[00:00:00] Adam Walker: 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.
Welcome to another powerful episode of the Komen Health Equity Revolution podcast series and happy Black History Month. Each month we invite patients, community organizations, healthcare partners, researchers, and policy advocates to spark conversations about strategies and solutions that drive the health equity revolution forward for multiple populations experiencing breast health inequity.
Black women are most likely to be diagnosed with breast cancer at a younger age, at later stages and with more aggressive types of breast cancer than white women. This underscores the importance of learning about your personal risk of breast cancer. Dr. Kameelah Phillips joins us today to share her insights on the value of understanding breast cancer risk in the black community, how to advocate for yourself as a younger patient, and how lifestyle changes can contribute to lowering your risk of breast cancer.
Welcome to the show, Dr. Phillips.
[00:01:16] Dr. Kameelah Phillips: Hi, thank you for having me. I’m very glad to be here.
[00:01:20] Adam Walker: I am very glad to get to talk to you. It’s such an important topic and I’m very much looking forward to what you have to say about it. Can you tell us about the work that you do as an OBGYN and your commitment to women’s health, particularly in marginalized communities?
[00:01:37] Dr. Kameelah Phillips: Yes, it’s interesting. I feel like I’ve been working in women’s health at least since junior high. I started at Planned Parenthood when I was in junior high. My mom made me enter this, the junior high and what I’m about to say are a little different, but my mom made me enter this beauty pageant, which was so not my jam. And I actually lost the beauty pageant because on my resume, I talked about my work at Planned Parenthood because I grew up in San Diego and in my community, the junior high schools had lockers for like adult lockers and baby lockers because our pregnancy rate, our teen pregnancy rate was so high that in order to keep women in school, they were allowed to bring their babies to school.
And I told that story in the pageant, lost the pageant. My mom was upset. But I tell that brief story because I’ve been doing women’s health, especially in underserved marginalized communities since literally junior high. And then elevated all of that to becoming an OBGYN. And I always knew I wanted to be an OBGYN because my grandparents raised me, a matriarch raised me, my aunts, my mom, my grandparents, my grandmother, especially, and anytime they were not feeling well, I didn’t get dinner, my hair looked crazy, I barely got to school, so they’ve always had a passion for women’s health because if you take care of the woman, then you take care of the family, you take care of the community.
And so I took this interest. I trained at Bellevue, which is a very historic hospital here in New York City and I graduated from there with just such a diverse experience. Bellevue is the place where like you literally, you get off the boat, you come and we take you and we see you. And so having that diverse human experience in medicine, has eventually led me to start my own private practice where I feel like I’ve created a very safe space for women to talk about their health in the setting of their life experience, their trauma, what their culture brings to the table and how it may or may impact their health, what their family history brings, what their experience with the medical community, which isn’t always positive, especially for marginalized community. And we get to develop plans and plans of care that helps them work on their health literacy, their medical literacy, on nutrition, on exercise, understand the reasons that they need to do these preventative, care modalities like the mammogram, like ultrasound.
And yeah, that’s where I am right now. And it’s so rewarding and I don’t take it for granted. There are CEOs who don’t really understand the functioning of their body. and there are bus drivers and teachers and unhoused people like everyone deserves quality care. And that’s what we try and do. That’s what I try and do is to really elevate that experience for women.
[00:05:09] Adam Walker: I love that, everyone deserves quality care. That’s just a perfect way to say it and that’s why we’re having this discussion. So, we know that everyone’s at risk for breast cancer, but some individuals face significantly higher risks than others. So can you talk about what the factors are that might increase breast cancer risk in black communities?
[00:05:32] Dr. Kameelah Phillips: Yeah. There’s this show that I often think about. It was on Netflix and was called Black AF. Oh, I love that show.
[00:05:43] Adam Walker: Yes. It was so good.
[00:05:46] Dr. Kameelah Phillips: It was hilarious.
[00:05:47] Adam Walker: It was so good.
[00:05:49] Dr. Kameelah Phillips: Yes. Oh yeah. It was so good. And then it also was mad educational, right?
[00:05:55] Adam Walker: It was. It was. Yes. Yes.
[00:05:57] Dr. Kameelah Phillips: Yes. In the most, hey, you need to know this kind of way. Like I’m not sugarcoating this for you to protect your feelings. You need to know this. So if you watch the show, as as you did, you’ll know, every title of the show was like, race, racism. No, really, it’s about racism. Like every title, it’s so some derivation of how the issue could go back to race. So I embrace that because when I think about like my experience in medicine, the experience that patients share with me in the confines of our little exam rooms, we see higher rates of breast cancer in black women really because it boils down to racism and the structural racism that is really the core of our community. There were black codes that in the 1800s prevented black people from owning land, purchasing homes, passing on wealth.
