Building The Noise with Dr. Rachel Brem: EPISODE 011

SPEAKER_02 0:00

When I was 37 trying out some ultrasound equipment, I found my own breast cancer. Um so here I am at the end of a busy day, uh charged with picking ultrasound equipment. So I asked all the vendors to bring their stuff in. Um, and I found my own breast cancer. And it was at that moment at the first inkling of the Brem Foundation uh started, which is about educating and empowering. And uh I realized I felt so lucky when I looked at the screen and knew I had breast cancer because all of my patients, so many of them get that information and haven't spent a life studying, thinking about, and strategizing what to do. Welcome to the building the noise podcast.

SPEAKER_04 0:47

Ladies and gentlemen, welcome to the Building a Noise Podcast. My name is Matt Teresco, and with me today is a fantastic breast cancer innovator, advocate, and physician, Dr. Rachel Brem. She's the chief medical officer of the Rachel Brehm Foundation to defeat breast cancer. Uh, and really, Dr. Brem, where I'd love to start is why do you do what you do?

SPEAKER_02 1:12

So um, you know, I am thrilled to be part of the Brem Foundation to defeat breast cancer. I'm the chief medical officer and one of the co-founders. We've been, we just celebrated our 20th year. I do it because breast cancer has impacted everyone, and it's impacted me personally and starting from a very young age. At the age of 12, my mother had breast cancer. Um, she was told she had six months to live. Spoiler alert, she lived 44 years, got to raise us, see grandchildren, great-grandchildren. So little did I know that I was going to be the beneficiary of early detection before we knew how important it was. And then as a 12-year-old, uh, I decided I didn't want other young people to be impacted by breast cancer as we were, because we were profoundly impacted by it. My mother had very extensive uh treatment, surgery, all kinds of things. So I decided that I would go into medicine and uh was so lucky to be at Columbia Medical School in the 80s when we were first seeing the dating that we could decrease the death rate from breast cancer with mammography. And so I decided I wanted to be part of that. Um, and you know, interestingly, I had no idea what radiologists did before I started medical school, and here I am so many years later, really being part of the uh incredible impact of imaging on breast cancer. Uh, and we've seen a 50% reduction in the death rate from breast cancer. So let's say the second half of the story, which is at the aid of when I was 37 trying out some ultrasound equipment, I found my own breast cancer. Um Wow. So here I am at the end of a busy day uh charged with picking ultrasound equipment. So I asked all the vendors to bring their stuff in. Um, and I found my own breast cancer. And it was at that moment at the first inkling of the Brem Foundation uh started, which is about educating and empowering. And uh I realized I felt so lucky when I looked at the screen and knew I had breast cancer because all of my patients, so many of them get that information and haven't spent a life studying, thinking about, and strategizing what to do. So that that was sort of the first inkling of the foundation.

SPEAKER_04 3:37

That's fantastic. We just had a guest on recently, uh Abigail Johnson, who got her diagnosis very around the same time period as you, around 36 years old herself, uh was told stage two, um, and ultimately that turned out to be stage four. Um, it was in all of her bones. But I think uh uh in her concern, it was the lack of awareness and discussion in families, but also from from clinicians around what is the right age to begin mammography.

SPEAKER_02 4:12

Well, that's a great point, Matt, because we have strong societal recommendation as to when to start. But sadly, they're all different, very confusing. So, one thing is that um, you know, it confuses women, and some people don't go because of that. But the other reality today is that there is an alarming rate of increase in cancer and breast cancer in women under 40. And no matter what society listen to, we don't recommend screening mammography in women who don't have increased risk under the age of 40. So that might sound reasonable, but then think about these two facts that um the the incidence of breast cancer in women under 40 is increasing by 70%, and also um that um they have no screening in women under 40. So uh the Brem Foundation and others, I work with um a company called B Sound, very exciting, using ultrasound direct to consumers. So again, women can be empowered with information, and that's what we're all about. So there we all are.

SPEAKER_04 5:23

That's fantastic. As you think about that that 70% increase in patients under 40, yet there are no guidelines and or are no uh spots that patients can go to understand their risk, and even I think we've discussed this that uh many patients see the term average risk and don't think that that applies to them. Uh, what are your recommendations to patients today as they think about empowering themselves if they have a family history or if it's just a gut feeling?

