Perspectives of Medicine

Breast Cancer Diagnosis

One of the first questions I asked Dr. Teshome, was how early her patients receive their breast cancer diagnosis and the ways this impacts their perspective on their life choices. 

"About half of my patients come into my clinic asymptotic... with more localized disease which is considered curable cancer. They often find out they have developed breast cancer after routine mammogram screenings. Patients will often try to come to an understanding of why [breast cancer] is happening to them. The hard thing about this as a doctor is that [the cause] is not a question we can answer. We are always trying to figure out risk factors that could be modified to decrease cancer risk like obesity, alcohol use, smoking, etc, but there are things we can't change like age and unknown exposures. This may not be satisfying for patients, but something I always want them to walk away with is that they did not cause this. And without certainty, it's hard to give a patient an answer about what may have caused their diagnosis."

We also discussed how without complete certainty of what caused a diagnosis, providing a patient with a list of possibile exposures to EDCs and carcinogens can cause patients to be overwhelmed. This can end up being more harmful rather than informative to the patients who have already received devastating news.

Trends and Risk Factors of Breast Cancer 

I asked Dr. Teshome if there were any trends of cosmetic use that she suspected may impact breast cancer diagnosis. This led to a conversation about the identifiable risk factors of breast cancer.

"It is hard in our practice to know what causes breast cancer, but there is research that looks at different risk factors of breast cancer. I recently saw a study looking at the Black women's health study which looked at hair product use and breast cancer incidence. They found a potential increased risk in breast cancer among women who used hair relaxers very heavily. Before this study, I hadn't been aware of these exposures but there are still common risk factors. Some of the risk factors are age, sex -women are more at risk than men-, estrogen exposures -when you had your first period and when you start menopause-, family history, having children and breastfeeding. Even knowing these risk factors, it is hard to identify an exact cause other than the pure genetic link."

Demographics of Impacted Patients

We discussed how race is important to breast cancer diagnosis which led to the question of whether or not Dr. Teshome has directly seen demographic and racial trends of breast cancer incidence within her practice. 

"My hospital doesn't see everyone and mainly only sees patients with insurance. I think the patients I see probably follow the demographics of Texas. It's hard to see patterns because so much of my work is one-on-one, unlike the research you are looking at. This is kind of the separation between public health and medicine."

We then began to discuss how the perspectives that come from public health emphasize the patterns of impacted patients.

"Having a Master in Public Health helps me in my interactions with patients because I have a greater understanding of healthcare systems and the idea that individuals live in communities that can impact their health. The broader perspective helps strengthen my one-on-one interactions."