[00:00:00] Adam Walker: Support for the Real Pink podcast comes from Merck.
[00:00:06] From Susan G. Komen, this is Real Pink, a podcast exploring real stories, struggles, and triumphs related to breast cancer. We’re taking the conversation from the doctor’s office to your living room.
[00:00:21] Welcome to the Komen Health Equity Revolution podcast series. Each month we invite in patients, community organizations, health care providers, researchers, and policy advocates to discuss strategies and solutions that drive the health equity revolution forward for multiple populations experiencing breast health inequities.
[00:00:40] Today, we’re diving in to a vital conversation about personalized care and how that advances health equity. Joining me today is Dr. Ezinne Ihenacher, a diagnostic breast radiologist and passionate health equity advocate. Dr. Ihenacher brings her expertise and firsthand experiences to help us understand how personalized care can address systemic inequities.
[00:01:03] and improve outcomes for all. In this episode, we’ll discuss the transformative impact of personalized care, its role in addressing disparities, and how it can empower patients in their breast cancer journey. Let’s get started. Dr. Ihenacher, welcome to the show.
[00:01:19] Dr. Ezinne Ihenacher: Thank you so much, Adam. Thank you so much for having me.
[00:01:23] And I’m really excited to have this conversation because I think we all should be having these conversations with our friends, with our family. And just keep it going. So thank you for inviting me.
[00:01:34] Adam Walker: I’m excited. I really, I really like talking about personalized care because I feel like sometimes we forget how far medicine has come in the last 20 years.
[00:01:44] And so I think you’re going to continue to enlighten us on that topic, which is great. So, so what does personalized care mean to you and how is it different from traditional health care approaches?
[00:01:55] Dr. Ezinne Ihenacher: So it really means creating a care plan that’s unique to each patient. And sort of better fits the individual, it takes into account, you know, diet, lifestyle medical history, risk factors, things like that.
[00:02:10] And sort of tailoring a plan based on those things. Whereas traditional, you know, traditional care and medicine kind of is like a standardized sort of one size fits all approach. And both approaches are evidence based. But the former is more so thinking about sort of these nuances that also affect patient health and health and disease experience, I should say.
[00:02:38] Adam Walker: Well, I mean, it strikes me that like breast care is such a huge spectrum of of everything like a more nuanced approach would make sense because there is so actually I guess that’s my next question, right? So what what does personalized care mean in the context of breast cancer treatment and support?
[00:02:55] Dr. Ezinne Ihenacher: Yeah, so every patient’s going to be different and even if patients come in from the you know The same family they have the same racial and cultural background. They have the same sort of lifestyle, environmental factors, each patient still is going to be different. And in breast care specifically the reason why two people who have very similar backgrounds and genetic makeup can be different because no two sets of breasts are the same.
[00:03:24] So women who have, for example, more dense breast tissue, even in the same family, even with the same environmental factors, even of the same race. If one woman has more dense breasts than the other, then she’s going to need tailored care. Because, for example, mammograms, which are the, you know, that’s the modality that we use to catch early cancers.
[00:03:53] And that’s what every woman should be getting. But in the woman with slightly denser breasts, the sort of, you know, sensitivity for mammograms and finding some very, very small cancers is going to be lower, it’s going to be harder in her. So she may benefit from supplemental screening, other tools and other things.
[00:04:12] So that’s what I kind of mean by the nuances. You know, it’s not just you know, everyone has a liver and, you know, all of our livers do the same thing and kind of look the same for person to person when it comes to breasts. There’s so many different variations of what people’s breast tissue can look like.
[00:04:32] And so that’s why it’s important to tailor care in breast imaging.
[00:04:37] Adam Walker: I love that. And so let’s talk about your approach. How do you, how do you approach this and approach personalized care, I guess, in particular in your practice, and how does that address disparities in breast cancer outcomes?
[00:04:49] Dr. Ezinne Ihenacher: So for me, it really starts with education.
