Darrin Godin: Hello and welcome to Talking Hope. I'm your host, Darrin Godin. The medical term for a diagnosis at a younger age is early-onset cancer. That means hearing those life-changing words. You have cancer between the ages of 18 and 49, and these words are always unwelcome, but confronting them before 50 brings a host of challenges, which we will discuss today. Our guest today is Juliette Landgrave, and she's among the new young faces of cancer survivorship. Her story is one of resilience and hope, and it has been our privilege to care for Juliette here at City of Hope Orange County. Her multidisciplinary team includes our second guest who we are also excited to have on the show today, renowned radiation oncologist, Dr. Amanda Schwer. Thank you both for joining us.
Juliette Landgrave: Thank you for having us.
Dr. Amanda Schwer: Thank you very much. Honored to be here.
Darrin Godin: Our starting point today is going to be the unsettling rise in early-onset cancer. City of Hope Orange County has recently released a report that looks at the troubling increase in cancer rates among people under 50, especially in Southern California. And the rise in early-onset cancer is happening in Orange County across the U.S. and worldwide. So Juliette, let's start with you. You were diagnosed with breast cancer at the age of 38. Can you tell us about your journey with breast cancer and how you have reclaimed your life?
Juliette Landgrave: Yeah, getting those news that I had cancer were devastating. It was a real hard concept to grab, to be honest, for me to actually go from being a healthy individual to the day after a biopsy, two days after, being now given this life expectancy, to be honest. Whether I was going to live, whether the cancer was going to actually work with the chemo that they were giving me. And not only that, also being so young and planning for having a life and a family sometime soon also affected all those things, because I am triple-negative breast cancer, which is mostly more aggressive on younger women. So that's not only having the cancer card, but everything that comes with it. It was very hard to digest.
Darrin Godin: And in the midst of that difficulty to digest and hear that news, I understand you're a pretty optimistic and positive person. So what did you draw upon to say, "I'm going to get through this?"
Juliette Landgrave: One of the first things that when I was researching triple-negative, I did find out that one of the key drugs that is helping people like me live longer had been actually approved by the FDA, so I didn't have to jump through hoops to get this one drug that is helping people. So that was the beginning to always look at the positive and always be grateful for what I have being in this country, having hospitals like City of Hope that are here just for that. So yeah, being with the experts was one of the other really important things for me, because I knew that if I was with the best, they would be looking out for me and my well-being. So yeah, just looking always at the cup half-full and just saying that it was going to be the picture perfect for the drugs, because they were going to work, and I was going to be cancer free.
Darrin Godin: So you mentioned the word experts, and we talked about your multidisciplinary care team. Talk about them a little bit more.
Juliette Landgrave: Again, just hearing these words, "cancer," and then having to digest that, and then having such a wonderful team like my radiologist that's here present with us. But even when I went for my surgery, because I had had 16 rounds of chemo, I had complete response to chemo. So that means that the cancer wasn't visual, whether it was through the MRI or just feeling it. I wanted to have a lumpectomy because I'm still young. The physical appearance to me is still important. I want to also feel like a woman. I still want to feel like a young person. I knew that that was going to affect me dramatically.
So when I spoke to my surgeons, the first thing that they said, they were like, oh, we're so happy you decided on lumpectomy, which is mind-blowing, because other cases they might be pushing on mastectomy, which a lot of people... That was the only source that we had back in the day, that, "Hey, let's remove the breast and then you won't have cancer." Now, thankfully, because of the work that City of Hope does now, we've seen that lumpectomy with radiation is as good as a mastectomy. And again, those things, I know I could see myself and I still look like myself and I feel like myself after treatment, which are super important as a survivor.
Darrin Godin: Thank you. You also mentioned earlier about wanting to have a family, and those things were concerns, and I think those are one of the things that for a younger person, the younger face of cancer, those are the types of things that a younger person might face and be concerned about. So Dr. Schwer, I know you're seeing this more and more. You're seeing more younger faces present with cancer. Talk to us about, from a physician standpoint, what are the things you think about when you see a younger person and making sure that we're going to keep them whole?
