Cancer Clear and Simple
Welcome to 'Cancer Clear and Simple,' the podcast dedicated to simplifying cancer. Join us as we discuss the world of cancer, breaking down complex concepts for our listening audience. One of our goals is to equip individuals and families dealing with cancer by providing clear, and concise insights. Through personal stories, expert interviews and practical tips, listeners are enabled to make informed decisions. Whether you're a patient, caregiver, or just simply wanting information, tune in to 'Cancer Clear and Simple' for a easy-to-follow guide on understanding and coping with cancer.
Cancer Clear and Simple
Dr. Anand Narayan │ Advancing Equity in Cancer Care
Discover what it takes to ensure equity in healthcare with our insightful guest, Dr. Anand Narayan, an associate professor in the Department of Radiology and vice chair of health equity. Dr. Narayan's inspiring journey into radiology began with a focus on mammography screening outreach for indigenous populations and was further shaped by his medical training experiences in Baltimore. These experiences have driven his dedication to improving cancer detection and outcomes, particularly in addressing disparities in breast cancer care. Dr. Narayan shares the pivotal role of imaging technologies, such as mammography and MRI, in diagnosing breast cancer and highlights how mentorship and personal stories have influenced his career path.
Throughout our discussion, we tackle the pressing issue of bridging the gap between research and clinical practice. Despite having evidence-based interventions like mammography, barriers remain in implementing these solutions effectively to reduce breast cancer mortality. We delve into the systemic challenges and emphasize the urgency of translating scientific discoveries into real-world applications. Dr. Narayan shares compelling patient stories and reflects on the 17-year lag between research findings and their integration into practice. Together, we explore the societal inequities and the need for targeted outreach efforts to make healthcare more accessible and equitable for all.
In our concluding thoughts, we emphasize the importance of empowering healthcare professionals and communities to ensure that everyone benefits from the available tools and technologies. By focusing on patient-centered care and proactive community engagement, particularly for those most at risk, we can drive meaningful change in healthcare practice. As Dr. Narayan and I discuss the balance of professional and personal life, we end on a hopeful note, expressing eagerness to continue collaborative efforts to improve outcomes for breast cancer patients and reduce health disparities. Join us for this heartfelt conversation and be inspired to take action in advancing health equity in your own community.
Today we are joined by Dr Anand Narayan. Welcome. How's it going today?
Speaker 2:I'm doing fantastic, and how about you?
Speaker 1:I'm doing well. I just wanted to give a brief introduction as we kind of get into the conversation here. So Dr Anand Narayan is an associate professor in the Department of Radiology and the vice chair of health equity, and he has a focus on breast cancer and imaging with hopes to reduce breast cancer disparities. Is that a decent introduction? Absolutely Okay, I appreciate it. I appreciate it so, as we're kind of warming up here, if you could just share about your journey into your current role, particularly what influences led to your current work and what education training did you need to get?
Speaker 2:here, absolutely so. First, I just want to thank you for putting on this amazing podcast such a hunger and need for high quality information that patients are looking for to learn more about cancer and the types of steps that they can take to prevent cancer and also to support their loved ones, who are going through some of these processes as well. So I appreciate you getting this information out to everybody, because I think it's really important. So my journey, I think, is informed a lot by some of my early sort of experiences, both in my education as well as my medical training as well. So back earlier on, I think one of the things that I remember is when I was a college student, actually, I was looking for a summer job and it just so happened that the summer job I was looking for happened to be in a radiology lab and in that job we had the opportunity to work with some collaborators who were doing a lot of outreach work with mammography screening, and they were doing a lot of mammography screening outreach using telemammography. And this is very, very early on. This is about 20 years ago or so, so the technology wasn't developed at that time, but the idea was to use this technology to really improve cancer screening in indigenous patient populations, mostly in the West. And one of the things I really enjoyed about that was the opportunity really to be involved with research that had a real impact on improving the lives of patients and that early exposure that I had really helped to influence my interests in both radiology and breast imaging exposure that I had really helped to influence my interests in both radiology and breast imaging.
Speaker 2:And later on, as I ended up going into radiology, I think one of the things that always struck me was that I did my training in Baltimore and where we were we were about an hour and a half or two hours away from some rural sites, but obviously located in the middle of a larger city as well too.
Speaker 2:And what always struck me is that whenever I saw patients come to our doorstep, particularly from rural areas, I would see patients come to our doorstep in many occasions with very large cancers and things that had spread pretty far at that point.
