Breast Cancer in the Transgender Community: Addressing Unique Risks and Promoting Inclusive Healthcare

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Coming up on this episode of the
Healthy, Wealthy Wise podcast.

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Now, certainly you can have breast
cancer in both breasts at the same time.

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That does occur, but it's not, my
experience was it was not very common.

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Some patients who would get breast
cancer in one breast would say.

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Welcome podcast with Dr.

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William T.

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Choctaw, MD, JD.

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This podcast will provide you with
tools and actionable information

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you can use to help lead the way.

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Healthy, Wealthy, and Wise Life.

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It's powered by the over 50 years of
medical experience of this Yale University

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Medical School trained surgeon, who is
also a Western State Law School trained

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attorney, with executive experience being
a former mayor of Walnut, California, as

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well as the current chairman of the non
profit Servants Arms, and as president

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of Choctaw Medical Group, Incorporated.

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This is the leadership moment.

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Masterclass edition already in progress.

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Are there any questions?

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Any questions?

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Yes.

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Okay,

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excellent question.

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His question was, what's the age that
women would start doing mammograms?

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And the reason that's an excellent
question is that it's controversial.

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Uh, it used to be that you
started doing the mammogram at 60.

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Then they said, well, no,
I'll start doing it at 55.

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Then some said, no, I'll
start doing it at 50.

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So now my answer is, And ask your
respective physician, uh, but it's gonna

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be around about 50ish or so, you know.

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Some may do it at 4 to 5, some
may do it a little over, but it's

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gonna be around about that range.

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But it does vary, but you should
do the screening mammogram, again,

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because the mammogram picks up
lungs that are too small to feel.

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Yeah, of course.

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I'm like the entire circle.

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Okay.

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Uh.

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Uh.

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Do transgender women
have risk of cancer too?

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Transgender?

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Yes.

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Okay.

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Interesting question.

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Um, I would say yes, and the
reason is that transgender process

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involves hormone injection.

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Um, uh, because when we talk
about, uh, Uh, the breasts, and

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actually I want to show one slide.

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Um, when we talk about the, the breasts,

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Sorry about the call ins.

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I know, he's going crazy over here.

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Okay.

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All right.

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That's fine.

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Um, let, let me, they, they, the
breast tissue is ducks and labus.

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Uh, they're, they're like ducks
that go to the nipple 'cause

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that's where the milk goes.

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Right.

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And at, and then at the end
of the, of the duct, um, is

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like a little bunch of grapes.

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We call them LOEs.

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That's where the milk is made.

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Right?

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And that's based on hormones.

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Um, um, uh, uh, oxytocin
and other types of hormones.

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Those hormones, uh, basically are
felt to contribute to breast cancer.

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Oh, and that, that's one of
the reasons why women have

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more breast cancer than men.

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Now we have breasts, very little tissue.

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Um, but our rate is not as high as women
because of the hormones and the tissue.

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Transgender women.

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have the breasts, you know,
that's how they get the breasts.

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They have hormone injections.

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Now it's artificial, but the breast
is, it's still breast tissue.

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Um, and so their, their risk
is certainly higher than men.

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Uh, and so they, they
do have breast cancer.

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Thank you.

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Good question.

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Thank you for that.

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Good question.

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I would say at least once a year.

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I think, I think, now, again,
uh, in general, but certainly go

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to your healthcare professional,
see what they recommend.

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But in general, I think that's
usually the recommendation.

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I think Kaiser, go ahead.

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I think

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females should start having mammograms.

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Well, as I said, it varies
depending on who you talk to.

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Um, um, I, I would recommend,
you know, 50 and above.

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But talk to your doctor and
see what he or she recommends.

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Cause it, it, it changes.

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Different people recommend different ages.

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This is my point.

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For

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those of you that are online,
please unmute your microphone if

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you have a question or a comment.

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Any other questions?

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Yes, sir.

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I noticed I hear a lot of people
always, they have, I guess,

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massive, uh, Mastectomies?

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Yeah.

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Okay.

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And it's both.

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Ah,

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okay.

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Um, most, most of the times, the
question was, um, some people who

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have breast cancer ends up, end
up having bilateral mastectomies.

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Okay.

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Many times that's a choice.