What does that do to your community? You have no tax base. You have no tax base, you ain’t getting hospitals, people aren’t coming and investing in those communities. You lack infrastructure. And what does that do to the surrounding community? They have nowhere to go, and often they went to hospitals that were underserved. didn’t have the physicians that were well trained or if they were allowed to go to white hospitals did not seem to receive, we know the same level of care. And the infrastructure based in racism, I think about, I live in Harlem, I’m in New York and I think about all the time because I walked past a few of them. We have in Manhattan, the most bus depots. So our rates of childhood asthma in Harlem, like skyrocket compared down to Chelsea.
[00:08:20] Adam Walker: I never would have thought of that. Yeah. Never even occurred to me.
[00:08:24] Dr. Kameelah Phillips: It’s not accidental. So as a community, obviously, if you don’t have that representation, that tax infrastructure, you’re going to get a bus depot in your neighborhood.
You’re going to get garbage plants and all the things that come with that in your neighborhood. So when we think about how the impact of the environment on disease, the black community suffers from that. I think about education and health literacy, how often that information doesn’t trickle down.
So we don’t really have the greatest understanding of why we do mammograms. That breast cancer is not, a death sentence. these are all things that we can work on to improve, the experience of being a black person in medicine and dealing specifically with issues of the breast. The other two things that I probably would say are end roads is family history, that is a big one that I know in a lot of my women when they’re either diagnosed with breast cancer, or someone in their family is and not having just like that family history because of slavery and the migration of people and not having records. That is a huge, inroads that we can have.
I remember really clearly a patient. She was young, and unfortunately expired. She was 37 with breast cancer and I was just taking care of her. I was just randomly taking care of her for her other needs. And I was like, “did you do any testing?” It was a few years ago. I was like, “did you do any testing for your breast cancer? You’re so young.” She said “no, just, I have breast cancer.” I’m like, “no, that’s not really the answer. You don’t just have breast cancer. Like you’re 37.” So I actually did a BRCA screen on her, a genetic screen on her. And she’s an African American woman. And we think of, I think doctors and even myself, my own bias, I always have to check it.
We think of BRCA as like five to 10 percent of breast cancers, right? Not a huge thing, but we also think of it in terms of the Ashkenazi Jewish population, European, like white women. And I was like, let’s do this test for you. And she ended up being a BRCA carrier. And it threw me because one, she didn’t know anyone in her family, but there were, rumors like grandma, she didn’t have that history too.
It’s such a young age that no one else had suggested to her that she did that testing. And then also in doing that testing, it’s sparked a conversation. Her mom was actually a BRCA carrier. And which is really interesting because we think of that with younger cancers. Her mom was like 60 something, right. And so that changes like the trajectory of everyone’s life. And so I think when we talk about black women in particular, it’s really important that we understand it’s so multifactorial of why we have higher rates. Less screening, more aggressive cancers. But at each of those time, at each of those points, we can actually do something about it.
[00:12:00] Adam Walker: That’s right. That’s right. And so you mentioned family history. I wonder if you could talk just a little bit more about like, what do you recommend patients do about sharing family history and talking about these things?
[00:12:12] Dr. Kameelah Phillips: Yeah, it is so interesting to me that people don’t share their history with their family. And I’m gonna go out on a limb. I’m gonna say it’s very cultural, but I do think everyone does it. People don’t know why their grandmother or their great grandmother died. Older generations I find, are very private and have not wanted to give this information to their children or sisters or whatever.
They don’t want to be a burden. They don’t want people to worry, etc. But it actually does more harm than good. And I tell people, when you’re having these conversations, just normalize it. Just, “Hey, what’d you guys do today? I went and got my mammogram. Have you gotten your mammogram recently? My doctor said that we should be discussing these things. And I thought, let’s talk about it. How did grandma Marie die? Do you know?” And we start to build this data bank of information that is going to be extremely valuable and helpful for future generations. And that’s the other way I put it is, “okay, this might not be about you right now, but it’s about your grandchildren.”
Yeah, it might not be right, but this is going to impact and help your future generations. And then the other reason I encourage people to talk about it really in just a normalized way is, it allows the person who’s going through the issue, in my opinion, to allow and receive love and support during their diagnosis. Their family members can rise up, be their advocate.
I hear these stories all the time when someone reveals a diagnosis, the flood of community that comes to surround them in. They’re being vulnerable about their diagnosis, how it springboards other people getting tested conversations in the family. So I suggest that people just normalize it.
You talk about our hypertension all the time. I got to go take this pill. I could feel my pressure getting high. You getting on my nerves, just normalize it. I tell that to my kids all the time. I feel you. You’re raising my pressure. I’m going to walk away.