Speaker 2:And it always struck me in my head when I know that we have so much amazing technology and tools available to us to help people identify cancers early and really make sure that we have so much amazing technology and tools available to us to help people identify cancers early and really make sure that individuals have good outcomes. What are the things that sort of lead patients to coming and what are the barriers that we really have in our systems and in place to really prevent patients from getting timely access to all the technologies that we know we have? And so that stuck with me and just as the experience I had in college, the experience I had in medical school, stuck with me, so that led me both to a career in both radiology and public health that leverages my past experiences in public health training with my current clinical training and exposure to try to improve cancer detection and get really good outcomes. And there's no need for that. We really minimize any patients coming into our doorstep with bad cancer outcomes and we can really help people lead long and healthy lives.
Speaker 1:What are the major kinds of imaging? Or in a radiology lab, Like what? What are those kind of familiar things that people are hearing about when, when we should think of radiology?
Speaker 2:Yep. So radiology any kind of imaging test oftentimes will fall within the purview in a radiology department. So I'm in breast imaging. So for me that involves things like mammography screening, so getting x-rays of individuals' breasts to go ahead and see if there's any abnormalities or things that would warrant additional workup or follow-up. We do other tests as well, too, with things like ultrasound, which uses sound waves, things like MRIs that also rely upon other types of more advanced detection mechanisms CT scans, pet scans, nuclear medicine tests as well, too. These all avoid different sort of physical properties within the different tissues within our body to produce images. And the bottom line for all this, all these technologies, is that we're trying to get a look into people to try to figure out if they have any abnormalities or problems that would warrant any additional testing, any additional biopsies or anything that needs to be removed by our surgical colleagues as well, to help people find out if they have any problems or abnormalities, or to take out problems or abnormalities that we diagnose.
Speaker 1:Got it. Yeah, that clears up a lot for me, because about five of the things that you named I didn't know fell within the radiology department. I'm just used to hearing about x-rays, and so when you're talking about the whole gamut of different imaging things that are happening, I did not know and was not fully aware of that. And then so the follow-up question, the complimentary follow-up question as well, is who would you like to shout out in terms of your path to getting to this place in your profession, terms of your path to getting to this place in your profession? I know you said you started back in college and got a summer job, but who, along that line, would you like to kind of give a nod to?
Speaker 2:Yeah Well, first I'm going to shout out an individual that he passed away a few years ago, but his name is Dr Joe Gitlin and he is the first person that I worked with. But his name is Dr Joe Gitlin and he is the first person that I worked with, and it was purely by sheer chance that I happened to work with him after the end of my freshman year of college. But what was really exciting about him was he was a faculty member in the Department of Radiology, but he also had public health training. So he's pretty rare and a lot of his work was doing this outreach work that worked with the Indian Health Service to improve access to cancer screening for indigenous populations.
Speaker 2:But I think the thing that I found so exciting about him was he also served in World War II, and I was very fortunate that I was able to hear many of his stories about his work serving not just within that war but also subsequently working with US Public Health Service as well too.
Speaker 2:So he had a very large influence on me because I really learned from him the possibility of this sort of career in radiology and public health. But I'm also just grateful as well, too, that I've had the opportunity to interact with an individual from that generation who was involved in service and really helping to protect our nation from significant threats to our freedom and democracy, and so I was very fortunate. I think a lot of people currently younger individuals and things like that, and even people in my generation as well too, didn't have the privilege to be able to interact with individuals who were part of that generation, and so I was lucky, very lucky, to be influenced by him, but then also to have learned so much from him from both a medical and non-medical perspective as well too. So he's one, and then I could just keep going.
Speaker 1:That's good because you know the professional like underpinnings right. We're starting to fill out the story about Dr Narayan and youayan and how he got to where he is and things that are helping inform what it is that he's staying committed to, which is a great segue, not wanting to shy away from it. So what is difficult or what is a difficult area in your work in general for breast cancer disparities area?
Speaker 2:in your work in general for breast cancer disparities. I think one of the biggest challenges is the gap between the world of research versus the actual world of actually making things happen. And I think one of the challenges that we face and I think there are a couple of different ways that I think we are now exploring to address those gaps but one of the big challenges we do all these research studies, we accumulate all this really great knowledge and information and with all this great knowledge and information it really helps us to understand the different pathways of disease, the different risk factors, the different things that really influence adverse outcomes for patients. But then oftentimes what happens is that that knowledge itself and this incredible body of knowledge and wisdom that's generated, kind of sits on the shelf and it doesn't take the next step. And the next step is how do you leverage that knowledge and information that you gain to really improve the lives of patients? And that is a real gap.
