109: Cryoablation, Patient Choice, and the Future of Breast Cancer with Dr. Hania Bednarski

So when I ask if treatment for breast cancer has changed significantly in the last 20 or 30 years, the answer is almost a resounding no, with the exception of a few cutting edge people who are really thinking about treatment differently. And I have one of those people here today. So if you are someone who was interested in learning about or curious about cryoablation, then I took you to the source today because I am so delighted to have my friend and colleague, Dr. Hania Bednarsky here today. So Dr. Bednarski is revolutionizing how we treat breast cancer, and she's doing it in a way that is so forward thinking, and she is quieting the noise, which I always appreciate people who are willing to quiet the noise and forge ahead. So, Dr. Bednarski, welcome. I'm so happy to have you here.

I am thrilled to be here. Jen, thank you so much for having me. This is so much fun.

Of course. So, you know, selfishly, I wanted you to come because I wanted you to see what we were doing here at Perfection. I wanted you to have a scan, and I wanted someone who was also on the cutting edge to come see what I'm doing, because we actually have very similar roots.

Very, very similar. Very similar paths to where we are right now. Absolutely.

Tell me, because you're a breast surgeon, and I can only guess, I'm not insulting you or your age, but I can only guess that when you were training, they were not talking about using cryoablation to treat breast cancer.

Absolutely not.

So tell me about your early days.

Sure.

And what opened your eyes to the possibility that there was something else?

Yeah. So I have a bit of a convoluted story, as I think a lot of us do. Yes. So I started out thinking that I was going to be a trauma surgeon. That's what I really wanted to do.

Wow.

Yeah. So, you know, I love that adrenaline rush. Love to be the top dog in the. In the trauma bay. And about halfway through my residency, my. My general surgery residency, I did my first breast surgery with my. With my program director. And the program director's. The patient was his best friend's wife. And I thought, this is going to be amazing. We're going to do such great work. This is, you know, somebody that he truly cares about. And here we go. And so, you know, I was the underling. I just suctioned, as you know, during residency. This is, you know, especially starting out. And so I did. And when we were done, I gasped and I said, this looks awful. And when I said to him, can't we do better. Is this really what you're going to leave her with? His answer was exactly. She should be happy I got rid of her cancer. And.

Well, let's start with. If you ask a trauma surgeon.

Well, no, no, he was a general surgeon. He was a general surgeon who did breasts, which, sadly, I think a lot of people don't do their homework. Right. A lot of people go to general surgeons who are close to retirement who think that breast is easy. And so they start doing breast when they're close to retirement and they, they have, they don't have the credentials, they don't go to conferences, they don't know what it means to be a breast surgeon. They don't have the sk. That. And yet this is who's doing a lot of women's breast surgery.

Oh, that's horrible. It's a horrible story.

So, so I said to myself, you know what? I can do better. So that's when I decided that, you know, this would be my path because I, I just couldn't stand that this is what women would be left with. So I, I wanted to do breast surgery, but I wanted to do everything from start to finish. I wanted to give well rounded care to my patients and was told that that probably wasn't going to happen, that maybe I should focus on doing plastic surgery. So I wanted to pad my resume because my general surgery program was in Far Rockaway, New York. Not a very big program, not very well known. So I wanted to pad my resume. I did a hand and microsurgery fellowship, then had such a horrible experience in that fellowship. I got yelled at every single day and said, you know what? I just want to work. So I like to say I got a hand job. Can I say that? Can I say that on your podcast?

You got a hand job?

I got a hand job. So I started working as a hand surgeon. Wow. Yes. I started working as a hand surgeon for three and a half years.

I didn't know this about you.

Yeah.

Wow.

And it was fun. I mean, hand surgery is fun. It's quick. You know, you do eight, ten in a day. And, you know, carpal tunnels, trigger fingers, fractures.

I mean, it is, it's how so many people get into plastic surgery. It's like a back door to plastic surgery.

Exactly. So I did three and a half years of that. And the idea was that when I first signed onto this job, I had talked to the CEO of the company and I said to him, listen, my, my true passion is in breast surgery. So if you guys need a Breast surgeon, please let me know. And he said, absolutely. He said, no worries. You know, it was a handshake agreement.

A handshake and a hand job.

Yes.

Okay, got it. I'm getting to know a lot about you.

Exactly. Okay. So anyway, so I started working, and about a month after I started, he left. He was no longer the CEO, and so my handshake agreement went out the door.

Oh, boy.

And it was for forgotten. And nobody knew. It wasn't anywhere in my contract that I would do breast surgery. So about three and a half years later, by that point, I was. By that point, I was dating my now husband. And I said to him, I said, you know what? I can't do this anymore. I really want to do my passion, which is breast surgery. And he said, you're crazy. He said, you're doing so well as a hand surgeon. You're getting your name out there. You do great work. And I said, I don't care. And he had no choice but to agree. So I went back and did a breast oncoplastic fellowship where I did everything from biopsy through reconstruction. And that's how I started out. So I really wanted to minimize the footprint of breast surgery. From the very beginning, I knew that I didn't want to do mastectomies on every patient. In fact, I kind of proudly called myself a breast conservationist. You know, I really did minimalist mastectomies, certainly a lot fewer than many of my colleagues. And when I did a mastectomy, I usually did an implant reconstruction immediately. And. But for the most part, I did reductions and lifts and things like that, and still it didn't feel quite right. Right. It's still taking off a piece of a woman's body. And I think I had my biggest eye opening moment when I had a young woman come in and she had a breast tumor and. And she had very lopsided breasts. I mean, it was so just, I mean, like, one was a G and the other was a B. I mean, truly, like the most lopsided breast that I've ever seen in my life. And I said to her, I said, you know what? I have great news for you. I said, when we do your surgery to remove this tumor, I can actually balance your breasts. And she looked at me like I had three heads. And she said, but I love my breasts. It makes me really emotional. I'm so sorry. But, you know, it really was incredibly eye opening that even with that seeming deformity, which, you know, yeah, she came to love her breasts. And she, you know, didn't feel that there was anything wrong.

People embrace their imperfection.

Absolutely.

I can't tell you how many times as a breast surgeon, the people who I thought because I cared about how everyone looked, I mean, that was my platform as well. I was an oncoplastic surgeon from day one. And I thought in that point in time that that was my gift and that silver lining that I was giving people, like, what don't you like about your breasts? We can fix it. If they're big and you want them small, let's do it. If they're small and you want them big, let's do it. Give me the opportunity to offer you some silver lining here. Because cancer sucks.

Yes. It really does.

Right.

It really does sucks.