[00:14:45] Adam Walker: I’m going to need to use that one. I like that a lot. I’m going to, “I feel the pressure. I need to step away from a minute. I’ll be back. I’ll be right back.” I like that actually.So that brings me to my next question. What are some lifestyle changes that you recommend to help mitigate some of these risks?
[00:15:04] Dr. Kameelah Phillips: From a lifestyle perspective, I really do think that history is important and knowing your history, we talked about that just so you can make the necessary modifications in terms of screening. If you need to be someone who’s screened earlier or more often, the other thing is I try and not get annoyed by this, like lifestyle branding that people are doing now, but it’s a real thing.
Like we have to think about disease and illness in a really comprehensive form and conversation at this point. So in terms of lifestyle, it’s one in a weird way, like actually voting because voting is important. Voting doesn’t get major environmental hazards into your neighborhood. And we know that environmental conditions are important for chronic diseases and even sporadic things.
I think it is important for us to improve our health literacy. There should be nothing that your doctor explains to you that they can’t explain on the level of a sixth grader. And that’s not to insult adults or sixth graders. Really, we should be able to make things plain so people understand what’s going on with their body and why it is important that we take these next steps in terms of diagnosis and prevention.
I think that people can help themselves, advocate for themselves in the medical environment, especially because a lot of people just get nervous, right? With a white coat, which I don’t wear white coat, but bring a friend with you to help you hear more clearly what the conversation is, take notes so you don’t forget or you don’t get flustered. I think all of us also really need to demand that our insurance do better. That insurance companies don’t look at us as problems, but really focus on prevention in terms of nutrition and exercise and lifestyle coaching. So we can manage chronic disease that then leads to our increased risk of cancers and other debilitating things.
And I also really encourage patients, I know it sounds corny, but look, diet and exercise are really important. As the older I get to I see it, even in yourself. Like my 47 year old self is not doing what the 37 year old self with the 27 year old self.
[00:18:08] Adam Walker: So in sleep, too? Yeah.
[00:18:13] Dr. Kameelah Phillips: Oh, aging is not for the faint of heart. I asked them to really think about limiting their processed foods, being very mindful of what they’re putting in their body. I recognize that organic food is expensive. I personally live in an area that’s a food desert, but really trying to control and manage their intake of their food because that impacts our health.
Honestly, encouraging them to have a plant based diet as much as possible. So I think, from voting to changing diet, to having doctors that are receptive and engaging with patients, to insurance, all of those things can really help, elevate the experience we have and the advocacy that patients have in the medical space.
[00:19:08] Adam Walker: Great advice. That’s great advice. So, shifting gears just a little bit. I’m curious about just as it comes, as it relates to understanding breast cancer risk, what do you suggest women who are younger than 40 do when screening recommendations begin?
[00:19:27] Dr. Kameelah Phillips: Yeah. I know that It can get confusing because depending on what messaging, what society, family history, all of these things that you’re listening to, you’re like, “when do I do any of this?”
[00:19:41] Adam Walker: When do I do it? What do I do? What’s going on?
[00:19:43] Dr. Kameelah Phillips: Yeah. Is it an ultrasound? Is it a mammogram? I hear all these other modalities coming up. So I think first of all is, really knowing what’s normal for you and not ignoring that because of fear, access, a number of reasons, sometimes people just really dismiss obvious changes in their body and I would never recommend that.
So don’t ignore visible changes. Any enlarged lymph nodes that don’t go away. We call them lumps, bumps in the office that are persistent and concern you. Any nipple discharge, pain, dimpling, like all of these things. If your body or your breasts are changing, they should be evaluated, and there’s no right way to do it.
People worry about how they just know what’s right for you and not brush it off. And then when you come to the office, be very clear about what you’re experiencing and ask, “okay, so what is the next step? What is it? A blood test? Is it a mammogram? Is it an ultrasound? Here is my family history. How is my family history going to impact that? I’ve heard there’s some genetic tests. I have or have not done one. Should I do those? How does that impact my care?” So I would encourage them people to not ignore what’s going on. Because things, they’re not going to just magically go away, but to use what they know about their body to be their best advocate for themselves.
[00:21:19] Adam Walker: All right. So talk more about that. How do you encourage patients to advocate for themselves? I’ve heard a lot of interviewees on this show have talked about the need to advocate for themselves, but for you as a provider, how do you encourage your patients to advocate, particularly if they’re younger or historically marginalized?
[00:21:38] Dr. Kameelah Phillips: The first thing, and this might seem a little kind of off, but, and not the answer to your question, but I feel like in a way, patients, especially my patients, they’re like, “when I get to the hospital, how do I advocate for myself?” No, I should be advocating for you. And I feel like we have to rethink this idea of advocacy and in and putting the responsibility on more people other than the patient. Like she’s coming in, she’s terrified, she doesn’t have an M. D., it probably took her three months to get here. She just needs like someone, Jesus take the wheel, right? Doctors need to be doctors, P.C.P.E.S. Physician assistant, whoever is the person that she needs to really be working on exploring our bias in our life and in medicine and really understand how that impacts the physician patient relationship, how it impacts how she perceives my words, how she trusts my words and what I’m asking her to do or not do.