Speaker 2:And they say in the world of implementation science and translation of knowledge that it takes about 17 years or so for some sort of discovery to actually make its way out into routine clinical practice. And I would say that's certainly the case as far as knowledge about health equity and innovations as well, too, in that space, and in some cases I think there are factors that you could argue that actually even lengthen that process. So the real challenge is, when we get this knowledge or information, how do we really translate it into actual benefits for patients? And I think we're now seeing some new scientific trends and knowledge that really help to potentially bridge those gaps. So things like not only combining our knowledge with health disparities and some of the work that's done in terms of the health disparities frameworks and research things, but then linking those to concepts like implementation, science and quality improvement that really are focused on really accelerating that process of innovation actually out in practice.
Speaker 2:So I think that's one of the major challenges that affects our field. I can really speed up that process by which we take evidence-based interventions and really make sure that we get them in the hands of people who need them. And I think that's one thing that definitely sort of limits us, because we have in many cases in breast imaging we have a lot of tools in our hands. Mammography screening has been around since the 70s and just this one intervention alone we have evidence to suggest that if this really made its way into the hands of the vast majority of our country that essentially we would almost substantially or almost completely reduce breast cancer mortality disparities.
Speaker 1:Yeah, and in the space that I work in as far as prevention, that is always something that I'm having to navigate. As far as what does prevention really mean, right when it comes to cancer? Because we're not talking about a 0%, you can't get that down to 0% but what you're indicating is, with the proper screening and availability of these tools, we can really bring down the negative effects that we're seeing from breast cancer correct.
Speaker 2:Yeah, and I think about that every single time I see interact with the patients or something, especially ones who have cancers that look like they've grown and gotten bigger and spread. And I always think to myself you know, what can we do as a system? How can we do this better? And this is. I've been here for about three years now and I've practiced in other settings or environments. And this comes up in cities, it comes up in rural places, it comes up in the Northeast, it comes up in the Midwest, comes around all around the country. And I always think that to myself, like you know hey, you know we're not going to get to zero, it's never going to be 100%, but in many cases we go back, we think about the different patients that we see in their journeys and I always ask to myself, like, are there steps along the process that we could have jumped in to make sure the patients get better outcomes?
Speaker 1:Yeah. So what I'm hung up on just a little bit is that 17-year gap in being able to find some good knowledge, something that has been tested and researched into the clinical practice. So what keeps you motivated to do this important work?
Speaker 2:I think the thing that really drives me more than anything else is is there are two things. One is I think about the patients that I've seen who've experienced some of these adverse outcomes, and I think about their stories and the steps along the way in which we, as systems, have, in many cases, not allowed patients to get access to the kind of screenings and technologies that would help them get better outcomes. And I ask myself okay, you know, what can we do to improve outcomes for these patients? And the other thing that I get to as well is that I also know that, based upon my knowledge of imaging technologies and my background, that you really have a lot of terrific technologies in place that could make these things truly these really adverse outcomes, preventable.
Speaker 2:Now, it's not going to be like zero, but in many cases, you know, I say to myself like, hey, what if we had better access to mammography screening? What if we had better access to MRI? What if we had better access to biopsies? What if we had these things in this place? How would this have affected the patient that I saw, who came to our doorstep with larger cancer? And I've said that I've seen this happen in many places and asked myself these questions and all too often I find that these things keep popping up over and over again and I realized how preventable these are. And that's the thing that really drives me to seeing that you really have the ability, with the technologies in place, to really make sure that patients get really great outcomes, and that we can really I wouldn't I don't know if it's a completely eliminate, but, you know, nearly completely eliminate this, this, this burden of death and suffering that so many women face as a result of breast cancer.
Speaker 1:Yeah, I'm hearing you and I'm right, right there with you. You know it'd be great to get to that place, or when we get to that place, that's going to be quite the achievement. And so you're talking about the access pieces, right? What does that look like from your end of the spectrum as far as barriers to access?
