they're saying being older in age, which we talked about already, earlier age when your period starts.

Dr. Pamela Hayes (01:03:29.41)
Yeah, we are partners.

Jessie Ott (01:03:43.466)
which Dr. DiPasquale said it's now 11.

Dr. Pamela Hayes (01:03:49.658)
as far as like the, the, you talking about like the average age of when? Uh-huh.

Jessie Ott (01:03:50.124)
I think then 13, it's younger.

Jessie Ott (01:03:56.206)
Yeah, the average age of women are it's it's used to be 13. guess it's now 11 or younger. Having dense breast tissue, which was my case. Having other people in your family, BRCA, of course. Having had radiation to the chest, which I don't know about that. Having breast cancer in the past. DES or synthetic estrogen. Now, would that be like an IUD?

Dr. Pamela Hayes (01:04:02.777)
Yeah.

Dr. Pamela Hayes (01:04:24.442)
No, that must be more with women that are taking like hormone replacement therapy.

Jessie Ott (01:04:30.264)
therapy. Drinking more than five drinks, beer, wine, liquor per week, which by the way, we're now at what number 10 or 11 or 12 being overweight and not exercising. So for me, it's like, yes, this is, this is a thing, but, but why are we getting hit so hard with it? I guess is, you know,

Dr. Pamela Hayes (01:04:40.46)
yeah.

Dr. Pamela Hayes (01:04:54.052)
Well, in general, kind of circling back, think, you know, all of those risk factors are not made equal. And in general, most of those are going to be, I wouldn't say, for a lot of times, anything that's going to increase your body's baseline estrogen is going to be.

an increased risk. So it just makes it's kind of one of those like, well, no doubt when you think about it, but it's like if you have a cancer that is driven and fueled by estrogen and progesterone, anything that increases estrogen and progesterone in your body is going to increase that. And not only that, because again, with your cycles, you're going to have these peaks where it kind of gets high and drops off high and gets dropped off. So it's like it's stimulated and it's relaxing, it's stimulated and relaxing.

Jessie Ott (01:05:48.014)
For me, for example, given the fact that I literally have had a period every 28 days since I was 13, that's the highs and lows that you're talking about.

Dr. Pamela Hayes (01:05:56.532)
Right. And so it's just because when you, when you go through puberty and start your cycles, that's when your body is ramping up this estrogen. And so it's just saying you, when you go from that, and then you have either late menopause, it's just length of exposure to that fuel that, is a part of it. And then obesity again, that is just,

ways that there's gonna be a higher level of estrogen in the body in an obese individual. And so again, it's just that same type of thing where there's gonna be more chances of stimulations in those cells. And so with all of that, it's talking about like how much exposure you have to estrogen. And so I think within that, again, with

alcohol intake, we can see kind of higher levels. It's one of those things where it's like moderation is key, right? So we can definitely see higher rates of issues in patients that are, of course, abusers of alcohol. And more so if we're also dealing with either liver injuries or things of that nature.

Jessie Ott (01:07:01.1)
Right. 100%.

Dr. Pamela Hayes (01:07:18.776)
Breast cancer is not one that I think of as being strongly related with alcohol intake as opposed to head and neck cancers, gastric cancers, liver cancers that are going to be far more associated with in patients that are drinking a lot more. But it's kind of a securitist risk that if an individual is drinking a lot more alcohol, their system may have.

more that they have to process and deal with.

Jessie Ott (01:07:51.63)
Yeah, I could see where, you know, for example, if I have a drink or two and it affects my immune system, right? Because that can happen. And if your immune system isn't strong enough to fight the cells, because you have cancer in your body, right? At all times, your body just expels it. Am I understanding that right?

Dr. Pamela Hayes (01:08:12.558)
Yeah, mean, that's definitely your immune system is constantly in surveillance and cells typically that are having mutations where they could turn into cancers or have malignant potential. They will typically send out signals that something is wrong and the immune system will take care of that.

Jessie Ott (01:08:35.714)
Yeah. Which the body's pretty neat.

Dr. Pamela Hayes (01:08:38.326)
It is. It's also slightly terrifying to be like, my body is constantly trying to kill me. It's a little bit of a morose thought. But in general, yes, your immune system, especially in other types of cancers, namely skin cancers, are kind one of the top things that we think about with patients that are on either chronic immunosuppression,

Jessie Ott (01:08:44.844)
hahahaha

Dr. Pamela Hayes (01:09:06.242)
or have other conditions where their immune system is really knocked down, that we see that plays a big role in the generation of those types of cancers.

Jessie Ott (01:09:17.176)
Gotcha. Okay.

Dr. Pamela Hayes (01:09:18.584)
Now I can't unfortunately speak to any expertise on the effects of alcohol on the immune system and how robust that may or may not be. But in general, again, like what I say with my patients, I don't really like them to take it while they're on active chemotherapy, but when they're in their kind of maintenance phase, in surveillance,

I usually do not have a problem with having a glass of wine here or there. It's mostly moderation that we talk about.

Jessie Ott (01:09:54.316)
Yeah, well, there's a big movement in our industry towards moderation, but also just not drinking. THC, CBD drinks have really come to the forefront. Tinctures with adaptogens, feel-good things, legal things. But with the rise of these non-alcoholic cocktails and beers, you're seeing a lot of

people substitute a drink here or there. Restaurants are getting better and better all the time about having mocktails on the menus and they're getting really good at it. And so I think that, you know, especially with the generations that are coming behind us, there'll be a lot less drinking, I would say. It's just in general, like the baby boomers in our generation. I don't know if you're my generation X or not.