[00:04:54] And, you know, the joke about diagnostic or radiology or radiology of any kind is that we don’t have a particularly high amount of patient contact. And that is actually very far from the truth, particularly in breast imaging. We do read screening exams and that’s part of our day, but another larger part of our day and a part of our week is the sort of.
[00:05:19] Diagnostic workups that we do for women who come in with specific problems, and it’s very important for us to talk to her about those problems, get a good history, do the imaging, read the imaging on the spot, decided she needs additional pictures from those pictures, decides that she needs another type of imaging from mammogram to ultrasound, move her to a different room, talk with our technicians or talk with our technologists.
[00:05:48] For To make sure they’re looking in the right spot and then coming in and explaining to the patient the whole sort of gamut of what we’ve gone through in that day and what it means for her and what the next steps are. And when we’re talking to patients. The educational component is
[00:06:07] key
[00:06:08] because you’re already, you know, as the physician, you know, the patient’s history from what you see in the chart, but oftentimes she reveals other things.
[00:06:18] And I think it’s important to talk to the patients to make sure that there isn’t anything that you’re missing. So things that can be missing, for example. If a patient is Ashkenazi Jewish, she has a higher risk of being BRCA1 and 2 positive, and that may not be in the chart. You know, if a patient has had relatives that have had breast cancer, relatives are important, but we need to know the age of those relatives.
[00:06:49] And if they’re first degree relatives, meaning if they were diagnosed under the age of 50 with breast cancer, and you have a lot of these women in your family, that could set off alarm bells in terms of your risk. You know, so oftentimes there will be these nuances that you want to ask the patient a little bit about.
[00:07:05] And also, too, you want to get a good picture of what the patient is actually experiencing, because they may come in for a lump. But once you talk to them, you may know, oh, there’s also some other associated things with that lump. Like, there may be some discharge or, you know, sometimes you have to examine and see if there are skin color changes and things like that, and then establishing length of time.
[00:07:30] So, I would say that the educational component is very key and in terms of how it impacts, you know, treatment in marginalized communities. I mean, it is, it is tremendous. There, there are women who walk into my office who don’t even, you know, who don’t know that they’re at risk for
[00:07:50] Adam Walker: breast
[00:07:50] Dr. Ezinne Ihenacher: cancer. And women who, you know, are sort of the bedrock of their families who, You know, having come in for a mammogram in, in five years, no matter what her socioeconomic status is, or what, no matter what, you know, other sort of her lifestyle is, or what other privileges she may have.
[00:08:10] The privilege of time is something that affects women as well. And, and I kind of look at that as a marginalized community in a sense. I have a very big heart for women who are the bedrock of their families and don’t put their health care first. And those women are people that I can really, really touch and kind of underscore the importance of coming in and even make, you know, help if I have time and that’s a whole other issue with the system, but if I have enough time, kind of, you know, troubleshoot ways in which we can get her to clinics that are closer to her, to her home and, you know, things like that.
[00:08:51] So so, yeah, I would say probably that educational component.
[00:08:55] Adam Walker: Yeah, I love that. I love that. And I love how you talk about your, your patients. I can tell you really care a lot. So that’s that’s great. So I, so I wonder, you know, related to your patients, do you have any specific stories or examples where personalized care significantly impacted a patient’s breast cancer journey?
[00:09:12] Dr. Ezinne Ihenacher: Yeah, actually so I had a patient come in actually the other day who she, so she felt a lump. It was very, very small. And she had not had, I think, her last mammogram. She was. She was like in her 60s. Her last mammogram was sometime in her 50s, like in another country. We couldn’t get any priors or anything like that.
[00:09:40] And it could have just been, you know, just some benign sort of thing, but then it could also not be, and we didn’t have any comparisons. And she did not like to go to the doctor. I mean, she only came in because I can’t remember why, but I think she had said that someone had just been diagnosed with, like, pancreatic cancer, one of her friends, not even a family member, and like, basically, like, dragged her, like, forced her to go.