Speaker 2:I think so many things affect patients at multiple levels. People have a lot of things going on within their lives. They're juggling multiple jobs, they're juggling caregiving responsibilities, they have issues getting time off from work. They oftentimes have to rely on things like public transportation or they live in rural areas and they live far away from centers, and all these barriers can really and there's concern about cost costs are a big concern. Patients in the back of their minds, whether they tell you or not, if they're, if you're honored enough for somebody to actually be that honest with you about the kind of things that are really affecting their ability to get timely access to care. Oftentimes this cost thing will just keep coming back over and over again.
Speaker 2:The idea that if they go forward with this you know diagnostic evaluations and biopsies is that, is this going to really prevent me from, you know, paying my mortgage or my rent or something like that for the next month? And this is something that really weighs on people and it's a lot of uncertainty for people to come into healthcare systems with these concerns. So many of these things weigh on patients as they come in these healthcare systems environments. And in addition to that, then we also have to ask ourselves like, okay, well, just getting to the mammograms themselves. So many centers and facilities are struggling with workforce crises, where people are trying to meet the demands of aging populations. There's so much pent up demand from individuals, like even after the COVID, even after the worst parts of the COVID periods, people are still coming in from the centers that have not had mammograms for several years. And it always kind of makes me worried, because if somebody hasn't been here for that long, you wonder, and you just you know you hope, holding your breath.
Speaker 2:Exactly Because in my head, like if I say somebody's not been here for four years, so I think to myself, like four years? I was like, okay, well, that's 2020. And then that gets me saying, okay, keep our fingers crossed. Hopefully everything's all clear, Because, you know, I really hope that nothing's been cooking there. You know, no cancers, anything like that. That's when you see some of the worst outcomes that we see.
Speaker 2:So there's really many, many barriers that patients sort of experience that prevent people from getting timely access to screening. And a systems level is to you know, when can people get mammograms on Saturdays? Can they get them in the evenings? Can they get them? How close are they? Are they available? And you know the sites that are convenient, are accessible to them in terms of public transit, or are they? You know, can they get them if it's in a rural practice environment? Do you have to drive two hours to get to where I have my regular care, or is there a place that's closer by to it? So these are all factors that really play into access issues with patients, and we do have data from some of the work that I've done, and some of the many other colleagues as well too, that essentially when you start to think about some of these barriers, that you can really help to close these gaps, when you start addressing them systematically.
Speaker 1:Yeah, and in this landscape, how do you see cancer disparities changing in your work and how do you envision making progress?
Speaker 2:I think one of the real challenges with cancer disparities and this is inherent to any kind of issue with technology whenever you have new technologies coming in and we're thrilled by these, these new innovations, these new treatments, these new therapies, these new ways to diagnose things. These are all very exciting things and we should celebrate all these things. But oftentimes with new technologies, the way that these technologies are deployed is the people who are more digitally connected, the people who have health insurance, the people who have higher income oftentimes get these technologies before many others do, and oftentimes these are not the patient populations that have the highest levels of morbidity and mortality from all the different cancers that we think about or deal with. So, as a result of this, you end up getting this widening of disparities, and you've seen this throughout the last few decades. There have been incredible improvements in terms of treatment, in terms of diagnosis, that have really improved our ability to affect positively all aspects about the cancer screening, diagnostic and treatment and paradigms that the patients have access to. But because of the lack of access that some patient populations have had, in many cases, a lot of disparities have basically stayed the same or, in some cases, gotten even worse. So breast cancer mortality disparities between black and white women have basically not changed since the 1970s, and so I think that's a real cautionary tale for all of us that even though, despite all the incredible advances we've made, that because of the lack of access to many of these technologies is that that aspect of things these disparities have not really moved that much and in some cases have actually gotten worse because of the differential access to those technologies.
Speaker 2:I think, going forward, I think the murder of George Floyd and COVID-19 have really really cast a light on the cracks that exist within our societies in terms of lack of access to different services in the healthcare environments and because of this, I think there's more attention to this and people are paying more attention to how these health inequities sort of play out in terms of access to services. So I think that attention is very important play out in terms of access to services. So I think that attention is very important. So, as we design new programs in our healthcare environments, thinking about who gets access to them, who doesn't get access to them, how does this affect patients? And as we think through these different paradigms here, it really affects our ability to sort of get services for individuals and if we think carefully about these things, we really can move the needle for patients.
Speaker 2:But we have to think about these at every single step, saying, okay, hey, we're implementing this new program, how does this affect the patients who are living in rural environments?