Dr. Amanda Schwer: Yeah. Everyone who gets a cancer diagnosis faces a whole spectrum of challenges, but those challenges are honestly greater for younger people. There's just a whole slew of things, the emotional concerns, the psychosocial concerns, fertility preservation, which just has a whole spectrum of not only processes, but emotional aspect tied to it. Managing employment... I'll oftentimes, my patients have young children and have to manage caregiving duties, changes in physical function, body image, all of that is magnified even more with younger patients. So yes, there's a whole spectrum of things that come always with a cancer diagnosis, but it is particularly pronounced in younger people.
Darrin Godin: And Dr. Schwer, I know that you are a professional who has been practicing a long time, but this is personal for you, right? You're seeing more of this. Can you tell us how is it affecting you as a physician when you're seeing more younger and younger faces coming in presenting with cancer?
Dr. Amanda Schwer: Honestly, it is... I'll be completely honest. It has been taking an emotional toll recently. I am seeing so many more young people every day. I'm seeing a young person, I lost a thirty-year-old two days ago to metastatic breast cancer, and I'm starting a twenty-nine-year-old on Monday. And just seeing what they're going through and often meeting their young children. And it's tragic. And I grew up here in Orange County, and with our rates being so high here, it's affecting me professionally, but also personally. A lot of these are my friends. My sister had breast cancer at 42. It's happening, and it's affecting a lot of people.
Darrin Godin: Well, I know that City of Hope, we are aware that it is a problem. We're seeing the growth in the incidence rates, and I'm so grateful that we have folks like you and other professionals and other experts as Juliette talked about, who are really coming together to say, "What can we do to make a difference?" So talk to us a little bit, Dr., about obviously the question everyone has is why is this happening?
And I don't know that we have the complete answer for that, but the next part of that is, what can we do as younger people to help prevent cancer?
Dr. Amanda Schwer: Yeah, there's lots of things. I think both patients and caregivers need to be more diligent. Physicians are often trained to think that breast cancer starts at 40, and we really need to reset our mindsets. We need to be vigilant about screenings. Patients need to advocate for themselves. I honestly think doctors need to have cancer in their differential. I can't tell you how often I hear patients saying, "I was 28, I was bleeding, and I went to the ER and I was told it must be hemorrhoids because you're too young for it to be anything." So they didn't get the work up that an older person might have. "I felt something in my breast and I was told, oh, you're too young. Come back in a couple of months and if it's still there, we'll do something about it."
And so it's education on providers, but obviously patients need to take some of things into their own hands. Know your family history, be diligent about following up on things that run in your family tree. Get your screenings, mammograms, colonoscopies... The ages for those are getting younger. Exercise, eat well, cut down on alcohol, don't smoke. All of those things really make a difference. But screening is huge, and advocating for yourself and speaking up. If you notice something going on with your body that just doesn't feel right, and that's often what people say, is "It just didn't seem right."
Darrin Godin: Juliette, can you add some color to that, as well? Obviously you probably had some things you were experiencing, as well. How did you advocate for yourself and know to say, "Something's not right"
Juliette Landgrave: Well, like Dr. Amanda said, you know your body best, and you really know what normal and what is not. I found my lump just in the shower. I was just showering, and I felt something, a tiny lump, the signs of a bean, but it was something that I never felt before. I have pretty dense tissue in my breast, so I was like, "What is this? It feels a little rough. It feels a little... Let me get it checked out." And just like she said, people told me, "Oh, you're too young to be cancer." Not only that, I would tell them that I will feel pain in the breast, and they'll be like, "Oh, cancer doesn't hurt." So you have to constantly be asking questions. You have to make sure you advocate for yourself. If you go to a doctor and they don't see or they want you to wait, you could always have a second opinion, as well. If you know that that's not how your body works, continue asking, because maybe it's something deeper that the doctor cannot just see, that they need to do a scan or something like that. But yeah, it's really important that when you're taking a shower, just to check yourself. And breast cancer could happen on males, too.