SPEAKER_02 5:51

Well, let's get out with the family history statement. Remember, three-quarters of women, 75% of women who have breast cancer have no other risk factor except being a woman. So we can't just screen people with family history. We'll miss three-quarters of women. So that's one important thing. The other thing is that this increase in young breast cancer is a new phenomenon. And that's why it's so important that we address it now. Things like B sound, and we do have ways to find information. Bremfoundation.org, the website, has an enormous amount of information about screening, about young breast cancer. But I want to add to that, it is very important that women who don't have a family history who are at average risk, the 75% women have breast cancer, um, have to start at 40. Even though some societies, the American College of Family Physicians, just came out with a recommendation to start at 50 and get a mammogram every other year. But I can tell you a lot of my primary care physician friends come to see me starting at 40 every year. So think about that. And then, right? That's a and then the other thing is that even the American Cancer Society says start at thinking about it, consider it between 40 and 45, every year from 45 to 54, and every one to two years after that. Um only the American College of Radiology, the American and the American College of Surgery says get a mammogram starting at 40 every year. But what and the United States Preventative Services Facts Task Force recently changed its recommendation from starting at 50 to 40, which is great, but they didn't go far enough because they said every other year. And I want to talk about that for a minute. Every societal recommendation that recommends mammograms less than every um year starting at 40 says more women will die. And yet they continue to recommend that. And you might say, why, or you will say why. The answer is the harms of mammography. And according to them, the number one harm is not what you think, it's the transient anxiety women will feel if they get told they have to go in for additional screening or have an additional test or even get a minimally invasive biopsy to find out if they indeed have cancer. And that is maddening. Are we not powered educated women in 2026 or what? Yeah, that's that decision. And the anxiety is transient. And the thing of that is that um if you tell someone like the patient that you were talking about, the woman you were talking about, that they have incurable metastatic breast cancer, they are much more anxious than if you tell them they need another mammogram, an ultrasound, or even a biopsy.

SPEAKER_03 8:46

Yes.

SPEAKER_02 8:47

So the answer is to the people listening, if you have average risk, start at 40 and get a mammogram every year. If you have a family history uh of a first degree relative, then start five to ten years earlier than the age of your family member.

SPEAKER_01 9:04

That's fantastic.

SPEAKER_02 9:05

If you have dense breasts, which half of the women get screened, a mammogram, even a 3D mammogram, is not enough. You have to get ultrasound or MRI to find additional cancer.

SPEAKER_04 9:18

That's really important to point out. As you referenced, uh it not not just a 3D ultrasound, but you had to say ultrasound, 3D mammogram.

SPEAKER_02 9:29

And and some practices will say, oh, you don't need any additional, even though you have um even if you have a dense breasts, a 3D mammogram is the additional screening. It is not. And the reason it's not is because it's still a mammogram. And on a mammogram, dense breast tissue is white and cancer is white. So there's a masking effect. Trying to find a specific cloud in a cloud-filled sky. So you've if you have dense breasts, then you have to advocate for yourself and get ultrasound or MRI. And if you have a further increased risk, if you have um a greater than 20% lifetime risk by the Gale model or the tire Cusic model or the model that we have online at Checkmate at BrumFoundation.org, then you need to get an MRI every year. So we have to do risk-based screening, not a one-size fits-all anymore.

SPEAKER_04 10:25

Yeah. What are your thoughts when it comes to genomics and looking at our the genes that we were born with? I know that BRCA for a long time has been thought to be the end-all be-all when it comes to breast cancer and other, you know, uh cancers, including cervical, but I know that's just two of what, 70, if I'm not mistaken?

SPEAKER_02 10:44

That's exactly right, Matt. 70. So we now have at least 70 genes that are associated with a substantially increased risk of breast cancer. Only 5% of breast cancers are genetically uh mediated. But it's important to realize you can get that gene from your mother or your father. So if there is no breast cancer in your mother's family, but tons in your father's family, it's possible, right? And those that believe that everybody should get tested, because any death from a genetically mediated cancer is a failure of medicine. And then the final thing is it's very important to realize that in all comers, the prevalence of these genes is one in 400. In certain populations, like Ashkenazi Jews, it's one in 40. So unequivocally, every Ashkenazi Jew should get tested because they are at substantially increased risk. They are at a high-risk population.

SPEAKER_04 11:44

And if my genomics background serves me correctly, that's most of those that are Jewish in the United States. Um, there's a small population of Sephardics, but nonetheless, if you have Jewish ancestry, definitely again following Dr. Brem's recommendations here for you as well. And I know that you know, you people hear the word battleground, they worry about where they get access to those. And I know that you have wonderful resources on the Brem Foundation, but one of the elements that I found really fascinating about the work that the Brem Foundation was doing was partnering with organizations like Lyft to ensure that you could overcome those social determinants of health that many patients face. You can tell our audience a little bit about that.