Speaker 2:And you know, we're a state institution here at University of Wisconsin, so we're concerned for the health of our entire state. So we have to think a lot about, you know, the diverse patient populations that we serve and the different kind of obstacles and barriers they face in terms of getting access to services. So I think those are some of the challenges, but I think that the flip side of it is that, because of this increased awareness and attention and some of the new technologies and how we're deploying them, I think there's a real opportunity there to say, with a lot of these cancers which in many cases are very preventable things like breast and lung and colorectal we have great tests and we have a lot of ability to improve access to these services and really improve outcomes for patients. So I'm excited about that that we have these tests and these opportunities for it. But the challenge for us is then to go to the next step and figure out how we can get them in the hands of our patients.
Speaker 1:Yeah, yeah, okay, okay. Things are starting to make more sense in terms of the big picture, and just wanted to keep things moving with asking when do you get to engage with others about topics relating to disparities, and are those interactions productive?
Speaker 2:Yeah. So I think when you think about disparities, it's sort of always there as a consideration, and whenever I think about anything related to either my clinical operations roles or my research or my outreach, it's always sort of in the back of my mind, thinking about okay, well, I'm doing this outreach program, I'm doing this initiative to improve cancer screening, who's affected by this, who's differentially impacted by this, who benefits the most from this? And so it's always sort of back there in my mind. As part of my role, it's important for me to think about who gets access to some of these different services, and I think that's really critical because if you really want to move the needle in terms of improving cancer outcomes, you have to ask yourself which individuals are the most likely to experience increased morbidity and mortality from cancer. And so I think, when you think and you really focus on that, now comes our patient space and our mission, which is really this, founded on this Wisconsin idea that all that knowledge and all that brain power that we have is we exist here to serve the people who live in our state. And you say well, how are we serving those people?
Speaker 2:Who's dying from cancer, who's getting bad outcomes, who's getting, who's showing up to our doorstep with advanced cancer outcomes and and if you really focus on that is oftentimes I found to be having that laser-like focus on who's suffering, who's experiencing really adverse outcomes, really focusing on that and try to improve that. I found that focus really helps to drive the conversation, move things forward in a positive direction in a wide variety of audiences that I've worked in in practice settings in the cities and urban areas and suburban areas. I think when you really focus on that stuff and just say, like who's really suffering from these cancers, like are we truly committed to, you know, reducing outcomes and these terrible things that happen to the patients that we see, and if we focus on that, then I think we can really have productive conversations by just keeping that leisure-like focus on the patients and the people that we serve.
Speaker 2:Okay, okay and just it came to my mind that you know there's lots of models to so many organizations or groups I've learned so much from and I'm really grateful to have the opportunity to learn from some of these organizations or groups.
Speaker 2:I think one just working here in our cancer center, this general sort of focus on improving the health of the people of our state, that general principle, that that's what's supposed to be driving what you're doing.
Speaker 2:I think that our cancer center, that focus on that I think has really helped to guide a lot of my efforts and my thinking. Some of the other groups that I've also really helped to shape the way that I thought about things. Many of the groups that are focused on things like quality improvement, I think have really driven the way that I've thought about things. Groups like the IHI, for example, and the American College of Radiology. We have a quality and safety group that has conducted this thing called the Empower, this quality improvement collaborative, and the way that they think about problems and really help to drive outcomes has really helped to shape my thinking about these things. So these are a few groups and there are many others that I've learned so much from in terms of the way they think and process about information, and I've also supported many of these efforts as well too, but there was a couple that come to my mind immediately.
Speaker 1:The IHI stands for what the Institute for Healthcare Improvement? Ah, gotcha, Gotcha Yep. Just just didn't want to miss out on what that part was.
Speaker 2:I'm a radiologist, so a lot of the work that they do is not necessarily 100% directly in my scope. But what I've been so impressed by is when they think about problems. They think about problems from a scientific perspective, it's true, but the way that they phrase problems or issues is and a lot of this shaping. The Hartford Foundation, I think, has really played a very critical role in shaping this thought process as well too, and part of that is that when they think about problems, what they're talking about is not just the actual problem itself, but how actually the problem, the solutions to those problems, actually make their way out into practice. So IHI, for example, has invested in this thing called the Breakthrough Series, which the idea is that, as they think through innovations, what they want to do is not just ask okay, let's you know, think about the scientific innovation, how do we really get this in the hands of patients in different health systems? And and they almost talk about things as forming these like movements essentially um, yeah so Dr Terry Fulmer, for example, when, when I talked to her about the aging health systems, the friendly aging, aging, friendly, age, friendly health systems movement she talked to, she didn't talk to me much about science.