Darrin Godin: Yeah. Thank you for that, Juliette. And you're doing well today, right? How are you doing?
Juliette Landgrave: I'm doing really good. I am cancer-free, thankful. After almost two years of treatment, like I said, I had 16 rounds of chemo. I did a year of immunotherapy. I did 25 sessions of radiation. So I really went through the whole treatment, and it was a long time, but now I'm finished and I'm trying to reclaim my life back. And every day I feel and look like myself a little bit every day. And I still continues with my positive attitude and just really hoping to help others get through this news whenever they get them. Unfortunately, in every family, there's somebody that has had cancer or knows of somebody that has cancer. So yeah, just normalizing it, because this being part of a lot of families' journeys, unfortunately, today and age.
Darrin Godin: I had the opportunity to meet you recently, and I met your parents that day, and I could see in your parents' eyes as they thanked various folks at City of Hope, how grateful they were for the hope that they were given for you to be able to stand here today to say that. So I know that means a lot to families. We often think of our parents or our grandparents getting cancer, and the younger folks taking care of them, I imagine they never thought they would hear those words that you had cancer. So I just want to acknowledge that it does impact the family, and we thank you that you're advocating for other families, as well. Dr. Schwer, what's your message for others today, especially younger folks under the age of 50? What is your message?
Dr. Amanda Schwer: We are seeing every day a rise in the number of young people that we're seeing, but there's still hope. There's programs, there's research, there's prevention, screenings, prioritizing early diagnosis, education efforts. We're going to turn this trend around. With today's advanced treatment options, I feel so lucky to work at a place like this where we're constantly making breakthroughs, doing research, finding answers, finding drugs, and having the honor and privilege of taking care of incredible people like Juliette, who is not kidding when she said she stayed positive. Every time I saw her, she just had a grin on her face when she had been honestly through hell and back multiple times, and she just was always adorable and strong. I loved it.
But there's... Young adults with cancer, there's hope. Reclaiming your lives as possible, regardless of your age. Just stay vigilant. Pay attention to your body, listen to your body, take care of your body. If you have symptoms or feel that something's wrong, speak with your doctor and get it checked out. That's honestly... Get your screenings, all of that, and together I think we can make a big difference.
Darrin Godin: Thank you. Dr. Schwer, you just mentioned screenings. Let's talk about that before we close. Why is early detection of breast cancer specifically so important?
Dr. Amanda Schwer: In particular, breast cancer is so incredibly curable if you catch it early. So for example, when it's localized, meaning it hasn't spread outside of the breast, the five-year survival rate is 99%. So data between 2013 and 2019 gave us those numbers. But when it's distant, it goes down to 31%, meaning it's spread to the liver, the lungs, the bones, it has metastasized. I think those numbers are better now than they were between 2013 and 2019 because we are making strides every day, but still, they're sobering.
So at City of Hope, we're doing lots of screenings, encouraging education, and we're also doing lots of clinical trials for breast cancer patients. Immunotherapy is one of the drugs that Juliette referenced that has made a tremendous difference, particularly in triple-negative disease. We're doing trials, we're re-engineering blood cells to treat people with HER2 positive, solid tumors. We're exploring CAR-T cells for metastatic breast cancer patients. We're really in a renaissance of cancer care right now. There's a lot of really awesome opportunities for growth and cures and such coming down the road, but early detection is always the best thing that we have in our arsenal.
Darrin Godin: You said something that really stood out to me, in that all those different treatments that we have available to us, it sounds like those are more than just the standard of care. There is standard of care out there that is happening across the country at many great places, but the access to some of those things you mentioned, immunotherapies, CAR-T, cell therapies, those different trials and so forth, those are really what do make a difference, and those are what distinguish us from others that are doing similar work around us.
I know working for City of Hope, I get asked that a lot: "What is the difference between you and ‘put the name in there?’" I think you just really hit on it. And Juliette, you mentioned receiving some of those. So let's talk about that for just a quick minute. Juliette, what does that mean to be able to come to a place like City of Hope where you weren't just offered the standard drug that everyone else is using, but you were looked at as an individual, and your cancer was looked at to see, what are the different ways that we can come at this to make sure that you could say you're cancer-free? What did that mean to you?