And so anything we can do to ease that burden. Right. We try and we tend to give our own impressions. Right. And I think that that particular patient taught me so much, you know, and it was early on my career, thankfully, so I learned quickly. But from that moment on, I realized that I really couldn't guess at what patients wanted. I had 85 year old women who desperately wanted to keep their breasts, desperately wanted to have implants, to have anything so that they could still feel like they had their normal breasts, quote, unquote, normal. And then I had 25 year olds who said, I don't care, I don't care. Take them off, take them both off. I don't care. And everything in between.

Yeah.

And I don't know about you, but for me, I was often not correct in figuring who would care and who wouldn't.

Right.

Like, I would be in front of a woman who was like, grossly overweight and like, didn't seem to care that much about her appearance and yet grilled me about where the incision was going to be, how big, how much tissue am I taking out, what will it look like afterwards? And I'm thinking like, are you a stripper?

Right.

Are you going to be like parading around naked somewhere?

Yes.

But they care. And I was. I got to the point where I didn't even trust myself because you could not predict who would care and who wouldn't.

So true. It's so true. It's so true.

Mind blowing.

Absolutely. Absolutely. So. So I. So I did this fellowship and then I never looked back. I loved to be able to offer oncoplastic breast surgery to my patients, so I did that until.

So where did you start off doing this? Like, where was your first oncoplastic job?

So I was in. So I was in private Practice. I went into private practice in Southern Illinois. So I was. My hand surgery position was in New York, and then I did my fellowship in New York. So I did all my training in New York. I did my general surgery hand surgery fellowship, and then I worked as a hand surgeon all in New York. And then I went to my. My oncoplastic breast fellowship in New York. And then after that, I moved down to Southern Illinois. My. We lived in St. Louis, but my practice was in Southern Illinois and was there happily. Had a great relationship with a local hospital, great relationship with the hospital CEO. You know, he knew that I was in private practice, and everybody was happy. And in 2013, I went to an American Society of Breast Surgery conference in Las Vegas. And I think you were at the same conference.

Yep.

And at that time, brought my mother to that conference.

Conference.

There you go in your book.

Something I'll never forget.

Yep.

Yep.

So at that conference on Friday night, and you know, these conferences, I mean, you're in classes from 6am until 8pm they are exhausting. They're exhausting.

For any of you that think that this is a vacation, I assure you, it is not a vacation.

And all of us are such nerds. We go to every single thing, every single day.

My husband used to come with me, and he's like, I don't understand. We're in Miami. What are you doing? You're dressed like it's winter because it's so cold in those lecture halls. And he's like, I've seen you for 15 minutes. I said, I told you, I don't know what you think I do here.

Absolutely.

But I'm not, like, out partying it up in South Beach. I'm stuck in a horrible lecture hall for 14 hours freezing my butt off.

Yes, absolutely. Absolutely. So at that conference on Friday night, after the 8pm cutoff of the actual conference, my mentor from my fellowship came up to me and she said, you know, we got to go to this lecture. And I said, karen, I said, I'm exhausted. I've been at this since 6am I cannot go to yet another lecture. And she's like, you. No, no. This is earth shattering. You have to go. When she says I have to. You know, when your mentor says something, you listen. So I went and in this conference room, in that conference room, what am I saying? It was a small room. There were maybe, maybe 20, 25 people watching. I mean, it was tiny. There was a fellow who was speaking in English, but with a such a strong Japanese accent, you could barely make out any words. But he had a slideshow, and he was talking about this thing called cryoablation, and he was showing his results. This was Dr. Fukuma, who is a breast surgeon in Japan, and he was showing his results, and I was mesmerized. And within seconds, I turned to Karen and I said, why aren't we doing this? She said, this is why I wanted to bring you. And I said, oh, my gosh, this is incredible. We have to do this for our patients. So that was in 2013. By the time that, you know, the paperwork is signed and I got a machine and everything. It was about six or eight months later. So in 2014, I started to do cryoablation for my patients, and I never looked back. And in the last three years, so since 2022, I've devoted more and more of my practice to cryoablation. And actually, just recently, I decided. I made the really difficult decision, which I know that you know how difficult these decisions are, but I made the difficult decision to truly stop doing breast surgery. And I'm a damn good breast surgeon. I'm really good at what I do. But I've really decided to focus on cryoablation because I think it's so important for my patients.

Yeah.

To have that 100% commitment to that. And I still do some small procedures in my practice, in my office, I can do quite a bit under local anesthesia. I think a lot of surgeons don't realize how much they can do under local anesthesia. They like that comfort of the patients out. And I don't have to worry about it.

Yeah.

Which I think is also terrible and a huge disservice. But so now I really do 100% cryoablation.

Yeah.

The disservice is that most surgeons don't learn how to treat tissue. Right. Because when you are doing things with an awake patient under local anesthesia, first of all, you learn to do a really good block, because you certainly don't want to see anyone suffering in front of you.

Absolutely.

So you learn to do a really good block, and then you just talk to them through it, and it's over before they know it. But if you never develop that skill and you never learn how to do a good block, and we all know, like, most of the pain that comes after breast surgery can be completely avoided by blocking them first. I didn't do a mastectomy.

I didn't open.

I didn't touch the skin.

Yep.

Without blocking people first.

Absolutely. I had so many, especially early in my career. I had so many anesthesiologists say, you're numbing them. I've got them under anesthesia. I'm like, of course I'm numbing them. Of course I'm numbing them. Because post op, they need some relief.

It's like they don't understand that if you never let the pain cascade start, then it never starts. Right, right, right. So if you interfere with that perception from the very beginning, even though they're under anesthesia. Under anesthesia doesn't mean you're not in pain. In pain.

Right.

And we see that all the time with people's heart rates go up, people's blood pressure goes up because they're feeling it, they're in pain.

Exactly.

And, you know, you don't want to give those people beta blockade. You want to treat their pain, right?

Absolutely. Absolutely.

So I am just awestruck by you. And I want to know about what your experience has been like since 2014, since you've been doing this, since you adopted this. Because when I kind of. The last that I checked in with cryoablation, Rasha Simmons at New York Presbyterian was presenting her data, and I think she was really, really comfortable with presenting the data with regard to benign breast disease. And then when it got to cancer, she got squirrely, and she was really, you know, the pioneer for. For this, as far as I remember, at least with the, you know, American Society of Breast Surgeons, which was our most preeminent society. Right.

So.

How did you transition into cancer comfortably and what has your experience been like?

Yeah, so I came into cryoblation at a really interesting time. So certainly when I. So cryoablation for fibroadenomas has been FDA approved since 2002. Sadly, that doesn't necessarily mean investment from the insurance company. So a lot of people have the misconception that when there's FDA approval, then that means insurance coverage. It does not, unfortunately. In fact, there are still some insurance carriers that say that cryoablation for fibroadenomas is an experimental procedure. But that's.

I know all about that here at Perfection Imaging.

Absolutely.

So.