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Now certainly you can have breast
cancer in both breasts at the same time.

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That does occur.

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But it's not, my experience
was it was not very common.

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Some patients who would get breast
cancer in one breast would say,

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you know, doctor I don't want to
worry about this other breast.

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Just take both of them off.

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Um, I personally would not do that
because I said well you know I'm not

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going to remove a breast that doesn't
have a disease because you can't change

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your mind about that after it's gone.

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However, there are patients
who do choose to do that, and

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that is done in some people.

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But most of the time, it's
usually just one breast.

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Breast cancer is not
universally bilateral.

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Okay,

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reconstructive surgery
is something that's done.

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Some patients prefer to have it done.

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These patients have mastectomies.

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where we're removing the breast.

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A number of times I would operate beside,
uh, the plastic surgeon who would operate

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beside me as I would remove the breast.

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He would then step in and then
do the breast augmentation, uh,

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to, uh, to replace the breast.

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And sometimes we can
do it at the same time.

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Other times patients will wait two or
three months later, once everything

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is healed, then they would go see the
prosthesiologist and have that done.

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A lot of my patients would plan to do
that and then by the time they've had

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their mastectomy, a couple weeks later
they say, you know what, I think I'm done.

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I don't want, you know, I'm done.

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Because you can wear, um, um, padding.

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You know, you can wear the special bras.

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So that you can wear the low cut gowns.

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Um, and no one can tell that
you've had a mastectomy or not.

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So it's not something that you need.

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for some women.

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And so my experience was more and
more and more, um, my patients who had

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the one, the single mastectomy would
just go with the bras and clothing

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and they would be okay with it.

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Oh, yes.

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Thank you.

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Thank you.

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Um, yes, you had a question.

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Um, what is the average age of breast
cancer and if it's less than, let's

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say, 50 years or 45 years, why the
mammogram is advised around that time?

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Well, that's a good question.

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Um, I use, as I mentioned,
breast cancer increases with age.

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It increases with age.

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So if you're 60, you're more likely to
get breast cancer than if you're 35 or 45.

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Um, um, and that's why I always
say ask your individual physician

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what he or she recommends because
it really does vary a lot.

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Uh, but what we know is that
it occurs in older women.

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So then the key is when do I start
screening and is there a downside

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to getting a mammogram earlier?

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Yeah, there might be a little
radiation, but usually it's not.

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But that's a judgment call.

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That's a judgment call.

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What is the age range for Kaiser?

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You know?

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Okay, it might be.

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Because it keeps changing, too.

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It keeps changing.

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Somebody would do a paper, and then
everybody would go out and change it.

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And that's why that number keeps moving.

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It keeps moving.

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Remission.

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Remission is that the cancer is gone.

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Or that

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Back.

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Yes.

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It can come back.

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It can come back.

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Lorraine, you had a

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question?

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Yes.

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The question of, of, uh, individuals
that decide to have, um, bilaterals.

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Um, could that be, um, because
of they have the type of gene

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that you were talking about?

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The BRCA, absolutely.

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Like Angela Jolici decided.

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Yes, the BRCA.

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Right.

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Yes, absolutely.

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Those are, those are probably the ones
that get the battle out of them the most.

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And the reason is that they
know that their chance of

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getting breast cancer is high.

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relatively high.

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And they just say, you know what, I
don't want to think about this anymore.

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You know, I want it done.

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And that's fine.

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Yep.

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Yes.

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Uh huh.

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Does that mean that it's still
there for them to get cancer again?

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Because I know somebody had made,
um, mentioned about remission,

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but it's still like cancer.

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And it's like, I guess
it's not really going away.

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And, and, and, and I
understand your question.

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A lot of times it'll depend on, depend
on what your doctor means by remission.

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And that's probably always a
good question to ask your doctor.

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If she says, well, you're in remission.

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He said, well, what, what
exactly does that mean?

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Because it can mean either
one of those things.

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It could mean the cancer's there and it's
been growing, but it stopped growing.

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Right.

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It can mean the cancer's there, it's been
growing, but now it's getting smaller.

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It can mean that the cancer was there,
but now it's completely gone in terms

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of how we see it, uh, type thing.

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So it really depends on what your
doctor defines your mission to be.

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Uh, yes sir.

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Can I

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ask you a remission question?

