Breast Cancer Briefing, hosted by Sara Nunnery, MD, MSCI, a breast medical oncologist and the director of Breast Cancer Research at Tennessee Oncology in Nashville, is a podcast series that breaks down the latest news in breast cancer research, one conversation at a time.

In this episode, Dr Nunnery sat down with Matthew Kurian, MD, a hematologist/oncologist at St. Elizabeth Healthcare in Edgewood, Kentucky, as well as an assistant professor of medicine at the University of Kentucky College of Medicine in Highland Heights.

The experts discussed the role of artificial intelligence (AI) in oncology, beginning with foundational concepts. Dr Kurian explained that AI comprises systems trained to recognize patterns from large datasets, distinguishing generative large language models, such as ChatGPT, from retrieval-grounded tools, such as OpenEvidence, which draw from trusted sources like ASCO and the National Comprehensive Cancer Network (NCCN) Guidelines. He cautioned about pitfalls of AI, including hallucinations and automation bias, and stressed the importance of verifying AI outputs and using effective prompts.

The conversation then addressed AI scribes, with Dr Kurian citing data showing that primary care physicians derive the most benefit from these tools, whereas surgical specialists derive the least. He noted that although scribes help clinicians be more present, these tools have not reduced time spent working after hours, which he attributed to an efficiency paradox in which saved time is reabsorbed by additional patients or tasks.

Turning to FDA-authorized AI devices, Dr Kurian traced AI’s history in mammography from computer-aided detection to Clairity Breast, which uses existing mammograms to calculate a 5-year breast cancer risk in patients starting at age 35 years. He also discussed access and reimbursement limitations associated with this technology.

Finally, Dr Kurian issued a call to action urging ASCO and the NCCN to require prospective validation before integrating AI tools, warning against reliance on outdated retrospective data and the risk of widening disparities, while emphasizing balanced, responsible adoption of these tools.

Breast Cancer Briefing, hosted by Sara Nunnery, MD, MSCI, a breast medical oncologist and the director of Breast Cancer Research at Tennessee Oncology in Nashville, is a podcast series that breaks down the latest news in breast cancer research, one conversation at a time.

In this episode, Dr Nunnery sat down with Dana Bonaminio, MD, a breast radiologist and the director of breast imaging at Ascension Saint Thomas in Nashville, who is also a breast cancer survivor and community advocate.

The experts discussed breast cancer screening amid recent conflicting guidelines, beginning with an overview of the breast radiologist's role across screening, diagnosis, and image-guided procedures. Dr Bonaminio shared her own diagnosis at age 44, which was detected on supplemental MRI and underscored her advocacy for breast cancer screening in women with dense breasts.

The conversation then addressed breast density, which Dr Bonaminio explained affects approximately 50% of women, constitutes an independent risk factor, and can mask cancers through overlying tissue. She noted that women exceeding a 20% lifetime risk should undergo a supplemental MRI. She also reassured that breast implants do not preclude effective mammography. Dr Bonaminio also clarified the distinction between screening mammograms and diagnostic imaging, which is warranted for any symptoms, such as a lump, pain, or nipple discharge.

Turning to emerging technology, Dr Bonaminio detailed contrast-enhanced mammography, which she is bringing to Nashville, describing its ability to subtract normal tissue and highlight enhancing cancers, particularly in extremely dense breasts. She anticipated it becoming standard of care and serving as a staging tool.

The experts then contrasted screening guidelines, with Dr Bonaminio advocating for annual mammography starting at age 40 and cautioning against biennial or delayed approaches. She also reviewed artificial intelligence–based risk assessment tools, including Clairity Breast, as well as more traditional models.

Finally, Dr Bonaminio highlighted her advocacy work, which includes founding a Nashville chapter of Pink Ribbon Good, which provides free rides, meals, and peer support to patients with breast cancer.

Breast Cancer Briefing, hosted by Sara Nunnery, MD, MSCI, a breast medical oncologist and the director of Breast Cancer Research at Tennessee Oncology in Nashville, is a podcast series that breaks down the latest news in breast cancer research, one conversation at a time.