But that's how I started out. So I started out doing fibroadenoma treatments. And. But it's interesting because shortly after I started cryoablation, the frost trial got underway, which was the. Actually the first non excisional breast cryoablation trial. So there were cryoablation trials prior to that where the patient would have cryoablation, and then two to four weeks later, they would have surgery to see whether or not the tumor had been actually killed with cryo. Right. So that's how it all started.

So they would do the cryo and then two weeks later take out doing that.

Exactly. Yeah, exactly. Do the definitive surgery. Right? Yep. So the Frost trial was the first non excisional breast cryo ablation trial. It was being done with a different company than IceCure. So IceCure is now the preeminent company do that, that is offering machines for liquid nitrogen based cryo ablation. There are different types, but let's stick to that because that's what I do. Yeah. And with the Frost trial, there were very specific parameters, and the parameters were that the women that would be treated would be 70 years of age or older to very strict criteria. 70 years of age or older, invasive ductal cancer, 1cm or smaller, ERPR positive, HER2 negative with favorable lymph nodes and minimal, I think, less than 5% DCIS component. So really, very, very strict guidelines.

And if we're being honest, probably women, because of the age range, who would have died with their disease. Not absolutely their disease.

Absolutely, absolutely.

So, like no harm was coming towards women.

Correct.

Yeah.

Which is a really hard concept for most people to understand.

So, so difficult for them to understand. You know, I've got a whole separate discussion that we could have about my. My viewpoint about sentinel lymph nodes. But that's, you know. Well, I.

If I'm gonna guess, I'm gonna guess that your viewpoint about sentinel lymph nodes was confirmed this year with the sound trial.

Isn't it exciting? Yes. So exciting.

Yes.

Yeah.

So let's put that on our list to talk about, because we have to talk about that. But I want you to continue.

So. But the funniest story that I have during that Frost trial is I had a lady come to me and she was a German lady. And I'll never forget, she was so stoic. And she was 69 years old. And I said to her, I said, I'm sorry, but you don't meet the criteria. She said, and she said, well, if you're not going to do this cryoablation on me, then I'm just going to die with my cancer. And at the time I was like, oh, no, don't die with your cancer. No, you can't do that. And so with my hands tied, you know, she tied my hands. She's like, you have to do cryo ablation. I said, I can't. You're 69. You have to be 70. Stupid. Right? It's just stupid how we, we get. So we get these blinders on, right? And we don't think about the actual patient in front of us sometimes.

But in your defense, you were blazing a new trail, and that is scary. And sometimes you have to play by the rules in the beginning because you can get diminishing returns if you don't.

Absolutely, right. Absolutely. Well, let me tell you, I did do her cryo ablation. She did just fine. She did just fine. And in fact, she did so, so well that at the time, I was, as I said, I was in Southern Illinois and I was having my MRIs done across the river in St. Louis, and the radiologist was a good friend of mine, and this patient had her six month mri, and then she had her one year mri. And I remember my friend Christy called me and she said, what did you do? I said, oh my God, what's wrong? And she said, no. She said, there's nothing there. She's like, there's no scar, there's no tumor. What did you do? I said, I did cryo ablation. I was like, look at me. I did something really cool. And that really taught me that this is absolutely something that we can offer to our patients. She had amazing cosmetic outcomes. So that was where I kind of tiptoed my way in. And for a long time, I was, in one way or another, under the auspices of some sort of governing body. Right. So the hospital or my partner or this or that, you know, something that was constantly keeping me in check. Which, as you said, I think is really important when you're first starting. Yes, really important. And so we come to these last three years where I have really opened my mind to the idea of doing cryoablation for very different patients. So now I have done cryoablation for very young women. I've done cryoablation on pregnant women. I've done cryoablation on breastfeeding women. I've done cryoablation on very large tumors. I've done cryoablation on stage four disease. I've done cryoablation on HER2 positive cancers, on triple negative cancers. I've done cryoablation on the limb lymph nodes. And patients generally do well. Yeah, generally. Now, cryoablation is not a one and done deal. Right. It's not, it's not there to be by itself. It really does, in some of these cases need support. So for instance, in her two positive tumors, I do think that it's important to have immunotherapy to target HER2 receptor. Do I think that chemotherapy is important? Absolutely not. And I really wish that our chemotherapists, our medical oncologists would get on board.

Isn't it terrible?

It's awful. It's awful.

It's not necessary that they know that the results from chemo alone without Herceptin and HER2 positive disease is abysmal.

Yes, yes.

Right, right. And they somehow think that it's synergistic. I don't even know if they think. I think that they didn't do a trial of Herceptin alone or trastuzumab alone because they thought that that was unethical. Right. But then once that trial was done, I think that you have to either extrapolate or give women the option to do Herceptin alone.

Absolutely.

To do it. We, and absolutely they get. We, we treat these patients like they're idiots. Yes, right. Like they don't. They, they don't and shouldn't have a say in what happens to them. That they, they either. It's all or nothing. But why shouldn't they be part of the discussion? Why shouldn't they be part of the decision making?

Absolutely.

And, and they should be able to take responsibility for it. And this is not only in the world of chemotherapy, this is also incidentally in the world of radiation.

Of course.

Because you know, you and I can have a conversation about what radiation adds which most of the time is nothing but toxicity. Right.

It only allows for decreased recurrence in the breast locally, locally, locally.

But it does not affect long term outcome. And that's the only thing that matters. Because at the end of the day, oh any of us care about is survival and durable survival, long term survival and survival that is quality of life.

Absolutely.

Because many of these women who were extending their life with these drugs, we are not extending their life in a meaningful way.

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Back to our show.

So I forget which drug it was, but there was a big, like, press release last year by one of the big charitable organizations that this drug extended life in women with metastatic breast cancer. And it was six weeks that they were celebrating, which. Listen, who am I to say whether six weeks is worth it or not? But it was six miserable weeks of pain and toxicity and fatigue and, you know, like, you name it, why are we selling? And it was $100,000.

I was gonna say. And the cost. And the cost.

And again, I'm not putting a price on someone's life, but if you ask me, do I want to spend $100,000 to live for an extra six weeks miserably. Right, Right. Tied to a chair with an IV in my arm that's making me feel lousy, that when I don't have the IV in my arm, I'm lying in bed and doing nothing.

No.

No, thank you.

Right.

Like, let me sign now. Let's just get it all out there. No, thank you.

But I think that that's. That's the terror of our medical system, is that we so few people get the option to sign and say, no, thank you. Right.

Yeah.

I mean, breast imaging we could talk about. Right. It's so incredibly frustrating that a grown woman cannot make the decision whether, I don't want a mammogram. Okay. Sign here. No, no facility will actually say, sign here.

I know.

We will just sign here saying, we are not in the burden. If you do come back with breast cancer, I can tell you that 99.9% of my patients would be thrilled to sign something, a release saying, you have no foul here. You know, I take my matters into my own hands. I refuse to have a mammogram. I will have an MRI instead. I refuse to have an mri. I will have a mammogram. I will have an ultrasound. I will have qt.