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Um, hello?

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Yes.

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One moment please.

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If you dictate a person has, uh, its own
remission, that means cancer is gone.

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If it comes back, is it the same
or is it a different species?

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It would be the same, usually.

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It would be, more likely than
not it would be the same.

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So, yeah.

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Yes.

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Okay.

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No, it's, it depends on the patient.

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It depends on the patient.

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It depends on what that
physical condition is.

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That's why all these things about exercise
and eating right and not drinking and

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all that sort of stuff, it depends on
where that body is, um, at that time.

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Uh, because a lot of it's gonna depend
on the body's ability to fight the

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cancer and if that body is much weaker.

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Then, theoretically, you could
say the cancer is strong, so it's

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related to what that body's condition

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is.

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Those who had cancer, it was in
remission, and then when it comes

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back, I guess sometimes they say it's
very aggressive, and then the person

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don't live as long, they die, so, you
know, it comes back, and, um, I guess

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it's more aggressive than the person.

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Well, it depends on, it could be
more aggressive, but I would argue

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the person is probably weaker.

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You know, that when they first got
it, they were of a certain age and

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a certain body habitus or whatever.

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But then if you tell me that there have
been so many days and months and years

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of, fighting cancer, you know, more likely
than not, at the end of their process, and

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00:11:48,980 --> 00:11:53,400
they're older, and we're all, we're all
older, and by being older, we're not as

250
00:11:53,400 --> 00:11:55,069
strong as we were when we were younger.

251
00:11:55,390 --> 00:11:57,500
Uh, but it depends on the individual.

252
00:11:57,660 --> 00:11:57,910
Yeah.

253
00:11:58,399 --> 00:12:00,609
Someone online has Online,
did you have a question?

254
00:12:01,720 --> 00:12:03,180
Yes, I had a question.

255
00:12:03,300 --> 00:12:05,900
Um, it's multiple layers.

256
00:12:05,940 --> 00:12:09,750
So the first portion, well,
first of all, can you hear me?

257
00:12:10,669 --> 00:12:11,470
Because I'm driving.

258
00:12:11,540 --> 00:12:12,740
I don't know if you can hear me.

259
00:12:12,829 --> 00:12:13,189
Hello?

260
00:12:13,669 --> 00:12:13,850
We're good.

261
00:12:13,850 --> 00:12:14,150
Can you

262
00:12:14,150 --> 00:12:14,520
hear me?

263
00:12:15,150 --> 00:12:15,540
Okay.

264
00:12:16,250 --> 00:12:25,330
So, um, the first part is, if some
people elect to have, um, of course,

265
00:12:25,360 --> 00:12:32,755
the reconstruction surgery, Um, after,
um, having breast cancer, um, I was

266
00:12:32,755 --> 00:12:39,615
wondering, what is the percentages
of the, um, prosthesis failing?

267
00:12:40,235 --> 00:12:49,235
And then the second part to that is, when
the prosthesis fails, what is the, um,

268
00:12:52,505 --> 00:12:56,464
and the debris is within the tissue,
what is the percentage of being able

269
00:12:56,464 --> 00:12:58,605
to remove all of that successfully?

270
00:12:58,984 --> 00:13:00,165
I guess that's what I would like to ask.

271
00:13:00,915 --> 00:13:02,964
Okay, uh, let me make sure I understand.

272
00:13:03,124 --> 00:13:05,564
The prosthesis is just an object.

273
00:13:05,805 --> 00:13:07,624
It doesn't succeed or fail.

274
00:13:07,924 --> 00:13:14,094
It's just something that's placed there,
uh, to give, um, um, a certain tissue,

275
00:13:14,354 --> 00:13:16,875
a certain form, and for appearances.

276
00:13:17,224 --> 00:13:20,415
Um, so it doesn't succeed
or fail in general.

277
00:13:21,290 --> 00:13:27,879
So by failure I mean that it, the
prosthesis is no longer holding its shape

278
00:13:27,940 --> 00:13:33,019
and so the item, the substance that was
inside of it is now leaking outside of it.

279
00:13:33,030 --> 00:13:34,440
So to me that's failure.

280
00:13:34,639 --> 00:13:35,369
Uh, okay.