SPEAKER_02 12:25

Sure, absolutely. But let's uh talk about um high-risk populations. So, breast cancer is not an equal opportunity disease. Black women die 40% more frequently of breast cancer. They get more aggressive cancers called triple negative breast cancers more frequently, kind of the kind that's associated with a genetic mutation. And so um uh it's very important to, you know, you might say that the Brehm Foundation is for equal access to care. And we're not. We are very strong proponents of equal access to excellent care, and that is different because it makes a difference in outcome and access to the latest technologies, artificial intelligence, 3D mammography, all kinds of things. So um, you know, the black community um is challenged with access to the latest technology and to a much higher rate of breast cancer mortality. Um, so the reason, you know, we the Brent Foundation is really uh a terrific organization that's tried to identify the needs to break down the barriers for early detection. And the reason that's so important, and it's really important for the you know, the people on listening to this podcast, um, you know, we kind of sort of do have a cure for breast cancer. It's called early detection. Okay. And if we detect cancer early, we have almost a 99% five-year survival. Not a cure, but pretty close to a metric for cura, right? So, you know, um why uh and and we know that underserved communities often have later cancer diagnosis because of the inability of care. So the Brem Foundation tried to figure out what are the challenges to access. And that's how we started the Wheels for Women program, where we partner with Lyft and federally funded health centers where the most underserved women get their care, identify those women that that's a barrier to going and getting their mammograms. And you know, from a cost perspective, it's important to realize that they uh by law, since the Affordable Care Act, uh, women who have any insurance, uh, a screening mammogram is free. No copay, no deduction. So if we can get the women there, we can move closer to more early detection.

SPEAKER_04 14:48

Amen. That that that is the goal of all of the work that we do uh at Arco is ensuring that patients are educated, they're empowered, that they're not finding out the information when they needed it 10 months ago, 10 years ago, whatever it may have been, that they are on the cutting edge to the best of their ability so that when something does come their way, they're ready for it. And that's what I love that you've done at the Brem Foundation. If I could even give you kudos for doing the research as well to identify the barriers for different communities, I'm sure that you uncovered quite a few different types of barriers for different communities. If you don't mind sharing some of your work there.

SPEAKER_02 15:30

So uh obviously the Wheels for Women program. Um, and one of the things that's difficult about that is we have so many requests that we can't meet all those requests. And the Brunt Foundation has been spending an enormous amount of effort uh with resources to try to answer as many of those requests. We get requests from all across the country. Um, in addition, we have our uh our B Fund where we support direct care in the underserved community. So we identify women who wouldn't otherwise get care that they need, um, not only that they deserve, but that is their rights. So we support that. And then the third, so we have a three-pillar approach. We support care in the underserved community. We support education because knowledge is power. We've developed um really fun award-winning videos uh with on various topics. Overall, our pushback video, which is overall about breast cancer. What is dense breast tissue? Am I too young to have breast cancer? What should I ask my doctor? Um, and those are on our website through a partnership with WebMD. They've been seen by literally millions of Americans in 70% of the hospitals in the U.S. So that's fantastic. We also have a really terrific interactive uh risk assessment tool called Checkmate in English and Spanish on our website to see if you are, it won't give you your your definitive risk, but it will see if your risk is high enough that you should speak to your physician about earlier screening or more screening. And finally, we work very hard for meaningful um legislation so that with that respect we can break down barriers. So we testified um recently for the Early Act, which is to support reappropriations of the CDC for information, funds for information for underserved communities and young women, so needed. Very supportive of the Find It Early Act. We have wonderful members of Congress that are our partners. Um, and we do this at the state and national level. And uh, you know, one of the things that we discussed that we're so proud of is um the governor of Maryland signed into law a new law uh that uses mammograms in a completely different way. So it turns out that if you have a mammogram and you have calcifications in your arteries, not the kind of calcifications that are a sign of cancer, but calcifications in your arteries, then you have a substantially increased risk of cardiovascular disease. And nobody tells women that. It's free, it's no additional tests, it's simply additional information. And it's so actionable, right? If you have it, you can go on statins, lifestyle, see a preventive cardiologist, get a coronary CT. Um, uh cardiovascular disease kills more women than breast cancer. And so we have that information, and now we are forcing the hands of all radiologists to report that and telling women, if they do have that, that they should speak to their physicians about how to act on that so that uh they can impact their truly life-saving impact. So we're very excited about that.