Yeah, yeah. Give women the option.

Absolutely.

Give them medical autonomy.

Absolutely.

Right.

And now we know the reason why. Well, because it's. Yes. And it's entree into the system.

Right.

Because the more mammograms you have in your life, the higher the chances that you're going to be diagnosed with breast cancer. First of all, because mammograms are radiation.

They are minimal. But the fact is that you'll find cancers that you never should have found.

For 20 and 30 and 40 years. That minimal is not so minimal. The poison is in the dose. The second thing is that when we look at autopsy studies of women who did not die of breast cancer.

40% and. Right, 40%.

So that means. So 40% of women on autopsy studies will have evidence of breast cancer.

They do.

But the incidence of breast cancer in the population that we. That we know is about 0.1%. Okay, so there's a big difference there.

Absolutely. Right.

Like, what's happening to the rest of them? And the truth is that the rest of them are not clinically relevant and that we all have changes in our body. And if we took all of these organs out, like the thyroid is another one.

Yes.

If everyone had their thyroid taken out and looked at under the microscope, a large percentage would have evidence, you know, microscopic evidence of thyroid cancer.

Yes.

Do they all need to have their thyroid glands out? Do they all need to be treated for thyroid cancer? No, of course not. But it drives the system, and it's an $8 billion industry, and so it's not going away anytime soon. And the people that are caught up in it, like the radiologists, I really think that they are doing the right thing. They think they're doing the right thing.

I think that for the most part, you're right. I think that radiologists above and beyond any other specialty tend to overstep their boundaries a lot. And they do a lot of scare tactics. I know it's a lot of scare tactics. And I think that the most heartbreaking stories that I hear are of patients who. Going back to our earlier discussion about numbing patients, about, you know, knowing how to use anesthetics properly. So many harrowing and just awful stories of patients getting biopsies with zero perceptible anesthesia. Right. And the reality is I tell. I tell them, and when they're in my hands, they see that it's true. They didn't wait long enough. The radiologist you know, injected the.

And then.

And then just started right away. You have to wait for the anesthetic to circulate. Especially if you have an obese patient, especially if you have somebody with liver disease, Especially if you have a diabetic. You have to let that anesthetic circulate. My God. Ehlers Danlos patients, they take forever to numb, and they take larger doses. But you know what? In the end, I can get them numb.

Yeah, but you have to take patients.

How come I can get them numb and nobody else can? Because I'm patient. It's ridiculous. I have nothing special. Well, I think you're very special. Thank you. I think you are, too.

Yeah, that's exactly it. And that is a lot of, like, begets, like. And you do what you were trained to do. And I also think that that's where the scare tactics come from, and that's where their belief system comes from, is that they were trained to believe that mammograms save lives, even though there's no data to support that. In fact, there's data, on the contrary, that it leads to a lot of over diagnosis and a lot of over treatment. And that over diagnosis and over treatment is actually quite detrimental to women because it increases their risk of cardiovascular disease and neurodegenerative disease and osteoporosis and name it, and all the things that we know are the major threats to a woman's life. So, you know, if we're going to diagnose 60,000 women a year with DCIS, 98% of which, if they had no treatment, there would be no deaths over 10 years. And yet you treat them for breast cancer and then they get cardiovascular disease and die prematurely of an MI. Did you really help them?

Yeah, I think DCIs, above anything, and I know you'll agree with me, is the hardest thing to treat, because some of them, I mean, you're right, the great majority end up being a big fat nothing. And women live for years and years and years, and no big deal. It doesn't turn into anything. And then you have those select few that suddenly that DCIS just turns. Blossoms. I mean, it just. It just erupts, and it is devastating.

It is.

It is. And we can't tell who. Who's going to be who. Right. I think that that's the most frustrating thing from a breast surgeon standpoint, is treating dcis. Yeah.

But I mean, it was always my practice, and I don't know, maybe you feel this way, maybe you don't, but the DCIS that presented like breast cancer with breast changes, with a mass, with that kind of thing. Like, I don't care what the biopsy shows. If you're presenting to me like breast cancer, I'm treating you like you have breast cancer.

That's true.

And I have people come to me all the time who say, I just have dcis. Why do I need to get treated? And they have like, 8 centimeters of disease and a firm breast or an inverted nipple or something. And I said, I don't care what your biopsy showed.

Right.

You're acting like you have breast cancer, and so you need to be treated like you have breast cancer. And this is part of the conundrum, is that in conventional medicine, we want to put everything in neat packages. We want to group everything together and say if A, then B. Right. But it's not so. And people have different variations and behave differently, and they come to their disease for different reasons, and they're going to respond differently.

Absolutely.

And need more lacers, different treatment.

Absolutely. I always say cancer doesn't read the books.

Yeah.

You know, sadly, it doesn't obey by the rules and it doesn't read the book.

Yeah.

So, yeah.

So for people who are unfamiliar with cryoablation, take us through a procedure. Sure. That look like. Sure.

So I'd like to think that in my. In my hands, cryoablation might be a little different, but, you know, as far as the procedure itself is concerned, so. So cryoablation is done differently for different organs. Right. So we're talking about breast cryoablation here exclusively. So for breast cryoablation, we do this under ultrasound guidance. So what that means immediately is that the. Either the tumor needs to be seen under ultrasound or something needs to be identified under ultrasound, which, if the patient has a marker from a biopsy that was done, that can certainly be used as long as it's ultrasound visible. But something. There needs to be some roadmap on ultrasound. So that's the first thing. But then once that's there, then, you know, the. The way that I do cryoablation is I first start out by doing a full breast exam. So any patient that comes to me gets a full breast exam. I don't care that you don't have breast cancer in your left breast. You brought both breasts, you're going to have both breasts left out.

So you get a two for one.

You get a two for one. Exactly. So I do a full breast exam. I do do my own ultrasound to make absolutely certain that there's no surprise. Right. And I map out. So I draw a map of my plan on the patient's breast. And then we get started. So I numb the skin, numb the deep tissues, make a small incision that is some distance from the tumor. So we need to have that length so that we can position the probe properly. The probe itself is a probe. So I call it a probe, not a needle, because it is. It doesn't have an open ending or an opening at the end. So there's no liquid nitrogen that goes into the breast at all during this procedure.

Okay.