Speaker 2:She talked about creating movements to really improve outcomes for older patients and I was, and that really struck me that that was the way she thought about problems, which harkens back to my previous stuff that I've done in my life before but really focusing on how do we create a movement that really helps support older adults as they go through the healthcare system. So I look at that framework and that thought process in the same way for reducing breast cancer disparities.
Speaker 1:I appreciate that because I didn't know that these organizations and entities exist, right. It's important that I'm hearing from somebody who is a provider, who is in the science part of things, to know that the scientists are also thinking about the social aspects, right, and you know how we can potentially create bridges in having these conversations. That's encouraging to know that people are thinking on that side about these particular points I was thinking.
Speaker 2:Dr Fulmer you know she tells her background's in nursing and she would tell me stories about how she saw on the floor older patients who were treated very disrespectfully and not given appropriate sort of recognition of their age and their wisdom and some of the wonderful things that they bring to the table. And those experiences she had of older patients not getting treated well within her health care system really, really inspired her. And a lot of the conversation was there about, yeah, there's the science about how older individuals are treated within her health care system. But then then there was the idea of, hey, I'm going to really use these experiences that I've had working within healthcare systems to really inspire me to do the work that I do and really push this in, not just my system that I'm working in, but many others as well too.
Speaker 1:Yeah, yeah, very nice, very nice. What population needs more attention in the work to close disparities that is not getting enough visibility, and what can be a key factor in this oversight?
Speaker 2:I think there are a couple of different organizations or groups that I think a lot about in terms of who we want to target our outreach and our improvement of services with. And the first one I think we really have to pay tremendous credit to safety net hospitals, to critical access hospitals and federally qualified health centers and community health centers that provide such a valuable service for patients who are lower income, patients, who live in rural areas, diverse patient populations, and they really do heroic service in many cases with a wide variety of resources that are available to them to help support those services. And I see this in some of our data here. I'm lucky groups like the Access Community Health Centers here and incredible work from Dr Loving and so many other colleagues to really help to support patients. It's brought integrated, comprehensive services for patients. It's really just amazing to watch and it's really inspirational to see. The efforts that groups like that take to improve care for patients is really just amazing to watch and it's really inspirational to see the efforts that groups like that take to improve care for patients.
Speaker 2:But in so many other cases, the integration that these systems have with other types of health systems and subspecialty services, and particularly us in the oncology world is very variable and in many cases there are a lot of breakdowns in the kind of services that are offered for patients in many safety net environments and things.
Speaker 2:And that's where you really see a lot of breakdowns in the kind of services that are offered for patients in many safety net environments and things, and that's where you really see a lot of gaps in care and patients are lower income. But even safety net environments or hospitals they often they face financial challenges. You think about the kind of financial challenges that rural hospitals, for example, are facing in terms of being able to provide care for patients and really serve as anchors in many respects to many of the communities that they serve. And so I think these are. So these kind of entities or organizations are ones that I think about a lot in terms of care delivery and about who's doing the work out there and how we can sort of highlight and amplify their efforts and to really support these missions that they serve in terms of improving care for patients that they serve in terms of improving care for our patients.
Speaker 1:Yeah, that's very interesting to hear that connection of the gaps in service or the gaps in being able to get somebody from point A to point better right.
Speaker 1:That's what I'm thinking of when you're saying that right, and where the handoff may need to be from a federally qualified health center to a institution like UW Health or those kinds of things.
Speaker 1:And I know that there are relationships and collaborations happening. But as you're talking through this, you know just to kind of understand the fragility of what happens. Just earlier in the conversation you're talking about the access and the barriers and things like that. And if somebody is, you know really, you know just on that fine line of getting the help that they need desperately. But you know things are happening along the way that one handoff from one system to the next, you know that really can impact how somebody shows up to the next appointment and if their information is lost or it's not transferred over or you know just even a smaller minor thing, you know it could really throw a wrench in how this person's hope is really building, in the way that they are able to heal or get better, and so you know. Thank you so much for giving that perspective about the different systems that are at work, when trying to get these disparities under control wasn't an issue. What would your approach to changing the current dynamics look like in radiology from a health equity perspective.