281
00:13:35,440 --> 00:13:38,490
The prosthesis can be replaced
and you just replace it.

282
00:13:38,819 --> 00:13:39,149
Okay.

283
00:13:39,150 --> 00:13:40,970
And what happens to that substances

284
00:13:41,000 --> 00:13:44,099
that are now within your body
and is that easily removed?

285
00:13:44,730 --> 00:13:47,839
Uh, if you're talking about, it sounds
like you're talking about an implant.

286
00:13:47,839 --> 00:13:47,889
Okay.

287
00:13:48,220 --> 00:13:51,200
Um, an implant is, is,
is a type of prosthesis.

288
00:13:51,640 --> 00:13:56,110
In general, and again a plastic surgeon
can answer this better than I, but

289
00:13:56,130 --> 00:14:01,500
my experience has been that once the,
um, prosthesis is removed, let's say,

290
00:14:01,719 --> 00:14:03,810
some prostheses, prostheses leak.

291
00:14:04,680 --> 00:14:09,110
Uh, and so, uh, doctors remove them and
replace them, and my experience, what

292
00:14:09,110 --> 00:14:13,750
I've seen, uh, has been the patients
usually do pretty well, but again, I

293
00:14:13,750 --> 00:14:18,090
don't put them in and take them out,
and so I don't know a hundred percent,

294
00:14:18,110 --> 00:14:22,440
but most times they can be removed
and the patients do reasonably well.

295
00:14:22,849 --> 00:14:24,579
Okay, thank you so much.

296
00:14:25,009 --> 00:14:25,439
You're welcome.

297
00:14:25,839 --> 00:14:26,349
Okay.

298
00:14:26,379 --> 00:14:26,709
Yes.

299
00:14:27,039 --> 00:14:27,509
Yes, sir.

300
00:14:28,060 --> 00:14:29,800
As a father of two girls.

301
00:14:29,810 --> 00:14:30,149
Yes.

302
00:14:30,209 --> 00:14:32,930
Um, what's the best way we can help?

303
00:14:33,670 --> 00:14:37,849
Sometimes we're kind of like limited
in that, not limited because of

304
00:14:37,849 --> 00:14:41,180
knowledge, but limited in the
sense of that's more a woman thing.

305
00:14:41,410 --> 00:14:41,709
Okay.

306
00:14:42,569 --> 00:14:43,389
How can we help?

307
00:14:43,399 --> 00:14:45,800
How can we more effective?

308
00:14:47,454 --> 00:14:47,885
Okay.

309
00:14:48,055 --> 00:14:50,005
I, I, no, excellent question.

310
00:14:50,115 --> 00:14:55,064
I would say, uh, have regular checkups,
regular physicals, and as a part of

311
00:14:55,085 --> 00:14:58,595
their regular physical, have them
begin in the habit of examining the

312
00:14:58,645 --> 00:15:00,494
breasts, their breasts themselves.

313
00:15:00,605 --> 00:15:03,435
Because part of it is just becoming
familiar with your breasts.

314
00:15:03,860 --> 00:15:07,860
You know, and as you, you know, you're
washing in the shower or bathtub

315
00:15:07,860 --> 00:15:11,430
or whatever and you examined it and
saw, you know, I didn't feel this

316
00:15:11,440 --> 00:15:14,660
before, then you feel a little more
or whatever, uh, that's what they saw.

317
00:15:14,870 --> 00:15:16,340
I think that's probably the best thing.

318
00:15:16,610 --> 00:15:19,060
And just eat healthy, exercise, basically.

319
00:15:20,599 --> 00:15:20,949
Okay?

320
00:15:21,909 --> 00:15:22,359
Yes, sir.

321
00:15:23,339 --> 00:15:23,619
Okay.

322
00:15:24,430 --> 00:15:25,239
Yes, sir.

323
00:15:25,619 --> 00:15:25,889
Uh

324
00:15:25,890 --> 00:15:26,279
huh.

325
00:15:26,279 --> 00:15:26,669
Yes.

326
00:15:26,669 --> 00:15:29,784
The only other thing
about visiting is laundry.

327
00:15:29,905 --> 00:15:31,267
This is what they were saying.