The liquid nitrogen cycles through the probe. So the probe has three chambers. There's a chamber that allows the liquid nitrogen to go to the tip in a liquefied state state so that the area so that the probe can cool. There's a return chamber that returns the gaseous liquid nitrogen, and then there's a warming chamber that allows the area to be warmed. So, anyway, so, so once I numb the skin, numb the deep tissues, make a small incision, I place the probe through the tumor through the area of concern using ultrasound guidance. So I'm watching with the ultrasound the entire time, and then we take measurements, we make sure that the probe is in correct position in every direction. As a breast surgeon, I'm sure you've done ultrasound. So, you know, you can sometimes get fooled that you know your tumor is here and your probe is right next to it. Yeah, you don't want that. You want that probe to be right smack dab through the middle of that tumor. So you need to check it in different views to make sure that that's the case. So once we're in good position, we then start the freeze. The freeze cycle takes about 10 to 15 minutes. During that freeze cycle, some women will feel a vibration sensation. There are little clicks and whirs that the machine does. It kind of purrs and hums along. And then especially in small breasted women, there can be a pretty distinct sensation of pressure or fullness. Rarely do patients really feel cold. Sometimes they'll feel a burning sensation, which actually is cold. So all we do is we put freezer burn. It's freezer burn. So we put hot packs on the breast, and immediately the patients feel relief. So there are a lot of ways that we can mitigate a lot of the discomfort that they have. So that freeze cycle again, 10 to 15 minutes, then we turn off the liquid nitrogen. So there's a passive thaw phase which, where we turn off the liquid nitrogen again, also 10 to 15 minutes. During that time, the patient's Body temperature warms the area just a little bit, because the idea is that the cells that are closest to the probe get frozen. But as we kind of have that peripheral freeze, it's not as cold. Right. You can imagine that centrally this is negative 170 degrees. But peripherally, we may have, you know, negative 5 degrees. And really, breast cancer cells are frozen at negative 25 degrees Celsius, by the way. This is all celsius. So negative 25 degrees is ideal for breast cancer cell death. Really cold. Really cold, yeah. At the end of it, you feel like you can knock on the breast. There's like a hard rock in there, and it is freezing cold on the surface.

It's an ice ball.

It's an ice ball, yeah. Um, so we. We. We do that little fall, and then we do a second freeze to get those edge cells to go. We want, ideally to have margins. So just like with surgery, we want margins around a tumor. With cryoablation, we want margins. So we take measurements. So I. I say 10 to 15 minutes, but really, every tumor tells me how long it should be frozen by the size of the freeze. So we take measurements, we make sure that we're at an appropr in order to encompass not only the tumor, but the margins for the tumor. And then once we're done, we remove the probe, and the patient gets little steri strips. They're strapped into their compression bra, and we're in Myrtle Beach. So patients will go shopping, they'll go to the ocean to watch the waves, whatever they want to do. If they have a larger procedure. So if we have to do multiple freezes, multiple sites, then they may feel like they just want to go and take a nap. But then usually by the evening, they're good to go. So.

And then how do you decide who is and who isn't a candidate for this?

Yeah. So very honestly, there are few patients that are not candidates. Okay. Okay. So it's probably encouraging. It's probably easier to talk about those. So, number one, if I can't see it on ultrasound, they're not a candidate. You know, if the. If the marker is not visible on ultrasound, if they have micro calcification medications, if the marker washed out and they don't have anything to identify where that tumor was, then they're not.

Do you think the person that you can't identify something on ultrasound needs treatment?

That's an interesting question. So let's. So notwithstanding lobular cancer. Right. Because lobular cancer is its own animal.

Right.

So lobular.

Or is that Is that an A no for you?

So for me it's. It used to not be a no. I used to be pretty cavalier and I've realized that it really should be a no.

Because it tricks you.

It tricks you. It really does. It's not visible and it's. And it's sometimes just. You're blind to it. It's not visible because it's not. Because it's not there.

Yeah.

But because it's truly not visible, it's.

A diagnostic dilemma for everyone.

It really is. And we're talking about invasive lobular, we're not talking about lcis. So lobular carcinoma in situ is not a cancer. Let's just make sure that everybody understands that.

Although people really struggle with that and then they struggle with the. Well, why is DCIS cancer but lcis? Because there is not.

It's wrongly. It's wrongly named.

They're both wrongly named.

They're both wrongly named.

Right?

Absolutely. Absolutely.

But yeah, this is like a crazy debate that's happening right now on Instagram where because I do not treat DCIS like it's cancer unless it's acting like cancer.

Right.

Which is not to say that I tell people to not have DCIS treated.

Sure.

I think that, first of all, I think anyone who wants treatment should get treatment.

Absolutely.

Right. But I do not treat DCIS like it's cancer unless it's acting like cancer.

Right.

But if it's just a couple of calcifications that were, that were found on a mammogram and you biopsy it and all of it's removed with the biopsy and there's no evidence of anything left in the breast, why am I sending that person for surgery and radiation and five years of estrogen suppression? Like for what?

Yes.

Right. So I think that we need to do a better job of. A better job of determining who does and who doesn't need treatment. But invasive lobular is a problem.

It is a nasty animal.

What are you finding in terms of contralateral disease? Because I think the contralateral rate with invasive lobular carcinoma is not insignificant. It's somewhere around 25%.

Yeah.

Scary.

It's very scary. It's very scary. And like I said, I used to be more cavalier about lobular cancers and I actually treated a few patients with cryoablation with lobular cancers. And what I found is at their six month follow up imaging, they would have more and more cancer and it would just flower.

Chasing your tail.

And you're just chasing your tail. Exactly. I Mean, it is a horrible, horrible disease. So. Yeah, so. So that's one that I no longer.

No longer. Yeah.

Treat with cryo. I. Really strong. Unless I do have one lady that I just saw earlier, this or no, last week. She's 81 years old, and she has a mixed lobular ductile. And I do believe that I can see it well under ultrasound. So for her, she is, you know, to me, a candidate. But. Yeah, but especially I have women in their 30s reaching out to me with globular cancer. And I'm sorry, I'm not the person for you. Maybe there's another cryo ablation specialist out there who will be more cavalier than I. And if you want to go down that road, I guess. But please buy or beware.

What that usually translates into is that person is just less experienced because as we walk this journey, we just learn.

We learn. And sadly, you know, sometimes at the expense of patients, but at the same time, how. I mean, that's what all of medicine is. Yeah, all of medicine, we learn on the basis of our past experience, which is on the basis of patience, sadly.

Yeah.

So anyway, so that's labular. You know, honestly, the. So ulcerated. Ulcerated tumors.

Yeah.

So when it involves the skin.

Yeah, So I have done some. Some tumor types where, you know, if I can get. If I can do a little skin excision at the same time as the cryoablation, I feel very comfortable doing that. So in my hands, sometimes even that is okay. But if it's fully ulcerated, then no, they're not going to be a candidate. And inflammatory breast cancer. Right, so inflammatory breast cancer, that's an automatic. No.

Yeah.

You know, and that's a systemic disease.

That is.

That is a systemic disease.

Absolutely.

People need to recognize that.

Although speaking of systemic disease, I do treat stage four cancers, you know, so I do have patients who have stable disease elsewhere who decide that they want their primary tumor treated. And actually, of those patients, I have a couple who. The abscopal effect that I talk about actually is seemingly to be ongoing.