In this episode, Dr Nunnery sat down with Eleonora Teplinsky, MD, the head of Breast and Gynecologic Medical Oncology at Valley-Mount Sinai Comprehensive Cancer Care in Paramus, New Jersey, as well as a clinical assistant professor of medicine at the Icahn School of Medicine.

The experts discussed how to manage the adverse effects associated with endocrine therapy in patients with hormone receptor–positive breast cancer, beginning by dispelling the misconception that the disease reflects a hormonal imbalance. Dr Teplinsky explained that estrogen does not cause breast cancer but rather feeds cells already growing abnormally, and she distinguished the mechanisms of tamoxifen, aromatase inhibitors, and ovarian function suppression, clarifying that tamoxifen does not induce menopause.

Turning to symptom management, Dr Teplinsky reviewed short-term effects, including vasomotor symptoms, fatigue, and mood changes, as well as long-term concerns, such as bone, cardiovascular, and brain health. For hot flash management, she described nonpharmacologic strategies and off-label options before highlighting the neurokinin receptor antagonists fezolinetant (Veozah) and elinzanetant (Lynkeut), noting their efficacy and the need for liver enzyme monitoring, particularly in combination with CDK4/6 inhibitors.

The conversation then addressed genitourinary syndrome of menopause, with Dr Teplinsky endorsing guideline-supported vaginal estrogen and prasterone (Intrarosa), emphasizing that symptoms extend beyond sexual health to recurrent urinary tract infections. She also detailed aromatase inhibitor–associated musculoskeletal symptoms, stressing movement, physical therapy, and acupuncture, and expressed enthusiasm for oral selective estrogen receptor degraders, given their lower discontinuation rates.

Finally, the experts underscored the importance of proactive cardiovascular screening, including lipoprotein (a) testing, and reassured that most effects are reversible. They emphasized exercise, alcohol reduction, and individualized care, and Dr Teplinsky previewed her forthcoming book, Beyond the Pink.

Breast Cancer Briefing, hosted by Sara Nunnery, MD, MSCI, a breast medical oncologist and the director of Breast Cancer Research at Tennessee Oncology in Nashville, is a podcast series that breaks down the latest news in breast cancer research, one conversation at a time.

In this episode, Dr Nunnery sat down with Sarah Sunshine, MD, an ophthalmologist and assistant professor of ophthalmology at the University of Maryland School of Medicine in Baltimore, whose research focuses on the ocular adverse effects associated with cancer drugs.

The experts discussed how breast cancer therapies affect the eye, beginning with a primer on ocular anatomy. Dr Sunshine explained that the cornea and the broader ocular surface are where many antibody-drug conjugate (ADC)–associated toxicities manifest, and she noted that different drug classes can affect distinct structures, causing dry eye, macular edema, or uveitis. She observed that conventional cytotoxic chemotherapy can also produce dry eye, which is usually reversible with treatment.

The conversation then addressed photopsia, the flashing-light phenomenon seen with the selective estrogen receptor degrader camizestrant. Dr Sunshine emphasized that these events do not damage the retina but stressed that any patient reporting flashing lights requires a dilated eye examination to rule out a retinal tear or detachment.

Turning to ADCs, Dr Sunshine cautioned that these agents are not uniform in the ocular toxicities they are associated with, contrasting the severe corneal effects seen with belantamab mafodotin-blmf (Blenrep) with the milder, less frequent toxicity of breast cancer ADCs, such as datopotamab deruxtecan-dlnk (Dato-DXd; Datroway). She characterized Dato-DXd’s corneal toxicity as dry eye, possibly involving limbal stem cells, and detailed prevention and monitoring strategies, including using preservative-free artificial tears at least 4 times daily, undergoing a baseline comprehensive examination, and following up for eye evaluations during subsequent treatment cycles.

Finally, Dr Sunshine reviewed red-flag symptoms warranting patient referral to eye care specialists, distinguished optometrists from ophthalmologists, and emphasized ADC-specific eye examination forms, timely communication, and strong oncology/eye care partnerships as central to preventing permanent vision damage.

Breast Cancer Briefing, hosted by Sara Nunnery, MD, MSCI, a breast medical oncologist and the director of Breast Cancer Research at Tennessee Oncology in Nashville, is a podcast series that breaks down the latest news in breast cancer research, one conversation at a time.