Speaker 2:I think if money was an issue I think a cost thing is such a big concern that drives patients in terms of their willingness to go ahead and even get a screening mammogram and you see the data for this. But if money were not an issue, I would love to tell every patient who shows up at your doorstep that, hey, you know, come here, get your screening and if we find something, if we don't find something, whatever it is, you're not going to be shocked with some gigantic bill or something like that too, that could potentially be financially devastating for you, that some of these basic services in terms of cancer prevention, they would be covered for those services and they would not be faced with some gigantic bill down the road. And I think that, because that pops up so many times, not just in the research that I've done previously, but also in just the conversation that I've had with patients if money were no object, I would make sure that I would have some sort of fund to help patients along the way to say, hey, you know what. We're going to get you through this process. It's not going to. You're going to be able to have a roof over your head. You'll be able to feed your kids, take care of your family and do all that stuff. But we'll also take care of you doing this and support you along the way.
Speaker 2:And support, I mean patients go through so much along each step of the process for this, and even just getting to an appointment, I think, is something that we should just celebrate in many cases, just because it means taking time off means figuring out work, child care coverage. Taking time off means figuring out work, child care coverage, responsibility for family, loved ones and so many different things. But I think if money were no object, I think I would really invest in really supporting patients on the way to really get through and be able to get access to these services and not worry that there's going to be some sort of financial cliff that's going to befall them if they all of a sudden are not able to be able to pay for their housing or something like that too, if they get a large bill from a biopsy or cancer treatment or something like that too. So that would be my biggest thing to really give patients that assurance and that safety that yes, come on into the system, we'll take care of you, it's not going to bankrupt you.
Speaker 1:It just also dawned on me that in what you do as far as the radiology department and how many different screens or imaging processes there can be, has there been a time where just in thinking about that example of how the finances come into play, right when somebody has had to get like five or more like screenings just to get to an answer that is going to lead to a treatment process?
Speaker 2:Yeah, so what I mean for us, what usually happens is people get some sort of screening mammogram at that point, and that's just generally for women starting 40 or up. We tell people to come in and get just your regular sort of screening. But then after that, if people find stuff, oftentimes you may get additional tests to figure out what might be going on, and the vast majority of these times these turns out to be nothing. But you may get additional mammograms, you may get ultrasounds, you may get biopsies. So there are oftentimes for a fraction of patients. There may be a series of steps before people find out if they have something or don't have something. Again, more often than not it turns out to be nothing, but in many cases for patients, they do have to go through a series of these other tests to figure out what might be going on with them.
Speaker 2:And this is the issue that pops up as far as when people have access or don't have access to some of these services, and oftentimes you find these conversations hey, you know, can we talk a little bit about this, like I saw that you were.
Speaker 2:You know we're scheduled to get a mammogram for for this, to have this looked at, or something like that too.
Speaker 2:Then you know I haven't seen you for a couple of months or whatever it is.
Speaker 2:Can you tell me what's going on and the number of times I find out there's something financial related to that issue, or hey, I, you know I was worried about this thing.
Speaker 2:Well, and you know somebody says I'm changing a job so in between there I didn't have a health, and some people have seen not even get surgery for almost a year, just because I've seen patients not get surgery for a year just because they didn't have insurance and and or they were in between jobs and while they were figuring out what they were going on, what's going on with their job situation, they also had this other thing that's picked up or detected. So then people just and it, you just scratch the surface a little bit and you find this in so many people and um, but, but I'm also, I'm honored to, I'm honored for people to tell me this information as well too, like I'm really humbled that people feel comfortable enough that they would be willing to express this. But you know I'm also, you know these things do stick with me as far as then, also motivating me to try to improve access to care for our patients.
Speaker 1:Okay, Okay, Now I want to just understand a little bit more about Dr Narayan and how he keeps his work-life balance. I don't want to shy away from the fact that there's a lot of tough things that you come across as far as seeing what people are going through and being able to understand their health outcomes, their particular journey and things that might not look like they're going to end out in the best ways possible. So what does a healthy balance look like for you in doing your work and being fulfilled in your personal life?