Talk about what that means for the people that don't know.

Yeah, so we believe that when we treat with cryoablation, the immune system then recognizes the tumor and creates a weak vaccine and itself against the tumor. And where we see that is with people with stage four disease. So if we treat the primary tumor, we see other tumor sites shrink down. It's incredible.

It's really amazing.

It's really amazing.

The body is amazing.

Yeah.

Yes.

There are a few words to Actually describe how exciting that information is.

So I want to talk about why this has not gotten widespread adoption. And I think one of the arguments that we hear all the time, that it's very necessary for us to segue into this conversation is, well, what about the lymph nodes?

Yeah. Yeah.

Right.

So my training, I trained a little before you. My training and your training, we talked about having to do a lymph node sampling. Now, when I was training, it was like revolutionary to do a sentinel lymph node biopsy. Like, I was on the fringe of, you know, half of my attendings were for it and half of my attendings were horrified. And they used to say, chalfa, don't listen to them. You do a full axillary lymph node to sex. Don't you go out there and practice and say that I trained you and you're doing this stupid sentinel lymph node biopsy. Right. Like there was still.

Absolutely.

I was in very early days when the clinical trials were just coming. Coming out. Well, the world's changing.

Yeah, thankfully. Yeah, thankfully for good reason. Right?

Yeah.

I mean, we're having really great outcomes with just listening to the patient and seeing what's going on. Right. So when it comes. So we have the sound trial that just came out. I alluded to it earlier, and that says that if the patient has no clinical evidence of lymph node involvement, that maybe they don't need lymph node surgery and patients are doing well.

They are.

And it's so exciting. Yeah, it's really exciting.

Yeah.

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I, you know, not that I'm a soothsayer, but the reality is I have experience, right. I've been doing this a long time. And so there are times when I will do an ultra, you know, patients will come to me and say, lymph nodes are normal. You know, all my imaging is normal. And I'll do an ultrasound, be like, yeah, I just don't feel good about this one lymph node. Can we just do an ultrasound guided biopsy? Can we just do a biopsy? And usually they'll agree and we do a biopsy and sure enough, there's cancer there. Well, there are a couple of different ways to look at that, right? So if it's microscopic evidence, then I think that those are patients that could easily be argued that that is the perfect candidate to do cryoablation of a lymph node. I mean, it really is. Because I think that the thing that a lot of physicians don't tell their patients is that lymph node surgery, no matter what it is, lymph node surgery is never cured. It is not curative. It is only diagnostic.

It is only diagnostic. That is exactly right.

It only helps with staging. That's all it does.

Do you think that patients don't get told because most of the providers don't understand that?

Yes, yes. Just like, if I can such an infuriating piece of what I do. Just like I think that a lot of physicians don't understand how estrogen works in estrogen in hormone receptor positive breast cancers. I think that the saying that you have too much estrogen is ridiculous.

Ridiculous.

It is the most ridiculous statement that can be said.

I know.

Because if that were the case, then all of our pregnant ladies would be getting breast cancer because they have the highest spike of estrogen.

Or why do we see 80% of breast cancers in the postmenopausal women rather than in the premenopausal population? And there is an 800 fold less incidence of breast cancer in pregnancy than there is in other stages of life. Because estrogen, sorry, news flash, is protective. And we saw that when during the Women's Health Initiative, there were two phases of the trial. The first one was the combined with medroxyprogesterone that they found a 300 fold increase in breast cancers and and that was because of the medroxyprogesterone, which is a progestin. But in the estrogen alone part, there was a reduction in breast cancer. That, incidentally, was durable.

Yes.

So for the five years that they took was seen then, and it was seen even more in 2017 when they republished that study.

And even to this day, a lot of those, the writers of that study, are not telling the truth, which is really sad.

I know it's such a disservice. I know it's such a disservice.

But that's where segue.

But they're.

They're.

I mean, they are, for lack of a better word, they are an arm of the pharmaceutical industry.

That.

That. That was the purpose of that trial, was to say estrogen, bad. Pharmaceuticals.

Good.

Right. And listen, they got what they were looking for because now we have two decades of miserable women. Miserable women. Millions of women who have been denied the care and the support that they need. And we have two generations of providers who are untrained.

Yes. And who don't understand at all. At all. And this is. And this is, you know, circling back to what I was saying. So, you know, hearing women say, my doctor told me I have too much estrogen. That's why I got breast cancer. It is devastating to hear that. And it tells me that physicians have no idea what it all means. No, they have no idea. They have no idea about how lymph nodes work. They have no idea about, you know, how breast cancer spreads. You know, we used to. When I was first training, and I'm sure you, too, when we were first training, we were told that if there's no cancer in those sentinel lymph nodes and the risk of you having cancer anywhere else in your body is next to nothing. Which is ridiculous. It's simply not true.

Yeah.

It's simply not true. And, you know, there are just so many fallacies that I think that are out there and they're propagated because, you know, first of all, people don't want to learn. Learning is scary.

Right.

There are so many of my patients that come to me and say, I asked my doctor about cryoablation, and they told me I was signing my own death sentence. I mean, it's just infuriating. It's because they don't know and they're scared.

Yeah. Do you think that that's what it is? It's just fear?

Yes, I think. Well, I don't think that's the only thing it is, but I think that's a Big part of it. Yeah. You know, I think the other piece of it is money. It's so much more lucrative to do a surgery on a patient. Yeah, it's so much more lucrative for the hospital, for the surgeon. You know, they can charge for anesthesia, they can charge for the nurse anesthetist, they can charge for pre op care, they can charge for post op care. Never mind if the patient stays the night in the hospital. They can charge what, 50 bucks for a Tylenol? Yep. I mean, it's crazy. Yeah, it's crazy. So I do think that there's that big part of it too.

Yeah.

And I'm hopeful, I am hopeful that my colleagues will be more mindful and more available once we have FDA approval for cryoablation for breast cancer. Because we don't right now. I mean, I'll give you that. We don't.

Wait, is it approval or it's clearance. Clearance.

So we have clearance for the, for the machine. We do have clearance for the machine because the machine can also be used for other cryoablations. So cryoblation is FDA approved for kidney cancer, prostate cancer, liver cancer, some bones, some skin cancers.

Wait, they have the approval and breast doesn't? Why?

And to be fair, I really think it's because we didn't have the durable studies. Right. So the Frost trial that I mentioned at the very beginning that I actually entered a few patients into, unfortunately that fell apart because that company went bankrupt. That company went bankrupt and they could no longer support the study. There are now some physicians, some researchers who are following up on their findings, but it's not the entire study. Right. So that's unfortunate. It really did cause a dip because if we had the durability of that study, we would have at least 10 years data. And we don't. We don't. The ICE3 trial just resulted five year data. So now with five year data, the FDA is looking much more seriously at approval for breast cancer. And we do have favorable voting. So last November they voted favorably. So we're, we're really hoping, you know, we were hoping by Q1 didn't happen, Q2 didn't happen. We're still hoping it's going to happen this year. But you know, there's a lot of change in the FDA right now, as you know, so I'm not sure how that's going to go. But we're hopeful. We are hopeful because we do have the studies.