In this episode, Dr Nunnery sat down with Maelee Yang, MD, and Odette Abou Ghanem, MD. Dr Yang is a plastic surgeon with The Surgical Clinic in Nashville. Dr Ghanem is an assistant professor of plastic and reconstructive surgery, as well as a plastic and reconstructive surgeon, at Vanderbilt University Medical Center in Nashville.

In this episode, the experts discussed the breadth of breast reconstruction options available to patients who have had breast cancer, beginning with guidance on selecting a surgeon. Dr Yang stressed the importance of choosing a plastic surgeon who is board certified or board eligible, cautioning that cosmetic surgery certification does not confer equivalent training. Dr Ghanem explained that autologous reconstruction, which uses a patient's own tissue rather than a prosthetic, often relies on microsurgery, wherein tissue and its dedicated blood vessels are transplanted and reconnected under a microscope. She also noted that high-volume centers achieve superior flap success and have lower complication rates.

The conversation then addressed implant-based reconstruction. Dr Yang distinguished immediate approaches, including direct-to-implant and tissue expander placement, from delayed reconstruction, and explained that expanders allow gradual sizing and also protect skin that may be compromised following a mastectomy. She noted that she favors cohesive silicone implants over saline and described prepectoral placement, which reduces pain and avoids animation deformity.

Dr Ghanem characterized the deep inferior epigastric perforator flap procedure as the autologous gold standard using lower abdominal tissue. She also identified thigh, back, and buttock donor sites as alternatives and the Goldilocks procedure as a minimalist option. The experts reviewed candidacy considerations, including body mass index, smoking, and diabetes, and detailed surgical sequencing around chemotherapy and radiation.

Finally, the experts highlighted emerging techniques, including oncoplastic reduction, sensation-preserving mastectomy through nerve grafting, and procedures for lymphedema. They emphasized the importance of multidisciplinary communication, insurance barriers, and patient-centered choice throughout the reconstruction journey.

Breast Cancer Briefing, hosted by Sara Nunnery, MD, MSCI, a breast medical oncologist and the director of Breast Cancer Research at Tennessee Oncology in Nashville, is a podcast series that breaks down the latest news in breast cancer research, one conversation at a time.

In this episode, Dr Nunnery sat down with MinhTri Nguyen, MD, a breast medical oncologist, assistant professor, and lead faculty for Health Equity at Rush MD Anderson Cancer Center in Chicago, Illinois.

They discussed the emergence of giredestrant, an investigational oral selective estrogen receptor degrader (SERD), across the hormone receptor–positive, HER2-negative breast cancer treatment paradigm. Unlike aromatase inhibitors, which lower estrogen levels, or tamoxifen, which blocks the estrogen receptor (ER), SERDs degrade the receptor entirely, Dr Nguyen explained. He noted that ESR1 mutations, an acquired resistance mechanism that renders the ER constitutively active, confer worse prognosis and appear to be where oral SERDs derive their strongest signal.

The conversation first addressed the phase 3 evERA Breast Cancer trial (NCT05306340), which randomly assigned patients with previously treated advanced disease to receive giredestrant plus everolimus (Afinitor) or standard-of-care endocrine therapy plus everolimus. Dr Nguyen emphasized the elegance of targeting 2 resistance pathways simultaneously: the endocrine pathway and the parallel mTOR/PI3K/AKT axis. The combination significantly improved median progression-free survival in both the population with ESR1-mutated disease and the intention-to-treat population, though the experts cautioned that the patients with ESR1-mutated disease likely drove the overall benefit, as wild-type outcomes mirrored those in the control arm. The experts characterized giredestrant-associated adverse effects as largely everolimus-driven, most notably stomatitis, and highlighted class-associated bradycardia. They also noted that no photopsia was reported.

They then turned to the phase 3 lidERA Breast Cancer trial (NCT04961996), in which patients with predominantly high-risk, early-stage disease received giredestrant or standard endocrine therapy. Giredestrant produced a reduction in the risk of invasive disease recurrence or death, with markedly lower discontinuation rates and consistent benefit across premenopausal and postmenopausal subgroups.