Dr. Pamela Hayes (01:10:30.5)
Mm-hmm.

Dr. Pamela Hayes (01:10:49.778)
Yes.

Jessie Ott (01:10:52.148)
Okay, because I feel like our generation just followed the baby boomers. just did what, you know, okay, we'll just do whatever they did. It's the millennials that came in to swing in.

Dr. Pamela Hayes (01:10:58.746)
Well, again, I think in general, overall, think people are doing better about educating themselves on health and they're interested in, for better or worse sometimes, depending on what resources people are using to educate themselves. But I think there is with the internet and the ability to kind of educate yourself.

on a lot of things. think there is a push towards trying to kind of be a little bit healthier, understand the full repercussions of either alcohol abuse or smoking and anything like that that can increase your kind of health issues. And we're seeing less cases of smoking has been a lot less prevalent as we've learned a lot more about

the risks of smoking. And so I think that's the other thing is there's not really a good way to be able to say what is the safe amount of alcohol that doesn't increase your risk. And so in a lot of those cases, they just say, okay, the healthiest thing is then just don't drink. If we're not sure if it's going to be a problem for you or not, then of course the safest thing is not to drink.

Jessie Ott (01:12:24.462)
Yeah. Yeah. And that makes sense, you But I think it's, you know, it's... You look at all the processed foods people eat and all the, you know, all the other garbage out there and it's like... Why is that not cancer risk?

Dr. Pamela Hayes (01:12:39.866)
Right, yeah, but it's it's not But but I mean that that's that's a part of it too is what we were talking about you know on your list, you know obesity is it's definitely a risk and part of that is just You know we that that may be getting into you know, the just how hard life can be sometimes you know

Jessie Ott (01:12:50.093)
Yeah.

Yeah.

Dr. Pamela Hayes (01:13:08.836)
when it comes to finding healthy, balanced foods can be really challenging. But in general, like I said, in most times, I don't mind if patients have a cookie or a slice of cake or some ice cream, things like that. So again, I don't want them eating that for every single meal of the day, and that'd the only part that they get any nutrition.

Jessie Ott (01:13:35.33)
Right.

Dr. Pamela Hayes (01:13:38.21)
That's how anytime, because that's a big question that a lot of my patients will ask me is like, I've heard that we need to do intermittent fasting or that I need to cut out all sugar and things like that. And so I say, you you're going to hear a million different recommendations about a million different diets that this feeds cancer or this kills cancer. You need to eat this, but not this. And that's going to solve all of your problems.

Jessie Ott (01:14:07.086)
All

Dr. Pamela Hayes (01:14:07.992)
The problem is we're not gonna really ever have robust data on kind of any supplement or an exact diet or anything like that. So in general, a standard healthy diet, get some fruits, get some vegetables, get some good lean meats, all of that. But you can still have your coffee in the morning. You can still have a dessert here and there. You can still have a cocktail here and there. And overall, if...

otherwise your health is good and there's nothing else that I have any concerns about. I don't think that that is going to be the difference between you responding to your treatment or the risk of your kind of disease coming back when there are so many other modifiers such as, you know, having that routine exercise, continuing on your medications, continuing on your surveillance, that's going to be so much more important.

day to day than again a cookie every once in a while or a glass of wine every once in a while.

Jessie Ott (01:15:13.614)
Well, that's good. I don't really crave sugar very often, but I do love chocolate and I love peanut butter and I love oats. I'll do a peanut butter oat chocolate cookie every once in a while or make them without sugar and I just put them in the freezer and I'll just have one every once in a while. It feeds the...

Dr. Pamela Hayes (01:15:31.14)
That sounds amazing.

Jessie Ott (01:15:43.266)
feeds the need. Yeah. And I figure it's got, it's got oats in it, so can't be too horrible and it's got protein in it. So it's not, you know.

Dr. Pamela Hayes (01:15:44.494)
Yeah, go for it.

Dr. Pamela Hayes (01:15:54.522)
You can paint it however you want to do it. I'm saying it's fine, regardless.

Jessie Ott (01:16:00.274)
Awesome. Well, this has been really fun. Thank you so much for your time. Yeah, no, this is really great. I really appreciate just helping spread the word and educating us from a doctor, right? Not from necessarily a morning.

Dr. Pamela Hayes (01:16:08.962)
Yeah, absolutely. I enjoyed talking with you.

Jessie Ott (01:16:30.506)
news show. It's from someone that's active in the community helping patients every day. So I really appreciate it and I've learned a lot. So I thank you.

Dr. Pamela Hayes (01:16:41.082)
Absolutely, like I said, it's my absolute pleasure and I guess if you have any other questions in the future, you know, anybody could reach out to me again. I'm at Texas Oncology at Medical City in Dallas.

Jessie Ott (01:16:57.036)
All right, awesome. Well, thank you so much, Dr. Hayes. OK, bye. How is your recording?

Dr. Pamela Hayes (01:17:00.3)
You're so very welcome. Bye bye.

Dr. Pamela Hayes (01:17:09.931)
I mean, I.

Jessie Ott (01:17:09.966)
All right.