[00:10:10] And that’s why she was there.
[00:10:12] So
[00:10:12] imagine how she felt. When I told her I wanted to do a biopsy, not only did I see something I thought that was small, I thought that I needed to do a biopsy, especially given the fact that I don’t know if this thing has been, I don’t know if it’s new. I don’t know how if it’s maybe been there for 10 years.
[00:10:28] It’s probably something just benign. You can let it go. And she resisted. She was very resistant because of the time factor. She didn’t really have time for that. She was really scared of needles. She was kind of scared of, you know, she just hadn’t had good experiences with, you know, traditional Western medicine in the past.
[00:10:49] And, You know, it just, it wasn’t something that she really wanted to do, and I had them keep her around and go back to the way we were. I said, you can’t leave because I had one other patient and I came back. I said, you know, we have coffee and I tried to keep her there with coffee. And I was in, they also have to change back into their, you know, their regular clothes, you know, they wear a gown and everything.
[00:11:14] And. And. I just, you know, pulled her into another room after she got in change. And I said, listen whatever this is, it’s small. Okay. And because it’s small, I don’t want you to think that it’s innocuous. I don’t want you to think that it’s nothing because I said it’s small. Because you have to tell patients, if they ask, how big is it?
[00:11:40] What, you know, what does it look like? You tell patients, oh, it’s about, it’s actually about, you know, half a, half a centimeter. They’re like, oh, that’s nothing. But you have to communicate that it’s not just about the size, it’s about the features that make it suspicious and give that extra sort of understanding, because some people really do need a little bit more of a technical understanding of what’s going on to know the magnitude of what it could turn into.
[00:12:02] And so we had like a, we had a discussion and luckily her appointment was at the end of the day. So I had more time. And she did come in for the biopsy, she came in a few days later, I was the one who biopsied it, which continuity of care among your breast radiologists I think is amazing and I try to stay at the same sites you know, when I’m working.
[00:12:25] For that reason, why I’ve seen it, it was a cancer. It was a very aggressive cancer, but it was very small.
[00:12:33] So
[00:12:33] that’s where the size came up and I said, listen, it’s aggressive cancer, but it’s very small. It hadn’t been tasked the size to the lymph nodes and she was able to get it removed and she went back to her normal life.
[00:12:46] And I just thought that, you know, sometimes it just, it just takes a little bit of an extra. I don’t want to say an extra push because you really can push people away, but I think it’s important to kind of. Understand what people, what people’s resistance is for her, it was just bad experiences with doctors, Western doctors in the past and also not really computing or I shouldn’t say computing.
[00:13:10] She understood that it was small, but there are other factors that. You know, she needed to be aware of to know what the implications could be.
[00:13:21] Adam Walker: Yeah. Yeah. Wow. Sounds like you really helped her. That’s that’s amazing. I love that.
[00:13:28] Dr. Ezinne Ihenacher: I mean, I didn’t like the results came back. No, no, I mean,
[00:13:30] Adam Walker: of course. Yeah, no, no, no.
[00:13:32] But, but if they, but if, but if she had gone home. And not gotten the biopsy and gone for a year. I mean the results would have been significantly worse
[00:13:40] Dr. Ezinne Ihenacher: Oh, yeah, i’ve seen cancer grow like gangbusters like oh my goodness Yeah,
[00:13:47] Adam Walker: it was small then and you caught it when it was small then And and you know, had you not?
[00:13:53] Dr. Ezinne Ihenacher: And and she also did too because she and it was and it was in a low and this doesn’t always happen It was in a location that it was superficial or closer to the skin enough for her to be able to appreciate it Not so many people are lucky having not had mammograms, you know, for, in her case, it was about 10 years and then to palpate that, to heal that.
[00:14:13] Yeah, something that’s
[00:14:14] Adam Walker: obvious, right. Yeah. Yeah, that makes sense. So, alright, so, so what are the biggest challenges to implementing personalized care in marginalized communities from your perspective?