Finally, the experts contextualized findings from the negative first-line persevERA Breast Cancer trial (NCT04546009), concluding that a single negative readout does not close the oral SERD story, and that thoughtful patient selection will define giredestrant’s future role in the breast cancer treatment armamentarium.

Breast Cancer Briefing, hosted by Sara Nunnery, MD, MSCI, a breast medical oncologist and the director of Breast Cancer Research at Tennessee Oncology in Nashville, is a podcast series that breaks down the latest news in breast cancer research, one conversation at a time.

In this episode, Nunnery sat down with Annie Bond, a breast cancer survivor and patient advocate.

Diagnosed with breast cancer at age 26, Bond shared how her initial concerns about a breast lump were repeatedly dismissed by medical professionals who cited her youth and lack of a family history of breast cancer. It took months of persistence before she received a diagnosis, at which point the cancer had already spread to her liver.

Bond emphasizes the necessity of self-advocacy and the value of seeking second or third medical opinions. Regarding fertility preservation, her first oncologist discouraged her from freezing her eggs, but her third oncologist provided a more personalized approach, using CDK4/6 inhibitors rather than immediate chemotherapy based on her luminal A disease subtype.

A significant portion of the conversation focused on the mental health toll of cancer. Bond discusses the "warrior" stereotype, the guilt and shame she felt, and her struggle with post-traumatic stress disorder. She says she found critical support in community and support groups, which helped normalize her feelings and provided a sense of belonging.

Regarding physical adverse effects, Bond detailed the challenges of medical menopause, including "menopause brain" and joint pain, which she manages through walking and stretching. She expressed frustration with health education that focuses on diet or alcohol as "blame" factors, noting that cancer can often develop regardless of lifestyle.

Bond explained how she advocates for metastatic breast cancer research funding and the use of artificial intelligence risk assessment models to account for factors like breast density. Her mission is to increase early detection and ensure patients with metastatic disease are viewed with hope.

Breast Cancer Briefing, hosted by Sara Nunnery, MD, MSCI, a breast medical oncologist and the director of Breast Cancer Research at Tennessee Oncology in Nashville, is a podcast series that breaks down the latest news in breast cancer research, one conversation at a time.

In part 2 of this conversation, filmed live onsite at the 43rd Annual Miami Breast Cancer Conference, Dr Nunnery sat down with Irene Morae Kang, MD, an assistant professor in the Department of Medical Oncology & Therapeutics Research and the medical director of Women’s Health Medical Oncology at City of Hope Orange County in Irvine, California.

Their discussion focuses on the rapidly evolving treatment paradigm for first-line metastatic triple-negative breast cancer (TNBC), including the emergence of new data that is shifting standards of care. Dr Kang explained that TNBC is defined by the absence of estrogen, progesterone, and HER2 receptors, which historically restricted treatment options to non-targeted chemotherapy. A primary focus of the conversation was the role of PD-L1 expression and the use of immunotherapy. Dr Kang described PD-L1 as a checkpoint inhibitor protein on cancer cells that shuts off the immune system. By blocking this protein, oncologists can keep the body’s T-cells vigilant to fight the cancer. However, she noted that immunotherapy is typically reserved for the approximately 40% of patients who express PD-L1 and may be contraindicated for those with active autoimmune diseases or a history of severe immune-related toxicities.

The dialogue transitioned into the use of antibody-drug conjugates (ADCs). Dr Kang reviewed data from major trials using TROP2-targeting ADCs in the first-line setting. Dr Kang emphasized the importance of using these highly effective agents early, as many patients with TNBC do not survive to receive a second line of therapy.

Finally, Dr Kang highlighted the distinct toxicity profiles and administration schedules that guide clinical decision-making. Although sacituzumab govitecan-hziy (Trodelvy) is frequently associated with neutropenia and alopecia, the primary toxicities associated with datopotamab deruxtecan-dlnk (Dato-DXd; Datroway) are stomatitis and ocular adverse effects like dry eye. Using Dato-DXd in practice requires a rigorous prophylactic regimen, including steroid mouthwash and lubricating eye drops. Ultimately, Dr Kang noted that because efficacy appears similar between the 2 ADCs, the choice often rests on the patient’s lifestyle, their ability to adhere to preventative AE protocols, and infusion schedule preference.