SPEAKER_04 18:52

That's amazing. And we know that that which takes place in the states is what ultimately gets to the federal level. So, congratulations to you and the team on getting that accomplished in Maryland. We hope to see that continue in other states. Are there any states that our uh our audience should be aware of that that is currently in discussion? And we talked about this with uh Abigail Johnson. Sometimes you have to vote with your feet in healthcare, and that may be choosing where you go to get care or going to the polls. So uh if you're familiar.

SPEAKER_02 19:23

Yes, so we're um working with colleagues in various states, probably not a great idea because we're not close enough yet, but we've learned of how to do this because we've done it with dense breast tissue uh legislation. Now there's a national bill. So we're hopefully targeting New York next, um then working on federal bills as well. And I think we uh we've learned so much from how we advocated for got meaningful legislation about dense breast tissue that we hope this will be the first of 50 states as well as state legislat, as well as federal legislation. Um, and I think we have lessons learned for how we did it with dense breast tissue, so hopefully we can do it faster and better.

SPEAKER_04 20:05

That's fantastic. And and as you said, if patients have questions or if they don't understand how to maybe proactively approach different situations with their providers, they can find that information at the Brem Foundation's website, correct?

SPEAKER_02 20:17

Absolutely. Bremfoundation.org.

SPEAKER_04 20:20

Fantastic. So uh just a couple of points I want to point everyone to, and we will ensure that we include this in the notes as well. Obviously, the Brem Foundation itself, wonderful site filled with educational opportunities for patients to know uh obviously their risk with the checkmate program uh built in there, but also how to navigate breast cancer treatment, what what it's all about, what are the different phases of it, and how to be best prepared for that if that does happen. Uh be sound, as you reference uh with regards to your partnership in identifying uh breast cancer as early as possible with ultrasound for all. And then B Fund. Uh and if any of uh if if you're okay with this, if any of our pharmaceutical partners that are out there that are in that breast cancer space want to do what's right for patients by ensuring that these uh patients have the tools and resources available to them to find that breast cancer early, we would hope that you can would support the B Fund.

SPEAKER_02 21:19

I want to say, you know, we have a mechanism for that. We have a corporate advisory board. Um you know, uh members include GE and Whole Logic, Bristol Meyer Squib, um a number of pharmaceutical companies, and we're so grateful for that. Um so if there is anybody uh on the podcast that wants to support our efforts to really wipe out deaths from breast cancer, brumfoundation.org, we have mechanisms for that. We would welcome that opportunity. We need that support. We can't um answer all the needs for either our B Fund or Wheels for Women. Um and we would be so grateful for support. And we are extremely Extremely responsible about shepherding funds given to us. And it will be a life-saving decision.

SPEAKER_04 22:09

100%. And having worked with many of those organizations that you've referenced, they're always looking for the so what, the what has the funds, what have the funds been been used for? We can point to some amazing outcomes that not many organizations are able to point to, that they've had the ability to push across the goal line, like what's taking place in Maryland, like developing your Reals for Women program. Those are all actionable elements that mean real change to the patients that you serve. And honestly, the dollar could not be spent any better to help women in our community. It does, to me, I would love your take on this. It felt like women's health has fallen off the radar for many. And we need to get that back in front.

SPEAKER_02 22:52

Well, there are a couple of things that are so important. You know, women are the kingpins of families and they take care of their children, their husbands, their homes, their work. And so often they come l last. And that's why it's so important to raise awareness for that so that women don't because everybody needs you for that reason. Um and the other thing is, you know, the Brenn Foundation is all about empowerment. And so often insurance is the limiting factor. You know, you know you need an ultrasound, you know you need an MRI. It's requested, insurance denies it, and you walk away saying, Oh what? That's not okay. You call the insurance, you advocate for yourself. Um, you know, we like you to be respectful, but you know, we want you to raise your voice and do be heard, be forceful, and don't take no for an answer, right? We you know, we always are taught to be good girls. Don't be a good girl, be a loud girl that advocates for yourself. I can't tell you how often, you know, at one of the Brem Foundation educational events, we have, you know, educational events for all from the throughout uh the socioeconomic, you know, from the most underserved to the most privileged. And um, and no matter who you are, you know the pink ribbon, but you don't know that you have to call your insurance company and advocate it. Yeah, so often after that, people will tell us, because of that, I called my insurance and a small curable cancer was found. So what could be more important than that?