Now, where is the American Society of Breast Surgeons in all of this?

Yeah, that's an interesting Question. It truly vacillates from administration to administration. Right. So a few years ago, actually, two years ago.

Do you mean like who's president at the time?

Yes. Who's president of the American Society of Breast Surgery.

Does it still change every year?

Every two. No, every year. It's still every year. It is still every year.

Yeah.

That's.

That's really hard to get anything done.

Very hard to get anything done every year. Absolutely. So two years ago we had very favorable leadership. Very favorable leadership to the point that the presidential address, actually the very last few sentences of the presidential address were, if you don't get on board with cryoablation, your radiology colleagues will outlast you and they'll do the things that you don't want to do. It was amazing. It was amazing. Incredibly exciting. The following year, which was last year, they're in May, so. Yeah, May of 23. May of 24th, sorry, May of 24. We actually were supposed to have a pretty pre conference mini symposium on cryoablation. It was an all day affair. I was one of the speakers. You know, really the preeminent people who are doing cryoablation were the speakers for that course. We had a full day course. Two months, three months before the conference, it was suddenly and inexplicably canceled. The cryoablation course for the American Society of Breast Surgeons was canceled outright. Without any. Any explanation. Without any explanation. I got a text. I got a text on a Saturday morning to the point that I actually texted back and said, is this a joke? Like, are you just trying to, you know, you know, cause some sort of a rock here? Because it has to be a joke. Of course it has to be a joke. It was not a joke. It was canceled. And yeah, and we had so many.

Shock and sorry, my children lying on the ground.

So many people, breast surgeons came up to me during that conference and said what happened? And all I could say was, I have no idea. And then later on it came out that the people that were on the board that year were not really in favor of cryoablation and really didn't feel that it was ready for prime time and didn't feel that it deserved a symposium. So that year there was one tiny lecture on cryoablation which I think was a 10 minute talk. 13, you know, they have like 13 minute segments. So it was a 13 minute talk and that was it. And it was all about fibroadenomas and you know that only do this under study if you're using it for breast cancer. I mean, it is despicable.

What a disservice.

It really is a disservice.

And this year from the society that is supposed to be guiding forward thinking. Absolutely. Guiding technology, guiding innovation. I mean, how can we innovate when we're not being supported by our own society?

It's really hard.

Really hard.

Yeah. Wow. Yeah. So this year, sadly, it wasn't even a discussion. That's awful. Last November, when we got there, when.

You become president of the American Society of Breast Surgeons, you don't have that aspiration.

I do not have that aspiration. Absolutely.

How many of you are there? How many preeminent breast surgeons are out there saying, this is what we should be doing?

Sadly, not many. I mean, so between surgeons and radiologists. Right, so surgeons and radiologists in the United States, I think we have fewer than 25 sites.

No.

Yeah. Fewer than 25 sites.

That's horrible.

And unfortunately, the great. Unfortunately for me, I believe. For us, I believe the majority of them are radiologists.

Yeah.

Which is not a good thing.

It's not a good thing.

And I don't mean to throw radiologists under the bus, but.

And I think some radiologists are great.

Yes.

But they're not clinicians and they don't have the training.

They don't.

And they're truly what I. You know, they're trained to read studies and maybe perform biopsies, but that is all they're trained to do. And the ones that have sought out outside training to learn about clinical disease and management and all of that, they are few and far between, if they exist at all. I mean, there is some posing on Instagram that are trying to, like, correct me, but they're not. They're not clinicians.

You know, I used to joke around that I'm not just a monkey with a knife when I was doing mainly breast surgery. And now I say I'm not just a monkey with a probe. And unfortunately, a lot of these guys, and gals, not guys exclusively, are just monkeys with probes. You know, they're one trick ponies. They do the procedure and then out the door you go. There's no guidance. There's no. And I'm not talking. I'm not even talking about standard of care, which I do think that patients should know what their options are, standard of care and otherwise. But come on, like, guide them a little on supplements, guide them on diet, guide them on lifestyle, guide them on anything, which is so easy. I mean, and I always say, one of the things that I always Tell every single patient if you're a breast knew how to make breast cancer once. If nothing changes, it'll know how to make it again. So you got the recipe, you have the rest. Exactly. Yeah, exactly. Those cells do. That's already there.

Yeah.

So now it's time to make some drastic changes, you know, And. And it's heartbreaking when I hear patients say, how long do I have to do this? How long do you not want to have breast cancer?

I know.

You know?

I know. But that is the conventional thinking.

Yes.

Is that tamoxifen?

For five years. Yeah. And then you're good.

Yeah. Right.

Like, here's your band aid. Wear it for. For however long, and then, you know, I'll tell you when you're done, you rip it off and go back.

And.

And they talk about going back to normal. Well, normal is how they got here. Why would you want to go back to how you got here? Right. I mean, it's why I left. Yeah, it's why I left. Because that system is so broken.

It is.

And I knew that there were a lot of people who would continue to operate, like, they didn't need me in that role, and the role that I was needed for was so much bigger and so much greater.

Right.

And so here we are.

Thank goodness.

But there are not enough of you. And it's a problem.

It is a problem.

And largely it's a problem because if you are established in your job, there aren't a lot of people who are willing to start over again. And we actually, we had a similar turf war with the radiologists. Over ultrasound.

Still gone.

Over stereo.

It's been given up. Everything's been given up.

And it's so sad.

I speak to new surgeons coming out, and they're like, no, the radiologist does all that.

It's so sad.

I mean, I think of my ultrasound like it's a stethoscope.

Yes.

It's my. If I was a cardiologist, I would have a stethoscope. I'm a breast surgeon. I have an ultrasound. I stick my ultrasound on every single boob that comes in my door. Every single boob. For whatever reason.

Whatever.

There's a little lump here. I just want to double check. It's probably your rib, but let me just make sure. Oh, yeah, it's your rib.

Yeah.

I mean, I actually think that that's the next version of qt in that once we start to process these images much faster. And you had your scan today. So I would love. Yeah, I would love to hear Your impression. But once we start to process these scans much faster, I want to be able to say, okay, let's take a second look at that real fast and put an ultrasound on them and decide right there and then, like, do we need to do anything about this? And I'm curious. Talk to me about the follow up for cryo. Like, how do you know it worked?