Juliette Landgrave: Oh, it's night and day being treated at City of Hope to other places. They see you like a human. They know what you're going through, even if they haven't been through it. It's just night and day between a regular cancer center and you guys. You guys basically have the hall pass to all these treatments. You guys have joint programs with universities. So again, once I reached City of Hope, I knew I was in good hands. And touching back on what you said about my parents, is when I told them about me having cancer, I told them, "Hey, I'm going to have to go through chemotherapy." But I told them, I was like, "Look, it's breast cancer, so at least breast cancer has the most studies in all of the cancers." So whenever I gave the bad news, I always gave them with a positive spin, because like Dr. Schwer said, having a cancer diagnosis doesn't mean your life is going to end nowadays. It's not a death sentence. So even stage three in my groups, I see them being cured or being cancer-free. Obviously you need the five years to be cured, but yeah, it just, again, having City of Hope in literally the background of my home is just a godsend, to be honest.
Darrin Godin: Wow. Julie, I'm going to ask you one more question. When you finished all your treatment, I assume you got to ring the bell. Tell me about that moment and what that felt like.
Juliette Landgrave: I took every single time that I could ring the bell, every single time I could celebrate something, I would celebrate it, because again, not everybody got the results that I did. I know that other people struggle, so I took it with gratitude. I took it with hope and with grace, because again, I know that I was a very lucky person to be treated with City of Hope, to found the lump in the way that I found it, because I actually had two lumps, and only one was the one that I was able to physically touch. So if I hadn't had that other one, maybe it would've been a different story in my case. But again, thankfully, yeah, I celebrate as much as I can.
Darrin Godin: We love to hear the sound of that bell. Amanda, or Dr. Schwer. When you hear that bell, what do you think?
Dr. Amanda Schwer: It makes me so happy every single time. I hear it all day, and I still love it every single time, honestly.
And Darrin, to your point, I get asked a lot too, why do you work for City of Hope? Why are you here? Why is it better? All of that. And usually when I talk to patients about it, I honestly say that I use the same cliche every time. We literally have the latest and greatest in radiation. For example, we have every machine you could dream of. We have every technology. We have the fanciest and most up-to-date. And with the fanciest toys, I can do the best work, which is really nice. We have access to drugs, we have trials. And I when I came from a different hospital, I got asked why. And I said, "I want to be the best. I want to be the best at what I do. And the only way I can do that is to be at the best and to be surrounded by the best." And my peers are amongst the most brilliant, wonderful, empathetic, incredible humans around not only physicians, but humans. And I just feel so lucky every single time I walk in these doors, because we just do such a good thing here.
Darrin Godin: Thank you so much. Thank you, Juliette. Thank you, Dr. Schwer, for being on the podcast today, for sharing your story. It's so important. I'm encouraged. Even though the news that the face of cancer is getting younger is concerning, I'm encouraged, and I have so much hope after listening to both of you talk today, that like you said, it's not a death sentence. We have hope. And knowing that there's great folks like you and others that are continuing to put their brilliant minds to work every day to find the cures, I think we really have hope here in Orange County. So thank you both for that.
We hope that our conversation today also makes clear that nobody is too young for cancer. Cancer's new face is the face of our neighbors, our work colleagues, our children, our adult children, and so many more. And awareness is the first step in getting people screened and tested early. City of Hope is as focused on preventing cancer as we are on treating and curing it, and we offer a range of screenings and cancer prevention services, including mammography, colonoscopy, and a comprehensive cancer risk assessment that focuses on family history and genetics.
So for more information, we ask you to please visit cityofhope.org/OC, or if you need to make an appointment and see one of our specialists at any of our City of Hope Orange County or Long Beach locations, you can call us at 888-333-HOPE. When it comes to cancer, it's Hope First. I'm Darrin Godin.
Thank you so much for joining us today, and we'll see you on the next Talking Hope podcast.