SPEAKER_04 24:30

Could not agree more. And and as I'll point back to our guest Rachel Brem, who is a lawyer uh and helps on those types of discussions. If you do run into any trouble, I'm sure the Brem Foundation uh can also be of assistance. But having those conversations, knowing what to ask, knowing where to look in their medical policies, they could be telling you no, and it could be something that could be covered, right? It it's just the way of the system.

SPEAKER_02 24:55

You know, uh no does not mean no in this situation, right? It's the first pass at a no does not mean no. You call again, you advocate, you use forceful words, and uh and that's very important.

SPEAKER_04 25:09

And that's the power of patients telling their story as well, right? Is ensuring that just because you got a diagnosis does not mean that you can't continue to be loud either. That there are so many things that you can do to teach others around you, like you did, Dr. Brown, with your family. Once your mom got diagnosed, she opened the world of education to the rest of the family.

SPEAKER_02 25:29

That's right. That's absolutely right. And and uh, you know, and I am so grateful for the passion she's instilled in me, this lifelong mission of making sure no woman dies of breast cancer.

SPEAKER_04 25:43

My my final question for you, as you think back to that 12-year-old who had to watch mom go through what she was going through and and picked medicine as as her discipline and wanting to help women, what would you go back and tell that 12-year-old today?

SPEAKER_02 26:02

You know, I I I need to go back for a second. I come from an immigrant family, I'm the first one to go to college. Um that I would say to that 12-year-old girl, think big because you can't imagine what you can do. And never alone. It's always in partnership with people like you, with the extraordinary team at the Brem Foundation. Yeah. Um but uh, you know, I always thought I would be um the only I never met a girl doctor when I went to medical school, neither do my parents. They they were not very um supportive of my going to medical school. They they had never met a girl doctor, right? Yeah. I thought that I would be a local physician, that which is all I knew. But um I'm so grateful for that entree into medicine for the ability to use medicine to impact people in ways that nothing else allows. But you know, think big, think outside of the box. What I would tell that 12-year-old and anybody who's listening is identify problems and figure out ways to solve them, even if it's things you never thought that you would do, like you and this podcast and um and all of that. So yeah, think big, think strong, and think outside of the box.

SPEAKER_04 27:17

Fantastic.

SPEAKER_02 27:18

It it think collaboratively, very important.

SPEAKER_04 27:22

Great, great point there. And it speaks so much to what you do today. Uh, again, coming from that 12-year-old who knew her mission, knew her passion, and then thought collaboratively, was innovative in your approach, and have brought forth amazing solutions for patients all over this country, both from a legislative perspective, but also the day-to-day that patients face in the clinic and ensuring that they're getting excellent care, as you reference, not just care in general, right? Not just the standard of care, but excellence in in healthcare, which is what we're all about here and what the United States healthcare system should be all about as well. We thank you so much for your time today, Dr. Brem, and really, really thank you for all the work that you're doing on behalf of women and patients around this country.

SPEAKER_02 28:08

And that, you know, without partnerships like you, spreading the word, the the word would be a whisper. So this this is another really critical collaboration. Media has been our partner and has alongside with us. So thank you for doing this.

SPEAKER_04 28:25

The way that I see it is if I had to go, if I went through it, my mess now becomes my message. And that's for everyone, right? You gotta you went through it for a reason, and it's typically to help that person that you once were. And you once were that 12-year-old witnessing what mom was going through, and you want to make sure that no other child has to do the same, and and ensure that that is caught early, as you referenced, and you've put that life mission together successfully thus far, and it's been an amazing, amazing trip to watch.

SPEAKER_02 28:56

And it's it's been such a life-enhancing thing for me. I'm so grateful that I've had these opportunities. You know, from a personal standpoint, it's been extraordinary.

SPEAKER_04 29:05

I mean, you know, uh I'm sure watching your your kids watching you must be impressed, I would say at the least.

SPEAKER_02 29:13

Uh yeah, I'm impressed with my kids. They're awesome. They're I I have three extraordinary daughters and a goggle of fantastic grandkids. But that's awesome. Yeah, and you know, even uh two years ago, Dr. Christy Thiel and I wrote a book called No Longer Radical, empowering women with the information they need to make the best decisions for them, embracing that every decision um is different for each person. And Simon and Schuster published it. So that's another wonderful resource, No Longer Radical. It's available on us.