I think we need to be more conscious of a patient’s experience both negative and positive in medicine, incorporating their culture and really think about her in a very holistic fashion as a doctor, as a healthcare provider, because she’s scared. She shouldn’t have to advocate for herself. That’s what we should be doing. So I just wanted to answer that from the doctor perspective, because tell me that, I’m like, “that’s my job.” What do you just go have a baby or you just go get the mammogram. You know what I mean? That’s my job. but for patients, I would say, I think it’s really helpful to have questions before you come in.
I can’t even explain how often people just like, frustrated, flabbergasted, they’re forgetful, the three F’s and it’s important to write things down so that you make sure you’re checking off your boxes and you understand what’s going to happen next. I have them ask questions. Okay. You’re having this concern about your breasts and immediately people go to cancer, right?
But ask about what else is in their differential and the differential is like all the different things that it could possibly be. Ask your doctor what else is in the differential and how are we doing? Is this study going to click off all those boxes so that we make sure that we’re not missing anything else in the differential?
Again, always bring something someone with you. I tell my patients, bring your family member at your next visit because any disease state- Again, because I believe women are like, you know the world, anything that in, so I know I love, I’m biased. I love.
[00:24:48] Adam Walker: No, I love it. I love it.
[00:24:49] Dr. Kameelah Phillips: That is my bias though, right? Yeah, I love it. No, that’s great. That’s great. But because there’s any condition, if there’s any condition that impacts a woman. It inevitably is trickling through the family down to the kids parallel to brothers, sisters, the ability to care for parents. So it impacts everyone. So bring someone with you to help really understand how we are going to navigate this as a family, especially as it relates to issues of cancer, breast cancer, any cancer really, but the treatment that comes with that.
And then I would finally say, look, we’re not friends with all of our family. Like we distance ourselves from some family members, not every doctor patient relationship is a good fit. And so if you have to explore other relationships so that you have a better understanding of your health, you feel easier with communication, you leave the room feeling empowered, then sometimes we just, we got to do that. And I have patients all the time who are like, “Oh, I just felt so bad. We’ve been together for 20 years.” I’m like, “Okay. I understand that you guys, built a relationship over time, but like your needs are changing, your concerns are changing and that’s okay. It doesn’t mean any love loss, but really the most important person in the room is you.”
We got to get that taken care of.
[00:26:24] Adam Walker: As the patient, they’ve got to do what’s right for them. It doesn’t matter about everything else. All right. So then last question, and you’ve moved in this direction already several times, right? So what does it mean for you as a provider to be in partnership with your patients and how can other providers do the same?
[00:26:45] Dr. Kameelah Phillips: Yeah. I think as a provider, part of my job is honestly, to see people win. I love when we see people win, it makes my job honestly easier because you’re living your best life. You’re taking care of your family, friends, you’re able to work, you’re able to provide. And it means a lot for me to be in partnership with someone because it means you’re going to win.
And I think that when I think of partnership, it really is like a marriage and marriage to me is not 50 50. It’s 100 and 100.
[00:27:32] Adam Walker: That’s right. That is right. Yes, that’s it.
[00:27:34] Dr. Kameelah Phillips: Yeah, I love it, right? Everyone’s doing their job all the time. So my ability to partner with someone in their health, meet them where they are in that health journey, learn about the fears that they have that might be barriers to care, the family issues, the medical knowledge that might be barriers to care, all of that, their negative experiences in medicine that might be barriers to care.
So I don’t inadvertently repeat those or send them to the same place, all of those things are really critical. And I think helping patients win. So that’s how I see myself.
[00:28:25] Adam Walker: I love that. Dr. Phillips, you have got to just be an amazing doctor. I love your approach, and how you advocate for your patients.
So thank you for the work that you’re doing and just thank you for joining us on the show today and sharing your experience and your expertise. I really appreciate it.
[00:28:43] Dr. Kameelah Phillips: Thank you so much. Thank you so much. I hope people learn from this and I hope doctors learn from it too. And I look forward to talking to you again.
[00:28:52] Adam Walker: Me too. I would love that. And thank you for joining another episode of the Komen Health Equity Revolution podcast series. We will continue to galvanize the breast cancer community to support multiple populations experiencing breast health inequities to advance and achieve breast health equity. Because ending breast cancer needs all of us to learn more about health equity at Susan G Komen, please visit Komen.org/healthequity.
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 @SusanGKomen on social media. I’m your host Adam You can find me on twitter @AJWalker or on my blog AdamjWalker.com.