328
00:15:31,267 --> 00:15:35,545
I don't know how true this is, but
it has no cause, no fever, no nothing

329
00:15:35,545 --> 00:15:40,805
in it, and as you do, you get some
symptoms, but not like the symptoms

330
00:15:41,004 --> 00:15:43,780
you get with the old type virus.

331
00:15:43,780 --> 00:15:47,249
The new virus is going to be
more contagious, more dangerous.

332
00:15:47,249 --> 00:15:47,564
Okay.

333
00:15:47,944 --> 00:15:49,951
But anyway, we went in
and got enough shots.

334
00:15:49,951 --> 00:15:50,346
Okay,

335
00:15:50,346 --> 00:15:50,741
okay.

336
00:15:50,741 --> 00:15:52,718
Now, I understand your question.

337
00:15:52,718 --> 00:15:59,254
Uh, the reason why you want to get the new
shots is because or updated shots, they

338
00:15:59,254 --> 00:16:03,644
call them boosters, is if you're over 60.

339
00:16:03,925 --> 00:16:07,945
Because the COVID, the infectious
season is coming back around, you know,

340
00:16:07,985 --> 00:16:11,505
usually that hits around about December,
January, it's coming back around.

341
00:16:11,505 --> 00:16:15,184
So I, and I, my wife and I got
the, got the same thing you did.

342
00:16:15,854 --> 00:16:22,790
So being over 60, Uh, we got the booster
shot, which also affects the new bars.

343
00:16:23,060 --> 00:16:26,760
There are differences between the
new bars or the latest, the latest.

344
00:16:27,515 --> 00:16:33,035
Variation of the virus, um, from
the others, but, uh, it does, in

345
00:16:33,135 --> 00:16:38,145
fact, it may not be as detectable in
terms of symptoms as the other, but

346
00:16:38,744 --> 00:16:43,965
the impacts on patients in terms of
mortality and morbidity is still great.

347
00:16:43,965 --> 00:16:46,245
So the recommendations, you get it anyway.

348
00:16:46,275 --> 00:16:47,565
So that, that was what we did.

349
00:16:47,735 --> 00:16:48,205
That's what I did.

350
00:16:48,685 --> 00:16:50,275
Did I, did I explain it to them right?

351
00:16:50,435 --> 00:16:50,895
Yep.

352
00:16:51,255 --> 00:16:51,675
Okay.

353
00:16:52,135 --> 00:16:52,805
Very good.

354
00:16:53,625 --> 00:16:54,664
Thank you very much.

355
00:16:54,685 --> 00:16:55,445
God bless.

356
00:16:55,695 --> 00:16:56,695
Have a wonderful day.

357
00:16:56,695 --> 00:16:56,769
Bye bye.

358
00:16:57,185 --> 00:16:57,814
Thank you, sir.

359
00:16:58,305 --> 00:16:58,814
Thank you.

360
00:16:59,324 --> 00:16:59,814
Bye-Bye.

361
00:17:00,005 --> 00:17:01,935
Thank you, Jay.

362
00:17:02,064 --> 00:17:02,814
Thank you, sir.

363
00:17:03,819 --> 00:17:07,000
Thank you for listening to the Healthy,
wealthy and Wise Podcast with Dr.

364
00:17:07,000 --> 00:17:09,520
William t Choctaw, MDJD.

365
00:17:10,050 --> 00:17:13,860
You can listen again to this and
any of the previous episodes.

366
00:17:14,099 --> 00:17:21,960
Leave a comment or pose questions to
the doctor by going to www.twp.com.

367
00:17:22,319 --> 00:17:27,660
That's www.thwwp.com and you've got it.

368
00:17:28,329 --> 00:17:31,270
It's also available wherever
you get your podcasts.

369
00:17:32,140 --> 00:17:36,020
Be sure to follow, like, share, and
subscribe if you haven't already.

370
00:17:36,300 --> 00:17:39,190
Then tune in for the next
episode of the Healthy, Wealthy,

371
00:17:39,190 --> 00:17:40,790
and Wise podcast with Dr.

372
00:17:40,790 --> 00:17:41,349
William T.

373
00:17:41,349 --> 00:17:42,490
Choctaw, M.

374
00:17:42,490 --> 00:17:43,380
D., J.

375
00:17:43,380 --> 00:17:47,210
D., a production of Changemakers
Communications, LLC.