SPEAKER_04 29:45

No longer radical. I I love that. I I have a book coming myself, so I I love that you went through that process. It's a difficult, daunting one, right?

SPEAKER_02 29:55

It's uh uh a life-enhancing eye-opening one.

SPEAKER_04 29:59

That's right, that's right. There you go back, and sometimes you have to rehash the traumas that you put away, and uh it gives you the opportunity to see where you may have missed some opportunity and go right back to it. Uh, so I I that is something that we will point our guests to as well. You know, as you think about the woman who's maybe listening to this podcast for the first time today, and they may be mid-30s, don't really know where they stand or what they should do, where do they start?

SPEAKER_02 30:29

Well, the recommendation is to get a mammogram, start a first mammogram at the age of 35, and then without any, if you have no other problems, continue on at 40. But listen to your body. Nobody knows you like you need you. And we don't have routine screening for 35 to 40 unless you have a family history. So if anything's wrong, and um you go to the doctor and they say it's fine, and you're not you're not satisfied.

SPEAKER_04 30:56

I feel fine.

SPEAKER_02 30:57

See another doctor.

SPEAKER_04 30:58

Yeah. Oh, you're speaking my language. Don't be afraid to fire one. Just or just because you reached the extent of one's knowledge doesn't mean that you've exhausted medicine. It just means you're done with that one, time to find another. Um, you've brought you brought some amazing insight to our audience, and and I appreciate all of the ways you've brought these tools together under one house for patients to be able to have easy access to all of those potential barriers that they'll run into, but also the innovation with B Sound. I do want to give you an opportunity to talk a little bit more about that because I find that so innovative, as you referenced before, but also bringing together different organizations to get that done for patients.

SPEAKER_02 31:40

B Sound is a commercial organ. You know, the Brenn Foundation does not have a relationship with B Sound. It's just an opportunity that's out there for women under 40 to get screened. And uh B Sound is um the CEO is Bailey Ranger, a brilliant um force of nature, a young woman herself who under who's had a brush with breast abnormalities and is trying to change the world to make things better, not starting with breasts, but overall women's health and wellness. So um I it's a privilege for me to work with Bailey and to offer women under 40 uh a tangible option to advocate for themselves.

SPEAKER_04 32:20

Especially with as diverse as this country is and access options, and not everyone else, not everyone has an NCI, you know, a designated cancer institute close by, or their community oncologists may be hours away. There's the new technologies that are coming, and AI, I'm sure, is going to be an interesting one uh in the breast cancer space and in radiology alone. Uh, but with that comes opportunities to identify these patients earlier.

SPEAKER_02 32:48

You know, AI is now used in our practice at George Washington. We use transpara by screen point on every mammogram. And it's important to realize that you should have your mammogram evaluated by AI because we know we can find cancers up to five years earlier. And in fact, in Europe, there are now five countries that use transpara, only this AI, transpara by screen point, as a second reader to allow more women to get screened and better screened. So we know that women do better, and we're beginning to use AI on mammograms for short-term risk assessment. Screenpoint is developing um AI for breast MRI, which is increasingly being used. So AI in breast cancer is changing the landscape in the most positive of ways. I'm very excited to be part of that as well.

SPEAKER_04 33:41

That's an awesome opportunity for patients as a whole, but uh great for the discipline as well from a radiology perspective. Um, I do want to be cognizant of your time. I know we're trying to squeeze this in for you. Um my last question to you as you as you think towards the future, as you look towards what uh innovations are coming, what excites you, which keeps you uh passionate about this this space?

SPEAKER_02 34:07

Well, the enormous AI, enormous number of opportunities to make things better, to change the way we look at breast cancer. Uh, there's a company in Canada called Breathe Biomedical that's looking at volatile organic compounds, something that breast cancer emits to be able to figure out who needs an MRI this year and who doesn't. And that way we'll be able to better triage really um effective but limited resources. But what really excites me is the opportunity to read about breast cancer in the history books, and that nobody will know.

SPEAKER_04 34:41

Yes.

SPEAKER_02 34:42

So that excites me.

SPEAKER_04 34:44

And we will end it on that. Uh that excites me too to put breast cancer in the rearview mirror and do what we have all said we wanted to do as far back as the early 2000s with personalized medicine. Put some of these cancers in the rearview mirror. I think we'll get there with leaders like you. So thank you.

SPEAKER_02 35:01

Thank you so much. This has been wonderful. Thank you.

SPEAKER_04 35:04

Have a wonderful afternoon. Thank you.