Speaker 2:Yeah, I think for me, one of the things that I'm pretty aware of is that when we think about things like being involved in cancer centers and things that we often are faced with dealing with many cases, to difficult discussions and conversations, I'll say that we're lucky in the world of breast cancer and oncology that we can offer hope to so many people with the kind of new developments and treatments and advances that are present now that weren't there even 10 or 20 years ago. So that's one thing that helps us sort of grounded, that oftentimes we, because of the things we can do and the opportunities and clinical trials we offer, that we can offer a lot of hope in situations for patients, offer a lot of hope in situations for patients and I'm excited about that and I think that's hopefully a source of comfort for people who are coming in for these things that cancer is not a death sentence these days. So that's one thing that keeps me grounded personally in some of these conversations or discussions. And personally, just you know my family, like my wife and my three kids, it's a chaotic household. Mine's kids are a six, five and that one was a very uh, it's a lively house, but it's also incredibly joyful. It's, um, it's a lot of fun, even even small little things. You know the the the little things in life, just, you know, just uh, walking down the driveway and all of a sudden, you know they see a group of ants sitting in the corner of the driveway and that becomes, you know, literally excitement for the next carries on for the next three hours, like you know, just looking at this ants and just, you know, seeing if they're going to climb on this leaf or not, and then talking about these ants and the ant colony for the next three or four days, and you know, just the simple small things that that come along with and just the joy of watching these kids grow up and participating activities with them.
Speaker 2:As a family. We'll, you know, going out to different things and just um, just enjoying sort of being present with them and all the fun stuff that goes on in the summer in particular. Uh, now as well too, um, just enjoying all that stuff. And you know my wife and I enjoyed watching tv and sports and stuff like that too, so that that's there too.
Speaker 2:But, you know, with the little kids then, uh, some of the, some of the tv shows that we watch are, um, you know, there's a, there's this thing that that will be on, uh, when the kids around, and there's also a tv show that you know perhaps is not the most child appropriate. Uh, some things here, uh, that sort of that sort of keep me sort of grounded. I would think sports. Sports is generally a it's a, it's a fun thing that I enjoy, and I enjoy it with you know, get together with some friends and watch games and stuff like that too. But that can also be a big source of frustration too, you know, because you know only one team wins a Super Bowl every year.
Speaker 1:Okay, so you're talking about the American football here we go here with Scott and the Packer fans. You know, we definitely have that different model set up of collective ownership and that definitely pulls people in and gives them something to cheer about.
Speaker 2:Yeah, I mean, I think sports can be great and frustrating. I grew up in Baltimore so I'm actually a Baltimore Ravens fan, but still nevertheless I think it's very especially football. Base baseball is a little different because that's more of like a slow burn kind of thing, because it's you know long, it's like the game for you know, for a six-month period there's a game on basically every day, so it's not quite as like intense as like one Sunday or something like that too, but you know it's not quite as like intense as like one Sunday or something like that too.
Speaker 2:But uh, but it's fun. But you know it's fun why I get together some friends. You know we'll go out and just go on tailgate a little bit and have some fun. So, um, so so it's. It's, it's great, but it's also um, can be source of frustrations.
Speaker 1:Gotcha, yeah, no, I, I was asking for the balance.
Speaker 2:And I'm hearing it, you know there's give some, there's take some. So, as we're wanting to wrap up a little bit here, what is your parting message to listeners and future guests on this podcast? Yeah, I think I think just the opportunity with the cancer education and the work that you're doing here to communicate this to sort of a broader audience is that we have so much available to us and we have so many great opportunities to really improve outcomes and lives for our patients. And it's it's. There are certainly challenges that obviously the pandemic and things have really shined a light on the many challenges and obstacles that we sort of face. But we also can take a step back and say to ourselves and sometimes even just think about what was it like to practice five years ago, what was it like to practice 10 years ago, 15 years ago, 20 years ago, and to take a step back and think of all the incredible advances we have made and our ability to really impact the lives of our patients very positively.
Speaker 2:So, if anything it gets, it's to me like the biggest sort of message and I think about things like breast cancer disparities is we have the tools in our hand. You know, when we talk to patients. We have the things that are, we have the ways of communication, we have the technologies, we have the tools in our hand to really, for a very large number of the cancers that we deal with, that to really improve outcomes for our patients, and that, to me, is very exciting. And so for people doing work and things like breast cancer and stuff, to say to ourselves like the tools are in our hands to really make the lives of our patients better. And so that's so. That's my takeaway message that the tools are there for us and it's up to us to get out there into our communities and to work on health centers to make sure that our patients live long and healthy lives and scratch this one cancer off the list of things that cause the major public health problems in our country.
Speaker 1:That sounds fantastic. I really, really have liked being able to connect with you here, dr Narayan. I very much appreciate being able to be a terms of getting people involved, getting people in the know, understanding, taking proactive, proactive. We know we have our stance of wanting to be proactive, so all of those things have been very well received and I look forward to being able to continue more of this work as we continue on forward.