Yeah, yeah, that's a great question. So, you know, ideally the patient would have whatever imaging they had to begin with that showed the tumor. They'll have that imaging six months later to see what's going on. Now, when I actually, for a long time, actually until just really quite recently, I would insist that six months after cryoablation they would also have a biopsy to really show tumor kill. What I now do is we are getting such great imaging and, you know, such really robust tumor killing that it's evident. You know, it's really obvious, especially on mri PET scan. It's amazing. I have patients that for whatever reason, they'll have a PET scan two weeks after cryo ablation, that tumor is ded. Dead. It is dead. No longer than that. I mean, it's no longer viable. And it is such. It is so gratifying to see that. Yeah, it's wonderful. Why do I need a biopsy of that? Yeah, I know what's going on there.

Yeah.

So. So now I'm a lot more, you know, critical of what I'm seeing. So certainly if there's anything there that worries me, then. Sorry, you're gonna get a biopsy.

Yeah.

But generally speaking, if the imaging looks good, then there's really no reason to do a biopsy.

And is the standard imaging afterwards? MRI is the standard imaging ultrasound or is it whatever imaging got them there is what you're gonna use to follow.

So generally speaking, whatever imaging got them there is what I'm gonna use to follow. However, I do like an MRI because an MRI is physiologic.

Right.

It really shows us, you know, where there's blood flow, where there's increased inflammatory response.

Yeah.

And I agree with you. I think that. I think that MRI is the diagnostic tool after cryo.

And what I tell a lot of my patients, because I have more and more patients asking about qt. What I tell a lot of my patients is what if we get QT and MRI side by side at that six month mark and then if they, if they show similar results, then we don't need MRI ever again. We can just keep doing the qt.

So my issue with that is that QT is not physiologic. An MRI is. And if you really want to know that there's not abnormal blood flow, that there's not viability there, you need an. Mr. Yeah. Will something change in the future? I don't know. I think that QT is revolutionary. I think that it's going to have a huge role in the future. I think that between the ARIA test, which is a biologic test, to tell who is and who is not at risk for breast cancer, combined with QT, which is 100, 100% safe imaging, so we're not putting anyone in harm's way to do it.

And boob just gets dunked in water.

And it's a lovely procedure, right?

It is lovely.

It's like a spa visit of sorts.

Yes.

And so I think that that is going to become the standard of care. And I have dedicated my life and pretty much bent the barn that this is going to become the standard of care. But I think for cryo and for treatment purposes and even maybe response to treatment, I still think that we need something physiologic. And I'm still in favor of MRI in that situation. I know people are concerned about gadolinium. I have a whole protocol. So do I. Oh, perfect. Of course you do. So, because, you know, the risk of gadolinium toxicity is very real.

It is. And it's, you know, it's frustrating, you know, that patients are told that it's no big deal. We just don't know what the deal is. I mean, that's really what it is. We don't know.

Yeah.

Although the renal doctors and the neurologists are starting to get to know what the deal is, because they're seeing the renal failure and they're seeing the degeneration of the brain. So it's real, right? It's real. I love what you're doing. I'm so, so, so grateful for you. And you are a pioneer. And I hope that more people will look, look at your example and realize that this is a very real and viable option for many breast cancer patients. We spoke about the people that it's not an option for. And listen, there is no perfect anything. There's no perfect imaging, there's no perfect treatment. But if we can leave women with something that they can live with and kind of be proud of in a way, in that we are invested in our breasts, they're a part of us. They're a part of our appearance, our sexuality, and they are a part of making women feel Whole. And if you do cryo in treatment of the breast cancer and of course, work on all the other things that we talked about, work on the diet and the movement and the mindset and get them on proper supplementation and detoxification and avoiding toxins and all of that, you know, if we're giving them the whole package and they have something that looks exactly like their breast, they're going to be really happy. Whereas I always say if you. I don't care how good a surgeon you are, if you give a woman a mastectomy, even a partial mastectomy and she has deformity. And I was a really great surgeon. You're a really great surgeon. But we're not God, no. And there will never come a day for the rest of their life that they won't look down and remember that they had breast cancer. And yet if you can take them to a better place that will become part of their history and not part of their present or part of their future. And you are paving the road to that. So for that I am so grateful. Oh, so proud to call you friend. So proud to call you colleague.

Yes. And I could say all the same of you, you're such an incredible pioneer. And thank you so much for giving me the opportunity to chat with you.

Well, this was amazing.

Phenomenal.

How can people find you? Yes.

So Our website is serenitysurgery.com My practice is called Serenity Surgery and Wellness. I am on. Not so much on Facebook, but a little bit on Facebook. But really, just go to our website. You'll get a pop up that says, do you want a free book? Please say yes. We send lots and lots of books out and we're happy to just educate. And I think that that's the thing that people don't understand. Just because you talk to me doesn't necessarily mean that you're going to end up having cryoblation. I just want patients to understand that they have options.

Yeah.

And you may end up saying, you know what, I really do want a surgery after all. And that's okay.

Yes.

And that's perfectly fine. I just want to. I just want you to know that there's potentially another way.

Yeah.

And we'll talk about, you know, the risks, the benefits, the reasons to do surgery over cryoablation and the reasons to do cryoablation over surgery. Yeah, absolutely.

And at the end of the day, that's what it's all about. Helping women to make educated decisions because they're not given the opportunity to do that.

Now, yes.

And there's too much confusion between I don't know and no in conventional medicine right now. And that's really what it needs, what needs to change. So you see people from all over and they come see you and have consultations and have treatment.

So we see patients from all over the world. The majority of our patients are from the US and Canada, but really all over the world, we do our initial evaluation in most cases as a televisit, so it's pretty accessible to just about anybody. And then obviously, if you end up having cryoablation, you do come to me. We don't have a mobile service yet, so we are in beautiful Myrtle Beach. We're right by the beach and it's a nice place, but.

Yeah, I don't know if I've ever shared with you, but do you know it's Dr. John Klock's dream that he will have mobile cryoablation centers where it's just going to be like a van that has a QT and an ultrasound and a cryo machine.

Let's do it.

And you get your diagnosis, your confirmation and your treatment all at once. And then when the van comes around again in six months, you get rescanned and re. Let's do it to make sure. Right? It's kind of brilliant.

It's totally brilliant. Yeah, Yeah.

I love it, actually, as a concept.

Yep. Yeah, absolutely.

It is brilliant. Dr. Bednarski, thank you so much for being here today.

Thank you.

This is wonderful. I think this was probably my favorite conversation, just because, you know, we just. We have so much commonality and it was just. It's just a beautiful thing to see what you're doing and I love spending the day with you.

Thank you. It's been lovely.

And thank you all for joining us. I hope you enjoyed it. I know that Teddy enjoyed it.

He's.

He's taken his nap now and if you liked this conversation, if you know someone that needed to hear this conversation, then please share it with them and know that I will be back next week, same time, same place. It's Dr. Jen. Bye for now.