[00:14:24] Dr. Ezinne Ihenacher: So, and I kind of, you know, made references or stated this outright earlier, probably is time. You know, I work in private practice and my group is great because they don’t, you know, there are these big, huge private practice, you know, private equity, you know, practices that really prioritize, you know, fitting patients into time slots
[00:14:49] instead
[00:14:49] of working the time slots around the patient and their problem.
[00:14:53] Adam Walker: Right.
[00:14:54] Dr. Ezinne Ihenacher: And. It’s, you know, that’s probably a whole other conversation about, you know, for profit organizations and things like that. But, you know, I would say that time is is, is a, is a big
[00:15:06] one
[00:15:07] and then also insurance. So insurance is a big one too, because the scope of coverage for specialized breast imaging modalities is limited based on what kind of plan you have and based on what the indications for advanced imaging is.
[00:15:29] So, you know, all women will have, who have health insurance should have their standard mammogram covered. Like that’s, that should be like, that’s like bare bones for any health insurance. Plan but then when you get into diagnostic workup, if a woman has an issue, she has to go to, you know, her private or her, her ordering her family medicine doctor, or, you know, whoever is her primary doctor reported to them and then have them put in an order
[00:15:59] for
[00:15:59] diagnostic workup and diagnostic workup is a step.
[00:16:02] Is a mammogram with specialized views, plus potentially an ultrasound for, you know, if we do find something, an ultrasound of that area, which is kind of like targeted imaging. But then after that, you know, a lot of women, you know, they need. MRIs of their breasts and indications for MRI are many fold women who already have a history of breast cancer.
[00:16:27] That’s what that’s an issue. That’s who have had breast cancer and had it removed. That’s an indication for MRI people who have genetic profiles that put them at higher risk for breast cancer. That’s an indication. People who have, you know, X, Y and Z. They’re, they’re standard. Indications for MRI, but there are still things that are very newly indicators for MRI that haven’t really been recognized by all insurance companies.
[00:16:53] For example, having dense breasts.
[00:16:55] It
[00:16:57] does actually put you at a higher risk for breast cancer, but it’s not technically under all insurance plans. And indication for
[00:17:04] MRI.
[00:17:06] Now, if I will put in my report, well, she has dense breasts. I recommend MRI that type of language could help push over the edge and say, okay, you know what?
[00:17:18] The insurance company will cover it. Whereas other physicians don’t say dense breasts. Yeah. It puts her at a higher risk of MRI. They’ll put that in the report, but they don’t specifically recommend or put specific language insurance companies can easily just say, well, we’re not going to cover it. It wasn’t recommended.
[00:17:36] So I would say those are, you know, some of the nuances that we have to kind of dance around when it comes to these special cases insurance company and timing.
[00:17:49] Adam Walker: Yeah, that’s a, those are two major hurdles. So, I mean, you identified them. So talk a little bit about why personalized care is particularly important for advancing health equity in the breast cancer space.
[00:18:03] Dr. Ezinne Ihenacher: I mean, it really just ensures that every patient kind of, you know, gets the resources that they need, like just regardless of their background, just to achieve just better outcomes overall. I think. I mean, in the grand scheme of things, I would say that’s why it’s important.
[00:18:20] Adam Walker: Yeah, that’s right. That’s right.
[00:18:22] Well, all right. So, so then kind of to follow up on that, right? What is your, like, if you had one hope, what is your one hope that you, for the future of personalized care and its role in achieving health equity?
[00:18:35] Dr. Ezinne Ihenacher: My one hope, one of my many hopes, is that honestly, like, it becomes the standard, not the exception.
[00:18:45] And I know that sounds a little bit kind of fanciful but, you know, a girl can
[00:18:50] Adam Walker: That sounds reasonable. I mean, is it, is it progressing that way? I mean, I feel like we’re talking on this podcast more and more and more and more about personalized care. So, I mean, it seems, it feels to me. Like there’s a trend towards that.
[00:19:02] Is that correct? Or is that not?
[00:19:05] Dr. Ezinne Ihenacher: Oh, yeah. I would say so too. And, you know this, you know, I would go as far as to say, because, well, so here’s the thing. And a lot of my friends were doctors. You know, we kind of came up around the same time, graduated medical school around the same time, which is, I graduated in 2018.
[00:19:26] It’s really, you know, training sort of like these culturally competent doctors. You know, doctors who actually you know, care about personalized health care, right? And the curriculum in medical school, and to make sure that they sort of include these things, right? Because, I mean, medicine is a very, very, very old profession.
[00:19:55] And there have been so many changes and shifts. In terms of not the knowledge that we bring to each patient encounter, but the way in which we practice the knowledge that we have. And as a medical student, you know, we had these sort of add on things, the curriculum, for example, like, every week, we’ll have a 45 minute group discussion about, like, you know.
[00:20:22] Death and dying and, you know, about, you know, just culturally sensitive issues and things like that. And I I went to a medical school that was actually, I went to UCLA and they were actually pretty good about that then. And so now I can only imagine, you know, how much more has been integrated into the curriculum to into the curriculum and also.
[00:20:47] I sat on the medical, the medical school admissions committee at my school, and the application, the applicants were so much more impressive than I was when it came to, you know, people who really were people. And their resumes was much more than, you know, typical pre med bio science courses, like they were taking anthropology courses and writing, like, you know, theses and like, sociology and like, and they were just very, very.
[00:21:20] They were much more well rounded. A lot of them to didn’t go straight from and again, this was back in 2018. Didn’t go straight from undergrad to medical school. They had taken some time in between to live life, to have another career, to see, to be a patient, right? And not just be some student who’s going to your, you know, your your, the student, right?
[00:21:42] Nurse at college, but like actually, you know, have to work and, you know, provide, you know, you know, have health care and be a working professional for a little bit of time. We’re going into medical school to understand some of these things that I’m talking about. So
[00:21:57] I really do think it started at the training level to move it forward.
[00:22:03] Adam Walker: I love that. I love that. All right. Last question. How can listeners advocate for personal care in their communities or for themselves?
[00:22:14] Dr. Ezinne Ihenacher: First of all, educate yourself, educate, educate, educate, educate yourself about, you know, your risk factors your, you know, genetic profile. One, one of the things I wanted to mention is that every, you know, and this is specific to breast cancer.
[00:22:29] So I’ll just. I also say, you know, keep it there, but you know, every woman, if you have health insurance, you can ask your your primary care physician to refer you to a geneticist or a genetic counselor, I should say, have a conversation with your genetic counselor and they will ask you a series of questions.
[00:22:51] They’ll ask you about age at your first period. They’ll ask you if you’ve ever been on birth control. They’ll ask you all types of things. And these, there’s a lot of things that kind of go into your risk.
[00:23:03] And so educate yourself about those things. And then also ask to see a genetic counselor because if your number is borderline or just high enough to say, this person needs genetic screening.
[00:23:18] That’s, that should be included in your insurance for the, for the most part, I’m speaking generally, but it should be, and a lot of women don’t know that they don’t and that could tell you, listen, like, and I hadn’t done myself, they could say, listen, I, not just BRCA1, BRCA2, but there are a lot of other, you know, other sort of things on the profile that can increase your risk and they run a lot of different genes that can increase your risk of breast cancer.
[00:23:45] So, educate yourself about that. What else? Ask questions. When you’re at the doctor, any type of doctor, bring a pen and paper and ask follow up questions. Ask them what they mean when they say something that you don’t understand. If they’re talking too fast, ask them to slow down. If you, if English is your second language, request an actual interpreter.
[00:24:15] Interpreter services are at every clinic. You can call on the phone, put the interpreter on the speakerphone. Sometimes, The doctor may, you know, may know a little bit of your language, but not be fluent. Sometimes they may pull in a nurse who knows a little bit, but isn’t fluent. Ask for an official interpreter.
[00:24:34] These are things that you can request. You’re not being demanding. You’re not being, you know, a nuisance. These are things that are possible. And, and also to remember that you’re not being demanding. You’re not being a nuisance. And if you are, so what?
[00:24:50] Adam Walker: It’s your health. Be demanding. Yeah, that’s right. Yeah.
[00:24:52] Advocate. Advocate. Yeah,
[00:24:54] Dr. Ezinne Ihenacher: right. Don’t be a monster. Nobody wants to deal with that, right? But, you know. Speak up and yeah, and if you do have trouble speaking up for yourself, bring someone with you.
[00:25:06] Adam Walker: That’s right
[00:25:06] Dr. Ezinne Ihenacher: Bring someone with you who who doesn’t have trouble speaking up on your behalf. Bring your best friend.
[00:25:12] Bring your mom Bring your sister, you know, bring your cousin if you can’t call them on the phone. I’ve had patients who if I was giving them information, they’ll stop me and they say, can I call my son? Can I call my daughter and put them on speakerphone? And that kind of makes doctors a little nervous sometimes because it’s like, Oh, who is this person?
[00:25:32] Like, I mean, yeah, you just never know. It’s like, right, right, right. Are they calling their lawyer, their lawyer daughter? No, I’m kidding. But, but, but no, no, one’s going to say, no, you can’t call your doctor. You can’t call your, excuse me. You can’t call your daughter or whatever. You should probably report that doctor if they do that.
[00:25:53] But you know, that’s your daughter. Okay. Let me communicate to him so that, you know, you can have a second pair of ears to help you make sense of things. You know what I mean? Yeah, it starts with speaking up empowering others in your life to do the same. Yeah, and I think that’s just how we make personalized care.
[00:26:16] That’s, that’s a part of making personalized care the norm because you can teach your doctor. Hey, you need to learn how to give me personalized care and I’m going to show you. by advocating for myself.
[00:26:26] Adam Walker: That’s right. That’s right. Well, this is great. That’s great advice. It’s like, like a perfect summary of some of the best advice I’ve ever heard on this podcast, honestly.
[00:26:34] So Dr. Ihenacher, I really appreciate you coming on the show, sharing this appreciate you kind of giving us a behind the scenes of how you interact with your patients. That was so helpful. And just thank you for joining us on the show today.
[00:26:46] Dr. Ezinne Ihenacher: Thank you so much again for having me. This was really, really fun.
[00:26:50] And I, I feel really, really good about doing this and having this conversation with you and with the listeners and. I just hope that together we can really make things better for, for patients.
[00:27:04] Adam Walker: That’s why we’re here. That’s why we’re here. And thank you for joining another episode of the Komen Health Equity Revolution podcast series.
[00:27:11] A huge thank you to Dr. Ihenacher for sharing her insights in how personalized care can be a powerful tool in advancing health equity in breast cancer. Her stories and expertise remind us all of the importance of tailoring care to meet individual needs, especially in communities that are underserved.
[00:27:29] If you’d like to learn more about personalized care services at Susan G. Komen, visit our Komen Patient Care Center by calling 1 877 465 6636 or email helpline at komen. org. We’ll continue to galvanize the breast cancer community to support multiple populations experiencing breast health inequities. To advance and achieve breast health equity for all to learn more about health equity at Komen Please visit Komen org forward slash health equity Thanks to Merck for supporting the Real Pink Podcast.
[00:28:10] Thanks for listening to Real Pink, a weekly podcast by Susan G. Komen. For more episodes, visit realpink. komen. org. For more on breast cancer, visit komen. org. Make sure to check out at Susan G. Komen on social media. I’m your host, Adam. You can find me on Twitter at AJ Walker or on my blog, adamjwalker. com.